Tonsillitis

26 Jun 2020 | Skedoc

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What Is Tonsillitis?

Tonsillitis is a common childhood condition that involves the inflammation of the tonsils that are present on each side at the back of the throat. The tonsils are an important part of the immune system in the young and help to prevent bacteria and viruses that are inhaled or ingested from causing serious infections by acting as gatekeepers that alert the immune system and bring it into action.

Alternate names

Pharyngitis

Is this condition a medical emergency?

Tonsillitis is not a medical emergency.

Types of this condition

Tonsillitis may be of the following types:

  • Acute tonsillitis
  • Recurrent tonsillitis
  • Chronic tonsillitis
  • Purulent Tonsillitis and Peritonsillar abscess

Causes of tonsillitis

The most common cause of Pharyngitis is viral infections, followed by bacterial infections. It is mostly an airborne infection and is seen in the school-aged children. It is also more common in the autumn and winter months. Acute tonsillitis may be caused by:

  • Adenovirus
  • Herpes simplex virus
  • Measles virus
  • Cytomegalovirus
  • Streptococcus pyogenes
  • Mycoplasma pneumonia
  • Corynebacterium diphtheriae
  • Chlamydia pneumoniae

Recurrent tonsillitis may be caused by:

  • Streptococcus pneumoniae
  • Staphylococcus aureus
  • Haemophilus influenzae

Chronic tonsillitis may be caused by:

  • Streptococcus bacteria
  • Staphylococcus aureus
  • Haemophilus influenzae
  • Bacteroides

Peritonsillar abscess may be caused by:

  • Prevotella
  • Porphyromonas
  • Fusobacterium
  • Peptostreptococcus

Risk factors for tonsillitis

The risk factors for Pharyngitis are:

  • Age: Pharyngitis is rarely seen in children less than 2 years old. Viral infections affect younger children while bacterial infections are more common in the age group of 5 - 15 years. Peritonsillar abscess (PTA) is also seen in the mid-teens and young adults.
  • Sex: Until around the age of 14 years, girls are more affected by PTA, but after that age boys are more affected by PTA.
  • Poor hygiene and frequent exposure to germs are also risk factors for the development of Pharyngitis.

Symptoms & signs of tonsillitis

The symptoms and signs of Pharyngitis may include:

  • Sore throat and difficulty swallowing
  • Red and swollen tonsils, with/without pus-filled spots
  • High body temperature and/or chills
  • Headache, and/or pain in the ears or neck
  • Weight loss
  • Tiredness and feeling unwell
  • Swollen lymph nodes in the neck
  • Nausea and/or vomiting
  • Bad breath
  • Furry tongue
  • Change of voice
  • Loss of appetite

In very young children

  • Drooling
  • Refusal to feed
  • Irritable

Investigations

The following investigations may be done through:

  • Laboratory tests: Such as CBP and ESR.
  • Throat swab: To test for the organism causing the infection and also to test its sensitivity towards antibiotics.
  • CT scan with contrast: May be required if a Peritonsillar abscess is suspected.

Diagnosis of tonsillitis

Diagnosis of Pharyngitis is established based on medical history, clinical evaluation, and results of investigations if any.

Tonsillitis treatment options

The treatment of Pharyngitis depends on the causative organism and the type of Pharyngitis. Supportive home care and medical management are usually enough, but surgical intervention may sometimes be required.

A. Medical management

Medical management of tonsillitis may include:

  • Antibiotics: Are prescribed only for bacterial tonsillitis. Either broad-spectrum antibiotics or penicillin if it is a streptococcus infection are prescribed.
  • Analgesics: For pain
  • Antipyretics: For fever
  • Immune Globulins: Reserved for use in very severe infections.

B. Interventional including surgery and indications for surgery

Surgical management of Pharyngitis in the form of a Tonsillectomy may be required in the following cases, namely:

  • Recurrent tonsillitis: More than 7 episodes in a year, more than 4-5 episodes each year in the preceding two years, and more than 3 episodes each in the preceding three years.
  • Obstructive sleep apnea
  • Breathing difficulties
  • Swallowing difficulties
  • Peritonsillar abscess not responding to antibiotics.

C. Role of diet/exercise/lifestyle changes/preventive measures

Viral and bacterial tonsillitis being treated with antibiotics may benefit from:

  • Getting enough rest
  • Drinking plenty of fluids especially warm beverages
  • Saltwater gargling
  • Medicated lozenges
  • Avoiding irritants such as smoke or dust that can irritate the throat.

Maintaining proper hygiene, avoiding close contact with sick people, and eating healthy can help to reduce the risk of transmission of Pharyngitis infection. Some measures that can help are:

  • Washing hands before eating and after using the toilet.
  • Avoiding sharing of food, water bottles, drinking glasses.
  • Cough and sneeze into a tissue.

Complications

Some of the complications of tonsillitis include:

  • Formation of peritonsillar abscess
  • Spread of infection deep into the neck tissues causing cellulitis.
  • Spread of infection to the mediastinum
  • Rheumatic fever: Streptococcus infection
  • Post streptococcal glomerulonephritis

Prognosis

The prognosis for Pharyngitis is generally good and complications such as scarlet fever are very rare and few.

When to contact the doctor or hospital/How to identify the emergency or complications?

It is advisable to seek medical attention if the symptoms of throat pain are persisting beyond 2 days and getting worse with difficulty in swallowing, breathing, and extreme irritability.

Indications for hospitalization if required

Hospitalization is not required for tonsillitis, although if a surgical intervention is needed or planned, a short hospital stay may be necessary.

Suggested clinical specialist/Departments to consult for this condition

Tonsillitis will be attended to by a family physician or specialist from the Department of ENT or Pediatrics.

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