Tonsillitis

What is tonsillitis?

Tonsillitis is an infection and swelling of the tonsils which are oval-shaped lymph nodes located in the back of the mouth and the upper part of the throat. Our body has two sets of tonsils. One pair can be seen at the back of the throat. These are called the palatine or faucial tonsils. The other pair is at the back of the tongue and is called lingual tonsils. Also part of the same group of lymph nodes are the adenoids, which are situated behind the nose, and above the throat. Their main function is to filter out bacteria and other microorganisms. Tonsillitis commonly means the inflammation or infection of the palatine tonsils. However, sometimes the infection can involve the lingual tonsils and other lymph nodes in the back of the throat, especially the adenoids. The infection may also be present in the throat and surrounding areas, causing pharyngitis (infection of the pharynx).

What are the causes?

Tonsillitis is most commonly caused by a bacterial infection, mainly due to the Streptococcus, Pneumococcus and Haemophilus bacteria. Viruses such as the Adenovirus and Epstein-Barr virus may also cause tonsillitis. The infection spreads by:

• Coming in close contact with someone who has tonsillar or pharyngeal infection with the above organisms
  
• Having a sore throat that develops into tonsillitis
  
• Sharing utensils or toothbrushes with people infected by or carrying streptococcal bacteria or the Epstein-Barr virus.

What are the symptoms?

Tonsillitis may be acute, sub-acute and chronic. Symptoms for acute tonsillitis include:

• Rapid onset of a severe sore throat that worsens over time
  
• Moderate to high fever
  
• Difficulty and pain in swallowing
  
• Red and enlarged tonsils that may or may not have pus
  
• Swollen or tender lymph nodes below the jaw
  
• Hoarseness or loss of voice may or may not be there.

Symptoms for sub-acute tonsillitis can last from 3 weeks to 3 months and include:

• Enlarged tonsils
  
• Foul smelling, pasty, infected material that collects within the pits on the tonsils
  
• Sore throat
  
• Bad breath
  
• Mildly swollen, tender lymph nodes
  
• Previous history of acute sore throat which has not been adequately trearted by antibiotics, and some pain has persisted

Symptoms for chronic tonsillitis include:

• Enlarged and mildly red tonsils that are scarred with large pits
  
• Slightly enlarged lymph node that are not usually tender
  
• Sore throat off and on

How is it diagnosed?

The diagnosis is based on the symptoms and a physical examination of the patient. The tonsils are usually reddened and may have white spots on them. The lymph nodes of the jaw and neck may be enlarged and tender to the touch. A careful examination of the throat is necessary to rule out diphtheria and other conditions that may cause a sore throat.

A culture of the tonsils may show bacterial infection. A culture for the streptococcus bacteria may also be taken. A blood test may also be done to rule out a more serious condition or infection, and to check the white blood cell count. In some case, the doctor may ask for blood tests for glandular fever or mononucleosis, since most patients with mononucleosis develop streptococcal infections of the tonsils.

What is the treatment?

The treatment depends on the cause of the infection. Mostly, tonsillitis is caused by viruses and so antibiotics are ineffective. However, often a viral tonsillitis may lower the resistance, and be secondarily infected by bacteria. In these cases if the tonsillitis is not settling, antibiotics may prevent the bacterial infection. Only if the cause is a bacterium such as streptococcus, antibiotics are given to cure the infection. If oral antibiotics are used, they must continue for the full course and must not be discontinued after the patient feels comfortable, or the infection will not be cured completely.

Medicines may also be given to treat pain and fever. Fluids especially bland, warm or very cold may soothe the throat. Gargle with warm salt water or povidone iodine antiseptic mouthwashes or sucking lozenges containing benzocaine also helps in reducing pain. Surgery to remove tonsils (tonsillectomy) may be necessary for some people who have repeated attacks of tonsillitis. However the number of children who need surgery is very small. Surgery is only indicated if there are more than 4-5 episodes of severe tonsillitis a year, or the child has persistent breathing and eating difficulty, or in adults if there has been more than one attack of peritonsillar and tonsillar infection needing intravenous antibiotics.

How can it be prevented?

The bacteria and viruses that cause tonsillitis are easily spread from person to person. Avoiding exposure to anyone who is already suffering from tonsillitis or sore throat can lower the risk of transmission. Drinking glasses and eating utensils should not be shared. Old toothbrushes should be replaced to prevent reinfection. People taking care of someone suffering from tonsillitis should wash their hands frequently to prevent spreading the infection to others.