What is Tonsils?
Tonsils are paired lymphatic organs present on the lateral wall of Oropharynx between the Anterior pillar or Palatoglossal arch and Posterior pillar or palatopharyngeal arch. When it is infected, it is called tonsillitis. It is an acute or chronic inflammation of tonsils.
The reason behind acute tonsillitis is a virus or bacteria. It may be subacute which is mainly caused by actinomycoses. Chronic tonsillitis is caused by Bacteria. Acute Tonsillitis is a generalized inflammation of the mass of the tonsils and usually accompanied by a degree of inflammation of the fauces and Pharynx. Tonsils are part of Waldeyer ring Lymph node which protect us against infection. Situated at the opening of the pharynx to the external environment, the tonsils and adenoid are in a position to provide primary defense against foreign matter.
Some Facts About Tonsils
- Most Common In Children 5-10 Years age, may occur in Adult even at 50 years of age.
- 50% is caused by Viruses such as Influenza, Para Influenza, adeno virus, enterovirus, rhinovirus.
- Bacterial causes includes Group A streptococcus (GABHS), streptococcus pneumoniae, Haemophylus influenzae and aerobic organism.
- General factors causing Tonsillitis are Malnutrition, Immunodeficiency, Exposure to cold, Atmospheric pollution.
Acute streptococcal tonsillitis is a disease of childhood, with a peak incidence at about 5 to 6 years of age but can occur in children younger than three years of age. Outbreaks may arise in epidemic forms in institutional settings such as recruit camps and daycare facilities. So diagnosis and immediate treatment is quite urgent and requires careful attention.
Clinical Features of Tonsillitis:
Clinical features consist of Symptoms and signs. Symptoms are what that can be understood by a Nonmedical person. Signs are the findings by clinical exam and consists of Medical term. So for all nonmedical person reading this topic, symptoms will be helpful to understand. Rapid enlargement of one tonsil is highly suggestive of a tonsillar malignancy, typically lymphoma in children.
Symptoms of Tonsillitis:
- There may be a prodromal illness like fever, malaise, headache for a day before the onset of the main symptom’s.
- Moderate to a severe sore throat.
- Difficult and painful swallowing.
- Ear ache is some times noted.
- There may be trismus and dribbling of saliva in children.
- Some children may have abdominal pain due to mesenteric lymphadenitis.
Signs of Tonsillitis:
- The tonsils are swollen, edematous, inflamed congested enlarged. The tonsillar crypts are filled with pus or debris. There is whitish membrane over the tonsils.
- The high rise of temperature or Pyrexia and shivering.
- Tender Jugulodigastric lymph nodes.
- A palpable spleen or axillary adenopathy increases the likelihood of the diagnosis.
How to Diagnoses Tonsillitis:
The diagnosis is made mainly by History and clinical examination. Some investigations are helpful to establish and confirm the diagnosis. However the following tests are helpful:
- Blood for Leucocyte count.
- Paul bunnel test or Monospot test to exclude Infectious mononucleosis.
- Throat swab culture for diagnostic confirmation. This is a simple and extremely useful test but must be skillfully performed by swabbing the posterior pharynx and tonsillar areas. But the problem is it delays to obtain the result. Approximately 18 to 48 hours are needed. Management is thus initiated before culture results.
Treatment of Tonsillitis:
Acute tonsillitis is needed urgent care, and medical treatment is indicated while in chronic tonsillitis Tonsillectomy is performed.
For Acute Tonsillitis:
- General measures, Bed rest, Plenty of oral fluid, soft diet. In severe cases, patients need admission for Intravenous Fluid and Antibiotic.
- Phenoxymethyl Penicillin is still the choice of Drug. Clinical failure of penicillin should lead to the suspicion of ß-lactamase–producing organisms. In such cases, the patient complains of a sore throat that never resolves completely despite penicillin management.
- An alternative to the use of penicillin is to use penicillin plus a ß-lactamase inhibitor such as clavulanic acid (e.g., amoxicillin/clavulanic acid). Other alternatives include clindamycin or a combination of erythromycin and metronidazole.
- Erythromycin is reserved for the patients who show penicillin sensitivity. Ampicillin is contraindicated in children with glandular fever due to development of Maculopapular rash. Other drugs are cephradine, Coamoxyclav, etc.
- Antibiotic therapy within 24 to 48 hours of symptom onset will result in decreased symptoms associated with a sore throat, fever, and adenopathy 12 to 24 hours sooner than without antibiotic administration. The use of antibiotics also minimizes the chance of suppurative complications and diminishes the likelihood of acute rheumatic fever. Ten full days of therapy are necessary, as eloquently demonstrated by Schwartz, Weintzen, and Pedreira, who showed that children receiving ten days of therapy have lower clinical and bacteriologic recurrence rates than children receiving only seven days of therapy – according to Cummings – Otolaryngology – Head and neck surgery.
Thanks for being with us. Next, I will discuss everything about Tonsillectomy, Complications of tonsillitis, Differential diagnosis, details in chronic tonsillitis.