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December 19, 2018
 

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Weekend doctor: The scoop on tonsillitis

By Evan McBeath, MD
Otolaryngology – Head & Neck Surgery
ENT & Allergy Specialists of Northwest Ohio

The tonsils are the two oval-shaped pads of tissue located in the back of the throat. In addition to adenoid tissue located in the back of the nose, tonsils are part of a complex network of special tissue that helps to fight infection in the head and neck region. However, due to their prominent location in the throat, their amount of exposure to bacteria and viruses, and their makeup with numerous crypts and pits, the tonsils often harbor bacteria and become overwhelmed with infection. Tonsillitis, or the inflammation of the tonsils, often leads to swelling, painful and difficulty swallowing, and tender lymph nodes in the neck. Headaches, earaches, fever and coughing are also common symptoms.

Although tonsillitis is most commonly caused by viral infections, bacteria such as streptococcus can also cause it. Additionally, certain streptococcal bacterial species can lead to other severe infections such as rheumatic fever and kidney damage, so rapid treatment with appropriate antibiotics is necessary in these cases.

The initial diagnosis of tonsillitis consists of performing a rapid strep test to determine whether a virus or bacteria caused the tonsillitis. Testing for tonsillitis related to mononucleosis, a viral infection, should also be considered. A rapid strep test involves swabbing the surface of the tonsils to determine whether the streptococcal bacteria is present, which is often followed by a throat culture for more definitive results. If the results are positive for a bacterial infection, then amoxicillin or a similar antibiotic should be used to treat the infection. If the strep test is negative, then the tonsillitis is likely the result of a virus, and treatment therefore focuses on supportive care with the use of over-the-counter medications, rest and plenty of fluids to reduce symptoms. However, patients should contact their health care provider if their symptoms are associated with a high fever, severe difficulty or painful swallowing, trouble swallowing their own saliva, a muffled voice, or failure to begin improving after about one week.

Although less common, some patients experience tonsillitis frequently over long periods of time with disruptive symptoms such as a persistent sore throat, difficulty swallowing and even the potential formation of tonsil stones, which is called chronic tonsillitis. If someone has had more than seven separate episodes of tonsillitis in one year, five separate infections each year over two consecutive years, or three or more infections per year over three or more consecutive years, it is called recurrent acute tonsillitis.

Surgery may be recommended to remove the tonsils to help control infection and improve symptoms. This procedure, called tonsillectomy, is typically done as an outpatient and lasts about 45 minutes. Tonsillectomy, with or without adenoidectomy (removal of the adenoids), is also commonly performed to assist with the management of sleep apnea, especially in children. Although the recovery following tonsillectomy can be prolonged and painful, especially as an older child or adult, most patients undergoing tonsillectomy are able to return home the same day of the surgery and are typically back to work or school 10-14 days after surgery.

Children are unfortunately the most affected by tonsillitis with the majority of infections occurring between the ages of four and ten. Preventative measures, such as teaching children good habits of frequent hand washing and avoidance of sick contacts can decrease their chances of obtaining tonsillitis. Regardless of age, preventative techniques should be implemented both at home and in public spaces to minimize the risk of tonsillitis. If you or a loved one is experiencing symptoms of tonsillitis, speak with your ENT physician.