Adenotonsillitis: Diagnosis, Treatment and Complications
Adenotonsillitis is inflammation of the palatine tonsils and adenoidal tissue, usually caused by a viral infection but sometimes by bacteria, particularly group A streptococcus. Recurrent or hypertrophic disease may impair breathing, sleep, hearing and swallowing.
Drooling, stridor, severe respiratory effort, inability to swallow fluids, toxic appearance, neck swelling or trismus requires urgent assessment for airway compromise or deep-neck infection.
Learning objectives
- Differentiate common viral and bacterial patterns.
- Assess severity and airway risk.
- Outline supportive, antimicrobial and surgical management.
- Recognise peritonsillar and systemic complications.
Causes and transmission
Respiratory viruses cause most acute episodes. Group A streptococcus is the major treatable bacterial cause; other bacteria and Epstein–Barr virus are considered from the clinical context. Infection spreads mainly through respiratory droplets and close contact.
Clinical features
| Acute infection | Adenoidal hypertrophy/chronic disease |
|---|---|
| Sore throat, fever, odynophagia, tender cervical nodes, erythematous enlarged tonsils with or without exudate. | Nasal obstruction, mouth breathing, snoring, hyponasal speech and sleep disturbance. |
| Headache, malaise, reduced appetite; children may have abdominal symptoms. | Recurrent otitis media or effusion from auditory-tube dysfunction, poor sleep and impaired daytime concentration. |
Cough, coryza, hoarseness and conjunctivitis favour a viral cause. Tonsillar exudate is not by itself proof of bacterial infection.
Assessment and diagnosis
- Assess airway, hydration, vital signs and ability to swallow.
- Inspect tonsils, uvula, palate, posterior pharynx and neck.
- Look for unilateral bulging, uvular deviation, muffled voice and trismus suggesting peritonsillar abscess.
- Use validated clinical criteria and local guidance to estimate streptococcal probability.
- Rapid antigen testing or throat culture may confirm streptococcus where available and indicated.
- Consider testing for infectious mononucleosis when compatible; avoid forceful examination if airway risk exists.
Management
Supportive care
- Fluids, rest and appropriate analgesia/antipyretics.
- Soft foods, warm or cool drinks according to comfort.
- Infection-control advice and avoidance of tobacco smoke.
Antibiotics
Most viral cases do not benefit from antibiotics. Treat confirmed or strongly suspected bacterial disease according to current Uganda Clinical Guidelines and local antimicrobial policy, considering allergy, age and severity. Complete the prescribed course.
Surgery
ENT assessment for tonsillectomy or adenotonsillectomy may be appropriate for documented severe recurrent episodes, obstructive sleep-disordered breathing, significant hypertrophy, recurrent peritonsillar abscess or selected complications. The decision balances benefit against pain and bleeding risk.
Complications
Peritonsillar abscess, retropharyngeal/parapharyngeal infection, airway obstruction and cervical lymphadenitis.
Dehydration, post-streptococcal disease such as acute rheumatic fever or glomerulonephritis, and sepsis in severe disease.
Severe unilateral pain, trismus, “hot-potato” voice, drooling and uvular displacement require urgent ENT evaluation, drainage and antimicrobial treatment.
Prevention and follow-up
- Hand hygiene, cough etiquette and avoiding shared utensils during acute illness.
- Document frequency and severity of recurrent episodes.
- Review sleep symptoms, growth, school performance, hearing and middle-ear disease in children with adenoidal obstruction.
Review pharyngeal anatomy and pharyngitis.
Key examination points
- Most acute adenotonsillitis is viral.
- Exudate alone does not diagnose streptococcal infection.
- Adenoidal hypertrophy causes nasal obstruction and sleep symptoms.
- Trismus with uvular deviation suggests peritonsillar abscess.
- Antibiotic and surgical decisions should follow validated criteria and local guidance.
References and further reading
For education only. Apply current Uganda Clinical Guidelines and local antimicrobial protocols.
