What are the clinical findings of tonsillitis on physical examination?

Clinical Findings of Tonsillitis on Physical Examination

Tonsillitis on physical examination typically presents with tonsillopharyngeal erythema (redness) with or without exudates, often accompanied by edema of the tissues and tender, enlarged anterior cervical lymph nodes. 1

Key Physical Examination Findings

Oropharyngeal Findings

• Tonsils:

  • Erythema (redness) of the tonsils 1
  • Edema/swelling of the tonsillar tissue 1, 2
  • Exudates (white or yellow patches) on the tonsils 1
  • Tonsillar enlargement or asymmetry 1

• Associated Structures:

  • Pharyngeal erythema 1, 2
  • Soft palate petechiae ("doughnut" lesions) 1
  • Beefy, red, swollen uvula 1
  • Palatal edema 1

Cervical Lymph Node Findings

• Tender, enlarged anterior cervical lymphadenopathy 1
• Cervical adenitis (inflammation of lymph nodes) 1

Distinguishing Bacterial vs. Viral Tonsillitis

Findings More Suggestive of Bacterial Tonsillitis

• Tonsillar exudates 1, 2
• Absence of cough 1, 2
• Tender anterior cervical lymphadenopathy 1
• Fever (typically 101°F to 104°F) 1
• Absence of rhinorrhea, conjunctivitis, or cough 1, 2

Findings More Suggestive of Viral Tonsillitis

• Conjunctivitis 1, 2
• Coryza (nasal discharge) 1, 2
• Hoarseness 1, 2
• Cough 1, 2
• Diarrhea 1
• Characteristic viral exanthems or enanthems 1
• Diffuse pharyngeal erythema 2
• Oral ulcerations 2

Clinical Pearls and Pitfalls

• Important caveat: Clinical findings alone cannot reliably distinguish between bacterial and viral tonsillitis; laboratory testing (rapid antigen detection test or throat culture) is necessary for definitive diagnosis 2

• Age considerations: Classic exudative tonsillitis is most frequently observed in school-aged children (5-15 years), while presentations in teenagers and adults may be atypical 1

• Non-tender neck masses are more suspicious for malignancy than tender masses, which are more typical of infectious tonsillitis 1

• Systemic symptoms that may accompany tonsillitis include:

  • Fever (often 101°F-104°F in bacterial cases) 1
  • Headache 1
  • Nausea, vomiting, and abdominal pain (especially in children) 1
  • Pain on swallowing (odynophagia) 1

• Examination technique: A thorough examination requires adequate lighting and may be performed with a nasal speculum, otoscope with nasal adapter, or tongue depressor. Ask the patient to open the mouth without protruding the tongue (which can obscure the view of the oropharynx) 1

The physical examination findings of tonsillitis must be interpreted in the context of the patient's history, including the pattern of symptoms, duration, and associated features, to guide appropriate management decisions.