Tonsillitis - Overview

Anyone with growing children or those who remember their childhood days will know of tonsillitis, an inflammation of the tonsils. Tonsils are balls of lymph tissue on both sides of the throat, above and behind the tongue. They act as filters, trapping germs that could otherwise enter the airways and cause infection. They also produce antibodies to fight infection. Tonsils can sometimes get inflamed when affected by bacteria or viruses; when they swell and get inflamed, it is known as tonsillitis.

Tonsillitis is common, especially among children. The condition can occur occasionally or frequently. When a person infected with bacteria or virus breathes, coughs or sneezes nearby, the infection can spread to others around through air droplets, causing tonsillitis. The main symptom of tonsillitis is sore throat. The throat and tonsils usually look red and swollen. The tonsils may have spots or pus that covers them completely or in patches. Fever is also common. Tonsils are normally large during childhood, but they can cause trouble when they get infected or grow too large.

 

Tonsillitis - Causes

Tonsillitis can be caused by a virus, such as the common cold, or by a bacterial infection, such as strep throat. Viruses are the most common cause of tonsillitis. Children come in close contact with others at school and play, exposing them to a variety of viruses and bacteria. This makes them particularly vulnerable to germs that cause tonsillitis

 

Tonsillitis - Symptoms

Tonsillitis most commonly affects children between preschool and mid-teenage years.

Common signs and symptoms of tonsillitis are as follows:

  • red, swollen tonsils
  • white or yellow coating on tonsils
  • patches on tonsils
  • sore throat
  • pain while swallowing
  • fever
  • an itchy throat or a muffled voice
  • bad breath
  • headache
  • enlarged, tender glands (lymph nodes) in the neck
  • possible irritability or a poor appetite among children too young to express themselves

There are two types of tonsillitis:

1.      recurrent tonsillitis, in which multiple episodes of acute tonsillitis occur in a year, with each episode lasting for 4 to 10 days.

2.      chronic tonsillitis, in which episodes last longer than acute tonsillitis, with other symptoms like chronic sore throat, bad breath and tender lymph nodes in the neck.

Tonsillitis - Diagnosis

It is most often diagnosed in children from preschool to teenage years. Diagnosis is based on a physical examination of the child’s throat. Our doctor will start with a physical exam that will include using a torch to look at the child's throat, followed by the ears and nose, as these may also be sites of infection. Next, the doctor will gently start feeling (palpating) the child's neck to check for swollen glands (lymph nodes) and listen to their breathing with a stethoscope.

Complications

·        A middle ear infection (otitis media) - where fluid between the eardrum and inner ear gets infected by bacteria

·        Difficulty breathing

·        Disrupted breathing during sleep (obstructive sleep apnoea)

·        Infection that spreads deep into the surrounding tissue (tonsillar cellulitis)

·        Infection that results in a collection of pus behind a tonsil (peritonsillar abscess)

If tonsillitis is caused by group A streptococcus, the child has an increased risk of rare problems such as rheumatic fever, an inflammatory disorder that affects the heart, joints and other tissues; or an inflammatory disorder of the kidneys that results in inadequate removal of waste and excess fluids from blood.

 

Tonsillitis - Complications

Let us put some light on complications of long standing tonsils problem or acute throat infections:

1.      Peritonsillar abscess:
Some individuals have a tendency to develop an abscess (also known as quinsy medically) several days after onset of Tonsillitis Symptoms. The abscess clinically presents as a pus-filled sac that forms between the wall of the throat and the back of one of the tonsils.
 

2.      Spread of infection:

o   Bacteria present in the abscess may infect the surrounding area like the nearby vein which could infect the blood and give rise to septicemia. This condition, also called as Lemierre's syndrome, can be fatal if not treated quickly and appropriately.

o   Infection from the tonsils may also spread to the middle ear resulting in its infection.

3.      Crypt formation:
The bacteria can also colonize in the pits on the surface of the tonsils resulting in the formation of crypts. These crypts are yellow or white in color and form foul smelling stones called tonsilloliths.
 

4.      Breathing difficulty:
Tonsils get inflamed severely and almost touch each other (also called kissing tonsils). This may lead to snoring, disturbed sleep and mouth breathing. This condition is known as obstructive apnea.
 

5.      Streptococcus Infection:
Streptococcal infection of the tonsils can lead to complications such as rheumatic fever which may affect the heart valves and the joints or glomerulonephritis which is infection of the kidney.

Tonsils are an important component of the immune system and should not be removed unless required. Timely intervention with the best treatment option would save you from complications of tonsillitis.

 

Tonsillitis - Treatment

The first line of treatment in conventional medicine is prescribing antibiotics when the symptoms of pain and inflammation do not subside within four days. This is done to prevent secondary bacterial infection. Due to the emerging resistance of antibiotics, the usual practice is to identify the bacteria's sensitivity towards antibiotics before prescribing it. But this can be exhausting after sometime.

Surgical removal of the tonsils is a widely applied procedure in cases of recurrent or chronic tonsillitis. Due to a series of fatal outcomes after hemorrhage in children in Austria (in 2006), the standards and indications for tonsillectomy have slowly changed in Germany.
Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4273168/

Hence, a criterion for surgical removal of tonsils was created, known as ‘Paradise Criteria’, which are listed as below:

  • 7 episodes of acute throat infection in the previous year
  • 5 episodes of acute throat infections in each of the previous two years
  • 3 episodes of acute throat infections in each of the previous three years

Tonsillectomy may seem as the easiest solution to get rid of acute throat infections but it is associated with a significant risk of primary and secondary hemorrhage, and could be fatal in few cases. Moreover, it needs to be considered that even after getting the tonsils removed, the individual can still suffer from sore throat. Just like any other surgery, tonsillectomy may have the following risks:

  • Anesthesia given during a surgery has minor side-effects like a headache, feeling of nausea or vomiting and could have major risks like death also.
  • In a few cases, there could be problems like severe bleeding which could require longer hospital stay.
  • Risk of infections post surgery is not un-common. Tonsillitis can complicate, normally when caused by a bacterium, especially by the Tuberculosis bacterium.
  • Swelling of the tongue or soft palate and bleeding during healing is also very common.