Tonsillitis – Causes and Risk Factors, Pathophysiology, Clinical Manifestations, Diagnostic Evaluations and Management

Tonsils are two small masses of tissue at the sides of the throat; its function is to defend the body against toxic substances that are found in the blood. Tonsillitis is a painful disease that is caused by an inflamed tonsils, the inflammation is due to infection or because they are filled with foreign substance. Most attacks of tonsillitis occur in persons between the ages of 10 to 40.

When tonsils are infected, they will look swollen red and tender. A grayish-white or yellowish coating may cover part or all of the tonsils. The surrounding area of the throat near the tonsils also may appear red and inflamed. There may be swelling at the sides of the neck as the lymph nodes grow larger while producing cells to fight the infection.

 

CAUSES AND RISK FACTORS

There are several variations of tonsillitis; acute, recurrent, and chronic tonsillitis and peritonsillar abscess. Acute tonsillitis can either be bacterial or viral in origin. Subacute tonsillitis is caused by the bacterium Actinomyces. Chronic tonsillitis, which can last for long periods if not treated, is mostly caused by bacterial infection.

Some important causes of tonsillitis includes: Streptococcus and glandular fever. When tonsillitis is caused by bacteria, the most common type of bacteria that causes tonsillitis are Group A beta-streptococci. Glandular fever is one of the viral illnesses which can cause tonsillitis, but there are many other viruses that may also be responsible. These includes: herpes simplex virus, Streptococcus pyogenes and Epstein-Barr virus, cytomegalovirus, adenovirus and the measles virus.

PATHOPHYSIOLOGY

As viruses and bacteria enter the body through the nose and mouth, they are filtered in the tonsils. The tonsils work by surrounding them with white blood cells which causes the body to develop a fever that can become extremely high in children. As the infection becomes serious, the tonsils will inflame and become painful. The infection may also be the present in the throat and surrounding areas, causing inflammation of the pharynx. This is the area in the back of the throat that lies between the voice box and the tonsils. Tonsillitis is contagious disease usually spreads from person to person by contact with the throat or nasal fluids of someone who is already infected.

CLINICAL MANIFESTATIONS

The characteristics of the disease are pain in the throat and trouble swallowing. Tonsillitis is characterized by signs of red, swollen tonsils which may have a purulent exudative coating of yellow or white patches (i.e. pus). Each person with tonsillitis may not experience all of the symptoms. Some of the major symptoms of tonsillitis are:

• Swelling and pain in the throat or severe sore throat
• Referred pain to the ears
  
• Painful/difficulty in swallowing
  
• Fever and chills
  
• Headache
  
• Myalgia (muscle aches)
  
• Stiff neck
  
• Swelling of lymph nodes in the neck
  
• Swelling of the eyes, face and neck may occur
  
• Nausea can occur in severe cases
  
• Bad or foul breath (halitosis)
  
• Snoring and disturbed sleep patterns
  

Other uncommon symptoms that can be experienced with tonsillitis include loss of appetite, vomiting, abdominal pain, constipation, a tongue that feels furry or fuzzy, difficulty opening the mouth, headaches and a feeling of dry or cotton mouth.

 

DIAGNOSTIC EVALUATIONS

A thorough physical examination is performed and a careful history is obtained to rule out related or systemic conditions. Tonsillitis can be diagnosed by performing a rapid strep test, also called a throat culture. To perform the throat culture, the doctor will use a long cotton swab to swipe off some of the stuff on the surface of the back of your throat. The doctor will then test the “stuff” on the cotton swab. This test will determine whether you have tonsillitis and whether it is caused by a bacteria or a virus.

 

MANAGEMENT

Treatments of tonsillitis consist of pain management medications and lozenges. Ibuprofen or other analgesics can help to decrease the edema and inflammation, which will ease the pain and allow the patient to swallow liquids sooner.

If the tonsillitis is caused by bacteria, then antibiotics are prescribed, with penicillin being most commonly used. Erythromycin and clarithromycin are used for patients allergic to penicillin. If tonsillitis is caused by bacteria, with antibiotic treatment, the illness is usually cured within 1 week. However, it may take several weeks for the tonsils and swollen glands to return to normal size.

If the tonsillitis was caused by a virus, your body with fight off the infection on its own. However, medication can be prescribed to alleviate the symptoms. When tonsillitis is caused by viruses, the length of illness depends on which virus is involved. Usually, people are almost completely recovered within 1 week.

If the child is having recurrent attacks (approximately two attacks in a month); when tonsils are interfering with speech swallowing and respiration; when there is risk of developing heart disease then surgery to remove the tonsils (tonsillectomy) should definitely be considered.

 

Some important herbal treatments for tonsillitis include:

• Gelsemium 6C: it is a well known herb for the treatment of tonsillitis. It is mainly used for the healing process of tonsils.
• Belladonna 30C: A homeopathic remedy used for fast relief of acute fever, pain headaches, sore throat, swollen tonsils, dry cough
  
• Gallium Aperine (also known as Cleavers): It is an excellent cleansing tonic and has a beneficial effect on all the lymph glands, including the tonsils. Gallium aperine is effective in relieving swollen tonsils and other lymph glands and is also recommended for glandular fever
  
• Salvia Officinalis: It has a beneficial effect on all conditions of the mouth  and throat and has well-known herbal astringent, antibiotic and antiseptic properties.
  

Home Remedies for Tonsillitis

• ​The first thing to do is detoxification, drink orange juice and aloe. Eat plenty of green vegetables and fresh fruits
  
• Take aspirin if you are an adult, acetaminophen if you are a child, which help to numb the throat
  
• Stay hydrated by drinking a lot of water. Drink iced beverages or suck on popsicles. Frozen liquids help numb the throat. Try hot teas with honey, and clear soups
  
• Get plenty of rest and avoid cigarette smoke and other irritants
  
• Gargle with warm salt water and fenugreek seeds: A gargle made from fenugreek seeds is very effective in severe cases of tonsillitis ​
  

Post Operative Care Instructions Following Tonsillectomy

The following instructions will help you know what to expect in the days following surgery. Do not, however, hesitate to call if you have any questions or concerns.

• Physical Activities: After this surgery, children should rest but may play inside after one or two days and may be outside after 3 or 4 days, if they feel up to it. Strenuous physical activity following surgery is discouraged. Children may return to school whenever comfortable; a week in average, but 10 days is not unusual.
• Diet: The more your child drinks, the sooner the pain will subside. Water, apple juice, grape juice and Gatorade are excellent sources of liquid. Soft foods such as ice cream, sherbet, yogurt, pudding, apple sauce and jello, should also be encouraged. Other soft, easily chewed foods are also excellent. Avoid hot or spicy foods, or foods that are hard and crunchy. Often, chewing gum speeds comfortable eating by reducing the spasm after surgery and can be started anytime after surgery.
  
• Pain: For the first several days following surgery, pain in the throat is to be expected. This can usually be controlled with Liquid Tylenol (acetaminophen) or Tylenol with Codeine. Avoid medication containing aspirin, ibuprofen, or other anti-inflammatory medication, for 2 weeks. Pain is often worse at night and may prompt the need for additional pain medication. Ear pain, especially with swallowing is also a common occurrence; it is not an ear infection but due to referred pain from the surgery. Treat it with Tylenol or Tylenol with Codeine. Occasionally a stiff neck may occur. Please call if it becomes excessively painful
  
• Ice Collar: an ice collar can also be helpful for post operative sore throat. Make this by placing ice cubes and water in the large Zip-Loc bag and wrapping it in a towel. Gently lay the ice pack on the front of the neck.
  
• Fever: A low grade fever following surgery may occur and should be treated with Tylenol (acetaminophen). Follow the directions on the bottle. While children have a fever, they should play quietly or remain in bed. If the fever persists (more than two days) or if a higher fever develops, call. Fever may indicate that you have not taken in sufficient fluids or may have an infection.
  
• Bleeding: Post-operative bleeding is unusual, but it can occur up to 2 weeks after surgery. Most bleeding is minor and you may only see a little coating of blood on the tongue. Put your child into bed, sitting upright, and place an ice collar on their neck. Watch for spitting, coughing, or vomiting of blood.  If you suspect bleeding following surgery, call immediately. 

Tonsillitis – Causes and Risk Factors, Pathophysiology, Clinical Manifestations, Diagnostic Evaluations and Management