Tonsillitis

What are the tonsils?
The tonsils are fleshy clusters of tissue that lie on both sides of the back of the throat. They are part of a group of lymphoid tissue that helps fight off upper respiratory tract infections. They do this by trapping bacteria and viruses and then helping to make the immunoglobulins that can destroy them. Although the tonsils have a role in helping to treat infections, the tonsils themselves can become part of the problem.

When this tissue gets infected, you suffer the condition known as tonsillitis. If the tonsils get repeated infections, the tissue undergoes changes which make them more of a burden. Removing this tissue can in these instances improve your child’s health. Removal of the tonsils has not led to an increase in infections or a loss of immune (disease fighting) function. This is because there are hundreds of other lymph nodes in the head and neck that perform the same function.

What is tonsillitis?
Tonsillitis is an infection of the tonsils. This can cause the tonsils to become enlarged, red, and often coated by a substance that is yellow, gray, or white. Tonsillitis usually occurs as part of a generalized throat infection (pharyngitis). This infection is uncommon in children less than one year old. It is seen most frequently in children four to seven years of age.

What are the symptoms of tonsillitis?
Tonsillitis usually results in a bad sore throat and difficulty swallowing. The throat visibly looks inflamed (red) and the tonsils themselves are often quite swollen. A child may also experience loss of appetite, malaise (a generally ill feeling), chills, and fever above 101 degrees Fahrenheit. Glands in the neck and at the angle of the jaw may be swollen and quite tender. In infants, tonsillitis may include symptoms that appear to be less focused on the throat such as poor feeding, runny nose, and a slight fever.

What are some of the causes of tonsillitis?
Tonsillitis may be caused by either viruses or bacteria, and often the symptoms are the same no matter which germ is causing the infection. In about 85% of cases, viruses are the cause of tonsillitis and antibiotics will not help to treat this. The second most common cause is from bacteria known as Streptococcus (group A Beta hemolytic streptococcus) commonly known as “strep throat”. This is the kind of infection which can be treated with antibiotics. To try and help figure out what germ is causing the infection, your doctor may perform a throat culture.

How is tonsillitis treated?
It is important to have your primary care physician determine if the cause of the infection is viral or bacterial. Viral tonsillitis is primarily treated with bedrest, Tylenol® for fever and pain relief, and lots of fluids. Include soothing teas, warm nutritious soups or cool soft drinks, milk shakes, ice cream and popsicles. Gargling with salt water may also help. You may use a cool mist humidifier to add moisture to the air which can help soothe your child’s sore throat. Antibiotics do not help treat this type of infection.

Bacterial tonsillitis does require the use of antibiotics, primarily to help get rid of the infection quickly and prevent complications. Complications can include an infection in the bloodstream, heart problems, rash and others. If you have received an antibiotic for “strep throat” make sure that your child takes all the doses and completes the entire course of medicine. This will help prevent complications like rheumatic fever or a peritonsillar abscess (a collection of pus surrounding the tonsil).

Prevention:
To prevent tonsillitis, avoid exposure to anyone who already has tonsillitis or a bad sore throat. At home, when someone is infected with tonsillitis, be sure to keep drinking glasses and eating utensils separate, and wash dishes in hot soapy water. All family members should wash their hands frequently. All forms of tonsillitis can be contagious and usually spreads from person to person by contact with the throat or nasal fluids of someone who is already infected.

What are some of the reasons that you may be referred to a pediatric ENT specialist for evaluation of tonsil removal (tonsillectomy)?
Tonsillitis can become difficult to treat or infections may recur frequently. This can result in fatigue, poor weight gain, and poor school attendance among other things.

The tonsils can become so enlarged (tonsillar hypertrophy) that your child may have chronic difficulty swallowing or breathing at night. If severe enough, this can lead to obstructive sleep apnea.

If enlargement of only one tonsil occurs, this may be suggestive of a cancer and the tonsil is usually removed as a biopsy.

Occasionally, an abscess or collection of pus may develop around the tonsil and needs to be drained.

These are some of the more common indications for removing the tonsils. Each child, however, is evaluated for their own unique history and circumstances.