Clinical grading of acute tonsillitis
Reading File
Finding Sources
Finding Sources
Searching PubMed
acute tonsillitis AND grading
Searching the Web
clinical grading acute tonsillitis Mackenzie grading tonsil size
Reading Web Page
https://www.ncbi.nlm.nih.gov/books/NBK544342
Reading File
Clinical grading in acute tonsillitis usually refers to the degree of tonsillar enlargement on oropharyngeal examination:
| Grade | Appearance |
|---|---|
| 0 | Tonsils absent, usually after tonsillectomy |
| 1+ | Small tonsils, confined within the tonsillar pillars |
| 2+ | Enlarged up to the pillars |
| 3+ | Extend beyond the pillars, narrowing the oropharyngeal space |
| 4+ | “Kissing tonsils,” touching each other at the midline |
This is commonly termed the Brodsky tonsil grading scale. A comparable 0-4 description in the Friedman system defines grade 4 as hypertrophic tonsils with midline contact. K J Lee’s Essential Otolaryngology, p. 87.
For clinical severity and likelihood of group A streptococcal infection, do not use tonsil size alone. Use the Centor/McIsaac score, based on:
- Tonsillar exudate or swelling
- Tender anterior cervical lymph nodes
- Fever
- Absence of cough
- Age adjustment in McIsaac scoring
A high grade of enlargement can raise concern for airway compromise, but it does not by itself establish bacterial tonsillitis. The StatPearls clinical review describes use of Centor or McIsaac clinical scores to guide testing and treatment decisions.
This is a shared conversation. Sign in to Orris to start your own chat.