From the Guidelines
TOS postviral should be managed by monitoring for symptoms associated with COVID-19, as GI symptoms may precede COVID-related symptoms by a few days, and considering COVID-19 testing in a high COVID-19 prevalence setting. When evaluating patients with postviral taste and smell disorders (TOS postviral), it is essential to consider the potential gastrointestinal (GI) manifestations of COVID-19, as outlined in the AGA Institute rapid review 1. The study highlights the importance of ascertaining information about high-risk contact exposure and obtaining a detailed history of symptoms associated with COVID-19, including fever, cough, shortness of breath, chills, muscle pain, headache, sore throat, or new loss of taste or smell.
Some key points to consider in managing TOS postviral include:
- Monitoring for symptoms associated with COVID-19, as GI symptoms may precede COVID-related symptoms by a few days
- Considering COVID-19 testing in a high COVID-19 prevalence setting
- Obtaining a thorough history of GI symptoms, including onset, characteristics, duration, and severity
- Being aware that the overall prevalence of GI symptoms in the context of COVID-19 is lower than estimated, as noted in the study 1
In terms of treatment, while the provided evidence does not specifically address TOS postviral, general management strategies may include olfactory training, intranasal corticosteroids, oral zinc supplementation, and alpha-lipoic acid, as these have been shown to support recovery in some cases. However, it is crucial to prioritize the management of potential COVID-19 symptoms and consider the patient's overall clinical context.
From the Research
Tonsillitis Overview
- Tonsillitis is an inflammatory process of the tonsillar tissues, usually infectious in nature 2
- It is caused by a viral infection in 70% to 95% of cases, while bacterial infections account for 5% to 15% of cases in adults and 15% to 30% of cases in patients five to 15 years of age 3
Postviral Tonsillitis
- There is no specific information available on postviral tonsillitis in the provided studies
- However, it is known that tonsillitis of viral origin is usually treated with supportive care 2
Diagnosis and Treatment
- Diagnosis of acute tonsillitis is clinical, and it can be difficult to distinguish viral from bacterial infections 4
- Rapid antigen testing has a very low sensitivity in the diagnosis of bacterial tonsillitis, but more accurate tests take longer to deliver results 4
- Treatment is focused on supportive care, and if group A beta-hemolytic streptococcus is identified, penicillin should be used as the first-line antibiotic 3
- In cases of recurrent tonsillitis, watchful waiting is strongly recommended if there have been less than seven episodes in the past year, less than five episodes per year for the past two years, or less than three episodes per year for the past three years 3
Recurrent Acute Tonsillitis
- The definition of severe recurrent throat infections is arbitrary, but recent criteria have defined severe tonsillitis as: five or more episodes of true tonsillitis a year; symptoms for at least 1 year; and episodes that are disabling and prevent normal functioning 4
- Tonsillectomy is indicated and is highly effective if the patient has had ≥7 adequately treated episodes in the preceding year, ≥5 such episodes in each of the preceding 2 years, or ≥3 such episodes in each of the preceding 3 years 5
- Antibiotic treatment is an option in patients with recurrent acute tonsillitis who have contraindications for tonsillectomy 6