Tonsillitis
From Wikipedia, the free encyclopedia
Tonsillitis is an inflammation of the tonsils in the mouth and will often, but not necessarily, cause a sore throat and fever.
Symptoms may include pain in the tonsil area and inability to swallow and/or painful swallowing, white spots may also appear on the tonsils.
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[edit] Causes
Tonsillitis may be caused by Group A streptococcal bacteria, resulting in strep throat. Most tonsillitis, however, is viral in origin, such as the Epstein-Barr virus (the cause of glandular fever) or the Coxsackie virus. Sometimes, tonsillitis, is caused by a superinfection of spirochaeta and treponema, in this case called Vincent's angina or Plaut-Vincent angina.[1]
[edit] Treatment
Treatment consists of painkillers and fluids; if caused by bacteria then antibiotics are also prescribed. Usually penicillin, or erythromycin if the patient is allergic to penicillin. Amoxicillin should not be used, unless bacterial infection has been microbiologically confirmed, because if mononucleosis is mistaken as tonsillitis and amoxicillin is given, a rash might develop and it may be wrongly assumed that the patient has developed an allergy to penicillins.
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.
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.
In chronic cases tonsillectomy (surgical removal of tonsils) may be indicated.
[edit] 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). It is believed that the first president of the United States, George Washington, died as a result of this complication.
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)[2][3][4], 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.
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.
Tonsilloliths (or tonsil stones) which occur in the crypts of the tonsils can only be completely cured by tonsillectomy or by resurfacing the tonsil by laser, but practicing good oral hygiene and use of a water pick may help lessen the symptoms. It is still possible to get tonsiloliths after removal of the tonsils unless a complete tonsillectomy is performed.
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.
[edit] Footnotes
- ^ Van Cauwenberge P (1976). "[Significance of the fusospirillum complex (Plaut-Vincent angina)]". Acta Otorhinolaryngol Belg 30 (3): 334-45. PMID 1015288. - fusospirillum complex (Plaut-Vincent angina) "forms about 40% of all cases of acute tonsillitis"
- ^ (January 1999) “6.3 Referral Criteria for Tonsillectomy”, Management of Sore Throat and Indications for Tonsillectomy. Scottish Intercollegiate Guidelines Network. ISBN 1899893-66-0. - notes though that these criteria "have been arrived at arbitrarily" from:
Paradise J, Bluestone C, Bachman R, Colborn D, Bernard B, Taylor F, Rogers K, Schwarzbach R, Stool S, Friday G (1984). "Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials.". N Engl J Med 310 (11): 674-83. PMID 6700642. - ^ Paradise J, Bluestone C, Colborn D, Bernard B, Rockette H, Kurs-Lasky M (2002). "Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children.". Pediatrics 110 (1 Pt 1): 7-15. PMID 12093941. - this later study by the same team looked at less severely affected children and concluded "modest benefit conferred by tonsillectomy or adenotonsillectomy in children moderately affected with recurrent throat infection seems not to justify the inherent risks, morbidity, and cost of the operations"
- ^ Wolfensberger M, Mund M (2004). "[Evidence based indications for tonsillectomy]". Ther Umsch 61 (5): 325-8. PMID 15195718. - review of literature of the past 25 years concludes "No consensus has yet been reached, however, about the number of annual episodes that justify tonsillectomy"
