WHAT IS IT?
Tonsillitis is an inflammation of the tonsils due to infection and adenoiditis is an inflammation of adenoid tissue. The tonsils are located on both sides of the back of the throat and form part of the body's defense system against upper respiratory tract infections. The tonsils can themselves become repeatedly infected by the microorganisms they fight. Although tonsillitis is most common in children, it can also occur in adolescents and young adults.
The adenoids are located above the tonsils at the back of the nose. They are not visible without the use of medical instruments. The adenoids are composed of lymph nodes containing white cells (lymphocytes) that help fight infection and are part of the body's defense against upper respiratory tract infections. Adenoids tend to enlarge during early childhood, when infections of this type are common. They usually begin to shrink after the age of five years, disappearing altogether by puberty. In some children, however, instead of shrinking, they become even larger. The enlarged tissue may obstruct the passage between the nose and the throat, causing snoring, breathing through the mouth instead of the nose, and a characteristically nasal voice. Obstruction of the eustachian tube (tube that connects the middle ear to the throat) can cause infection and diminished hearing. If the flow of secretions behind the nose becomes obstructed, it can result in infection in the nose (rhinitis), middle ear (otitis media), or the air sinuses behind the nose (sinusitis).
HOW IS IT DIAGNOSED?
History: Symptoms of tonsillitis may include a sore throat, difficulty swallowing, headache, earache, fever, unpleasant smelling breath, and vomiting. The illness occasionally causes temporary deafness. When the infection originates in the adenoids, the individual may also notice nasal discharge or congestion.
Physical exam of the neck and throat may reveal tender glands, enlarged tonsils, a coated tongue, bad breath, and redness in the area around the tonsils. Pus or an abscess (quinsy) may be seen on the tonsils.
Tests: Culture of a throat swab will identify the organisms causing the infection. A lighted mirror is used to inspect the adenoids for enlargement.
HOW IS IT TREATED?
Tonsillitis and adenoiditis caused by viral infections cannot be treated with antibiotics, and must be allowed to run their course. Treatment usually consists of saline gargles, plenty of liquids, a soft diet, and analgesics to relieve fever and pain. Infections caused by bacteria usually respond well to antibiotic therapy.
Surgical removal (tonsillectomy and adenoidectomy) is usually recommended if the tonsils and/or adenoids become chronically infected, impair normal function of the nose or throat, interfere with work, or reduce the general level of health.
WHAT MIGHT COMPLICATE IT?
Enlarged tonsils and adenoids can interfere with breathing, leading to snoring, sleep disturbances, and chronic ear infections. Many individuals, especially those with mononucleosis, may suffer enlargement so severe that the airways become blocked. In addition, serious infections may result in peritonsillar abscesses, which must be drained either by incision or needle aspiration. In some cases, an immediate tonsillectomy is recommended. In very rare cases, individuals have such difficulty swallowing that they fail to get proper liquids and nutrition. In such cases, hospitalization may be required to provide intravenous feeding and antibiotic therapy.
When the infection is caused by the group A Streptococcus bacteria, it is vital that the individual finish the entire course of antibiotics. Failure to do so has been associated with the development of rheumatic fever, a potentially life threatening disease of the heart.
PREDICTED OUTCOME
Most cases of tonsillitis heal well. Bacterial infections usually respond favorably to antibiotic therapy. If infections recur frequently, surgical removal of tonsils and adenoids may be advised.
ALTERNATIVES
Conditions with similar symptoms include
strep throat and other forms of
pharyngitis.
APPROPRIATE SPECIALISTS
Internist and otolaryngologist.
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