Infectious mononucleosis is clinically difficult to distinguish from bacterial causes of tonsillitis/pharyngitis. First-line investigations include monospot testing, despite 63% sensitivity in certain cohorts. Therefore, national recommendations include repeating an initial negative monospot within five to seven days. A point-of-care clinical scoring tool could improve clinical outcomes, increase diagnostic accuracy and reduce unnecessary testing. We conducted a retrospective cohort study at Luton and Dunstable University Hospital including patients aged 15-24 presenting with sore throat, lymphadenopathy or fever between 01/01/2021 and 31/01/2024 who underwent monospot testing. Extracted data included demographics, observations, and laboratory results. Patients were randomly split into training (80%) and testing (20%) cohorts. Eleven parameters were used to develop four predictive models; classical multivariate logistic regression, machine-learning logistic regression with LIBLINEAR approximation, machine-learning decision tree classifier, and a simplified clinical risk-stratification model from machine-learning methods. Total of 278 presentations from 264 patients were included. The machine-learning decision tree classifier demonstrated superior performance, achieving 100% sensitivity, 98.0% specificity, and 98.2% diagnostic accuracy using only three parameters: lymphocyte count, neutrophil count, and alanine aminotransferase. The simplified clinical risk-stratification model demonstrated 83.3% sensitivity, 98.0% specificity, and overall 96.4% accuracy. All four models represent potential methods for developing clinical tools to predict monospot positivity. Our risk-stratification model showed significant promise as an easily memorisable, point-of-care clinical scoring tool. Using this, we propose an alternative diagnostic pathway with early counselling and de-escalation of antibiotics in high-risk cases, and reduced testing in low-risk cases; reducing population-level morbidity and epidemiological spread, whilst improving diagnostic accuracy and conserving resources.

BackgroundRecurrent and chronic tonsillitis significantly impairs adult quality of life through frequent pain and functional disruption. While tonsillectomy offers definitive symptomatic relief, its associated postoperative morbidity has sparked an ongoing debate favoring conservative care.MethodsA comprehensive search of PubMed, CENTRAL, Embase, Scopus, Google Scholar, and Web of Science was conducted up to May 2026 to identify randomized controlled trials (RCTs) and non-randomized comparative studies. The primary outcome the recurrence rate, defined as the incidence of any recurrent episode of sore throat, tonsillitis, or pharyngitis during follow-up. Risk ratios (RR) and mean differences (MD) were pooled using a random-effects model.ResultsEight studies (four RCTs, four observational) involving 3,111 adult patients were included. Tonsillectomy was associated with a significantly reduced risk of symptomatic recurrence compared with conservative care (RR: 0.28, 95% CI [0.13, 0.59]; p < 0.001). Additionally, surgical intervention significantly decreased the overall number of sore throat episodes (MD: -4.31, 95% CI [-7.17, -1.46]; p = 0.003), symptomatic days (MD: -15.20, 95% CI [-28.81, -1.60]; p = 0.03), and days absent from work or school (MD: -6.94, 95% CI [-13.33, -0.55]; p = 0.03). However, there was no significant reduction in healthcare visits (p = 0.20), and 13% of conservatively managed patients eventually required surgery.ConclusionTonsillectomy can be effective in reducing the disease burden of recurrent throat infections in adults, significantly decreasing recurrence, symptomatic days, and functional absenteeism. However, the benefit must be balanced against postoperative pain and bleeding, and the certainty of the effect size is limited by current clinical heterogeneity and the risk of bias in observational evidence.

Antibiotics save lives, but their long-term side effects are often underestimated. To prevent side effects and maintain the effectiveness of antibiotics, uncomplicated infections should be treated as narrowly as possible, while life-threatening infections should be treated as broadly as necessary. Acute upper respiratory tract infections should only be treated with antibiotics if there is a clear bacterial cause and the infection is severe. Penicillin V is the first-line treatment for tonsillopharyngitis, amoxicillin for acute otitis media (AOM) and acute rhinosinusitis (ARS), and a group 1 cephalosporin for furuncles and skin phlegmons. For severe infections with possible involvement of anaerobic bacteria (abscesses of the mouth and throat, oto- and sinogenic complications), aminopenicillin-beta-lactamase combination therapy is the first choice. Fluoroquinolones, cephalosporins (except group 1), clindamycin, and carbapenems should only be used in well-founded exceptional cases.

Background/Objectives: Otorhinolaryngologic (ENT) complaints constitute a substantial proportion of emergency department (ED) visits, ranging from minor to life-threatening problems. The patterns and frequency of these presentations in Saudi Arabia remain poorly described. This study, therefore, aimed to address this gap by examining the most frequent ENT-related presentations to the ED at a tertiary center in Riyadh, Saudi Arabia, to identify common diagnoses, describe patient demographics, and evaluate annual trends in ED visits. Methods: A retrospective study of all consecutive ENT-related emergency department visits between January 2019 and December 2024 was conducted at King Abdulaziz Medical City, a tertiary care center in Riyadh, Saudi Arabia. Diagnosis classification used the International Classification of Diseases, 10th Revision (ICD-10). Data on patient demographics, presenting complaints, and hospital admissions were extracted. Descriptive analyses were performed to assess annual trends and common diseases. Results: A total of 22,014 patients were included in the present study, with a slight male (54%) predominance. Across 34,290 ED visits, annual presentations were the highest in 2019 (23.9%) and lowest in 2020 (9.2%). Most patients were discharged from ED (91.9%). The most frequent diagnoses were acute pharyngitis (29.1%), acute tonsillitis (26.2%), and otitis media (22.3%). Conclusions: The study examined the otorhinolaryngology conditions most frequently encountered in an ED setting. The findings highlight a range of ENT disorders that are commonly seen in this setting. Recognizing these prevalent conditions and their patterns can improve ED physicians' preparedness, triage, and management of patients presenting with ENT emergencies.

An immunocompetent adolescent male presented with severe tonsillitis that rapidly progressed to a life-threatening upper airway obstruction requiring intensive care. Initial empirical antibiotics were ineffective. Sputum culture isolated Raoultella ornithinolytica, a rare environmental pathogen. Treatment was commenced and titrated based on sensitivities leading to a full recovery. This case establishes R. ornithinolytica as a cause of severe obstructive tonsillitis in healthy immunocompetent individuals. It highlights crucial learning points: clinicians should consider emerging environmental pathogens in severe tonsillitis especially with relevant exposure history. Microbiological sampling is critical in atypical or treatment-refractory cases to guide therapy. Additionally, the use of modern diagnostic methods is essential for accurately identifying such uncommon pathogens, ensuring appropriate antimicrobial stewardship.

The persistence of resistant pathogens in otorhinolaryngology is associated with substantial disease burden and limited effectiveness of the available antimicrobials. We aimed to provide an updated overview of nationwide antimicrobial susceptibility surveillance for major pathogens causing otorhinolaryngological infections in Japan. The 12th joint four-society survey was conducted between 2021 and 2023 in 37 institutions nationwide. Bacterial isolates from patients with acute otitis media, acute exacerbation of chronic otitis media, acute tonsillitis, and peritonsillar abscess were analyzed. Among 537 patients, 378 target bacterial isolates for antimicrobial susceptibility testing were recovered, including Haemophilus influenzae (59 isolates), Streptococcus pneumoniae (23 isolates), and anaerobes (124 isolates). The proportion of penicillin-susceptible S. pneumoniae (at a benzylpenicillin [PCG] minimum inhibitory concentration [MIC] of ≤0.06 μg/mL) was 56.5%, and penicillin-resistant S. pneumoniae (at a PCG MIC of ≥2 μg/mL) isolates were not detected. Capsular serotyping revealed that almost all S. pneumoniae isolates were non-pneumococcal conjugate vaccine 13 (PCV13) serotypes, with 10A and 35B being the most frequent; only one isolate belonged to a PCV13 serotype (19A). Notably, all 35B isolates were classified as penicillin-intermediate S. pneumoniae (PCG MIC, 0.12-1 μg/mL) and harbored pbp1a, pbp2b, and pbp2x mutations. H. influenzae showed a modest recovery of ampicillin-susceptible strains. Anaerobes from peritonsillar abscesses remained highly susceptible to β-lactam/β-lactamase inhibitor combinations and metronidazole. The 12th nationwide surveillance revealed improved antimicrobial susceptibility in major otorhinolaryngological pathogens; however, non-PCV13 serotypes such as 35B warrant continuous monitoring in the post-PCV20 era.

Introduction Upper respiratory tract infections (URTIs) are commonly encountered in primary care. Azithromycin has emerged as a preferred therapy for URTIs due to its once-daily dosing, low resistance risk, and favorable gastrointestinal tolerability. This study evaluated the real-world effectiveness and safety of azithromycin (500 mg/day) in moderate to severe acute URTIs. Materials and methods This subgroup analysis of a retrospective, multicenter, observational study analyzed data from 184 ENT centers in India over 12 weeks. Medical records of adult patients with moderate to severe URTIs treated with azithromycin 500 mg daily for five days were included. Key clinical signs (pharyngeal and tonsillar erythema, exudates) and symptoms (sore throat, fever, daily activity interference) were assessed on a 3-point scale. Treatment effectiveness was evaluated through changes in cumulative symptom scores and Clinical Global Impression scores on day 5. Data were analyzed using paired t-tests and McNemar-Bowker tests, with p<0.05 indicating significance. Ethical approval was obtained, and all data collection adhered to Good Clinical Practice standards. Results Data from 427 patients with moderate to severe URTIs were analyzed. By day 5, significant improvements were observed across all clinical parameters. Proportion of patients with moderate pharyngeal erythema (40.7%) and severe cases (59.3%) reduced significantly to 16.6% and 0.2%, respectively, and severe tonsillar erythema (63%) reduced from baseline to no cases with severe tonsillar erythema at day 5. Tonsillar exudates reduced from 52.9% to 7.6% for moderate cases and from 47.1% to 0.2% for severe cases. Sore throat severity dropped from 73.5% to only 0.2% reporting difficulty swallowing. Fever resolved in 96.7% of patients, and work absenteeism reduced from 71.2% to 0.9%. Clinical Global Impression scores indicated improvement in 90% of patients. Adverse events were reported in only 2.1% of cases. Conclusion Azithromycin demonstrated significant clinical effectiveness in managing moderate to severe URTIs, with marked improvements in key symptoms and signs.

Tonsillar tuberculosis, a rare observed presentation of Mycobacterium tuberculosis affecting the palatine tonsils. Often secondary and associated with concurrent pulmonary tuberculosis, it may clinically manifest as chronic or recurrent tonsillitis, occasionally mimicking malignant conditions. Diagnosis of this condition is often delayed and complex, frequently necessitating histopathological examination for confirmation. Its management predominantly hinges on antitubercular medications.We present two distinct cases of tonsillar tuberculosis. The first case involves a 64-year-old male receiving anti-TNF therapy for ulcerative colitis. He was hospitalized for lateral neck swelling and persistent ulceronecrotic angina despite initial antibiotic treatments. Tonsillar tuberculosis was suspected and confirmed by histopathological analysis. The second case involves a 46-year-old female presenting with right ulceronecrotic angina associated with ipsilateral jugulo-carotid adenopathy. The diagnosis of caseous-follicular tonsillar tuberculosis was confirmed by biopsy. The patient was initiated on antitubercular treatment for a period of 6 months, resulting in a significant improvement in symptoms. Neither patient had pulmonary tuberculosis.