Background: Tonsillitis, an inflammation of the palatine tonsils, is a common condition associated with viral or bacterial infections. While most cases result from viral or bacterial causes, a specific form known as glandular fever or infectious mononucleosis is primarily linked to Epstein-Barr virus (EBV) infection. Glandular fever can lead to severe complications, including splenic rupture, encephalitis, chronic fatigue syndrome, and acute acalculous cholecystitis. These complications underscore the importance of early identification and targeted management for patients presenting with tonsillitis symptoms, as missed diagnoses can result in significant patient morbidity. Implementing timely and accurate diagnostic protocols is essential to avoid these potential risks and establish appropriate care plans. 

Objectives: This study aims to quantify the number of missed glandular fever cases that may have been misdiagnosed as simple tonsillitis. Additionally, it emphasizes the importance of screening for EBV in patients presenting with tonsillitis-like symptoms to prevent the complications associated with untreated glandular fever. 

Methods: A retrospective single-centre cohort study was conducted over a 12-month period at Lincoln County Hospital in England. A total of 185 patients diagnosed with tonsillitis were included in this analysis. Patient data, including presenting symptoms, liver function test results, and glandular fever screening outcomes, were reviewed to determine the prevalence of EBV infection within this cohort. 

Results: Among the 185 patients (average age: 26 years), 112 were screened for EBV infection, with 35 (31.3%) testing positive. Of these EBV-positive cases, 74% (26 out of 35) showed abnormal liver function test results. Applying this proportion to the 73 unscreened patients suggests a potential 23 missed EBV cases, which represent 12% of the total cohort. 

Conclusion: This study highlights a significant risk of undiagnosed EBV infections among patients with tonsillitis. Routine EBV screening in tonsillitis cases may enhance diagnostic accuracy and improve patient outcomes through timely intervention and management.

Abubaker Elamin, an ENT specialist with a dedicated focus on head and neck surgery, has been practicing in the United Kingdom for the past five years. Complex conditions within the head and neck regions, particularly intricate neck dissections and tumors affecting these areas, are managed as the primary areas of expertise. A strong passion for advancing care standards is held, and ten peer-reviewed publications, including seven as first author, have been authored, contributing to the body of research in ENT and head and neck oncology. Currently, active involvement is maintained in the development of clinical guidelines for upfront neck dissections in the treatment of oropharyngeal Squamous Cell Carcinoma (SCC). These guidelines are intended to standardize and optimize care for patients with oropharyngeal SCC, improving outcomes and providing a framework for best practices in surgical treatment. Ongoing work emphasizes the importance of evidence-based approaches and interdisciplinary collaboration in the management of head and neck cancer.