Diseases of Tonsils

Dr N Dhaneshwor Singh *

Tonsils and Throat :: Pix - Wikipedia : Blausen.com staff. "Blausen gallery 2014". Wikiversity Journal of Medicine. DOI:10.15347/wjm/2014.010. ISSN 20018762

What are tonsils?

The tonsils (palatine tonsils) are a pair of lymphoid tissue collection in the throat, one on each side of the root of the tongue. Tonsils are part of the lymphatic system, which helps to fight infections. They act as filters, trapping and killing germs that could otherwise enter our airways and cause infection. Sometimes overwhelmed with bacteria and viruses the tonsils themselves get infected and become troublesome.

Common problems of Tonsils

Acute tonsillitis-Sore painful throat with swollen tonsils due to infection by bacteria or virus. Tonsils may develop a gray or white coating. Persistent infection of the tonsils as a result of repeated episodes of acute tonsillitis causes chronic tonsillitis.

Peritonsillar abscess: – Untreated tonsillitis may create a pocket of pus next to the tonsil, pushing it inwards. Peritonsillar abscess must be drained urgently to prevent life-threatening neck and chest complications.

Acute mononucleosis-Usually caused by the Epstein-Barr virus, it causes massive swelling of the tonsils, fever, sore throat, rash and severe fatigue. Early identification and treatment help preventing rare but possible splenic rupture in such patients.

Chronic sore throat: – chronic bacterial infection of tonsils and throat causes permanent changes at cellular level causing a sensation of dryness and constant “something in the throat” feeling, often accompanied by low grade fever and neck pain.

Enlarged tonsils: Large tonsils become troublesome causing difficulty in swallowing, change of voice, snoring or disturbed sleep (sleep apnea).

Tonsilloliths (tonsil stones):- Grey-white to yellowish concretions are formed when food debris trapped in grooves in tonsils calcifies and hardens.

Tonsillitis is inflammation of the tonsils most commonly caused by viral or bacterial infection. It is a very common condition, most frequent in children aged 5-10 years and young adults between 15 and 25 years.

When do you know you have Tonsillitis?

Patients suffering from tonsillitis commonly complain of a sore throat, pain in swallowing, excess salivation, mouth breathing, chills and fever, red-swollen tonsils often covered with yellow-white pus, coughing, headache, tiredness, furry tongue, bad breath (halitosis), voice change, loss of appetite, snoring and anxiety/fear of choking.

Patients may occasionally present with painful blisters or ulcers in the throat. Pain may sometime radiate to the ears or neck. In children, symptoms may also include nausea, vomiting and pain in abdomen. Recurrent tonsillar problems hamper a child’s mental and physical growth, which may reflect as failure to gain weight, increase in ‘days-of-absence-from-school’ and poor academic performance.

Diagnosis and treatment

Management for tonsillitis depends on its cause and severity. The most common cause is viral infection (>80%), which includes adenovirus, rhinovirus, influenza and respiratory syncytial virus. Viral tonsillitis in most cases resolves by itself within few days and needs only supportive treatment for pain and fever. Bacterial tonsillitis, predominantly caused by Group A ß-hemolytic streptococcus (GABHS), if strongly suspected on clinical examination, or confirmed with rapid screening tests or throat swab culture requires appropriate antibiotics along with medications for fever and pain.

Useful home remedies to reduce the discomfort from tonsillitis include getting enough rest, drinking warm fluids and eating smooth semisolid foods, using a vaporizer or humidifier in the room and gargling with warm salt water. Sucking on lozenges also help ease throat pain.

When is surgery required?

– Tonsillectomy (surgical removal of tonsils) is considered in
– Recurrent throat infections defined as seven or more episodes in one year or five episodes per year for two years or three episodes for three years.
– Two weeks or more work/school day-loss in a year.
– Peritonsillar abscess
– Hypertrophy of tonsils causing (i) Airway obstruction causing difficulty in breathing, snoring and disturbed sleep. (ii) Difficulty in swallowing & (iii) Interference with speech.
– Tonsillitis causes febrile seizure
– Hemorrhagic tonsillitis
– Large symptomatic tonsillolith
– Suspected cancer
– Diphtheria or streptococcus carrier
– Recurrent streptococcal tonsillitis in patients with valvular-heart diseases or IgA nephropathy.

Tonsillectomy is also performed as part of other procedures i.e. Palatopharyngoplasty for sleep apnoea syndrome and styloidectomy. Traditionally tonsillectomies were done by conventional “cut and remove” method using steel scalpel. More recently techniques such as lasers, radiofrequency, harmonic scalpel, electrocautery and cryosurgical techniques are being increasingly used.

Tonsils are an important part of our immune system, however if tonsils themselves become seed for infections, removing them becomes beneficial. Multiple studies have proved it beyond doubt that removal of the tonsils does not increase ones susceptibility to infection.

Prognosis

Earlier a major preoccupation in the treatment of streptococcal tonsillitis was prevention of rheumatic fever, and its major effects on the nervous system, heart and kidneys. But with significant decrease in the prevalence of rheumatogenic strains of streptococcus in recent times, treating tonsillitis as a means of preventing rheumatic fever is considered irrational.

Problems of tonsils are more troubling to a patient than harmful. Though very rare serious complications of untreated severe tonsillitis deserve considering. They include dehydration and kidney failure due to difficulty swallowing, and blocked airways due to inflammatory swelling. An abscess may develop at the side of the tonsils (Peritonsillar abscess) which requires urgent drainage. Rarely, the infection may spread beyond the tonsil resulting in infection of deep neck spaces and life threatening chest complications. Involvement of major blood vessels i.e. internal jugular vein, may give rise to a spreading septicaemia (Lemierre’s syndrome).

Conclusion

Diseases of tonsils are very common, mostly in children. Generally these problems resolve within a week, but in case tonsillitis is severe and/or recurrent, one should consult an expert for opinion and treatment. Untreated prolong tonsillar problems negatively affects a child’s growth and development. Majority of tonsillar ailments are successfully managed conservatively on medications.

For those who requires a surgical intervention, two facts worth mentioning are:
(a) Removal of tonsils do not negatively effects ones immune system and
(b) With the present state of technological advancement in the field of medical science, surgeries of the tonsils have become much more convenient and safer.