How is it Diagnosed?
Tonsillar diseases include a range of conditions such as acute tonsillitis, peritonsillar
abscess, chronic tonsillitis, and tonsillar hypertrophy. Diagnosis begins with a clinical
history and physical examination. Symptoms may include sore throat, dysphagia, fever,
halitosis, snoring, or recurrent throat infections.
In acute tonsillitis, the tonsils appear red and swollen, often with white or yellow
exudates. Palpation may reveal tender cervical lymphadenopathy. Differentiating viral
from bacterial causes is important. The Centor criteria—fever, tonsillar exudates, tender
anterior cervical lymph nodes, and absence of cough—help assess the likelihood of
streptococcal infection.
Rapid antigen detection tests (RADT) and throat cultures are commonly used to confirm
Group A Streptococcus. Throat swabs are cultured for bacterial pathogens in cases of
recurrent or treatment-resistant infections. Blood tests, such as a complete blood count
(CBC), may show leukocytosis in bacterial infections. Monospot test or EBV serology is
advised if infectious mononucleosis is suspected.
In chronic or recurrent cases, an ENT evaluation is warranted. Sleep studies may be
conducted in children with tonsillar hypertrophy and obstructive sleep apnea. Imaging,
such as a neck ultrasound or CT scan, is reserved for complications like peritonsillar
abscess or suspicion of tonsillar malignancy.
In summary, diagnosis of tonsillar disease relies on clinical examination, microbial
testing, and selective imaging, with attention to distinguishing between infectious,
obstructive, and neoplastic causes.