Tonsillitis: Signs, Causes & Treatment!

Tonsillitis is a type of pharyngitis characterized by the inflammation of the tonsils.

It is commonly referred as tonsils by the general population.

SIGNS & SYMPTOMS OF TONSILLITIS

  • Sore throat
  • Red & swollen tonsils
  • White pus filled spots on the tonsils
  • High fever
  • Fatigue
  • Chills
  • Headache
  • Pain in swallowing
  • Difficulty in swallowing
  • Malaise
  • Difficulty falling asleep
  • Swollen lymph nodes
  • Nausea & vomiting
  • Pain in the ear or neck
  • Weight loss
  • Anxiety/fear of choking
  • Bad breath.

COMPLICATIONS

  • Dehydration
  • Blocked airways due to inflammation
  • Pharyngitis
  • Peritonsillar abscess, developed lateral to the tonsils
  • Lemierre’s Syndrome, infection & inflammation of the internal jugular vein which can lead to sepsis
  • Inability to swallow anything
  • In strep throat associated with tonsillitis very rarely diseases like rheumatic fever or glomerulonephritis can occur.
  • Untreated strep throat related to tonsillitis can lead to pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).

CAUSES OF TONSILLITIS

Virus

  • Adeno virus
  • Rhino virus
  • Influenza virus
  • Corona virus
  • Parainfluenza
  • Epstein Barr Virus
  • HIV
  • Herpes simplex virus
  • Cytomegalovirus
  • Respiratory syncytial virus

Bacteria

  • Group A β-hemolytic streptococcus (GABHS)
  • Staphylococcus aureus
  • Streptococcus pneumoniae
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
  • Bordetella pertussis
  • Spirochaeta

DIAGNOSIS

  1. Physical symptoms like swollen tonsils, swelling of the lymph nodes in the neck, presence of exudate, sore throat, inability to swallow & fever are noted.
  2. For the detection of the particular bacterial strain causing the infection, a bacterial culture stain is produced by a throat swab test.
  3. An increase in antistreptolysin O (ASO) streptococcal antibody titer 3–6 weeks following the acute infection can provide definitive confirmation of GABHS infection.
  4. Lymphocyte count in a full blood test is done for detection of Epstein Barr Virus.
  5. Increased values of secreted phospholipase A2 & altered fatty acid metabolism in patients with tonsillitis is identified and provides a positive diagnostic approach.
  6. Nasoendoscopy in patients with severe neck pain and inability to swallow food, for differential diagnosis of masked epiglottis & supraglotitis.

TREATMENT FOR TONSILLITIS

  • Antibiotics like;
  • Penicillin
  • Amoxicillin-Clavulanic acid
  • Clindamycin
  • Azithromycin
  • Erythromycin
  • Cephalosporins like cefixime
  • IV antibiotics
  • Pain medications/NSAIDs like ibuprofen
  • Drugs for fever like paracetamol
  • Opioid drugs like codeine & tramadol
  • Anesthetic mouthwash
  • Corticosteroids to reduce inflammation
  • Chronic cases can involve surgical removal of the tonsils: Tonsillectomy

MANAGEMENT

  • Warm water gargles
  • Lozenges
  • Honey
  • Management of bacterial infections.