Tonsillitis and Tonsillectomy

What are Tonsils?

Since the mouth and the nose are the common routes of entry into the body there is lymphoid tissue scattered around these openings which helps trap any infective agents or allergens and prevent them from spreading into the rest of the body. The lymphoid tissue is arranged in the form of a ring called the Waldeyer's ring and this constitutes the Adenoids (nasopharyngeal tonsil behind the nose); Tubal tonsils (Gerlach's Tonsils), Palatine tonsils (oral Tonsils); Lingual tonsils (situated in the back of the tongue) and Pharyngeal Lymphoid tissue. Also it is important to note that there is lymphoid tissue scattered along the mucous membranes all the way along the digestive tract and in the small intestine this is called the Peyers patches. All these lymphoid tissues are commonly grouped and called as MALT or mucosa associated lymphoid tissue. This is also the reason why sometimes children who are having tonsillitis may also have severe abdominal pain as there is inflammation of all the MALT groups of lymphoid tissue and especially the Peyer's patches in the abdomen.

What causes Tonsillitis?

Generally when we say tonsillitis, we are referring to the inflammation of the Palatine Tonsils, which are the largest of the lymphoid tissue in the Waldeyer's ring and situated in the back of the oral cavity on either side of the tongue

Most of the time the inflammation of the tonsils is Viral in nature and and later on there is infection with bacteria after 24 to 48 hours.

It is important to note that infection with the Streptococcal group of bacteria is associated with what is commonly called a Strep throat which if untreated, leads to Scarlett fever in children or even the now uncommon Rheumatic fever and Rheumatic hear disease.

Another condition called Glandular fever or Kissing disease (Infectious Mononucleosis) is clinically very similar to tonsillitis but it is caused by a virus called the Epstein Barr virus (EBV)

It is believed that in children especially between the ages of 3 and 5 years, there are recurrent infections of the tonsils which help in building their immune system. Similarly there are recurrent infections of the adenoidal lymphoid tissues or adenoids in the age group between one year and three years.

What are the symptoms of Tonsillitis?

Usually the symptoms of tonsillitis last about four to five days and can include

Sore throat which is the most common symptom of tonsillitis.

The other symptoms of tonsillitis are as follows

Pain and difficulty to swallow

Fever (can be high temperatures)

Nausea and loss of appetite

Ear pain (as the ear and the tonsils share the same nerve supply)

In some children abdominal pain (stomach ache)

Red and inflamed tonsils sometimes with white spots on them (pus)

Occasionally cough and sneezing

Swollen glands (lymph nodes) in the neck

Tiredness

abscess around the Tonsil (quinsy/ peritonsillar abscess) can be seen in young adults and will need drainage

How to manage tonsillitis?

At Home

Drinking plenty of water and eating small frequent meals is the best way to manage tonsillitis. It is vital to understand that the more often we swallow the chance of bacterial accumulation is significantly reduced and therefore bacterial infection can be prevented. This is the underlying logic to having small frequent meals.

Since pain is the most significant symptom of tonsillitis, taking regular doses of pain killers either Paracetamol or Ibuprofen or a combination of them will give significant relief and help resolution of this problem quickly. Here it is important to note that taking the painkillers at frequent intervals of 4 to 6 hours for the first two or three days will be far more beneficial than taking large doses only when the pain gets severe.

Warm water gargles are very important in obtaining early resolution of the infection as the warm fluid tends to ease the pain while frequent gargling ensures reduced bacterial load in the mouth. I generally do not recommend saltwater gargles especially in adults as most adults may have early or underlying hypertension and the added salt may not be beneficial in them.

Some people may find lozenges, mouthwashes or mouth sprays which are available from the local pharmacy beneficial.

At the Hospital

Although most cases of tonsillitis are mild, however in some cases, specially those with severe symptoms or with a bacterial Infection such as a strep throat, early intervention and treatment in the hospital is recommended.

Anybody who's not able to eat and drink is better treated in the hospital to prevent dehydration and other complications.

Especially in children who are having airway compromise in the form of difficulty to breathe and drooling of saliva, early intervention is needed as an emergency as the underlying causeway may be due to Serious infection called Epiglottitis.

In those patients who have a compromised immune system, again early intervention and hospital care is recommended

Since Blood tests are the only way to differentiate between Glandular fever and Tonsillitis, consulting a doctor early to establish the correct diagnosis is also very important.

When is a Tonsillectomy to be considered?

As most cases of tonsillitis are usually mild and infrequent especially after the age of five, Tonsillectomy is not necessarily the first line of treatment. However if tonsillitis occurs very frequently and each episode needs antibiotics or admission to hospital, then surgical intervention in the form of tonsillectomy should be considered. Especially if one is having more than six episodes in a year then it makes sense to offer tonsillectomy.

Tonsillectomy is to be considered very carefully in children below the age of 5. This is because it is generally believed that the adenoids and tonsils are integral to priming and developing the immune system in children, however after the age of 5 the only consideration for tonsillectomy should be the frequency and severity of the infection.

Also it is important to note here that once the tonsils have been removed following a tonsillectomy, the patient may still get sore throats but only not as frequently or as severely as before. It is also important to understand that the other lymphoid tissue which constitutes rest of the Waldeyer's ring will still be active and now will take over the function of the adenoids and tonsils and this accounts for sore throats in patients even after they have the tonsils removed.

For more information about the benefits. the risks and the complications of Tonsillectomy, please see the article on Tonsillectomy.