Tonsillitis is an infection of the tonsils and will often (but not necessarily) cause a sore throat and fever. There are 3 main types of tonsillitis: acute, subacute and chronic. Acute tonsillitis can either be bacterial or viral (75%) in origin. Subacute tonsillitis (which can last between 3 weeks and 3 months) is caused by the bacterium Actinomyces. Chronic tonsillitis, which can last for long periods if not treated, is almost always bacterial. An abscess may develop lateral to the tonsil during an infection, typically several days after the onset of tonsillitis. This is termed a peritonsillar abscess (or quinsy). Rarely, the infection may spread beyond the tonsil resulting in inflammation and infection of the internal jugular vein giving rise to a spreading septicaemia infection (Lemierre’s syndrome). In chronic/recurrent cases or in acute cases where the palatine tonsils become so swollen that swallowing is impaired, a tonsillectomy can be performed to remove the tonsils. Patients whose tonsils have been removed are certainly still protected from infection by the rest of their immune system. Bacteria feeding on mucus that accumulates in pits (referred to as “crypts”) in the tonsils may produce whitish-yellow deposits known as tonsilloliths. These may emit an odor due to the presence of volatile sulfur compounds.
Causes of Tonsillitis
Bacterial tonsillitis may be caused by Group A streptococcal bacteria, resulting in strep throat. Viral tonsillitis may be caused by numerous viruses such as the Epstein-Barr virus (the cause of infectious mononucleosis) or the Adenovirus. Sometimes, tonsillitis is caused by a superinfection of spirochaeta and treponema, in this case called Vincent’s angina or Plaut-Vincent angina. Although tonsillitis is associated with infection, it’s currently unknown if the swelling and other symptoms are caused by the infectious agents themselves or by the host immune response to these agents. Tonsillitis may be a result of aberrant immune responses to the normal bacterial flora of the nasophary.
Symptoms of Tonsillitis
Symptoms of tonsillitis include a severe sore throat that may be experienced as referred pain to the ears, painful/difficult swallowing, headache, fever, chills and change in intonation that causes a “hot potato” voice. Tonsillitis is characterized by signs of red, swollen tonsils that may have a purulent exudative coating of white patches (i.e., pus). There may be enlarged and tender neck cervical lymph nodes as well.
Treatment of Tonsillitis
- Viral Infection: Most cases of tonsillitis are caused by a viral infection, so antibiotics won’t help. The only thing you can do is take over-the-counter medicine and let the virus run its course—and take steps to relieve pain and inflammation. Recovery may take a week or two.
- Medications: Treatments of non-viral tonsillitis consist of pain management medications. If the tonsillitis is caused by bacteria, then antibiotics are prescribed, with penicillin being most commonly used. Erythromycin is used for patients allergic to penicillin.Take acetaminophen (Tylenol and others) or ibuprofen (Advil, Motrin and others) to help reduce fever and decrease pain. Because of the risk of Reye’s syndrome—a potentially life-threatening illness—don’t give aspirin to children younger than age twelve. Ibuprofen or other analgesics can help decrease the edema and inflammation, which will ease the pain and allow the patient to swallow liquids sooner.
- Topical Anesthetics: In many cases of tonsillitis, the pain caused by the inflamed tonsils warrants the prescription of topical anesthetics for temporary relief. Viscous lidocaine solutions are often prescribed for this purpose.
- Salt Water: Gargle with warm salt water to help deal with this condition. Mix ¼ teaspoon of salt in eight ounces of warm water, gargle and then spit out the water; don’t swallow. Do this several times a day until your pain is eased.
- Warm Liquids: You can also drink warm, soothing liquids like soup, broth and tea. On that note, drink more warm fluids as well.
- Honey and Lemon: Use a honey and lemon solution. Stir honey and lemon to taste into a glass of hot water. Allow it to cool to room temperature before you sip it. The honey coats and soothes your throat and the lemon helps reduce mucus. Don’t use honey or corn syrup in a drink for children younger than age one.
- Lozenges and Hard Candy: Suck on a throat lozenge or hard candy. This stimulates saliva production, which in turn bathes and cleanses your throat.
- Humidify the Air: Adding moisture to the air can reduce throat irritation and make it easier to sleep. Be sure to change the water in a room humidifier daily and clean the unit at least once every three days to help prevent the growth of harmful molds and bacteria.
- Pollutant Aversion: Avoid smoke and other air pollutants. Smoke irritates a sore throat.
- Rest your voice: Talking may lead to more throat irritation and temporary loss of your voice (laryngitis).
- Tonsillectomy: Chronic cases may indicate tonsillectomy (surgical removal of tonsils) as a choice for treatment. Surgical removal of the tonsils (tonsillectomy) is rarely needed for adults. During childhood, surgery may be recommended when a child has had seven or more serious throat infections in one year, five or more serious throat infections every year over a two-year period and three or more serious throat infections every year over a three-year period. Tonsillectomy may also be recommended to treat an abscess that doesn’t improve with antibiotic treatment or if swollen tonsils are blocking breathing. Tonsillectomy is usually done on an outpatient basis. That means you or your child will be able to go home the day of the surgery. As always, complete recovery may take up to two weeks.
- Hygiene: The germs that cause viral and bacterial tonsillitis are contagious. Frequent hand washing is the best way to prevent all kinds of infections, including tonsillitis. Wash your hands often, and encourage your children to do the same.
- Common Sense: Other common-sense precautions apply too. Cough or sneeze into a tissue and dispose of your refuse properly. Don’t share drinking glasses or eating utensils. Finally, avoid close contact with anyone who’s sick.
In summary, most cases of tonsillitis are caused by a virus and are treated at home with over-the-counter sore throat remedies. Less often, tonsillitis is caused by a bacterial infection and antibiotics are needed. At one time, removing the tonsils (tonsillectomy) was a common treatment for recurrent tonsillitis. Today, surgery is only recommended if tonsillitis doesn’t get better with other treatments.
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