This is the
talk page for discussing improvements to the
Tonsillitis article. This is not a forum for general discussion of the article's subject. |
Article policies
|
Find medical sources: Source guidelines · PubMed · Cochrane · DOAJ · Gale · OpenMD · ScienceDirect · Springer · Trip · Wiley · TWL |
Archives: 1 |
![]() | This article is rated C-class on Wikipedia's
content assessment scale. It is of interest to the following WikiProjects: | |||||||||||||
|
![]() | Ideal sources for Wikipedia's health content are defined in the guideline
Wikipedia:Identifying reliable sources (medicine) and are typically
review articles. Here are links to possibly useful sources of information about Tonsillitis.
|
Starting point. SandyGeorgia ( Talk) 00:35, 21 November 2020 (UTC)
Looking back in time, the article was established with the Diberri/Boghog citation style (which we used to use on all articles). But now it is all over the map. Before we start work, we should decide on a citation style, and how we are going to provide page numbers. We know my preference :) If people want to drop citations in according to their familiar style, I am happy to standardize to one style, if we decide what that will be. SandyGeorgia ( Talk) 21:32, 1 November 2020 (UTC)
Feel free to add to this list, either with normal separate posts or in-line if you'd prefer to keep it all in one place. Looking forward to making some progress together. Ajpolino ( talk) 01:15, 2 November 2020 (UTC)
Let's make a list of potentially useful sources. WhatamIdoing ( talk) 06:12, 2 November 2020 (UTC)
The NICE Clinical Knowledge Summary Acute Sore Throat is worth consulting. It is based on the SIGN Guideline 117 which is dated 2010 and a BMJ Best Practice that I can't get access to.
The NHS "Behind the Headlines" reported Children's tonsils 'are being removed unnecessarily' analysing how the story was covered in the press, and the study itself. The study is from 2019 -- is this mentioned in any very recent review? -- Colin° Talk 15:06, 2 November 2020 (UTC)
Reading all about tonsils. Didn't know you had four kinds in different parts of your nose/throat. Didn't know they got bigger in childhood and shrunk in adulthood. Didn't know about peritonsillar abscess aka quinsy. Never heard of "quinsy". Thought it might be archaic but then I saw the NHS used that term so perhaps that's actually the common term, and should be in our lead. Either way "peritonsillar abscess" or "quinsy" probably don't mean anything to many people, so might need explained. Didn't know about tonsil stones. I knew tonsillectomy was performed more often in the 70s and less so now, but didn't know that it was REALLY common early 20th century and is an ancient procedure. I'm seeing "tonsillotomy" mentioned on some websites/papers (is this a partial tonsillectomy?) but isn't mentioned here (it is mentioned at tonsillectomy but there isn't even a tonsillotomy redirect). We probably should have a bit more about tonsillectomy here, even though there is a dedicated article.
I think the statement "as viruses and bacteria enter the body through the nose and mouth, they are filtered in the tonsils" is probably bollocks. They do seem to be involved in an immune response (is that only a local response, or can it generate immune response elsewhere such as in the lungs?) but the idea they are a kind of face mask is a bit silly. Since they shrink in adulthood, and are relatively large in childhood vs throat size, I can see very physical reasons why tonsillitis is a childhood disease. But is there more to it than that and can we give more on the age-related epidemiology. Is there any more epidemiology? If the tonsils are part of your immune system, why is it that they are the ones to suffer when you get the infection? Wouldn't those bits be best at fighting it off? If you don't have much tonsil as an adult, how does that change your incidence or severity of sore throat? -- Colin° Talk 21:59, 3 November 2020 (UTC)
In several sections (symptoms, causes, treatment) there are statements sourced to 4..7 sources. Looking at the archive, this seems to date from User:BSW-RMH's external review in 2010, and they were perhaps unfamiliar with how best to add citations. I think we need to trim that back to just one source if possible, as it is a barrier to editing and verification -- the reader/editor needs to check all the sources to verify if the list is all sourced. Some of the sources are books, which also makes it harder for us to check.
The Merk aka MSD manual entry is for "tonsillopharyngitis" and overlaps infection of the pharynx. The BMJ Best Practice: Tonsillitis entry (which I can only read the summary) has a definition: "Acute tonsillitis is an acute infection of the parenchyma of the palatine tonsils. This definition does not include tonsillitis as part of infectious mononucleosis, although tonsillitis may occur in isolation or as part of a generalised pharyngitis. The clinical distinction between tonsillitis and pharyngitis is unclear in the literature, and the condition is often referred to simply as 'acute sore throat'." That definition excludes infectious mononucleosis, i.e. Epstein-Barr virus that our article says counts for between 1 and 10% of cases. It also claims the literature is unclear wrt pharyngitis. I do note that it is explicitly saying "palatine tonsils" vs the other tonsils. It seems that, if unqualified, then "tonsils" means "palatine tonsils" but our article could perhaps be clearer if this is the appropriate restriction. Another issue is our definition at NCIthesaurus is for "acute tonsillitis", which is also what the BMJ is for. But there is also "chronic" and/or "recurrent" tonsillitis. Is it ever genuinely chronic or does the recurrent one just feel that way? I assume some causes would be more typically "acute" and only some lead to chronic/recurrent cases.
I had a look at Centor criteria to find out how it got its name. There is a rather dubious and unsourced mnemonic on the page. I see an alternative mnemonic at this page, though am still unconvinced it would help anyone. Looking at the sources, I note that the paper from 1981 lead author was an "RM Centor" so I guess they are the source of the name. Perhaps we should consider if this or any mnemonic is WP:WEIGHT sufficient to mention on that wiki article, or if Wikipedia is simply perpetuating what one guy made up one day. -- Colin° Talk 18:44, 4 November 2020 (UTC)
Above is a lot to process, so I'll make some comments and see whether these lead to more specific questions/clarifications. The tonsils are in the pharynx, so (as an internist, infectious diseases specialist, and research immunologist) I'm not sure what distinction is desired - tonsillitis is a specific location/type of pharyngitis, but the former could be part of the latter. Tonsils are part of Waldeyer's ring, a component of gut-associated lymphoid tissue or the more inclusive mucosa-associated lymphoid tissues (MALT), and therefore a component of the system of secondary lymphoid organs (which almost uniquely contain resident naive lymphocytes, lymphoid follicles, and other specialized structures/functions of the immune system). The immune system supports a degree of compartmentalization, such that naive lymphocytes recognizing antigens in MALT for the first time tend to remain localized to tissues of the same type (e.g. tissue-resident memory T cells). Happy to discuss further (life - especially pandemic life - is very busy, but I'll try to keep an eye on this page and my email notifications are turned on). — soupvector ( talk) 00:00, 9 November 2020 (UTC)
Hi all, I'm sure this will pop up a few times but the article currently attributes 50 to 80% of tonsillitis to viruses, sourced to a 2014 review in Clinical Otolaryngology. A 2018 review in Surgery gives a bit less to viruses (sorry Graham), claiming 40-60%. Anyone see other numbers to break the tie, or have a reason to prefer one source over the other? Ajpolino ( talk) 03:42, 6 November 2020 (UTC)
References
I am working on what to do about the
PANDAS fraud ummm ... statement. That controversy now involves PANDAS,
PANS and CANS, and has moved well beyond strep, but we still have to say something.
PMID
29398245
PMID
29689421
Tourette syndrome#Causes
SandyGeorgia (
Talk) 14:55, 10 November 2020 (UTC)
Sources for PANDAS/PANS/CANS
|
---|
Marazziti 2018 [2] PMID 29689421
Zibordi 2018 [3] PMID 29398245
|
Obsessive–compulsive disorder and tic disorders are hypothesized to arise in a subset of children as a result of a post- streptococcal autoimmune process. [1] [2] [3] Its potential effect was described in 1998 by the controversial hypothesis called PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections), a condition thought to be triggered by GABHS infections. [1] [3] [4] The PANDAS hypothesis is unconfirmed and unsupported by data, and two new categories have been proposed: PANS (pediatric acute-onset neuropsychiatric syndrome) and CANS (childhood acute neuropsychiatric syndrome). [2] [3] The CANS/PANS hypotheses include different possible mechanisms underlying acute-onset neuropsychiatric conditions, but do not exclude GABHS infections as a cause in a subset of individuals. [2] [3] PANDAS, PANS and CANS are the focus of clinical and laboratory research but remain unproven. [1] [2] [3]
References
{{
cite journal}}
: CS1 maint: DOI inactive as of June 2022 (
link)
Could be shortened? May still give undue emphasis to GABHS, which persist thanks to Susan Swedo? SandyGeorgia ( Talk) 17:35, 10 November 2020 (UTC)
Suggestions 2409:4042:4E99:E47E:194E:C4AF:6F19:358E ( talk) 20:49, 29 April 2022 (UTC)
i slay 86.22.124.150 ( talk) 08:07, 22 November 2022 (UTC)
This is the
talk page for discussing improvements to the
Tonsillitis article. This is not a forum for general discussion of the article's subject. |
Article policies
|
Find medical sources: Source guidelines · PubMed · Cochrane · DOAJ · Gale · OpenMD · ScienceDirect · Springer · Trip · Wiley · TWL |
Archives: 1 |
![]() | This article is rated C-class on Wikipedia's
content assessment scale. It is of interest to the following WikiProjects: | |||||||||||||
|
![]() | Ideal sources for Wikipedia's health content are defined in the guideline
Wikipedia:Identifying reliable sources (medicine) and are typically
review articles. Here are links to possibly useful sources of information about Tonsillitis.
|
Starting point. SandyGeorgia ( Talk) 00:35, 21 November 2020 (UTC)
Looking back in time, the article was established with the Diberri/Boghog citation style (which we used to use on all articles). But now it is all over the map. Before we start work, we should decide on a citation style, and how we are going to provide page numbers. We know my preference :) If people want to drop citations in according to their familiar style, I am happy to standardize to one style, if we decide what that will be. SandyGeorgia ( Talk) 21:32, 1 November 2020 (UTC)
Feel free to add to this list, either with normal separate posts or in-line if you'd prefer to keep it all in one place. Looking forward to making some progress together. Ajpolino ( talk) 01:15, 2 November 2020 (UTC)
Let's make a list of potentially useful sources. WhatamIdoing ( talk) 06:12, 2 November 2020 (UTC)
The NICE Clinical Knowledge Summary Acute Sore Throat is worth consulting. It is based on the SIGN Guideline 117 which is dated 2010 and a BMJ Best Practice that I can't get access to.
The NHS "Behind the Headlines" reported Children's tonsils 'are being removed unnecessarily' analysing how the story was covered in the press, and the study itself. The study is from 2019 -- is this mentioned in any very recent review? -- Colin° Talk 15:06, 2 November 2020 (UTC)
Reading all about tonsils. Didn't know you had four kinds in different parts of your nose/throat. Didn't know they got bigger in childhood and shrunk in adulthood. Didn't know about peritonsillar abscess aka quinsy. Never heard of "quinsy". Thought it might be archaic but then I saw the NHS used that term so perhaps that's actually the common term, and should be in our lead. Either way "peritonsillar abscess" or "quinsy" probably don't mean anything to many people, so might need explained. Didn't know about tonsil stones. I knew tonsillectomy was performed more often in the 70s and less so now, but didn't know that it was REALLY common early 20th century and is an ancient procedure. I'm seeing "tonsillotomy" mentioned on some websites/papers (is this a partial tonsillectomy?) but isn't mentioned here (it is mentioned at tonsillectomy but there isn't even a tonsillotomy redirect). We probably should have a bit more about tonsillectomy here, even though there is a dedicated article.
I think the statement "as viruses and bacteria enter the body through the nose and mouth, they are filtered in the tonsils" is probably bollocks. They do seem to be involved in an immune response (is that only a local response, or can it generate immune response elsewhere such as in the lungs?) but the idea they are a kind of face mask is a bit silly. Since they shrink in adulthood, and are relatively large in childhood vs throat size, I can see very physical reasons why tonsillitis is a childhood disease. But is there more to it than that and can we give more on the age-related epidemiology. Is there any more epidemiology? If the tonsils are part of your immune system, why is it that they are the ones to suffer when you get the infection? Wouldn't those bits be best at fighting it off? If you don't have much tonsil as an adult, how does that change your incidence or severity of sore throat? -- Colin° Talk 21:59, 3 November 2020 (UTC)
In several sections (symptoms, causes, treatment) there are statements sourced to 4..7 sources. Looking at the archive, this seems to date from User:BSW-RMH's external review in 2010, and they were perhaps unfamiliar with how best to add citations. I think we need to trim that back to just one source if possible, as it is a barrier to editing and verification -- the reader/editor needs to check all the sources to verify if the list is all sourced. Some of the sources are books, which also makes it harder for us to check.
The Merk aka MSD manual entry is for "tonsillopharyngitis" and overlaps infection of the pharynx. The BMJ Best Practice: Tonsillitis entry (which I can only read the summary) has a definition: "Acute tonsillitis is an acute infection of the parenchyma of the palatine tonsils. This definition does not include tonsillitis as part of infectious mononucleosis, although tonsillitis may occur in isolation or as part of a generalised pharyngitis. The clinical distinction between tonsillitis and pharyngitis is unclear in the literature, and the condition is often referred to simply as 'acute sore throat'." That definition excludes infectious mononucleosis, i.e. Epstein-Barr virus that our article says counts for between 1 and 10% of cases. It also claims the literature is unclear wrt pharyngitis. I do note that it is explicitly saying "palatine tonsils" vs the other tonsils. It seems that, if unqualified, then "tonsils" means "palatine tonsils" but our article could perhaps be clearer if this is the appropriate restriction. Another issue is our definition at NCIthesaurus is for "acute tonsillitis", which is also what the BMJ is for. But there is also "chronic" and/or "recurrent" tonsillitis. Is it ever genuinely chronic or does the recurrent one just feel that way? I assume some causes would be more typically "acute" and only some lead to chronic/recurrent cases.
I had a look at Centor criteria to find out how it got its name. There is a rather dubious and unsourced mnemonic on the page. I see an alternative mnemonic at this page, though am still unconvinced it would help anyone. Looking at the sources, I note that the paper from 1981 lead author was an "RM Centor" so I guess they are the source of the name. Perhaps we should consider if this or any mnemonic is WP:WEIGHT sufficient to mention on that wiki article, or if Wikipedia is simply perpetuating what one guy made up one day. -- Colin° Talk 18:44, 4 November 2020 (UTC)
Above is a lot to process, so I'll make some comments and see whether these lead to more specific questions/clarifications. The tonsils are in the pharynx, so (as an internist, infectious diseases specialist, and research immunologist) I'm not sure what distinction is desired - tonsillitis is a specific location/type of pharyngitis, but the former could be part of the latter. Tonsils are part of Waldeyer's ring, a component of gut-associated lymphoid tissue or the more inclusive mucosa-associated lymphoid tissues (MALT), and therefore a component of the system of secondary lymphoid organs (which almost uniquely contain resident naive lymphocytes, lymphoid follicles, and other specialized structures/functions of the immune system). The immune system supports a degree of compartmentalization, such that naive lymphocytes recognizing antigens in MALT for the first time tend to remain localized to tissues of the same type (e.g. tissue-resident memory T cells). Happy to discuss further (life - especially pandemic life - is very busy, but I'll try to keep an eye on this page and my email notifications are turned on). — soupvector ( talk) 00:00, 9 November 2020 (UTC)
Hi all, I'm sure this will pop up a few times but the article currently attributes 50 to 80% of tonsillitis to viruses, sourced to a 2014 review in Clinical Otolaryngology. A 2018 review in Surgery gives a bit less to viruses (sorry Graham), claiming 40-60%. Anyone see other numbers to break the tie, or have a reason to prefer one source over the other? Ajpolino ( talk) 03:42, 6 November 2020 (UTC)
References
I am working on what to do about the
PANDAS fraud ummm ... statement. That controversy now involves PANDAS,
PANS and CANS, and has moved well beyond strep, but we still have to say something.
PMID
29398245
PMID
29689421
Tourette syndrome#Causes
SandyGeorgia (
Talk) 14:55, 10 November 2020 (UTC)
Sources for PANDAS/PANS/CANS
|
---|
Marazziti 2018 [2] PMID 29689421
Zibordi 2018 [3] PMID 29398245
|
Obsessive–compulsive disorder and tic disorders are hypothesized to arise in a subset of children as a result of a post- streptococcal autoimmune process. [1] [2] [3] Its potential effect was described in 1998 by the controversial hypothesis called PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections), a condition thought to be triggered by GABHS infections. [1] [3] [4] The PANDAS hypothesis is unconfirmed and unsupported by data, and two new categories have been proposed: PANS (pediatric acute-onset neuropsychiatric syndrome) and CANS (childhood acute neuropsychiatric syndrome). [2] [3] The CANS/PANS hypotheses include different possible mechanisms underlying acute-onset neuropsychiatric conditions, but do not exclude GABHS infections as a cause in a subset of individuals. [2] [3] PANDAS, PANS and CANS are the focus of clinical and laboratory research but remain unproven. [1] [2] [3]
References
{{
cite journal}}
: CS1 maint: DOI inactive as of June 2022 (
link)
Could be shortened? May still give undue emphasis to GABHS, which persist thanks to Susan Swedo? SandyGeorgia ( Talk) 17:35, 10 November 2020 (UTC)
Suggestions 2409:4042:4E99:E47E:194E:C4AF:6F19:358E ( talk) 20:49, 29 April 2022 (UTC)
i slay 86.22.124.150 ( talk) 08:07, 22 November 2022 (UTC)