Tonsillitis is a condition characterised by inflammation of the tonsils, a pair of lymphoid tissue present on either side at the back of throat. The most common cause of tonsillitis is infection due to virus and bacteria.
Tonsils are a lymphoid organ which along with the adenoids forms a barrier to microorganism entering through the oral route. Like all lymphoid tissue tonsils also mature with age and as they are exposed to more and more microbes they get inflamed over and over again during childhood and adolescence.
Tonsillitis commonly presents with fever, sore throat, throat pain, inability to swallow, swollen tender glands in the neck, a white coating over the tonsils, and drooling of saliva. Some children may complain of difficulty swallowing and breathing. Other symptoms of tonsillitis include stiff neck, headache, bad breath and stomach ache, refusal to eat and unusual fussiness in small children.
An infection of the tonsils is always accompanied by infection of the adenoids as well. Inflammation of the adenoids is accompanied by hypertrophy of the adenoids and leads to difficult and obligate mouth breathing in children.
The commonest causes of tonsillitis is streptococcus pyogenes, however other bacteria like H influenza and staph may also cause tonsillitis.
Since tonsillitis is a very common complaint in children, it is necessary to know when to contact the doctor to prevent unnecessary hospital visits. Some of the danger signs of tonsillitis include neck stiffness, drooling of saliva, breathlessness, increasing swelling in the neck, high grade fever not responding to couple of doses of fever medicines and altered consciousness. However most children are likely to recover completely from tonsillitis.
Tonsillitis is usually diagnosed clinically after a clinical exam. The doctor may ask for a throat swab to find out more about the cause. A throat swab is a very simple procedure and is not painful at all. You will just need to open your mouth wide and leave the jaw muscles loose. This way you will not gag. Along with a throat swab, a complete blood count is performed as well. Usually no other investigations are required.
Tonsillitis is commonly managed supportively. It is important to ensure that the child is well hydrated and drinks lot of fluids. Warm caffeine free tea or honey with water can be soothing. You can also use lozenges and salt water gargles to soothe the throat and make the child feel better. Also ensure adequate rest for your child. You can treat the fever and throat pain by giving Ibuprofen or acetaminophen in the recommended doses.
The use antibiotics in tonsillitis are a very contentious topic with many doctors for and against it. Although the balance is not clear, it is preferable to withhold antibiotics till some complication is imminent as tonsillitis tends to resolve with just supportive therapy alone.
Although tonsillitis is a benign condition which resolves without any complications, two complications are worth mentioning.
- Rheumatic fever is a condition which affects the heart and joints. This usually follows a streptococcal pharyngitis or tonsillitis by two to three weeks and is due to a cross reaction between the components of the cell wall of the bacteria and proteins found on the heart and joints. This commonly presents with fever, joint pains which shift from one joint to another, mild chest pain and breathlessness. If this is not treated and recurrent bouts of rheumatic fever can lead to rheumatic heart disease, a condition in which valve abnormalities are seen.
- Post streptoccoal glomerulonephritis is another complication of tonsillitis. Like rheumatic fever, PSGN is also due to immunologic cross reactivity. This causes inflammation of the kidneys and commonly causes brown urine with high blood pressure and retention of water in the body. This condition more often resolves spontaneously with no deficits.
Other then these complications two other complications are important. The infection can spread into the surrounding tissues in the neck, leading to a peri- tonsillar abscess which requires surgery to evacuate. Although rare, tonsillitis may cause meningitis, an infection of the covering of the brain.
When is tonsillectomy required?
Tonsillectomy is a procedure where in the tonsils are removed surgically. Once very commonly employed, its incidence has now fallen because new research has shown that removing the tonsils is much more harmful than the recurrent infections due to the vital role they play in immunity. Now tonsillectomy is recommended only for the following categories of patients.
- More than five to seven episodes in one year
- More than four episodes a year over two years
- More than three episodes a year over three years
This procedure is also performed in a case where there is no improvement in spite of antibiotics and an abscess of the tonsils.
Tonsillitis being a infection can be prevented by taking few general health precautions. Follow these precautions and teach your children as well to prevent tonsillitis and other infections.
- Wash his or her hands thoroughly and frequently, especially after using the toilet and before eating
- Avoid sharing food, drinking glasses or utensils
To help your child prevent the spread of a bacterial or viral infection to others:
- Ask your doctor when it's all right for your child to return to school
- Teach your child to cough or sneeze into a tissue or, when necessary, into his or her elbow
- Teach your child to wash his or her hands after sneezing or coughing