Definition and Overview

Tonsillitis is a common pharyngeal disease that causes the tonsils to become inflamed. Tonsils, along with adenoids, are the body’s first line of defense as part of the immune system. Located at the rear of the throat, they are composed of tissue similar to lymph nodes and function by preventing disease-causing pathogens from entering the body.

Tonsillitis is most commonly caused by a viral infection and can spread between people through airborne droplets released during sneezing or coughing. It can also be transmitted indirectly through contact with infected surfaces such as utensils, tissue or cups. It is often diagnosed in school-aged children with a higher incidence rate during fall and winter seasons. If caused by the bacterium group A streptococcus, the condition is referred to as strep throat. It is important for clinicians to determine the cause of tonsillitis so appropriate treatment can be prescribed.

Tonsillitis is very rarely a serious condition and most of the time, it can be resolved without medications. However, patients who suffer from chronic tonsillitis may be advised to undergo a procedure called tonsillectomy to permanently relieve their symptoms.

Causes of Condition

Because tonsils regularly come in contact with pathogens, they are susceptible to infection. When they get infected, they swell and become inflamed. The condition’s common causes are viral infections such as:

  • Adenovirus - Infects the membrane of the respiratory tract as well as the urinary tract, eyes, intestines, and nervous system.

  • Coronavirus - A common type of virus that infects the upper throat, sinuses, and nose.

  • Influenza - Causes fever, headaches, body pain, dry cough, and sore or dry throat.

  • Respiratory syncytial virus - Causes infections of the respiratory tract and lungs. It is very common in children but can also affect adults.

  • Rhinovirus - The most common virus that causes common colds.

  • Epstein-Barr virus - Belongs to the family of herpes viruses that cause genital herpes, chickenpox, and shingles. It is very common affecting more than 50% of children under five years old.

Key Symptoms

Common signs and symptoms of tonsillitis include:

  • Difficult or painful swallowing

  • Difficulty sleeping

  • Fatigue

  • Fever

  • Headaches

  • Loss of appetite

  • Malaise

  • Muffled voice

  • Pain in the neck and/or ears

  • Red, swollen tonsils

  • Sore throat

  • Stomachache

  • Swollen lymph nodes in the neck

  • Vomiting

  • Weight loss

  • White pus-filled spots on tonsils

  • Bad breath

Depending on the severity of the condition, swollen tonsils can also disrupt breathing during sleep. If the infection spreads to surrounding structures, patients are at risk of tonsillar cellulitis and peritonsillar abscess or the collection of pus behind the tonsils.

Who to See and Types of Available Treatments

Diagnosing tonsillitis starts with a thorough physical exam wherein a general practitioner or paediatrician performs the following:

  • Checks the patient’s throat, ears, and nose for signs of infection

  • Checks the patient’s skin for a rash that is associated with strep throat

  • Checks the patient’s neck for swollen lymph nodes

  • Checks the spleen for enlargement

The physical exam is commonly followed by a simple test in which a sample of secretion from the patient’s throat is obtained using a sterile swab. The sample is then checked in a laboratory for streptococcal bacteria. If the result is negative, it means that the condition is caused by a viral infection. Otherwise, it is caused by bacteria.

If the condition is caused by a virus, doctors will recommend at-home care strategies that can help relieve patient’s symptoms and resolve the condition without the use of medications or antibiotics. Patients are advised to get plenty of rest, increase fluid intake, gargle with warm salt water, and use a humidifier to eliminate dry air. If the patient has fever or throat pain, ibuprofen or acetaminophen is prescribed. If the condition is caused by a bacterial infection, it is treated with antibiotics, which have to be taken for ten days. Steroids may also be prescribed to treat inflammation.

Tonsillectomy, or the surgical procedure that removes the tonsils, is sometimes recommended if the patient is suffering from chronic tonsillitis (at least seven episodes in one year) or bacterial tonsillitis that does not respond to antibiotic treatment. The procedure is also performed if the condition causes serious complications including breathing and swallowing difficulty and obstructive sleep apnoea.

Tonsillectomy is an outpatient procedure, which means that patients are able to go home the same day. However, an overnight stay at the hospital may be required if there are complications or if the patient has a complex medical condition. The surgery is performed under general anaesthesia. The tonsils are removed using a scalpel or a specialised surgical tool that uses sound waves or heat energy.

Although relatively safe, the procedure has certain risks, including:

  • Allergic reactions to the anaesthetic used

  • Swelling of the tongue and soft palate, which may lead to breathing problems

  • Bleeding

In general, the prognosis for tonsillitis is excellent. More than 90% of patients recover within a week without long-term problems and any complications. The majority of viral tonsillitis cases resolve within a week with watchful waiting while strep throat is mostly cured with a single course of antibiotics. Meanwhile, the prognosis for patients who develop serious complications, such as obstructive sleep apnoea, is dependent on the extent and severity of the complication.

References:

  • Fact sheet: Tonsils and adenoids. American Academy of Otolaryngology — Head and Neck Surgery. http://www.entnet.org/?q=node/1432.

  • Stopping the spread of germs at home, work and school. Centers for Disease Control and Prevention. http://www.cdc.gov/flu/protect/stopgerms.htm.

  • Tonsillopharyngitis. Merck Manual Professional Version. http://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/oral-and-pharyngeal-disorders/tonsillopharyngitis.

  • American Academy of Otolaryngology - Head and Neck Surgery. "Tonsillitis." http://www.entnet.org/content/tonsillitis

  • American Academy of Otolaryngology - Head and Neck Surgery. "Tonsils and Adenoids." http://www.entnet.org/content/tonsils-and-adenoids

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