Tonsillitis Symptoms and Treatment

The tonsils are modified lymph glands that sit at either side of the throat at the back of the mouth. They normally act to intercept and destroy bacteria and viruses that are entering the body. If a tonsil is overwhelmed by the germs it is trying to destroy, tonsillitis occurs and the gland becomes enlarged, red, painful and covered in pus. The infection can easily spread to the other tonsil and to glands below the jaw and around the ear. The patient develops a sudden high fever, headache, throat pain, has offensive breath and finds it difficult to swallow or speak. Tonsillitis may occur at any age, but is far more common amongst children than adults.

A number of different bacteria (e.g. Streptococci, Staphylococci, Haemophilus) may cause tonsillitis, and these can only be differentiated by a throat swab. A cotton or synthetic swab is rubbed across the tonsil and then sent to a laboratory for culture. The infecting organism and the correct antibiotic to kill it can then be identified. In some mild to moderate cases, swabs are not necessary, and a broad spectrum antibiotic (e.g. penicillin, erythromycin, tetracycline) can be used by a doctor with reasonable confidence that it will be successful. Even when a swab is taken, antibiotics are usually started while awaiting the result. If tonsillitis is left untreated, the infection may spread to cause an abscess or septicaemia.

Before antibiotics became readily available in the late 1940s, the vast majority of patients with tonsillitis did recover, but often after a very uncomfortable and distressing few weeks. As a result, tonsils were removed to prevent further attacks of the disease. In the last two decades, because attacks of tonsillitis can be easily controlled by safe and effective antibiotics, the rate of tonsillectomy has steadily decreased so that it is now only performed if the patient has recurrent attacks of tonsillitis, excessively large tonsils, or other significant reasons for the procedure to be performed.

Treatment of acute tonsillitis involves bed rest, fluid diet, aspirin or paracetamol, antiseptic mouth washes and antibiotics. It is important to finish the course of antibiotics. Although symptoms may rapidly disappear, the tonsillitis may recur if the antibiotic course is not completed, and the responsible bacteria may no longer respond adequately to the previous antibiotic as it may have developed resistance to it.

Viral infections of the tonsils may also be severe but will not respond to antibiotics. One of the more common causes of viral tonsillitis is glandular fever. This can be diagnosed by a specific blood test. Unfortunately no treatment is available, and pain-killing tablets and gargles must be used to give relief, while prolonged rest allows a cure. Another cause of tonsillitis, which is rare today due to vaccinations, is diphtheria.

Tonsillitis is infectious, and the causative bacteria or viruses may be passed to another person who has close contact with the patient.

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