Tonsillitis: More than just a sore throat
THE body was created in such a way that it could act as a natural defence system. The tonsils, for example, are fleshy masses or organs which are located at the back of the throat on both sides and serve the distinct purpose of supporting the immune system in its fight against infections. But sometimes, just as the immune system can become compromised, the tonsils also fall victim to viral and bacterial infections.“Tonsillitis is a term used to describe the inflammation of the tonsils by viral or bacterial agents which result in an obvious swelling and redness of the lymphoid tissues. These causative agents are usually airborne or passed on from individual to individual, for example, through coughing, sneezing and kissing,” Paediatrician Dr Anona Griffith explained.
Known viruses and bacteria as identified by Dr Griffith include Epstein-Barr Virus which causes infectious mononucleosis or “kissing disease” and is common in small children and adolescents. Another common bacterium identified is the Streptococcus pneumonia (strep throat). She also notes that some individuals are carriers of the bacteria but do not manifest the disease.
Tonsillitis affects all age groups, but it is particularly common among small children and may present in many forms — acute, meaning short on the onset; chronic, meaning long-standing; and recurrent, meaning it resolves with treatment then happens again often shortly after recovery.
But how do you know when your child’s sore throat is tonsillitis? Dr Griffith lists a number of the most common symptoms below:
•A sore throat
•Pain and difficulty swallowing
•Swelling of the glands or lymph nodes in the neck
•Hoarseness
•A headache
•Ear pain
•Fever
•Coughing.
When the illness is more severe, other symptoms, including pus on the tonsils, drooling, and inability to open the mouth as well as the airway becoming obstructed requiring hospitalisation may present alongside other common symptoms.
“Treating tonsillitis is dependent on a number of things, including severity as well as identification of the causative agent. Differentiating between the causative agents will be done based on history, clinical presentation and definitively based on cultures in order to adequately treat and prevent any possible complications,” Dr Griffith advised.
For example, in acute cases, the infection usually resolves with pain relief and hydration over a five-day period but may persist even up to two weeks. However, tonsillitis caused by bacteria or severe cases of the illness must be treated with antibiotics. If left untreated or inadequately treated, Dr Griffith advised that tonsillitis, especially bacterial, may result in a number of complications including:
1. Development of an abscess around the tonsils that can extend into the surrounding tissues (quinsy). Imaging such as an ultrasound and CT scan may assist in telling the extent of the disease
2. In the case of tonsillitis caused by the bacteria Streptococcus pyogenes, complications usually occur a few weeks after the initial infection and include Rheumatic fever, which affects the heart and other tissues and may require lifelong therapy; Scarlet fever; infection of the joints (septic arthritis); and acute post-streptococcal infection of the kidneys.
In some cases, especially when the illness is recurrent and severe, an ear, nose and throat (ENT) specialist may recommend a tonsillectomy as a permanent fix to the problem.
“A tonsillectomy is done based on a clinical assessment by the ENT which takes into account many factors, including the number of bacterial tonsillar and/or adenoidal infections over a particular period of time, or recurrence of the disease despite optimal treatment. It will also take into account the complications of persistently enlarged tonsils on the patient, which may include difficulty breathing, especially at nights,” Dr Griffith advised.
