Tonsillitis: types and treatment

Tonsillitis is the inflammation of the tonsils, which are lymph nodes found on both sides of the throat. This inflammation is usually of infectious, viral or bacterial cause, and is acquired by direct contact (saliva and contaminated objects) or through the air (cough and sneezes).

The most common cause of tonsillitis are viruses, of which there are hundreds: adenoviruses, influenza viruses and human parainfluenza, the Epstein-Barr virus (infectious mononucleosis), or herpetic viruses, among others. As for bacterial causes, the most frequent is called streptococcus pyogenes, but there are a large number of bacteria that can cause tonsillitis, and sometimes it is a combination of several.

Types of tonsillitis

There are different types of tonsillitis. The most common is acute infectious tonsillitis, which can be viral or bacterial. When this infection occurs repeatedly, it is called recurrent tonsillitis.

There are also cases in which the inflammation is chronic, leading to a considerable and permanent increase in the size of the tonsils known as amygdala hypertrophy, and also caseous tonsillitis which is an accumulation of a whitish material in the tonsils

Tonsillitis: symptoms

In acute tonsillitis, the incubation period from infection to the first symptoms is difficult to establish given the wide variety of microorganisms that can cause it, with it ranging from a few hours to a week. The infection causes pain when swallowing, fever, swollen lymph nodes and general malaise. Sometimes symptoms can also display with a headache or stomachache. The tonsils have a very reddish appearance, sometimes with the presence of pus plaques or a kind of whitish membrane on their surface.

Chronic tonsillitis causes constant discomfort in the throat, sometimes with loss of appetite and fatigue, the tonsils may be permanently inflamed and there may even be an infection in other organs of the body. If the tonsils are enlarged, they can obstruct breathing and cause sleep problems, as well as alterations in the development of the palate and teeth placement. In caseous (cryptic) tonsillitis the patient may experience episodes of pain and halitosis.

Treatment for tonsillitis

A trip to the doctor’s is usually the first step towards treatment for tonsillitis, to make sure the right tests and medications are given.

A quick test to detect streptococcus can be taken, and if it is positive, the bacterial infection causing the tonsillitis can be treated with antibiotics. The patient needs to complete the drug course but symptoms usually improve in 3-4 days.

Some types of medication may also be prescribed to relieve pain and fever, treating the symptoms of viral tonsillitis rather than the infection itself. During this time, the patient is advised to eat soft foods at room temperature and sour juices or hard foods should be avoided as they may inflame the throat even more.

There are several types of ‘gargle’ remedy that can improve the symptoms of tonsillitis - salt, honey, thyme, and diluted antiseptic mouthwashes help prevent colonisation of germs in the throat.

If suffering from acute tonsillitis, the patient should rest at home, at least while the fever is being treated to reduce the potential spread of the disease. It is also important that the patient and any caregiver frequently wash their hands.

Repeat infections or obstructive problems caused by tonsillitis may require surgery, after consulting an ENT specialist. Complete removal of the tonsils is called a tonsillectomy, while a reduction is often called a partial tonsillectomy and can be performed using various techniques (laser, radiofrequency, electric scalpel).

Although not frequent, acute tonsillitis can be complicated by the formation of phlegm or abscesses around the lymph nodes of the neck, and rheumatic fever with cardiac, renal or joint involvement. In chronic tonsillitis, a syndrome of obstructive sleep apnoea may occur, as well as dental malposition and swallowing problems.

Signs of danger in these infections are high fever, difficulty swallowing or breathing, or the appearance of a reddish rash on the skin.