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Tonsillitis and When Is Tonsillectomy Needed

What is Tonsillitis?

Tonsillitis is an inflammation of your tonsils called palatine tonsils — two oval-shaped masses of soft tissue that sit at the rear of your throat— one on each side.

Tonsils are part of your immune system and help fight off germs entering through your nose and throat. They are, therefore, at risk of becoming infected.

Though tonsillitis is more common in children and teens, adults can also develop the condition.

What Causes Tonsillitis?

Tonsillitis occurs due to an infection, most likely a viral infection (such as the common cold) but a bacterial infection (most commonly a strep throat) may also trigger the condition. You or your child can contract these bacteria or viruses after coming in contact with contaminated droplets of an infected person during coughing, sneezing, talking, or kissing.

What are the Different Types of Tonsillitis?

Tonsillitis can be:

  • Acute, in which case it lasts anywhere from three days to two weeks, and can either be bacterial or viral in origin.
  • Chronic, which can persist for long periods, usually beyond two weeks, and is almost always bacterial.
  • Recurrent, in which case, a patient experiences several, usually five or more episodes of tonsillitis in a year.

What are the Signs and Symptoms of Tonsillitis?

Tonsillitis can give rise to the following signs and symptoms:

  • Sore throat
  • Difficulty or pain while swallowing
  • A scratchy sensation inside the throat
  • Fever
  • Headache
  • Earache
  • Stomachache
  • Bad breath
  • Jaw and neck tenderness
  • Red and enlarged tonsils
  • Inflamed, or red, throat (pharynx) in acute tonsillitis — which is why acute tonsillitis is also sometimes called pharyngeal tonsillitis
  • Whitish or sometimes yellowish spots on tonsils

How Is Tonsillitis Diagnosed?

Diagnosis of tonsillitis requires complete evaluation and tests to determine if tonsillitis is caused by a bacterium or a virus. The treatment will vary with the causative factor. Hence, it’s imperative to establish the cause of tonsillitis.

Examination for tonsillitis includes the following: 

  • Examining your throat for redness, swelling or white spots on the tonsils
  • Examining your ears and nose for other signs of infection
  • Feeling the sides of your neck to check if the lymph nodes are swollen and tender

Determining the Cause of Tonsillitis

After examination, the next step is to determine the cause. To confirm or refute strep throat as the underlying cause, your ENT specialist will order a rapid antigen test (RADT), also known as a rapid strep test. This test entails swirling a long cotton swab inside the back of your throat to collect a sample. The results of this test are readily available in about 10-15 minutes.

However, If RADT is negative, but there’s a strong suspicion of strep throat, a throat culture can be ordered to confirm the diagnosis. This test checks for the presence of specific bacteria in your throat. Its results come back in 2-5 days.

Negative test results for bacterial tonsillitis indicate that the tonsillitis is viral, not bacterial.

How do you Treat Tonsillitis?

The treatment of tonsillitis depends on the cause.

Viral tonsillitis

It is treated with supportive measures such as:

  • Adequate rest
  • Plenty of fluids to stay hydrated
  • Medications for relieving pain and lowering fever, like ibuprofen or acetaminophen (paracetamol)
  • Sucking on throat lozenges
  • Gargling and rinsing with warm salt water to help soothe a sore throat

Bacterial tonsillitis

If the test results detect a bacterial infection, an antibiotic is prescribed for about 7 to 10 days to help the infection go away somewhat faster. Taking an antibiotic will also stop you or your child from being contagious within 24 hours. But this doesn’t mean that you stop taking the antibiotic before completing the entire course. Doing so can worsen your condition. Besides, antibiotics can also cut down your risk of developing complications – though these are rare in tonsillitis.

When is a Tonsillectomy Needed?

Tonsillectomy is the surgical removal of the tonsils. It used to be a fairly common procedure for treating tonsillitis in the olden days. Today, however, tonsillectomy is not recommended for every patient with tonsillitis. It is only performed in patients who have:

1. Recurrent, frequent episodes of tonsillitis, generally defined as:

  • At least seven episodes in the preceding year
  • At least five episodes a year in each of the previous two years
  • At least three episodes a year for three years in a row

2. Chronic or recurrent bacterial tonsillitis that fails to respond to optimal doses of appropriate antibiotics.

3. Severe symptoms that hamper everyday life, such as missing school or work.

4. Complications of tonsillitis, such as:

  • the formation of a pus-filled pocket close to your tonsils called peritonsillar abscess – that doesn’t improve with medical treatment or drainage
  • difficulty breathing due to enlarged tonsils
  • pauses in breathing while sleeping, indicating a condition called sleep apnea (more than 70% of children who undergo tonsillectomy for sleep apnea report an improvement of their symptoms)
  • difficulty swallowing

5. Multiple antibiotic allergies or intolerances.

How is a Tonsillectomy Performed?

A tonsillectomy is done under general anesthesia (i.e., by sedating you or your child with medications). You will not be aware of the procedure and will not feel any pain while your ENT surgeon is removing the tonsils.

There are several ways of surgically removing the tonsils. However, Surgeons at Ear, Nose, Throat & Allergy Specialists use the Coblation method of tonsillectomy due to its high precision and safety profile.

What is a Coblation Tonsillectomy

Coblation, which means controlled ablation, delivers low-temperature radiofrequency waves with the help of an electrical wand to dissolve the tonsils at the molecular level. This procedure allows your tonsils to be precisely removed without injuring the nearby tissues.

Because there is minimal to no damage to surrounding areas, coblation tonsillectomy is considered a minimally invasive procedure. It leads to considerably less pain, post-operative bleeding, fewer infections, and a faster return to daily activities as compared to the traditional approach.

How is the Recovery after a Tonsillectomy?

Recovery from a tonsillectomy can take anywhere between 10 to 14 days, and depends on the type of surgical procedure employed. It’s normal to experience small streaks or specks of dark or dried blood right within 24 hours of surgery (called primary bleeding) and between 5 and 10 days when scabs fall off from the surgical site (called secondary bleeding).

Adults usually take longer to recover from the surgery than children. You’ll have throat pain and discomfort for 1 to 2 weeks or even longer. The pain may get worse before it gets better and may make your ears hurt. You may also sleep with your mouth open and breathe through your mouth, especially while lying down at night.

All these complaints usually improve in 7 to 14 days after surgery. However, mouth breathing can make your mouth very dry. Therefore, make sure to keep yourself or your child well-hydrated. Placing a humidifier by the bed may also be a good idea to increase humidity and ease dry mouth symptoms.

What to Eat After a Tonsillectomy?

The key to recovery is drinking plenty of fluids. It’s always best to start with clear liquids and advance to soft, semi-solid foods that are easily chewable. You may gradually add to your or your child’s diet as tolerated. It’s best to avoid hard, crunchy, and spicy foods, as these can aggravate discomfort and irritation.

File:Blausen 0859 Tonsils&Adenoids.png. (2018, January 31). Wikimedia Commons, the free media repository. Retrieved April 29, 2020 from https://commons.wikimedia.org/w/index.php?title=File:Blausen_0859_Tonsils%26Adenoids.png&oldid=284404815.