Tonsillitis

What is Tonsillitis?

Tonsillitis is a disorder involving inflammation of the tonsils. There are two tonsils, situated on either side of the back of the throat and they form part of the body’s immune system.

When the main site of infection is within the tonsils: they swell, become red and inflamed and may show a surface coating of white spots.

Tonsillitis is extremely common in children and young people, but it can occur at any age. The characteristics of the disease are pain in the throat and trouble swallowing.

What are the signs and symptoms of tonsillitis?

• Pain in the throat (sometimes severe) that may last more than 48 hours and be associated with difficulty in swallowing. The pain may spread to the ears.
• The throat is reddened, the tonsils are swollen and may be coated or have white spots on them.
• Possibly a high temperature.
• Swollen lymph glands under the jaw and in the neck.
• Headache.
• Loss of voice or changes in the voice.

What complications may arise?

Usually a throat infection, such as tonsillitis, causes no trouble and only lasts about a week. But the following complications can arise:

• A secondary infection may occur in the middle ear or sinuses.
• If the sore throat is due to a streptococcus infection, there may be a rash (scarlet fever).
• An uncommon complication is a throat abscess that occurs usually only on one side. If sufficiently large this can need surgical drainage (Quinsy throat).
• In very rare cases, diseases like rheumatic fever or a particular kidney disease (glomerulonephritis) can occur. This is much less commonly observed now than it was several decades ago.

Treatment

Medicines

In the vast majority of people, infection caused by a virus infection need only be treated with paracetamol (eg Calpol, Panadol) to bring the temperature down. Aspirin (eg Disprin) is also useful, but should not be given to children under 16 years of age, unless on the advise of a doctor.

In a small minority of patients, tonsillitis caused by bacteria is treated with penicillin or erythromycin (eg Erythroped) if the person is allergic to penicillin. If antibiotics are prescribed, it’s important to complete the full course, or the infection may not be cured.

Antibiotics are advisable for immunocompromised patients, eg those receiving chemotherapy.

Surgery

Surgery to remove the tonsils (Tonsillectomy) may be necessary for those patients suffering from repeated, severe infections (five or more per year) that refuse to respond to treatment and significantly interfere with their school or work schedule.

Tonsillectomy

A tonsillectomy is a 3,000-year-old surgical procedure in which the tonsils are removed from either side of the throat.

The procedure is performed in response to cases of repeated occurrence of acute tonsillitis or adenoiditis, obstructive sleep apnea, nasal airway obstruction, snoring, or peritonsillar abscess.

For children, the adenoids are removed at the same time, a procedure called adenoidectomy.

Indications

Tonsillectomy may be indicated when the patient:

• Experiences recurrent infections of acute tonsillitis. The number requiring tonsillectomy varies with the severity of the episodes.
• Has chronic tonsillitis, consisting of persistent, moderate-to-severe throat pain.
• Has multiple bouts of peritonsillar abscess.
• Has sleep apnea (stopping or obstructing breathing at night due to enlarged tonsils or adenoids)
• Has difficulty eating or swallowing due to enlarged tonsils (very unusual reason for tonsillectomy)
• Produces tonsilloliths (tonsil stones) in the back of their mouth.
• Has abnormally large tonsils with crypts (Craters or impacts in the tonsils)