Tonsillitis

Definition

Tonsillitis is a medical condition characterized by increased redness and painful swelling of both the tonsils due to inflammation. Most cases of tonsillitis are due to a bacterial or viral infection. The characteristic symptoms are a sore throat and hoarse voice. Frequent tonsillitis includes difficulty in breathing, disruption of breathing, collection of pus behind the tonsil and even rheumatic fever involving the joints, heart valves may occur in untreated or incompletely treated streptococcal infection.

In most of the cases tonsillitis recovers completely. Usually in about 40% cases the symptoms resolve within three days and about 7 days are required in 85% cases. Treatment options include intake of adequate fluid, rest, adequate nutrition, drugs to treat fever, antibiotics and surgery in some cases. Recurrent tonsillitis can lead to complications which warrant removal of the tonsils to prevent future attacks.

Symptoms

Tonsillitis is common disease usually affecting children of pre-school age but may continue till the mid-teens. Common presenting symptoms include :

  • Redness and swelling of the tonsils with white or yellow patches on them.
  • Sore throat characterized by painful swallowing, constant discomfort or prickly sensation felt at the back of the throat.
  • High fever, generalized body ache, loss of appetite and headaches.
  • Enlarged painful neck gland.
  • Muffled voice with hoarseness and ear pain.
  • Bad breath and stiffness of the neck.

Repeated attacks of tonsillitis due to repeated infection may lead to number of complications like :

  • Shortness of breath during attacks and interrupted sleep with frequent nighttime awakening due to obstruction of the airways by swollen tonsils.
  • Spread of infection from the tonsils to the adjacent tissue leads to tonsillar cellulitis.
  • Spread to infection even behind the tonsils may lead to tonsillar abcess

Tonsillitis caused by group A streptococcus if not treated adequately or completely may lead to :

  • Rheumatic fever where the immune system of the body starts producing antibodies against the joint and heart, as there is structural similarity between the bacterial protein and the heart or joint proteins. There is impairment of the heart valve function leading to number of health problems.
  • Post-streptococcal glomerulonephritis is a condition when antibodies are produced against the kidney leading to impairment of kidney function resulting into inadequate removal of waste and toxic products from the body.

Causes

Tonsils are a pair of glands located at the back of the throat on either side of the tongue. This is the first line of defense against infection. Any virus or bacteria entering the throat are first attacked by the white blood cells of the tonsils. If the microbes are not completely eradicated, inflammation of the tonsils may set in.

Commonly infecting viruses include adenovirus, rhinovirus, influenza, corona virusm Epstein –Barr virus, cytomegalovirus and even HIV infection. Bacterial infection may also lead to tonsillitis. Commonly responsible bacteria are staphylococcus, streptococcus (group A), mycoplasma, Chlamydia and pertussis.

Treatment

In many cases tonsillitis resolves without any specific treatment as virus is the most common causes. In the event of a bacterial infection antibiotics are required besides home care. Other drugs may help with pain relief and fever such as acetaminophen and ibuprofen. Adequate nutrition with plenty of fluid and rest is essential to recover from the infection quickly without any complications. Gargling with lukewarm salt water or using commercial antiseptic gargles or lozenges. Surgical removal of tonsils is required if there is repeated infections or where the patient does not respond well to medication.

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