As with all ‘-itis’, tonsillitis also refers to an inflammation, in this case an inflammation of the tonsils. The tonsils are two small glands at the back of the throat that play a part in our immune system during childhood and early teenage, although their function in not quite clear yet.
Tonsillitis is essentially an infection/inflammation of the tonsils which may lead to sore throat, difficulty swallowing, fever and cough. It spreads through airborne particles, and by hand-to-hand contact with an infected person. Most causes of tonsillitis are caused by viruses, but some may be caused by bacterial infections as well. The commonest bacteria causing tonsillitis is Streptococcus pyogenes – the same bacteria that causes strep throat.
SIGNS AND SYMPTOMS
The commonest age to get tonsillitis is in young children and young adults, between the ages of 3 years to 16 years. The immune function of tonsils declines rapidly after puberty, which may explain why adults do not usually get tonsillitis. Common symptoms include:
Swollen, red tonsils
difficult or painful swallowing
enlarged glands in the neck which are painful to touch
stiffness in the neck
headache and lethargy
Younger children may also have the following in addition to the above:
refusal to eat
DIAGNOSIS AND MANAGEMENT
Tonsillitis can be diagnosed by a good history and physical exam. A lighted instrument should be used to examine the back of the throat to look for signs of inflammation on the tonsils. Lymph nodes are also enlarged in patients with acute tonsils infection, and often times are painful to touch.
Throat swab may be done in patients suspected to have tonsillitis. A small, sterile swab is gently swooped over the tonsils and sent to the lab to check for the causative organism. Blood tests for acute signs of infection, such as CBC and CRP, may also be performed.
If a viral cause is suspected for the infection, antibiotics should not be prescribed or used. They have NO EFFECT on the duration or treatment of viral infections. Viral infections self-resolve within 7-1o days.
Make sure the patient gets adequate rest, fluids – especially warm liquids ( easier to swallow and may sooth the throat). Gargles with salt water are also recommended. For fever and/or pain, OTC medicines such as paracetamol or ibuprofen can be used.
If the infection is bacterial, antibiotics should be prescribed. Penicillin by mouth is the most common antibiotic recommended for tonsillitis.
Occasionally, recurrent episodes of tonsillitis that severely disrupt normal life of the child (school, social engagements, development) may warrant surgical removal of the tonsils. The procedure is called tonsillectomy. Read more about the criteria and process of tonsillectomy here.
COMPLICATIONS OF TONSILLITIS
Complications resulting from tonsillitis are uncommon, but some of the problems that can occur are outlined below.
Middle ear infection (also known as otitis media) is a build-up of mucus in the middle ear, between your ear drum and inner ear. In most cases, the infection clears by itself.
Quinsy is a rare condition that sometimes develops when infection spreads from a swollen tonsil to the surrounding area, causing an abscess (pus-filled swelling) in the throat. Abscesses can be easily treated using antibiotics, although a small operation to drain the pus may sometimes be needed.
Swelling of the face and neck, although rare, can potentially block the airways and prevent a person from breathing. Chronic tonsillitis can cause obstructive sleep apnoea, which prevents some of the oxygen from getting to your brain and may lead to disturbed sleeping patterns.
Septecemia (spreading of the infection to the blood) can occur if bacteria get into your bloodstream and multiply.
Glomerulonephritis (very rare) is inflammation (swelling) of the filters in your kidneys, caused by streptococcal bacteria.
Rheumatic fever is a rare condition that causes widespread inflammation (swelling) throughout the body.
Lemierre’s syndrome is a rare condition in which bacteria spread from your throat to major veins in your neck. Small ‘clumps’ of bacteria then travel through your bloodstream to your lungs, joints and bones. Lemierre’s syndrome can be easily treated with antibiotics but can be fatal if it is not diagnosed quickly.