Peritonsillitis often follows no recorded sore throat

Design

Population-based registry study, Region Kronoberg, Sweden, 2012 to 2016

Population

607 episodes of peritonsillitis in 555 patients, with pharyngotonsillitis episodes for context

Primary outcome

Patient characteristics, preceding pharyngotonsillitis and referral pathways

Effect

23% preceded by pharyngotonsillitis within 30 days; 74% first diagnosed in primary care, of whom 71% were managed in ENT

A population-based registry study in Region Kronoberg, Sweden, covered all episodes of peritonsillitis (including peritonsillar abscess and cellulitis) and pharyngotonsillitis diagnosed in primary care and hospitals between 2012 and 2016. It found 607 peritonsillitis episodes in 555 patients.

Incidence peaked in late adolescence and young adulthood and was low in children and older adults, with no sex difference within age groups. Only 23% of episodes were preceded by a recorded pharyngotonsillitis in the previous 30 days (median interval 2 days), rising to 29% among cases confirmed in the ENT department. Most patients (74%) were first diagnosed in primary care, and 71% of those were then managed in the ENT department. Overall 85% of episodes involved initial primary care management. Incidence fell over time alongside pharyngotonsillitis.

The data are from one Swedish region and rely on recorded diagnoses, so a sore throat that was never coded would be missed. For a family physician, the practical message is that peritonsillitis is not just a late complication of a known tonsillitis, and a young adult with severe unilateral throat pain, trismus or a muffled voice needs assessment even without a recent sore throat.

• Consider peritonsillitis in adolescents and young adults with severe one-sided throat pain, difficulty opening the mouth or a muffled voice.
• Do not wait for a history of recent sore throat; most episodes did not have one recorded.
• Examine for uvular deviation and asymmetric tonsillar swelling, and refer promptly for ENT assessment when suspected.
• Safety-net patients who are treated for tonsillitis: worsening one-sided pain, drooling or trouble swallowing needs same-day review.

Why it matters

It weakens the assumption that peritonsillar infection is a late complication of tonsillitis you will already have seen.

Don't overread it

This is a descriptive registry from one Swedish region and cannot say how to prevent peritonsillitis or whether treating tonsillitis with antibiotics would reduce it.

The statistics, in plain English

The 23% figure means that about three in four episodes had no recorded sore throat in the preceding month. It describes recorded diagnoses in one region, so the real proportion without symptoms may be lower if mild sore throats were not coded.

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