Tonsillitis Management : Causes, Symptoms & Management

Overview

Tonsillitis is the inflammation of the tonsils (two oval-shaped masses of tissue located at the back of the throat) typically caused by infection with common viruses. In some cases, tonsillitis is also caused by bacteria. Symptoms of tonsillitis include sore throat, difficulty swallowing, and swollen and red tonsils. Treatment for tonsillitis depends on the cause. Viral tonsillitis often resolves independently and is managed with rest, hydration, and pain relief medications. Bacterial tonsillitis, particularly strep throat, is usually treated with antibiotics. Let’s understand the condition in detail here.

What is Meant by Tonsillitis

Tonsillitis is the inflammation of the tonsils, usually due to an infection with a virus or bacteria. Symptoms may include sore throat, enlarged tonsils, and fever. In some cases, there may be white or yellow spots on the tonsils. A healthcare provider can diagnose tonsillitis through a physical examination of the throat and neck. In some cases, a throat swab may be taken to determine the cause of the infection, especially if it's suspected to be bacterial. If the cause of the infection is found to be bacterial, antibiotics may be prescribed. Some individuals may need a tonsillectomy in which the tonsils are removed surgically.

When Causes Tonsillitis?

Infections of the tonsils, typically from viruses or bacteria, result in tonsillitis. The main reasons are as follows:

• Viruses: Most cases of tonsillitis are caused by viruses. Typical viruses include rhinovirus, adenovirus, influenza virus, Epstein-Barr virus (which also causes infectious mononucleosis), and the respiratory syncytial virus.
• Bacteria: The most common bacterial cause of tonsillitis is Streptococcus pyogenes, the bacteria responsible for strep throat.

Though there are many other viruses and bacteria that may cause tonsillitis from the above, these are the most common ones. The disease can easily be spread from one person to another by airborne droplets (when a person breathes in the bacteria or virus after an infected person has coughed, sneezed, or even breathed) or by direct contact (e.g. when a person touches the infected area on another person and then touches his mouth or nose).

What are the Symptoms of Tonsillitis?

There are a wide range of symptoms of tonsillitis. Common tonsillitis symptoms include:

• Sore throat (most noticeable symptom, may be severe)
• Swollen tonsils and lymph nodes
• Difficulty swallowing
• Painful or tender neck lymph nodes
• Fever
• Earache (the pain may go away after a day or two, only for it to return worse than before)
• Bad breath (halitosis)
• Voice changes
• Stiff neck
• Headache
• Stomachache and nausea
• Loss of appetite
• Fatigue or a general feeling of wanting to just lie in bed.

How is Tonsillitis Diagnosed?

The primary diagnostic criteria for tonsillitis are a clinical examination and the patient's symptoms. The diagnostic procedure often entails the following:

• Physical Exam: Doctors will typically examine the throat using an instrument with a light, which will allow them to look at the throat for any signs of redness, swelling, or any white or yellowish areas on the tonsils. The doctor may also touch the neck to check for swollen lymph nodes.
• Throat Swab: A throat swab involves rubbing cotton or a looped swab over the back part of the throat to collect a sample from the area. The collected sample will then be tested to determine what bacteria might have caused the infection.
• Rapid Strep Test: This test identifies a sample caused by streptococcal bacteria. Results are usually available in a few minutes.
• Complete Blood Count (CBC): In some cases, mainly if the cause of the tonsillitis is not clear, patients may have a blood test to measure the number and types of blood cells. An increased number of white blood cells may suggest an infection.
• Monospot Test: If the doctor suspects mononucleosis (an illness caused by the Epstein-Barr virus) as the cause of the infection, a monospot test can identify these antibodies.

Treatment Methods for Tonsillitis?

The severity of the symptoms and the kind of tonsillitis (bacterial or viral) determine the course of treatment. The standard treatment options are as follows:

1. Self-care Measures:

• Rest: Allow your body time to heal. Getting proper rest will help your body fight off the infection.
• Fluids: Drink plenty of fluids to help relieve a sore throat and keep your body working efficiently.
• Warm salt gargle: A mixture of 1/4 to 1/2 teaspoon (1.25 to 2.50 milliliters) of table salt dissolved in an 8-ounce (237 milliliters) glass of warm water can help soothe a sore throat. You may do it 3 to 4 times a day.
• Humidifier: A cool-mist humidifier may help soothe a sore throat. If the air in your home is dry, such as it is if you have forced hot air heat, adding moisture to the air may help prevent or relieve a sore throat.

2. Medication:

• Antibiotics: If the tonsillitis is caused by a bacterial infection, a course of antibiotics, usually penicillin or amoxicillin, will be prescribed. It is important to take the entire course, even if symptoms improve before the medicine is gone.
• Pain Relievers: Over-the-counter pain relievers and fever reducers, such as acetaminophen (Tylenol) or ibuprofen (Advil), might help with throat pain or fever. (Note: Aspirin should not be given to children because it might cause a rare but potentially fatal disease called Reye’s syndrome in those whose bodies are fighting off a viral infection.)
• Lozenges or Hard Candy: Older children and adults can suck on lozenges or hard candy as a way to relieve a sore throat.

3. Tonsillectomy:

Surgery can remove the tonsils. This may be considered if:

• Tonsillitis keeps coming back or is chronic.
• Abscesses form around the tonsils.
• The tonsils are so big that they cause breathing problems or obstructive sleep apnea.
• Antibiotic treatment isn't working for a bacterial tonsillitis infection that keeps returning.

Complications of Tonsillitis

Tonsillitis can result in problems, some of which can be very serious if it is not adequately managed. The following are potential complications of tonsillitis:

• Peritonsillar abscess: This is a collection of pus that forms between one of the tonsils and the wall of the throat. It is usually caused by a spreading of infection from a nearby area, such as the tonsil. The main symptoms are the sudden onset of severe pain, fever, a muffled voice (“hot potato” voice), and difficulty opening the mouth.
• Tonsillar cellulitis: This is an infection which has spread to the areas around the tonsils, which causes a red, swollen, and painful throat.
• Rheumatic fever: Following an untreated streptococcal infection (which includes some types of tonsillitis), about 3% of children but only 0.3% of adults may develop rheumatic fever. This is an inflammatory condition that can impact the heart, joints, nervous system, and skin.
• Poststreptococcal glomerulonephritis: Following a streptococcal throat infection, 1-3 weeks later, about one child in every 3000 may develop an inflammation of the kidney.
• Middle Ear Infection (Otitis Media): The infection spreads from the throat up the Eustachian tube to the middle ear. This causes pain and may reduce the ability to hear. Hearing may remain temporarily reduced after the tonsils have improved. Fluid may also remain trapped in the middle ear.
• Breathing difficulties: Severely enlarged tonsils can occasionally cause problems, including difficulty swallowing, breathing, or disturbed sleep. Any child or adult with these symptoms should be seen or urgently assessed by a doctor.
• Obstructive sleep apnoea: Chronic tonsillitis may cause the tonsils to become enlarged and thus block the throat during sleep, cutting off the supply of air to the lungs.

Prevention of Tonsillitis

Keeping yourself away from the viruses and bacteria that might cause tonsillitis as possible is the main step in prevention. Here are some doable methods to stop tonsillitis from starting and spreading:

• Hand Hygiene: Washing hands thoroughly and often is one of the best ways to prevent the spread of infectious agents. Wash hands with soap and clean running water for at least 20 seconds. If soap and clean water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol to clean hands.
• Avoid Close Contact: Avoid close contact with people who are sick, especially people who are sick with or showing symptoms of flu or other respiratory illnesses, such as cough, fever, sore throat, runny or stuffy nose, muscle or body aches, headache, and fatigue.
• Cough and Sneeze Etiquette: Cover your mouth and nose with a tissue when you cough or sneeze. Throw the tissue in the trash after it has been used. If you don’t have a tissue, cough or sneeze into your upper sleeve or elbow, not your hands.
• Avoid Touching Face: Not touching face would seem an easy goal, given that so much of the influenza commentary of public health officials has focused on the importance of vigilant hand hygiene. 
• Disinfect Surfaces: Clean and disinfect frequently touched objects and surfaces, such as doorknobs, light switches, and electronics, especially if someone is ill or has recently been ill.
• Use Individual Items: Do not share drinking glasses, eating utensils, or oral care items, like toothbrushes, with others. Use individual items to help contain germs.
• Vaccination: Vaccinations can help reduce the risk of contracting many infections that can cause tonsillitis. Ensure that you and your child(ren) are up to date with recommended immunizations.
• Healthy Lifestyle: Eat a healthy diet, be physically active, get enough sleep, manage stress, and drink plenty of fluids. A healthy lifestyle can help support a healthy immune system

Staying up to date with vaccinations can also reduce the risk of certain infections that may lead to tonsillitis. Overall, these preventive measures can help minimize the likelihood of contracting this uncomfortable condition.

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