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Tonsillitis

Overview

Tonsillitis is the inflammation of tonsils, a tissue mass located on either side of the upper part of your throat. In the majority of the cases, a viral or bacterial infection triggers the immune system, which causes inflammation and swelling of tonsils. This may be associated with the enlargement of lymph nodes as well. The causes for tonsillitis and pharyngitis (inflammation of the pharynx) are almost similar; therefore, there is a possibility that they might co-occur. Tonsillitis usually resolves within two weeks, but severe or recurrent cases might require surgical options for a more permanent solution.

Causes

About 40% to 60% of cases of tonsillitis are reported to be caused by viral infections. Adenovirus is a well-known pathogen that causes common cold. Tonsillitis occurs as a result of infection by this virus. Influenza virus causes tonsillitis that is accompanied by fever and general body ache. Infectious mononucleosis also features tonsillitis along with lymph node enlargement. Other viruses that can cause tonsillitis include herpes simplex virus, rhinovirus, coronavirus, paramyxovirus, coxsackievirus, parainfluenza virus, HIV, etc.
Tonsillitis can also be caused by bacterial infections, out of which t group-A streptococcus bacteria cause the most common infection. The infection caused by this group of bacteria leads to a condition commonly known as strep throat. Other bacteria that might be causative agents for tonsillitis include streptococcus pneumoniae, chlamydia pneumoniae, treponema pallidum, Neisseria gonorrhea, etc.
A few non-infectious causes can also cause inflammation of the tonsils. These include gastroesophageal reflux disease, pericoronitis, Vincent’s angina, tuberculosis, etc. Certain medications can cause tonsillitis, too, as a side effect. Smoking and allergies can also be considered as triggering agents.

Types

Tonsillitis is divided into three types depending on its duration and rate of recurrence.
Acute tonsillitis is the most common cause by viral or bacterial infections. It persists for 10 to 14 days and resolves within this period with prescribed medications and symptomatic care.
Chronic tonsillitis occurs for longer due to an unresolved viral infection or allergies. In a few cases, it can persist for up to three months.
Group-A Streptococcus bacteria usually cause recurrent tonsillitis within a year. Since it causes extreme discomfort to the patient, surgical resection of tonsils is suggested in this case as a long-term treatment option.

Risk Factors And Epidemiology

The most common risk factor for tonsillitis is coming in contact with an affected person. Since viral infections cause the majority of the cases, they can quickly spread from one person to another through droplets coughed or sneezed in the air. Therefore any crowded space with even a single infected person is at risk. Doctors, nurses, and hospital staff are particularly at risk of catching these viral or bacterial infections. These infections are also more prevalent during cold weather than in any other season. Other risk factors are frequent sinusitis, allergic rhinitis, gastroesophageal reflux disease, etc. Patients with diabetes, cardiac conditions, weakened immune systems, or those taking corticosteroids are also prone to develop tonsillitis and other related symptoms. Smoking and allergies are included in risk factors of tonsillitis as well.
Tonsillitis is relatively common in children ranging from 5 years to 15 years old. However, it is more prevalent in countries with colder weather. Research has shown that females have higher susceptibility to develop tonsillitis than males.

Signs And Symptoms

The signs and symptoms of tonsillitis depend on the underlying cause. Viral infections lead to pain, redness, swelling, and irritation of the tonsils. This results in frequent coughing, a significant factor in spreading these infections. Painful and swollen tonsils also cause sore throat, difficulty swallowing food or water, and altered voice quality. Certain viral infections are accompanied by fever, headache, chills, lymph node enlargement, and general tiredness. Bacterial tonsillitis can also present features like a characteristic uniform rash, whitish or gray spots, and infectious discharge. Rare symptoms of tonsillitis include vomiting, nausea, difficulty opening the mouth, and bad breath.

Diagnosis

Accurate diagnosis of tonsillitis requires a history of onset, symptoms, and a thorough clinical examination of the tonsillar region. Torchlight is focused on the back of the throat to look for any redness, swelling, rash, or discharge from tonsils. Your doctor might also palpate your neck region to look for the presence of swollen or enlarged lymph nodes. A throat culture is necessary to confirm if a bacterial infection is suspected. A CBC might also be done to confirm the presence of leukocytosis (increased white blood cells). If a patient presents with symptoms of infectious mononucleosis, a blood sample is requested to verify the presence of this infection. 

Differential Diagnosis

Other conditions with similar symptoms as tonsillitis might include pharyngitis, retropharyngeal abscess, diphtheria, epiglottitis, peritonsillar abscess, croup, and other respiratory tract infections.

Treatment

Viral tonsillitis does not require any particular treatment except symptomatic care. If tonsils are causing extreme pain or discomfort, oral analgesics are prescribed to reduce the pain and inflammation. Home remedies are usually preferred, including intake of fluids, drinking warm soups or broths, gargling with warm saline water, using a nebulizer or humidifier, and bed rest. These remedies can help reduce the symptoms and speed up the recovery process. Throat lozenges are another suitable option. Acute bacterial tonsillitis requires a complete course of antibiotics prescribed by your doctor. Cases of recurrent or chronic tonsillitis might require tonsillectomy (surgical removal of tonsils) if medications or supportive care has not proven well enough to reduce the pain and discomfort of the patient.

Medication

Bacterial tonsillitis is treated by intake of oral antibiotics such as penicillin, amoxicillin, cephalosporin, etc. Your doctor decides the dose and duration of these antibiotics. Viral tonsillitis does not require medications. Antipyretics such as paracetamol or analgesics containing ibuprofen, aspirin, etc., may be prescribed.

Prognosis

Viral tonsillitis usually recovers well on its own within one to two weeks with only symptomatic care. Bacterial tonsillitis also recovers well if diagnosed correctly and prescribed antibiotic dosage is completed.

Prevention

Basic prevention methods to reduce the chances of developing pharyngitis include avoiding close contact with infected individuals, wearing a face mask in crowded areas, washing hands frequently, and using alcohol-based sanitizers. Most of these infections are spread from air droplets or oral secretions from an infected person; therefore, sharing toothbrushes or utensils should be avoided until their recovery.