Tonsillitis

Tonsillitis

What is Tonsillitis?

Tonsillitis is inflammation of the tonsils, two oval-shaped pads of tissue at the back of the throat — one tonsil on each side.

Structure and Function of the tonsils

The palatine tonsils are paired structures consisting of lymphoid tissue. They are located in the tonsillar fossa on each side of the tongue base.

Presentation

Acute tonsillitis is diagnosed mainly on the basis of clinical assessment.

  • There is a short history of sore throat with fever and pain on swallowing.
  • Examination generally reveals erythema of the tonsils and posterior pharyngeal wall, with obvious exudates on the tonsils occasionally.
  • This is usually associated with tender node enlargement in upper neck.

The tonsils are composed of lymphoid tissue with germinal centers located immediately submucosally. Both T- and B-lymphocytes are present though B-lymphocytes predominate. Tonsil serves both the cell-mediated and humoral immune function. There is no evidence to suggest that tonsillectomy results in impaired immunity.

Complications of acute tonsillitis

  • Peritonsillar abscess (QUINSY); It is a collection of pus lateral to the tonsil.
  • Retropharyngeal abscess: This is a rare but serious complication of acute tonsillitis, seen mainly in infants and children less than 5 years of age.
  • Parapharyngeal abscess: Occasionally, peritonsillar and Retropharyngeal abscess may be complicated by spread of infection to the parapharyngeal space.
  • Immune complex disorders: Acute tonsillitis caused by GABHS can occasionally lead to diseases related to immune complex formation, generated as a response to the infection. The two important diseases resulting from this phenomenon are acute rheumatic fever and acute glomerulonephritis.

Management of tonsillitis

In most of the cases both viral and bacterial tonsillitis tend to resolve quickly without treatment. The management of acute tonsillitis is mainly symptomatic, i.e. using analgesia and hydration until the symptoms subside. Antibiotics will shorten the illness and may reduce the risk of sequelae. In those patients in whom the illness shows no sign of improvement within 48–72 hours, antibiotics should be started.

When tonsillectomy is indicated?

Patients for tonsillectomy for both adults and children should meet all the following criteria:

  • Sore throats are due to Tonsillitis.
  • The episodes of sore throat are disabling and prevent normal functioning.
  • Seven or more well-documented, clinically significant, adequately treated sore throats in or three or more such episodes in each of the preceding 3 years the preceding year, or five or more such episode in each of the preceding 2 years, or three or more such episodes in each of the preceding 3 years.

Other indications for tonsillectomy are

  • Sleep Disordered Breathing
  • Suspected Malignancy
  • Peritonsillar abscess

Complications of tonsillectomy

  • Pain; Post-tonsillectomy sore throat is normal for at least 1 week and on an average return to school or work can take 1–2 weeks
  • Bleeding; Bleeding after tonsillectomy can be primary (within 24 hours after the operation) or secondary (after 24 hours until 2 weeks). The reported readmission rate for bleeding was 5%, with 1.5% requiring return to theatre
  • Infection: The first symptoms of post-tonsillectomy infection are fever and halitosis

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