Tonsilitis

Symptoms Of Tonsillitis

The symptoms of tonsillitis generally occur suddenly and they may include

• Fever (≦ 38℃)
• Lymph node swellings
• Swelling and redness of the tonsils
• White or yellow coating on the tonsils
• Sore throat
• Mouth ulcers
• Difficulty in swallowing
• Rashes on the roof of the mouth 
• Strawberry tongue
• Bad breath
• Decreased appetite
• Fatigue

Note: Typically there is an absence of symptoms of a viral upper respiratory infection like conjunctivitis, runny nose, or cough. 

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Causes Of Tonsillitis

Tonsillitis can be caused by both bacteria and viruses. Common bacteria that cause tonsillitis include beta-hemolytic and other streptococci. Though the role of viruses is uncertain, the most common infective agent in causing tonsillitis is the Epstein–Barr virus. It is present in 50% of children and 90% of adults. Cytomegalovirus is the other virus that can cause tonsillitis.

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Types Of Tonsillitis

Tonsillitis can be classified based on its duration of onset as follows:

1. Acute tonsillitis

This type of tonsillitis is primarily caused by bacterial or viral infections. It presents with swelling and redness on the tonsils, along with fever, cough, and headache. These symptoms usually last 3 or 4 days but can also last up to 2 weeks.

2. Subacute tonsillitis

It is mostly caused by bacterial actinomyces. This type of tonsillitis can last between 3 weeks and 3 months.

3. Chronic tonsillitis

This is when you have a long-term tonsil infection. An infection that persists for more than a duration over 3 months is known as chronic tonsillitis. The virus usually stays and leads to chronic inflammation.

4. Recurrent tonsillitis

It is caused by bacterial infections, by streptococcus. Tonsillitis is termed recurrent when there are more than 7 episodes in 1 year.

Any infection that recurs more commonly than usual might be because of decreased immunity.

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Risk Factors For Tonsillitis

Tonsillitis affects the younger age group and is mainly caused due to an infection with bacteria or viruses. Risk factors that can increase your chances of getting tonsillitis include-

1. Frequent exposure to viruses or bacteria

School-age children are usually in close contact with their friends and peers which increases their exposure to viruses or bacteria that can cause tonsillitis.

2. Young age

Studies show that the incidence peak of acute tonsillitis is observed in young children, especially the school-going age, but it may generally occur at any age.

3. Being immunocompromised

A decrease in immunity can be a major risk factor for inflammation of the tonsils causing tonsillitis.

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4. Environmental pollution

Air pollution can cause a huge rise in swollen adenoids and tonsillitis in children. Also, 

sore throat is a common side effect of exposure to polluted air. 

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5. Colder climates

Cold weather does have an impact on your tonsils as tonsillitis is easy to recur during the change of seasons, especially in winter.

6. Genetics

Studies suggest that genetic inheritance determines the severity of tonsillar damage in pediatric patients with a history of recurrent chronic tonsillitis in both parents.

7. Diabetes

Studies suggest that the chances of infections are more in individuals with diabetes. Infections and problems with the ears, nose, and throat like tonsillitis can be symptoms of diabetes.

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8. Prolonged use of corticosteroids

Corticosteroids can raise your risk of infections because they have a wide range of effects on the immune system. This can lead to tonsillitis.

9. Obesity

Research suggests that there is a possible link between being overweight or obese and ear infections that can also affect the throat like tonsillitis.
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Diagnosis Of Tonsillitis

Accurately diagnosing tonsillitis is important to reduce the further spread of infection and to limit complications. Diagnosis includes

1. History

A complete history provides important information to determine whether the patient has a sore throat, or whether there is deeper pain in the throat or neck. 

2. Physical examination

 Diagnosis of tonsillitis is mainly clinical and it is done by:

• Carefully looking in the throat at the infection site with light instruments
• Checking for any rash in the throat
• Observing ‘toxic’ appearance and signs of dehydration
• Palpating neck to check swollen lymph nodes
• Listening to the voice of patient
• Seeing if there is any enlargement of the spleen (can be a symptom of tonsillitis).

3. Laboratory tests

• Throat swab: This is a simple test in which doctors rub a sterile swab over the back of your throat to get samples of secretions. The samples are later checked in the lab or the clinic.
  
• Rapid antigen test: It may have low sensitivity in the diagnosis of bacterial tonsillitis but, the results for the presence of infection (positive or negative) are very fast.
  
• Complete blood count (CBC): If the strep throat lab test is negative, then CBC is done to determine the cause of tonsillitis. In this test, the number of different cells is counted by taking small amounts of blood samples from patients.

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Prevention Of Tonsillitis

It can be a little difficult to prevent tonsillitis completely, but there are things you can do to reduce your risk. They include:

• Always wash your hands often, especially before touching your nose or mouth
• Avoid sharing food, drink, or utensils with someone who’s sick
• Replace your toothbrush regularly, especially after infection
• Practice good oral care
• Keep a safe distance from tonsillitis patients 
• Cover your mouth with a tissue or the hand when you cough or sneeze
• Wash hands after coughing or sneezing
• Keep your child at home if they are sick.

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Doctor To Visit

The symptoms of tonsillitis can range from mild to severe. Doctors that can help you diagnose and treat tonsillitis include:

• General physician
• ENT specialist
• Pediatrician

An ENT specialist, also called an otolaryngologist, is a doctor who has special training in diagnosing and treating diseases of the ear, nose, and throat. A pediatrician is a doctor who deals with the diseases of children. 

When to see a doctor?

You should contact your doctor immediately if you have the following symptoms:

• Sore throat for four days or more
• Fever over 38.33 degrees Celsius (101 degrees Fahrenheit)
• Difficulty in swallowing 
• Difficulty in breathing.
• Painful or swollen tonsils.

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Treatment Of Tonsillitis

The treatment of tonsillitis depends on whether the infection is viral or bacterial. Tonsillitis is very common, it can be managed with proper rest and medications. The management consists of the following:

I. Medications

1. Antibiotics: This therapy is indicated for patients with signs and symptoms of the sore throat along with tonsillitis and the laboratory confirmation of bacteria as the pathogen. The drugs include-

• PenicillinV
• Amoxicillin
• Cephalexin
• Clindamycin
• Azithromycin

2. Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications are given to decrease inflammation and reduce fever. The commonly used drugs include

• Paracetamol
• Ibuprofen
  

3. Analgesics: These are a group of medications used to relieve pain. The most commonly used drug to manage pain include:

• Paracetamol
• Naproxen
• Ibuprofen

Note: Certain studies in adults and children show that corticosteroids in combination with antibiotic treatment provide symptomatic relief of pain and faster recovery.

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II. Surgery

Tonsillectomy is the surgical removal of the tonsils. Tonsillectomy may be considered after careful consideration of the risks and benefits and a thorough discussion of the options with the patient. It is usually performed when tonsillitis occurs frequently or doesn't respond to other treatments.

Home-care For Tonsillitis

The management of tonsillitis mainly depends on providing symptomatic relief along with a lot of rest. Some home remedies that can help relieve the symptoms include:

1. Gargling with salt water

Rinsing or gargling your mouth with warm salt water can help soothe pain caused by tonsillitis. It can also reduce inflammation, and may even help to treat infections. Just add ½ a tablespoon of salt to a glass of warm water and gargle to see the difference.

2. Using throat lozenges

Lozenges containing licorice as an ingredient have anti-inflammatory properties that can help soothe the discomfort and swelling in the tonsils and the throat.

 

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3. Drinking warm tea with honey

Studies suggest that raw honey has flavonoids and anti-inflammatory effects. Warm beverages like tea can help to reduce discomfort and adding raw honey may help to treat the infections causing tonsillitis.

 

4. Trying cold therapy 

Cold can be highly effective in treating pain, inflammation, and swelling. Popsicles, frozen drinks, ice chips, and ice cream can be particularly helpful to young children who can’t use other home remedies safely. 

5. Getting humidifiers

Humidifiers can help if you are experiencing dry mouth as a result of tonsillitis. Dry air can irritate the throat, and humidifiers can help decrease the discomfort in the throat and tonsils by adding moisture back into the air. 

6. Drinking a lot of warm 

Drinking warm liquids, including soups, broths, and teas, can help soothe a sore throat. Herbal teas containing ingredients such as honey, pectin, or glycerine may help soothe irritation in the throat.

7. Eating softer food items

For people with tonsillitis, eating hard or sharp foods can be uncomfortable and even painful. Individuals with tonsillitis should try eating softer foods that are easier to swallow.

8. Not straining your voice

Swelling in the throat can cause the voice to become muffled. See a doctor immediately if you have too much pain while talking as it can indicate a complication.

Complications Of Tonsillitis

Tonsillitis, if left untreated can lead to complications like; 

1. Peritonsillar abscess/quinsy: This is the spread of infection beyond the tonsil that may lead to a collection of pus (abscess) within the space between the tonsils.

2. Airway obstruction: this is a rare complication and requires immediate care, where surgical intervention may be considered an emergency.

3. Post-Streptococcal glomerulonephritis: it is an inflammatory disorder of the kidneys that can manifest 1–2 weeks after a streptococcal throat infection. 

4. Rheumatic fever: Rheumatic fever is a rare, but serious, complication of untreated or partially treated tonsillitis caused due to streptococcus bacteria.

5. Scarlet fever: It is an infection caused by group A streptococci bacteria that affects the throat. This is the same bacteria that can cause tonsillitis.

Alternative Therapies For Tonsillitis

Mild cases of tonsillitis can be managed with certain home remedies and plenty of rest. Some of the alternative therapy that has shown some promising results include:

1. Homeopathy

Tonsillitis is common among children and homeopathy is very safe and highly effective in treating most cases of tonsillitis. Studies have shown that homeopathy has been quite effective in managing acute viral tonsillitis. Belladonna is the most commonly prescribed homeopathic medicine for tonsillitis. 

2. Acupuncture

This treatment can help reduce inflammation and provide analgesic pain relief for a sore throat. Studies demonstrate that certain acupoints are used to treat the common cold, influenza, acute tonsillitis, and other respiratory tract infections.

Living With Tonsillitis

Recurrent and acute tonsillitis is very common among children. Managing kids can be quite a task, especially when they are sick. Some of the tips that can help parents in managing their children with tonsillitis include:

• Treat their pain and fever
• Give them soft and warm foods
• Tell them to take plenty of fluids
• Try to make them gargle with salt water
• Give them throat sprays instead of lozenges
• Make them comfortable as much as possible
• Be patient with them

Note: Talk to your doctor to understand the reason behind the recurrent infections and get the appropriate treatment. 

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