Tonsillitis

Posted in Disease Information

Introduction

Tonsillitis is inflammation of the tonsils, usually due to a viral infection or, less commonly, a bacterial infection. It is a common type of infection in children.

Symptoms of tonsillitis include:

• Sore throat that can feel worse when swallowing
• High temperature (fever) over 38°C (100.4°F)
• Coughing
• Headache

Symptoms will usually pass within 3-4 days.

When to see Dr. B C Shah

Tonsillitis is not usually a serious condition so you only need to see Dr. B C Shah if your child:

• has symptoms lasting longer than four days that show no signs of improvement
• has more severe symptoms, such as being unable to eat or drink because of their pain, or has breathing difficulties

Treating tonsillitis

There is no specific treatment for tonsillitis, but there are several things that can help alleviate symptoms, such as:

• Paracetamol or ibuprofen to help relieve pain
• Plenty of bed rest
• Encouraging your child to drink plenty of fluids

If tests show that a bacterial infection is the cause of tonsillitis, a short course of antibiotics may also be prescribed, although this is often not necessary.

Most cases of tonsillitis get better within a week. A small number of children have tonsillitis for a long time or it keeps coming back. This is known as chronic tonsillitis and may require treatment with surgery.

However, surgery to remove the tonsils (tonsillectomy) is now usually only recommended if your child has five or more debilitating episodes of tonsillitis in a single year.

What are tonsils?

The tonsils are two small glands found at the back of the throat behind the tongue. It is thought that they act as a barrier against infection in children whose immune system (the body’s defence against infection) is still developing.

The theory is that by becoming infected the tonsils isolate any infection and prevent it from spreading further into the body.

It is thought that the tonsils then lose this ability as the rest of the immune system fully develops. This may explain why tonsillitis is so common in children but relatively rare in adults.

What causes tonsillitis?

Most cases of tonsillitis are caused by a viral infection, such as the viruses that can cause the common cold or influenza (flu virus).

Some cases can also be caused by a bacterial infection, typically a strain of bacteria called group A streptococcus bacteria.

These types of infections spread easily so it is important to try to avoid passing the infection on to others by:

• keeping your child away from school or nursery until Dr. B C Shah says it is safe for them to return (this is usually when their symptoms have passed)
• encouraging your child to cough and sneeze into a tissue and throw it in a bin
• encouraging your child to wash their hands before eating, after going to the toilet and, if possible, after coughing and sneezing

Who is affected

Tonsillitis is very common in children aged 5-15 years old. Almost all children will have at least one episode of tonsillitis as they grow up.

Tonsillitis occasionally occurs in young adults. This is usually the result of a type of infection known as glandular fever.

Complications

Complications of tonsillitis are rare and usually only occur if the condition is caused by a bacterial infection.

They are usually the result of the infection spreading into another part of the body, such as the middle ear (otitis media).

Symptoms of tonsillitis

 The main symptom of tonsillitis is a sore throat. 

Other common symptoms include:

• Red and swollen tonsils
• Pain when swallowing
• High temperature (fever) over 38°C (100.4°F)
• Coughing
• Headache
• Tiredness
• Pain in your child’s ears or neck
• White pus-filled spots on your child’s tonsils
• Swollen lymph nodes (glands) in your child’s neck
• Loss of voice or changes to your child’s normal tone of voice

Less common symptoms of tonsillitis may include:

• Being sick
• A ‘furry’ tongue
• Bad breath
• Difficulty opening the mouth

Younger children may also complain of a stomach ache, which can be caused by the swelling of the lymph nodes in the abdomen.

Causes of tonsillitis

It is estimated that around 8 out of 10 cases of tonsillitis are caused by a viral infection.

Viruses known to cause tonsillitis include:

• Rhinoviruses – which are viruses that cause the common cold
• The influenza virus
• Parainfluenza virus – which causes laryngitis and croup
• Enteroviruses – which cause hand, foot and mouth disease
• Adenovirus – which is a common cause of diarrhoea
• The measles virus

In rare cases, tonsillitis can be caused by the Epstein-Barr virus, which is the virus that causes glandular fever. If this is the case, you will probably feel very ill. You may have swollen lymph nodes (glands) throughout your body and an enlarged spleen.

Bacterial tonsillitis

Bacterial tonsillitis may be caused by a number of different bacteria, but is usually caused by group A streptococcus bacteria.

In the past, serious bacterial infections, such as diphtheriaand rheumatic fever, have been associated with tonsillitis, but this is now very rare due to vaccination and improved treatment of these diseases.

How you catch tonsillitis

Tonsillitis is spread in the same ways as colds and flu. It’s contained in the millions of tiny droplets that come out of the nose and mouth when an infected person sneezes or coughs. You can then become infected with the virus by breathing in these droplets from the air.

You can also become infected by handling a surface or object that these droplets have landed on and then touching your face.

Diagnosing tonsillitis

See Dr. B C Shah if you think that your child has tonsillitis. Dr. B C Shah will examine their throat and ask them (or you) questions about the symptoms.

There are four main signs that determine whether tonsillitis is due to a bacterial infection rather than a viral infection.

These are:

• A high temperature
• White pus-filled spots on your child’s tonsils
• No cough
• Swollen and tender lymph nodes (glands)

If your child has two of the above, Dr. B C Shah may recommend further testing. If your child has three or more of the above then it is highly likely that your child has bacterial tonsillitis and antibiotics may sometimes be prescribed.

Laboratory testing

If a more detailed diagnosis is required, a swab sample can be sent to a laboratory for analysis. The results can take a few days to return.

Laboratory tests are mainly used for patients in high-risk groups (such as those with weakened immune systems) or if previous treatment has failed.

Blood test

If you develop tonsillitis as an adult and you also have additional symptoms such as swollen nodes and a very painful throat Dr. B C Shah may recommend you have a blood test to see whether you have glandular fever.

Treating tonsillitis

There is no specific treatment for tonsillitis.

Whether your child’s tonsillitis is caused by a virus or bacteria, it is likely that their immune system will clear the infection within a few days. In the meantime, there are some things that you can do to help.

Make sure your child has plenty to eat and drink, even if they find it painful to swallow. Being hungry and dehydrated can make other symptoms, such as headaches and tiredness, worse.

If your child has recurring bouts of tonsillitis, surgery may be considered.

Self-help

Over-the-counter (OTC) painkillers such as paracetamol and ibuprofen can help relieve symptoms such as a sore throat.

When treating children with painkillers it is important to check you have bought the correct type and dosage as younger children only need small dosages. Your pharmacist will be able to advise you.

Children under 16 years of age should not take aspirin.

There are also over-the-counter treatments that can soothe a sore throat, such as lozenges and oral sprays.

Some people find that gargling with a mild antiseptic solution can help relieve a sore throat.

An alternative method is to gargle with warm salty water. Mix half a teaspoon of salt (2.5g) with a quarter of a litre (eight ounces) of water. It is important never to swallow the water so this method may not be suitable for younger children.

Antibiotics

Even if tests confirm that your child’s tonsillitis is due to a bacterial infection they still may not be prescribed antibiotics. There are two main reasons for this:

• In most cases of tonsillitis the use of antibiotics will not speed up the recovery time but can still cause unpleasant side effects such as stomach pain and feeling sick
• The more an antibiotic is used to treat a non-serious infection, the greater the chance that it will not be effective in treating a more serious infection (this is known as antibiotic resistance)

Exceptions are made if:

• Your child’s symptoms are severe
• Your child’s symptoms show no sign of easing
• Your child has a weakened immune system

In these circumstances a 10-day course of penicillin is usually recommended. If your child has a known allergy to penicillin then alternative antibiotics, such as erythromycin, can be used.

Antibiotics sometimes cause mild side effects, such as an upset stomach, diarrhoea or a rash.

Surgery

Surgery for tonsillitis is now usually only recommended if:

• Your child has five or more episodes of sore throat due to tonsillitis in one year
• The episodes of tonsillitis are disabling and are disrupting normal activities, such as school work

Surgery involves removing the tonsils. This is done in an operation known as a tonsillectomy.

A tonsillectomy is done under a general anaesthetic, which means that your child will be asleep during the procedure. Your child’s mouth will be held open to allow Dr. B C Shah to see their tonsils, and no cuts will be made in their skin.

The operation can be carried out in a number of ways:

• Cold steel surgery. This is the most common method, where a surgical blade is used to cut the tonsils out. Bleeding is controlled by applying pressure or, occasionally, the blood vessels are sealed using heat generated by diathermy.
• Diathermy. A diathermy probe is used to destroy tissue surrounding the tonsils and to remove the tonsils. At the same time, the heat seals the blood vessels to stop any bleeding.
• Coblation (or cold ablation). This method works in a similar way to diathermy but uses a lower temperature (60°C). It is considered less painful than diathermy.
• Lasers. High energy laser beams are used to cut away the tonsils and then seal the underlying blood vessels shut.
• Ultrasound. High energy ultrasound waves are used in a similar way to lasers.

Each of these techniques is relatively similar in terms of safety, results and recovery .

Your child will usually be able to leave hospital the same day or the day after surgery is performed.

After surgery

After surgery it is likely that your child will experience some pain at the site of the surgery. This can last for up to a week. Painkillers can help relieve the pain.

Children who have had a tonsillectomy should be kept off school for two weeks. This is to reduce the chance of them picking up an infection from another child that will make them feel more uncomfortable.

They will probably find swallowing difficult after a tonsillectomy, but it is important that they eat solid foods as this will help the throat to heal more quickly.

They should drink plenty of fluids but avoid acidic drinks, such as orange juice, as they will sting.

It is important to make sure they keep their teeth clean as this helps prevent infection in the mouth.

The pain usually gets worse during the first week after the operation and gradually improves during the second week. Earache is common with tonsillectomies and is no cause for concern.

Post-operative bleeding

A relatively common complication of tonsillectomy is bleeding at the site where the tonsils were removed. This can occur in the first 24 hours after surgery or up to 10 days after surgery.

It is estimated that around 1 in 100 children and 1 in 30 adults will experience post-operative bleeding.

Minor bleeding is not usually a cause for concern as, in most cases, it resolves by itself. Gargling cold water can often help stem the bleeding as the cold water can contract the blood vessels.

However, in some cases the bleeding can be extensive, causing people to vomit up or cough up blood.

Extensive bleeding may need treatment with surgery or a blood transfusion.

Complications of tonsillitis

Complications resulting from tonsillitis are uncommon. Some of the problems that occur are outlined below.

Middle ear infection

Middle ear infection (otitis media) is when the fluid in the middle ear, between the eardrum and inner ear becomes infected by bacteria. In most cases, the infection clears by itself.

Quinsy

A much less common complication of tonsillitis is called quinsy. This is a collection of pus (an abscess) that develops between the back of one of the tonsils and the wall of the throat.

If your child develops quinsy their symptoms will become rapidly worse.

Quinsy is relatively rare. Only 1 in 1,000 children with tonsillitis will go on to develop quinsy.

Quinsy is usually treated using a combination of antibiotics and surgery to drain the pus from the abscess.

Sleep apnoea

If your child has persistent or recurring tonsillitis (chronic tonsillitis) it may cause breathing difficulties during sleep. This is known as obstructive sleep apnoea.

Your child will not usually wake up during sleep, but their deep sleep will be disturbed. This can make them feel very tired during the day.

Children affected by sleep apnoea will often snore or gasp loudly as they sleep.

If your child develops sleep apnoea due to tonsillitis, it would usually be recommended that their tonsils are surgically removed (tonsillectomy).

Other complications

Other complications of tonsillitis are now very rare and usually only occur if an underlying bacterial infection is left untreated. They include:

• Scarlet fever – a condition that causes a distinctive pink-red skin rash
• Rheumatic fever – this causes widespread inflammation throughout the body, leading to symptoms such as joint pain, skin rashes and jerky body movements
• Glomerulonephritis – an infection (swelling) of the filters in the kidneys that can cause vomiting and loss of appetite