Tonsillitis

An INFECTION of the tonsils (lymph structures at the back of the THROAT). Tonsillitis is common and often recurrent in children. Conventional wisdom holds that the tonsils (and the nearby ADENOIDS) serve to produce antibodies to help the body protect itself against invading pathogens (disease-causing agents such as viruses and BACTERIA). However, in the modern environment there is an overwhelming abundance of pathogenic agents, which many health experts believe accounts for the prevalence of tonsillitis. Some researchers believe that the tonsils are becoming, or have become, vestigial structures akin to the appendix.

The characteristic symptoms of tonsillitis are

• PAIN and swelling at the back of the throat
• difficulty swallowing
• FEVER
• HEADACHE

The tonsils may appear enlarged and reddened, and may ooze pus or be covered in small white dots. The infectious agent may be viral or bacterial; the doctor is likely to swab the throat to perform a rapid strep test to check for streptococci bacteria. Streptococci tend to migrate to other parts of the body such as the HEART valves, making any strep infection potentially dangerous. A throat culture can determine the presence of other pathogenic bacteria. Bacterial tonsillitis, including STREP THROAT requires treatment with ANTIBIOTIC MEDICATIONS. Viral tonsillitis generally runs its course within two weeks. In either case, ANALGESIC MEDICATIONS such as acetaminophen or ibuprofen can provide pain and fever relief.

Children should not receive aspirin for pain or FEVER because of the potential for REYE’S SYNDROME, a rare but serious complication.

The otolaryngologist may recommend tonsillectomy (an OPERATION to remove the tonsils) when recurrent tonsillitis causes the tonsils to remain enlarged to the extent that they interfere with BREATHING. Indications of this include loud snoring when sleeping and mouth breathing when awake, particularly in children. Enlarged tonsils can cause OBSTRUCTIVE SLEEP APNEA, in which there are episodes during sleep when the person does not breathe. In the normal course of development, the tonsils atrophy (shrink) as ADOLESCENCE approaches, and by early adulthood tonsillitis is uncommon. For this reason many doctors prefer to manage tonsillitis medically rather than surgically unless ANTIBIOTIC RESISTANCE develops.