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  Tonsillitis

Tonsillitis is an inflammation of the tonsils, the fleshy clusters of lymphatic tissue on both sides of the back of the throat that fight off any pathogen that enter the body through the oral cavity.

Tonsillitis Inflammation of the tonsils
Tonsillitis


Symptoms

A patient affected with this condition typically has a sore throat, fever, swollen glands in the neck, difficulty in swallowing (dysphagia) as well as painful swallowing (odynophagia). The tonsils become enlarged, erythematous (reddish) and can be coated with a yellow, gray or white spots on its surface also known as exudates.

Causes

Viruses such as the Epstein-Barr virus (EBV, the cause of glandular fever and infectious mononucleosis) or the Coxsackie virus are the causes of most tonsillitis. However, among the bacterial causes, the culprit is usually the Group A streptococcal bacteria resulting in strep throat. Sometimes, tonsillitis, is caused by a superinfection of spirochete and treponema, in this case called Vincent's angina or Plaut-Vincent angina.

Diagnosis and Treatment

Doctors often can tell the difference just by looking at the tonsils, and can detect strep bacteria with a rapid strep test or a throat swab culture. Treatment of tonsillitis depends on the probable causative agent. If the tonsillitis is caused by a virus, the length of the illness depends on which virus is involved. Usually viral infection is self-limiting, the body fights off the infection on its own within one week. However, some rare viral infection resolves for up to two weeks. If the tonsillitis is caused by strep bacteria then antibiotics are prescribed along with painkillers (acetaminophen or ibuprofen). It is advisable that the patient increases fluid intake along with soft diet. In pediatric patients complaining of difficulty in swallowing , try giving milkshakes, popsicles, icecream and mostly soup-based food. Usually penicillin, or erythromycin if the patient is allergic to penicillin. It is important that the patient completes the full course of antibiotics of treatment to prevent development of any complications. One might also try gargling a 50/50 mixture of water & hydrogen peroxide. Similarly, one can simply dip a cotton swab in hydrogen peroxide and then dab your tonsils. In chronic cases, a tonsillectomy (surgical removal of tonsils) may be indicated especially if there’s history of repeated infections over several years (more than 5 to 7 months in a year).

Complications

An abscess may develop behind the tonsil during an infection, typically several days after the onset of tonsillitis. This is termed a peritonsillar abscess or quinsy. Very rarely a secondary infection may grow in the abscess which can give rise to a spreading septicemia infection (Lemierre's syndrome).

When bacteria that collects on the tonsils consume mucus that has pooled in pits (referred to as "crypts") in the tonsils, a whitish-yellow deposit known as a tonsillolith is produced. These "tonsil stones" emit a very pungent odor due to the presence of volatile sulphur compounds and can only be cured by tonsillectomy or by sealing the crypts by laser.

A tonsillectomy can also be curative in cases of hypertrophy of the tonsils also known as “kissing tonsils”. Surgery is indicated because this condition can result in snoring, mouth breathing, disturbed sleep, and obstructive sleep apnea, during which the patient stops breathing and experiences a drop in the oxygen content in the bloodstream.

In very rare cases especially in developing countries, diseases like acute rheumatic fever or acute post-strep glomerulonephritis (APSGN) can occur as complications after a bout of strep throat infection .

Preventing Tonsillitis

Tonsillitis is a contagious disease so as preventive measures, avoid letting your child near anyone who already has tonsillitis or a sore throat and make sure to practice good hand-washing habits.

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