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Tonsillitis

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Tonsillitis
Classification and external resources
Enlarged, red tonsils and exudative white patches of tonsillitis
ICD-10	J03., J35.0
ICD-9	463
DiseasesDB	13165
eMedicine	ent/314
MeSH	D014069

Tonsillitis is an infection of the tonsils and will often, but not always, cause a sore throat and fever.

Types

There are 2 main types of tonsillitis:acute and chronic. Acute tonsillitis can either be bacterial or viral in origin. Subacute tonsillitis is caused by the bacterium Actinomyces. Chronic tonsillitis, which can last for long periods if not treated, is mostly caused by bacterial infection.

Symptoms

Symptoms of tonsillitis include a severe sore throat (which may be experienced as referred pain to the ears), painful/difficult swallowing, coughing, headache, myalgia (muscle aches), fever and chills. Tonsillitis is characterized by signs of red, swollen tonsils which may have a purulent exudative coating of white patches (i.e. pus). Swelling of the eyes, face, and neck may occur.
In some cases, symptoms of tonsilitis may be confused with symptoms for EBV infectious mononucleosis, known colloquially as mono(US) or Glandular Fever (elsewhere). Common symptoms of Glandular Fever include fatigue, loss of appetite, an enlarged spleen, enlarged lymph nodes, and a severe sore throat, sometimes accompanied by exudative patches of pus.

It is also important to understand that symptoms will be experienced differently for each person. Cases that are caused by bacteria are often followed by skin rash and a flushed face. Tonsillitis that is caused by a virus will develop symptoms that are flu-like such as runny nose or aches and pains throughout the body. Even though the infection will not cure immediately, tonsillitis symptoms usually improve 2 or 3 days after treatment starts.

Acute tonsillitis is caused by both bacteria and viruses and will be accompanied by symptoms of ear pain when swallowing, bad breath, and drooling along with sore throat and fever. In this case, the surface of the tonsil may be bright red or have a grayish-white coating, while the lymph nodes in the neck may be swollen. The most common form of acute tonsillitis is strep throat, which can be followed by symptoms of skin rash, pneumonia, and ear infection. This particular strand of tonsillitis can lead to damage to the heart valves and kidneys if not treated. Extreme tiredness and malaise are also experienced with this condition with the enlargement of the lymph nodes and adenoids.

Chronic tonsillitis is a persistent infection in the tonsils. Since this infection is repetitive, crypts or pockets can form in the tonsils where bacteria can store. Frequently, small, foul smelling stones are found within these crypts that are made of high quantities of sulfa. These stones cause a symptom of a full throat or a throat that has something caught in the back. A foul breath that is characterized by the smell of rotten eggs (because of the sulfa) is also a symptom of this condition. Other symptoms that can be caused by tonsillitis that are not normally associated with it include snoring and disturbed sleep patterns. These conditions develop as the tonsils enlarge and begin to obstruct other areas of the throat. A person's voice is generally affected by this type of illness and changes in the tone of voice a person normally has. While a person may only become hoarse, it is possible for laryngitis to develop if the throat is used too much while the tonsils are swollen or inflamed. Other uncommon symptoms that can be experienced with tonsillitis include vomiting, constipation, a tongue that feels furry or fuzzy, difficulty opening the mouth, headaches and a feeling of dry or cotton mouth.

Causes

Under normal circumstances, as viruses and bacteria enter the body through the nose and mouth, they are filtered in the tonsils. The tonsils work by surrounding them with white blood cells which causes the body to develop a fever that can become extremely high in children. Should the infection becomes serious, the tonsils will inflame and become painful. The infection may also be present in the throat and surrounding areas, causing inflammation of the pharynx. This is the area in the back of the throat that lies between the voice box and the tonsils.

Tonsillitis may be caused by Group A streptococcal bacteria, resulting in strep throat. Viral tonsillitis may be caused by numerous viruses such as the Epstein-Barr virus (the cause of infectious mononucleosis) or adenovirus.

Sometimes, tonsillitis is caused by a infection of spirochaeta and treponema, in this case called Vincent's angina or Plaut-Vincent angina.

Although tonsillitis is associated with infection, it is currently unknown whether the swelling and other symptoms are caused by the infectious agents themselves, or by the host immune response to these agents. Tonsillitis may be a result of aberrant immune responses to the normal bacterial flora of the nasopharynx.

The viruses that cause tonsillitis are often the ones that frequently affect the respiratory system or breathing. Most cases are caused by a virus and will only require treatment of sore throat remedies that can be bought over the counter. Bacteria-caused tonsillitis, however, is treated with prescribed antibiotic medication to reduce the risk for further complications. Tonsillitis most often affects children whose tonsils are responsible for fighting infections. This is also true because as we age, our tonsils become less active. Rare cases have been diagnosed with fungi or parasites being the cause. This generally takes place in persons with weakened immune systems.

There is no research to state that smoking cigarettes causes tonsillitis, however it is widely accepted that smoking weakens the immune system. Also, children and adults who live in a smoke-prone environment may be exposed to factors that could result in a tonsillectomy.

Treatment

Treatments of tonsillitis consist of pain management medications and lozenges. If the tonsillitis is caused by bacteria, then antibiotics are prescribed, with penicillin being most commonly used. Erythromycin and Clarithromycin are used for patients allergic to penicillin.

In many cases of tonsillitis, the pain caused by the inflamed tonsils warrants the prescription of topical anesthetics for temporary relief. Viscous lidocaine solutions are often prescribed for this purpose, and anaesthetic throat lozonges containing benzocaine, lignocaine, benzydamine and flubiprofen are widely avaliable without prescription.

Ibuprofen or other analgesics such as aspirin or paracetamol can help to decrease the edema and inflammation, which will ease the pain and allow the patient to swallow liquids sooner.

When tonsillitis is caused by a virus, the length of illness depends on which virus is involved. Usually, a complete recovery is made within one week; however, some rare infections may last for up to two weeks.

Chronic cases may indicate tonsillectomy (surgical removal of tonsils) as a choice for treatment.

Additionally, gargling with a solution of warm water and salt may reduce pain and swelling. If you are suffering from tonsilloliths (Tonsil stones) try to avoid dairy products like milk, ice cream, yogurt etc..

Complications

An abscess may develop lateral to the tonsil during an infection, typically several days after the onset of tonsillitis. This is termed a peritonsillar abscess (or quinsy). Rarely, the infection may spread beyond the tonsil resulting in inflammation and infection of the internal jugular vein giving rise to a spreading septicaemia infection (Lemierre's syndrome).

In chronic/recurrent cases (generally defined as seven episodes of tonsillitis in the preceding year, five episodes in each of the preceding two years or three episodes in each of the preceding three years), or in acute cases where the palatine tonsils become so swollen that swallowing is impaired, a tonsillectomy can be performed to remove the tonsils. Patients whose tonsils have been removed are certainly still protected from infection by the rest of their immune system.

Bacteria feeding on mucus which accumulates in pits (referred to as "crypts") in the tonsils may produce whitish-yellow deposits known as tonsilloliths. These may emit an odour due to the presence of volatile sulfur compounds.

Hypertrophy of the tonsils 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. A tonsillectomy can be curative.

In very rare cases, diseases like rheumatic fever or glomerulonephritis can occur. These complications are extremely rare in developed nations but remain a significant problem in poorer nations.

See also

• Tonsillolith

References

External links

• Tonsillitis at NetDoctor.co.uk
• Tonsillitis
• Tonsillitis at DrGreene.com
• Tonsillitis at eDoctor.co.in
• medicalook.com an image showing difference between viral and bacterial tonsillitis