Tonsillitis

What is Tonsillitis?

Tonsillitis is a common condition involving the inflammation of the tonsils on each side at the back of the throat. The tonsils are an important part of the immune system 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.

Is Tonsillitis condition a medical emergency?

Tonsillitis is not a medical emergency.

Types

Tonsillitis may be of the following types

• Acute Tonsillitis
• Recurrent Tonsillitis
• Chronic Tonsillitis
• Peritonsillar abscess

Causes

The most common cause of tonsillitis is viral infections, followed by bacterial infections. It is mostly an airborne infection seen commonly in school-aged children but can also affect adults. It is also more common in the autumn and winter months. 

Symptoms & signs

The symptoms and signs may include

• Sore throat and difficult and very painful 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
• Tiredness and feeling unwell
• Swollen lymph nodes in the neck
• Nausea and/or vomiting
• Bad breath
• 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

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

Treatment options

The treatment of tonsillitis is usually supportive home care and medical management with specific antibiotics and antiseptic gargles. Surgical intervention may sometimes be required, which an ENT doctor needs to assess.

Medical management

Medical management of tonsillitis may include:

• Antibiotics: These 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

Interventional including surgery and indications for surgery

Surgical management of tonsillitis in the form of a tonsillectomy may be required in the following cases:

• Recurrent Tonsillitis: More than 3 episodes in a year requiring a course of antibiotics
• Obstructive sleep apnea
• Breathing difficulties
• Swallowing difficulties
• Peritonsillar abscess not responding to antibiotics.

Role of Diet/ Exercise/ Lifestyle changes/ Preventive measures

Viral and bacterial Tonsillitis being treated with antibiotics may benefit from the following

• 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 and drinking glasses
• Cough and sneeze into a tissue

Complications

Some of the complications of tonsillitis include

• Formation of peritonsillar abscess
• Spread of an infection deep into the neck tissues causing cellulitis
• Spread of infection to the mediastinum

Prognosis

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

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 persist beyond 2 days and get worse with difficulty in swallowing, breathing, and extreme pain.

Indications for hospitalization if required

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

Suggested clinical specialists/ Departments to consult for this condition

Tonsillitis will be attended to by only a specialist from the Department of ENT or Pediatric ENT.