Tonsillitis

Tonsillitis is mostly loosely referred to as sore throat. However, sore throat is only one of the prominent symptoms of tonsillitis. It is common in children from the age of 3 up to 15 years of age, but also seen in adults.

The body has tissues which help to trap germs and destroy them before they get into the body to cause infections.

Tonsils are one of those lymphoid tissues in the mouth that perform this function .

This article explores the causes, symptoms, treatment and prevention of tonsillitis. It is called hakin wuya in Hausa language, mgbapia akpiri in Igbo, and belu belu in Yoruba language.

Tonsillitis versus adenoiditis

The tonsils are a lump of tissues on either side of your upper throat, just beside your soft palate whereas the adenoids are a lump of tissues at the roof of your mouth below your nose.

Although these tissues protect your mouth and upper respiratory tract from infections, they may become infected themselves. When large amounts of germs overpower the tonsils,either one or both tonsils become swollen, red and painful. This is called tonsillitis. Since both tissues are so closely located, both may be infected at same time.

tonsillitis

Types of Tonsillitis

The patient’s history determines the type of tonsillitis (acute, recurrent, or chronic tonsillitis).

Acute tonsillitis starts and resolves in 3-4 usually but takes up to 10 days to resolve fully.

Recurrent tonsillitis is when an individual has up to 6 bouts over the course of 12 months or 5 in 2 consecutive years l.

Chronic tonsillitis follows acute tonsillitis, with swelling of the tonsils and lymph nodes for months to years.

Risk factors

Tonsillitis is common in people whose immunity is low such as those who are on long term steroid medications or drugs that suppress immunity, people who have autoimmune diseases (diseases in which the body destroys its own cells because it has ceased to recognise itself), cancer patients, HIV/AIDS, diabetes mellitus.

It is also more common in adults who spend long hours in contact with children such as nursery school teachers. 

Causes of tonsillitis

Tonsillitis occurs due to viral or bacterial infections. Most viral causes should resolve on their own without antiviral treatment. However, viral infection makes room for bacterial infection of the tonsils which requires antibiotic treatment.

Viral causes of tonsillitis include Ebstein Barr virus (EBV), herpes simplex virus (HSV), influenza, adenovirus and SARS cov 2 (COVID-19).

Bacterial causes are the group A and B beta-haemolytic streptococcus. Sometimes referred to as strep throat, tonsillitis resulting from Group A beta-hemolytic Streptococcus (GABHS) is one of concern because of the numerous complications associated with infection by this organism. This infection is common in pre-school and school age children. It is contagious and transmitted through the air. When an infected person coughs or sneezes, the organism becomes airborne and can easily be transmitted to people in close contact with the infected person. It may also be transmitted by saliva of an infected person. Hence sharing of cups, spoons and water bottles or straws can predispose to the infection.

Symptoms of Tonsillitis

Symptoms of Acute tonsillitis are:

  • Painful swallowing
  • Sore throat
  • Fever
  • Difficulty swallowing
  • Pain and swelling of the lymph nodes in the neck
  • Bad breath (Halitosis)

Tonsillitis of viral origin may be associated with runny nose, cough and injuries in the mouth or lips (fever blisters).

When the tonsils become swollen enough to obstruct the airway, it may cause a reduction in free flow of air resulting in the following:

  • Breathing with the mouth
  • Snoring
  • Sleep apnoea
  • Unrefreshing sleep
  • Tiredness

Chronic tonsillitis is characterised by

  • halitosis,
  • persistent swelling of lymph nodes in the neck
  • persistently swollen tonsils

Tonsil balls (tonsil stones) : These are also called tonsiliths, these are yellowish, foul-smelling hard substances that are dislodged from the tonsils either spontaneously or during retching. It is formed from the build up of saliva, bacteria, and mucous secretions in the mouth. It then lodges in small holes or depressions on the surface of the tonsils.

tonsil stones
Pictures shows tonsil stones

Tonsillitis may become complicated by collection of pus within and around the tonsils. This is called a peritonsillar abscess (PTA). Symptoms are:

  • Worsening of sore throat
  • Worse pain on swallowing such that they start to drool.
  • Difficulty opening the mouth
  • Bad breath
  • Change in voice
  • Fever
  • Ear pain

Some long term complications of group A beta hemolytic streptococcus are that it may affect the heart, kidneys, joints and skin. When it affects the heart, occurs within 2-4wks it destroys heart valves, which if not replaced may lead to heart failure. Following infection with GABHS, effect on the kidney occurs within 1-2 weeks with reduced urine production, dark colored urine and body swelling. Arthritis (hot, swollen and painful joints) is another complication that may arise as a result of this infection. It may also cause reddish flat skin rashes.

Tests

Your doctor will ask questions regarding symptoms and then determine the degree of distress regarding airway and swallowing function.

Your doctor will examine your throat with your mouth open, tongue protruded and depressed with a spatula while shining light into it. S/he also takes a throat swab during this examination or later.

Treatment

Treatment aims at maintaining:

 -Hydration, either with oral or intravenous fluids. This also includes controlling fever with antipyretic and tepid sponging as fever increases fluid loss.

-Energy requirements with a high calorie soft or liquid diet.

-Pain control with analgesics and NSAIDS. Throat lozenges and salt water gargle helps to soothe the throat pain.

Treatment is with antibiotics and removal of the tonsils if it is chronic or recurrent and in those with complications such as peritonsillar abscess.

Both the Adenoids and tonsils may be removed surgically as a treatment for chronic tonsillitis. Tonsillectomy with or without adenoidectomy is the treatment for chronic tonsillitis

Prevention

Preventive measures to avoid spreading infection or getting recurrent infections include

-Hand washing particularly after coughing, sneezing or using the toilet.

-cough or sneeze into your elbow.

-Avoid sharing utensils, cups or drinks.

-Change toothbrush after treatment of a bout of tonsillitis.

  • Since tonsillitis could be a symptom of COVID-19, it’s imperative to strictly observe COVID-19 prevention protocols viz: social distancing, frequent hand washing, use of face mask and avoidance of crowded places.

About the author

Author profile
Doctor

Grace is an internist currently practising in Nigeria. She has gained experience practising both in the private and public health sectors over the last ten years. She is passionate about giving patients adequate information about their health conditions. She believes that a large part of the management of chronic diseases lies with patients' understanding of their illnesses and the need for lifestyle modifications and medications.