When I was working in the ENT Department of the Singapore General Hospital, there were at least 10 cases of patients every day with enlarged painful swellings in their throats.
These are infected tonsils and the bad breath emitted by the patient can be terrible.
Some of the patients could not even swallow their saliva.
Tonsillitis is inflammation (swelling) of the tonsils.
The tonsils are actually lymph nodes in the back of the mouth and top of the throat. They normally help to filter out bacteria and other microorganisms to prevent infection in the body.
They may become so overwhelmed by bacterial or viral infection that they swell and become inflamed, causing tonsillitis.(A Simple Guide to Tonsillitis)
The infection may also be present in the throat and surrounding areas, causing pharyngitis. The inflammation may involve other areas of the back of the throat including the adenoids ( A Simple Guide to Adenoiditis) and the lingual tonsils (areas of tonsil tissue at the back of the tongue).
Viral or bacterial infections and low immunity factors lead to tonsillitis and its complications.
The herpes simplex virus, Epstein-Barr virus (EBV), cytomegalovirus, adenovirus, and the measles virus cause most cases of acute pharyngitis and acute tonsillitis.
Bacteria cause 15-30 percent of pharyngotonsillitis cases.
Streptococcus pyogenes is the most common bacteria causing acute Tonsillitis
Tonsillitis most often occurs in children but rarely occurs in children younger than two years.
Tonsillitis caused by Streptococcus species typically occurs in children aged 5-15 years.
Viral tonsillitis is more common in younger children.
A peritonsillar abscess is usually found in young adults but can occur occasionally in children.
There are several variations of tonsillitis:
1.acute
2.recurrent
3.chronic tonsillitis and
4.peritonsillar abscess.
The type of tonsillitis determines what symptoms will occur.
Acute tonsillitis:
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Patients complains of:
1.Ear pain
2.Fever, chills
3.Headache
4.Sore throat which is severe and lasts longer than 48 hours
5.Tenderness of the jaw and throat
6.Voice changes, loss of voice
7.Foul breath, dysphagia (difficulty swallowing),
8.Odynophagia (painful swallowing), and tender cervical lymph nodes.
9.Airway obstruction due to swollen tonsils may cause mouth breathing, snoring, nocturnal breathing pauses, or sleep apnea.
( A Simple Guide to Obstructive Sleep Apnea)
10.Lethargy and malaise are common.
These symptoms usually resolve in three to four days but may last up to two weeks despite therapy.
Recurrent tonsillitis:
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This diagnosis is made when an individual has multiple episodes of acute tonsillitis in a year.
Chronic tonsillitis:
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Patients usually have:
1.Chronic sore throat, foul breath,
2.Enlarged tonsils, and
3.Persistently tender cervical nodes.
Peritonsillar abscess:
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Patients often have:
1.Severe throat pain, fever,
2.Drooling,
3.Foul breath,
4.Trismus (difficulty opening the mouth), and
5.Muffled voice quality (as if talking with a hot potato in his or her mouth).
I will usually look in the mouth and throat for signs of: 1.enlarged, visible tonsils that are usually reddened and may have white spots (pus) on them.
2.enlarged and tender lymph nodes of the jaw and neck.
3.Fever and chills.
4.Open-mouth breathing and muffled voice resulting from obstructive tonsillar enlargement.
5.neck and jaw stiffness (often found in acute tonsillitis).
6.Signs of dehydration (found by examination of skin and mucosa).
7.Palatal petechiae (pinpoint bleeding spots on the soft palate).
8.Unilateral bulging above and to the side of one of the tonsils when peritonsillar abscess exists.
A culture of the tonsils may show bacterial infection.
A culture for the streptococcus bacteria (strep) may be taken using a throat swab because it is the most common and most dangerous form of tonsillitis.
If the cause of the tonsillitis is bacteria such as strep, antibiotics are given to cure the infection.
The antibiotics may need to be taken for 10 days by mouth.
They must not be stopped just because the discomfort stops, or the infection will NOT be cured.
2.Rest to allow the body to heal.
3. Fluids especially warm (not hot), bland fluids or very cold fluids may soothe the throat.
Gargle with warm salt water or suck on lozenges (containing benzocaine or similar ingredients) to reduce pain.
4.Fluid replacement and pain control are important.
5.Hospitalization may be required in severe cases, particularly when there is airway obstruction.
When the condition is chronic or recurrent, a surgical procedure to remove the tonsils (tonsillectomy) is often recommended.
Tonsillitis symptoms usually lessen in 2 or 3 days after treatment starts.
The infection usually is cured by then, but may require more than one course of antibiotics.
A tonsillectomy may be recommended if tonsillitis is severe, recurrent, or does not respond to antibiotics.
Complications of untreated strep tonsillitis may be severe:
1.Rheumatic fever and subsequent cardiovascular disorders
2.Post-streptococcal glomerulonephritis followed by kidney failure
2.Dehydration from difficulty swallowing fluids
3.Blocked airway from enlarged tonsils
4.Peritonsillar abscess or abscess in other parts of the throat causing difficulty in swallowing. An operation is usually done to release the pus in the abscess.
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