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Are you suffering from a sore throat with pain and difficulty in swallowing yet again? It could be more than just a seasonal throat infection this time. Although majorly seen in children, recurring throat infections can occur in adults and may lead to tonsillitis, inflammation of the tonsils.

Tonsils are glandular, soft, red lumps that can be seen at the back of the throat. They are a part of the human immune system. Tonsils are made up of tissues that help the body defend itself against various disease-causing germs that gain entry into the body through the throat and the upper respiratory system. Sometimes, while protecting the body by attacking the entering bacteria and viruses, the tonsils can themselves get infected and inflamed.

Causes

Tonsillitis refers to the inflammation of tonsils usually caused by a viral infection or bacterial infection.

Viral Tonsillitis: Tonsillitis is caused by different viruses such as the common cold or flu viruses (influenza)

Bacterial Tonsillitis: The group A Streptococcus bacterium is responsible for causing bacterial tonsillitis.

Tonsillitis is not contagious, but the microorganisms causing it is highly infectious. Tonsillitis can therefore be passed from one person to another in the following ways:[1]

• Kissing a person with tonsillitis


• Sharing food, drinks and utensils with a contaminated person


• Touching one’s nose or mouth after touching contaminated surfaces


• Inhaling the tiny airborne particles when an infected person coughs or sneezes

Risk Factors

It is a common assumption that only children suffer from tonsillitis. But that’s not true. Tonsilitis is more common in children because their immune mechanism is not fully developed as in adults. This makes them more vulnerable to infections. Medical treatment of tonsillitis once during childhood does not mean that it cannot occur again.

Poor hygiene and a weak immune system alone can be good opportunities for bacteria and viruses to colonize the tonsils.

The risk factors for developing tonsillitis are as follows:[2]

• Compromised immune system


• Cardiac diseases


• Long term use of steroids


• Cold climates


• Suffering from diabetes


• Being overweight


• Close contact with children

Symptoms

Some of the most common symptoms associated with tonsillitis are:

• Recurrent attacks of Sore throat


• Painful swallowing (odynophagia)


• Fever and chills


• Yellowish spots (cheesy material) over the surface of the tonsils


• Swollen glands under the jaw


• Trouble in swallowing


• Fatigue


• Headache


• Bad breath


• Pain in the ears[3]


• Difficulty in swallowing[3]


• In the case of very large tonsils, one might experience difficulty in breathing[3]


• Stomach-ache and vomiting are common among young children[1]

Diagnosis

Once you visit a doctor, a physical examination will be performed to analyse the severity of symptoms. Occasionally, for detailed diagnosis, the doctor will take a throat swab for laboratory analysis of the infection.

Treatment

Generally, people go for home remedies such as drinking warm water, gargling salt water, or taking over-the-counter pain killers, such as acetaminophen, to get rid of throat infections. This approach might help to manage a few symptoms only for a short period. However, if symptoms persist, it is advisable to see a doctor.

For bacterial tonsillitis, the doctor usually prescribes a course of antibiotics. Penicillin is the most common antibiotic used to treat bacterial tonsillitis caused by Streptococcus bacteria. Even when symptoms disappear completely before the completion of prescribed antibiotics, the course should be continued to ensure that the infection is eliminated. In the case of viral tonsillitis, antibiotic treatment turns out to be ineffective. Therefore, symptomatic treatment is considered.

 

Surgery for the removal of tonsils (tonsillectomy) is not always required if the number of tonsillitis attacks is 2-3 per year.

Mostly, doctors recommend tonsillectomy when swelling and inflammation of tonsils obstruct breathing at night and cause painful swallowing due to unusual enlargement of tonsils, or complications like a peritonsillar abscess (Quinsy) develop. Tonsillectomy is also recommended if there are recurrent episodes of tonsillitis. Therefore, the type of tonsillitis, severity of symptoms and the response to antibiotics are the main deciding factors for considering tonsillectomy.

Tonsillectomy: The procedure

Tonsillectomy is still the commonest and safe surgical procedure performed worldwide. Before performing a tonsillectomy, the doctor prescribes antibiotics to control or prevent infection.

The surgery is carried out under general anaesthesia.

The conventional technique involves dissection of the tonsil from its bed by blunt instruments and clamping and crushing the lower pole with a snare.

Pain and post-operative bleeding are less in newer techniques like:

• Microdebrideromy


• Coblator assisted tonsillectomy


• Laser[5]

Prognosis And Complications

Things you should know after tonsillectomy:

• Do not smoke or perform rigorous exercise


• Do not take any medication without consulting the doctor


• Avoid going to crowded areas to reduce the risk of infections


• If pain flares up after discharge, immediately visit the doctor


• Complications of excessive bleeding may occur within a week of surgery

Remember that removal of tonsils does not affect the ability of the immune system to fight against disease-causing germs. It has been well-known that with increasing age, the tonsils shrink in size and become less important as the body’s defence organ. This is because the body gradually acquires other means of fighting infection. Therefore, the removal of tonsils will not hamper the body’s immune mechanism.

In most cases, tonsillitis remains a self-limiting infection. Surgery may be required in instances of recurrent tonsillitis.[4]

Complications

In the majority of cases, tonsillitis can be cured by treating it symptomatically. However, in some cases, it can lead to a few complications such as:

Chronic tonsillitis: If a person gets tonsillitis more than seven times a year, it is called chronic tonsillitis. In such cases, surgery is recommended to remove the tonsils.[1]

Scarlet fever: The presence of red rash all over the body and fever indicates tonsillitis's progression into scarlet fever. The prevalence of this is higher among children than adults.[1]

Peritonsillar abscess: The accumulation of pus around the tonsils is called a peritonsillar abscess. In such cases, the pus is surgically drained by a doctor. Children are less commonly affected by this as compared to adults and adolescents.[1]

Rheumatic Fever: If strep throat is left untreated, it can lead to rheumatic fever, which in turn can cause permanent heart damage. Children remain at a greater risk of developing rheumatic fever than adults.[1]

Glomerulonephritis: Patients with bacterial tonsillitis can sometimes develop glomerulonephritis, which is a kidney disorder. This condition may resolve spontaneously among young children but may be severe in the older population.[4]

Prevention

Due to a developing immune mechanism, children are more susceptible to tonsillitis, and in such phases, prevention is always better than cure. For children, following healthy hygienic practices is the best way to keep tonsillitis at bay.

Washing hands or disinfecting them with a hand sanitizer, carrying disposable wipes and avoiding contact with sick individuals are few ways to prevent infection. Children should be taught to cover their mouths while sneezing or coughing and to use tissues to wipe their noses. Since tonsillitis is all about immunity, it’s better to keep the immune system robust to prevent recurring episodes of tonsillitis.

Consumption of a healthy diet that includes immune-boosting foods can do a lot. Include sources of vitamin C, such as citrus fruits, and zinc, sources such as nuts, seeds, cereals, in the diet. Adequate water intake is also essential to prevent tonsillitis.

With winter slowly sneaking in, incidences of tonsillitis may reach their peak. Follow the above prevention suggestions and keep yourselves and your children far away from infections

References

1. Cleveland Clinic. Tonsillitis [Internet] [Updated on November 6, 2019] Available at: https://my.clevelandclinic.org/health/diseases/21146-tonsillitis.


2. Wikidoc. Tonsillitis risk factors. [Internet] Available at: https://www.wikidoc.org/index.php/Tonsillitis_risk_factors.


3. Medline Plus. Tonsillitis [Internet] [Updated on November 10, 2018] Available at: https://medlineplus.gov/ency/article/001043.htm#:~:text=The%20tonsils%20are%20lymph%20nodes,throat%20is%20a%20common%20cause.


4. Anderson J, Paterek E. Tonsillitis. 2020 August 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 31335062.


5. Verma R, Verma RR, Verma RR. Tonsillectomy-Comparative Study of Various Techniques and Changing Trend. Indian J Otolaryngol Head Neck Surg. 2017 Dec;69(4):549-558