Tonsillitis that has a membranous exudate, marked lymphoid hypertrophy, often a negative throat culture, and does not respond to penicillin, should be evaluated for infectious mononucleosis. Diagnostic tests include white blood count, differential, and a mononucleosis spot test. In areas of frequent cases of gonorrhea, resistant or unusual cases of pharyngitis should be cultured, specifically for Neisseria gonococci. Thornwaldt's Disease . Diagnosis is made by ruling out sinus disease and visualization of the draining bursa with the nasopharyngeal mirror, or, more clearly, the nasopharyngoscope, or Yankhauer scope.
Treatment requires either electrocoagulation or surgical removal of the cyst or pouch.
Peritonsillar Abscess . If spontaneous drainage is noted from a necrotic site, gentle suction and blunt, careful widening of the opening assists in providing adequate drainage. Hot saline throat irigations every few hours and adequate analgesics are necessary for the first few days. Occasionally, a second or third reopening may be necessary if considerable pus continues to accumulate. Emergency tonsillectomies are performed by some physicians as a treatment for the abscess, but this should only be done by experienced hands because of the danger of bleeding or sepsis.