From the Guidelines
The best course of action for a patient with tonsillitis who suddenly develops respiratory distress is to seek emergency medical attention immediately by calling 911 or going to the nearest emergency department. This is a potentially life-threatening situation that requires urgent professional evaluation and intervention. While waiting for emergency services, the patient should be positioned upright to maximize airway patency and breathing capacity. No home remedies or over-the-counter medications should be attempted as they may worsen the situation. Respiratory distress in tonsillitis patients can indicate several serious complications, including peritonsillar abscess (quinsy), epiglottitis, or severe inflammation causing airway obstruction. Medical professionals will likely administer oxygen, may give intravenous steroids such as dexamethasone (typically 10mg for adults) to reduce inflammation, and possibly antibiotics if bacterial infection is suspected. In severe cases, emergency procedures such as needle aspiration of an abscess or even intubation or tracheostomy might be necessary to secure the airway. Delaying treatment can lead to complete airway obstruction, which can be fatal within minutes, making immediate professional medical attention absolutely essential, as supported by recent guidelines 1.
Some key considerations in managing the airway in such patients include meticulous pre-oxygenation, use of a heat and moisture exchange filter, and avoidance of non-invasive ventilation and high-flow nasal oxygen, as recommended in the consensus guidelines for managing the airway in patients with COVID-19 1. Additionally, the use of intravenous dexamethasone for pain control and reduction of inflammation is supported by clinical practice guidelines for tonsillectomy in children 1. However, the primary concern in a patient with tonsillitis and sudden respiratory distress is securing the airway and ensuring adequate oxygenation, which may require immediate intervention by emergency medical services.
The patient's history and clinical presentation should be carefully evaluated to determine the underlying cause of the respiratory distress and to guide further management, including the potential need for surgical intervention or other treatments. In any case, prompt medical attention is crucial to prevent serious complications and ensure the best possible outcome for the patient. Given the potentially life-threatening nature of this condition, it is essential to prioritize immediate medical evaluation and treatment over any potential delays or attempts at self-treatment.
From the Research
Symptoms and Diagnosis
- A patient with tonsillitis who suddenly develops difficulty breathing may be experiencing a complication such as a peritonsillar abscess 2.
- Symptoms of peritonsillar abscess include fever, sore throat, dysphagia, trismus, and a "hot potato" voice 2.
- Diagnosis is usually made on the basis of clinical presentation and examination 2.
Treatment Options
- Drainage of the abscess, antibiotic therapy, and supportive therapy for maintaining hydration and pain control are the cornerstones of treatment 2.
- Antibiotics effective against group A streptococcus and oral anaerobes should be first-line therapy 2, 3.
- Penicillin is effective for Streptococcus pyogenes, but Staphylococcus aureus is resistant to it 3.
- Amoxicillin-clavulanic acid may be a suitable alternative for patients with peritonsillar abscess 4.
- Intravenous penicillin remains an excellent choice for therapy in cases of peritonsillar abscess requiring parenteral antibiotics after drainage 5.
Management and Referral
- Patients with peritonsillar abscess are usually first encountered in the primary care outpatient setting or in the emergency department 2.
- Family physicians with appropriate training and experience can diagnose and treat most patients with peritonsillar abscess 2.
- Referral to an ENT specialist may be necessary in cases where the patient's condition worsens or does not improve with treatment 4.
- Early administration of antibiotics and prompt recognition of the infection are important to avoid potentially serious complications, such as airway obstruction, aspiration, or extension of infection into deep neck tissues 2, 4.