How well do you know your tonsils?

What are Tonsils and their function?

Tonsils are lumps of tissue that are present in the back of the throat. 

These are lymphoid organs that form the first line of defence against local infections of the throat. They generate white blood cells that attack the microbes and foreign materials that enter into the mouth, thereby producing immunity.

What are the two main causes of Tonsillitis?

• Viral infections
• Rhinovirus
• Enterovirus
• Adenovirus
• Herpes Simplex virus
• Measles virus
• Epstein Barr Virus
• Bacterial infections
• Streptococcus pyogenes (GABHS)

Viral infections are usually the main culprit for causing Tonsillitis.

The Adenoids, which are located near the tonsils, can also be involved with Tonsillitis and is called Adenoiditis. 

Some common triggers for Tonsillitis are changes in water, a moist environment, eating and drinking cold food and beverages. In adults, the triggers can also be due to exposure to pollution, smoking and poor oral hygiene.

What are some common types of Tonsillitis?

Acute Tonsillitis– This is nothing but an acute infection of Tonsillitis with symptoms lasting from a few days up to 2 weeks.

These can be of different types based on the appearance of the tonsils,

• Superficial Tonsillitis in which tonsils appear inflamed and red.
• Follicular Tonsillitis has multiple pus points seen on the tonsils.
• Parenchymatous Tonsillitis, where the tonsils appear enlarged along with inflammation and redness.
• Membranous Tonsillitis, where a thick membrane forms over the tonsils.

Recurrent Tonsillitis– This happens when a person has recurrent attacks of acute Tonsillitis in a year.

Chronic Tonsillitis– Tonsillitis that occurs continuously for more than a period of 2 weeks.

What are its Symptoms?

• Sore throat
• Fever
• Painful swallowing
• Difficulty in swallowing
• Swelling in neck and pain over swelling
• Patches or pus over tonsils
• Halitosis (bad breath)

How to differentiate between viral and bacterial Tonsillitis?

Viral Tonsillitis is associated with a cough, fever for less than 3 days, symptoms of cold and the presence of other upper airway symptoms.

High-grade fever, pus points on the tonsil along with painful neck swelling (lymph-node swelling) without any cold or cough usually points more towards Tonsillitis of bacterial origin. 

Investigations

• Visualisation of the tonsils
• Tonsils enlargement is graded as per the size of the tonsil (Grade I-IV).
• Blood work up – Blood counts, inflammatory markers.
• Throat swab for culture
• Monospot test for Infectious mononucleosis

Treatment of Tonsillitis

Medical management

Viral Tonsillitis is often self-limiting and can be managed with supportive care at home. There is no indication for antibiotics in case of Viral Tonsillitis.

• Throat gargling with warm water with salt or antiseptic solutions.
• Drinking warm liquids and plenty of fluids for hydration.
• Over the counter painkillers and paracetamol. 
• Bacterial Tonsillitis can be managed with antibiotics on the recommendation by a doctor, along with supportive care.

Surgical management

The Surgical removal of tonsils (Tonsillectomy) can be done only when recommended by a surgeon. Some common reasons why tonsils are removed,

• Recurrent episodes of Tonsillitis, more than 7 episodes in a year.
• Formation of Abscess around tonsils.
• Difficulty in breathing and any obstruction in the airway while sleeping.
• Suspicion of Malignancy. 

When to visit a hospital?

• Tonsillitis in young infants.
• In high-risk patients or immunocompromised patients.
• Not able to take any oral feeds and dehydration.
• Difficulty in breathing.
• Cellulitis or Abscess in the throat.
• Stridor(Noisy breathing).

How can it be prevented?

1. Washing hands frequently.

2. Keeping your immunity in check.

3. To avoid water and food with symptomatic people.

4. To avoid smoking and drinking.

5. To have good oral hygiene.

6. In children – Vaccination against common viral infections.

7. Covering the mouth and nose while coughing and sneezing can also help prevent infection.

8. In adults, cessation of smoking. 

Conclusion

Tonsillitis is a very common infection that can be safely managed at home. The key lies in preventing the disease from occurring and practising good oral hygiene. Knowing and avoiding the triggers for infection also helps in stopping recurrent Tonsillitis.