The management of severe infectious mononucleosis tonsillitis and upper airway obstruction

• Published in: Journal of laryngology and otology 2001-12, Vol.115 (12), p.973-977
• Main Authors: Chan, S. C. S., Dawes, P. J. D.
• Format: Article
• Language: English
• Subjects: (RF) Otorhinolaryngology; Abscesses; Adolescent; Adult; Age Factors; Airway management; Airway Obstruction; Airway Obstruction - diagnosis; Airway Obstruction - etiology; Airway Obstruction - therapy; Anti-Inflammatory Agents - therapeutic use; Bacterial diseases; Bacterial infections; Biological and medical sciences; Child; Child, Preschool; Dysphagia; Ent and stomatologic bacterial diseases; Female; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Human bacterial diseases; Humans; Infectious diseases; Infectious Mononucleosis; Infectious Mononucleosis - complications; Infectious Mononucleosis - therapy; Male; Medical sciences; Mononucleosis; Ostomy; Otolaryngology; Oximetry; Patients; Pulse oximetry; Retrospective Studies; Sample Size; Steroids; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the upper aerodigestive tract; Tonsillectomy; Tonsillitis; Tonsillitis - etiology; Tonsillitis - therapy
• ISSN: 0022-2151; 1748-5460
• DOI: 10.1258/0022215011909792

Acute tonsillectomy has been advocated for severe infectious mononucleosis (IM) pharyngotonsillitis with upper airway obstruction (UAO) and not responding to corticosteroids. This paper reviews and rationalizes our management. A five-year chart review was carried out with a follow-up telephone survey. There were 36 admissions. Nine had UAO of whom 89 per cent (eight of nine patients) had a tonsillectomy. The diagnosis of UAO was not standardized. Twenty-seven patients did not have UAO and only a small proportion of these patients, 16 per cent (four of 25) went on to have an elective tonsillectomy. Corticosteroids made no significant difference to the tonsillectomy rate. UAO appears to identify patients with more severe disease who are likely to suffer recurrent tonsillitis. Acute tonsillectomy is an appropriate treatment option for this subgroup. The diagnosis of significant IM UAO is not defined and a schema is proposed. Recurrent tonsillitis is an uncommon sequela of severe IM pharyngotonsillitis without UAO.