Diagnostik und Therapie der rezidivierenden akuten Tonsillitis

Wann eine Indikation zur Operation der Gaumenmandeln bei Kindern und Erwachsenen mit rezidivierender akuter Tonsillitis (RAT) besteht, ist immer noch Gegenstand der Diskussion. Ziel des Beitrags zum Facharztwissen ist es, auf Basis aktueller Studien und der neuen S3-Leitlinie Tonsillitis eine Übersicht zur evidenzbasierten Entscheidungsfindung für eine optimale Diagnostik und Behandlung der RAT zu geben.

Abstract

When surgery on the palatine tonsils is indicated in children and adults with recurrent acute tonsillitis (RAT) is still the subject of debate. The aim of this article on specialist knowledge is to provide an overview of evidence-based decision-making for optimal diagnosis and treatment of RAT based on current studies and the new S3 guideline on tonsillitis. The diagnosis of a new episode of acute tonsillitis / sore throat should always include a classification with a scoring system (Centor, McIssac, FeverPain score) to assess the likelihood of bacterial tonsillitis, mainly due to group A streptococci (GAS). In unclear cases, a point-of-care test (POCT) for a GAS smear is helpful. Accurate counting of episodes is important in patients with RAT, as the cumulative frequency is the most important marker for or against tonsil surgery to date. In addition, a specific quality of life questionnaire should be used for each episode. Conservative symptomatic treatment of an episode includes a combination of paracetamol and/or non-steroidal anti-inflammatory drugs. If there is a high probability of bacterial tonsillitis, especially in high-risk patients, antibiotic treatment is initiated directly or by delayed prescription. Tonsillectomy is indicated and highly effective if the patient had ≥7 adequately treated episodes of RAT in the previous year or ≥5 such episodes in each of the previous two years or ≥3 such episodes in each of the previous three years. Whether a tonsillotomy is equivalent to a tonsillectomy in these cases will only be answered once the TOTO study has been completed. Standardized pain management is an essential part of the operation, as most patients are likely to experience severe postoperative pain. Nowadays, evidence-based treatment of patients with RAT is readily available.

Kernaussagen

• Die NATTINA-Studie und die neue S3-Leitlinie zur Tonsillitis haben für eine Reihe von Fragen Klarheit geschaffen bzw. lassen eindeutiger Therapieempfehlungen zur Behandlung der RAT zu.

• Es gibt nun eine klare Empfehlung, auf welcher Diagnostik basierend die Halsschmerzepisoden bei RAT gezählt werden sollen.

• Es besteht nun eine klare Evidenz, dass bei schwergradiger RAT eine Tonsillektomie hilfreich ist.

• Offen sind die Rolle der Tonsillotomie und die optimale Schmerztherapie; darüber hinaus fehlt es an objektiven Parametern zur Klassifikation der Schwere der RAT.

Schlüsselwörter

Tonsillitis - Halsschmerzen - Pharyngitis - Lebensqualität - Tonsillektomie - Tonsillotomie - evidenzbasierte Medizin - Antibiotika - klinische Studien

Keywords

Tonsillitis - sore throat - pharyngitis - quality of life - tonsillectomy - tonsillotomy - randomized controlled trial - antibiotics - evidence-based medicine

Publication History

Article published online:
01 April 2025

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