Monday, 25 July 2011

Understanding and Treating Tonsilitis

Published in City Times

Is Surgery for Tonsillitis Necessary
Gone are the days when tonsils were considered appendages to the body which really served no purpose and hence could be removed. The medical fraternity today, is more conservative in its approach to dealing with infected tonsils and opts for surgery only as a last resort when either medications have failed to restrict the frequency and severity of infection or when the tonsils become so enlarged as to affect the physiological functions of breathing, swallowing and speech. Dr.Nadhim Khadim Saaoudi, F.R.C.S. (Ed.) Specialist ENT, Head and Neck Surgeon, Prime Medical Centre and Jumeira Prime Medical Center, Dubai talks to us about tonsillitis and its treatment.

What functions do the tonsils perform?
Tonsils and adenoids comprise tissues which are similar to the lymph nodes found in the neck and other parts of the body. They are part of a ring of glandular tissue known as Waldeyer’s Ring, encircling the back of the throat. The tonsils lie on either side of the back of the throat and are usually of the same size, pink in colour like the area surrounding them. Because of their strategic location in the upper part of the respiratory tract, they serve as the first line of defense against disease causing organisms which enter the body through the nose, mouth, or throat it takes samples of viruses and bacteria to help our body to produce antibodies against them. Tonsils are normally bigger in children than in adults and as they grow to adulthood, the tonsils shrink, as part of natural physiology.

What is tonsillitis and what are its causes?
Tonsillitis is an infection of the tonsils that can be caused either by a virus or by bacteria. It usually accompanies influenza and other viral infections. A very severe form of the infection can be caused by the Beta Hemolytic Streptococcus Group A involving various complications.

Is it that only children are prone to tonsillitis?
Though most common in children after the age of 3 years, tonsillitis can affect adults too, though the attacks are less frequent and less severe in them. Rarely, children below the age of 3 are affected by it. Some children may be more prone to the condition on account of hereditary factors, especially when they are born with large tonsils.

Do weather conditions play a role in aggravating the incidence of tonsillitis?
Generally, most upper respiratory tract infections are more common in the winter months and tonsillitis too may be seen more in the cold seasons.
Is tonsillitis infectious?

To some extent, yes, when there is very close contact between family members. But it is not as infectious as other viral infections like measles or mumps.
What are the symptoms of tonsillitis?
Symptoms can range from mild to severe and include high fever, sore throat, pain while swallowing, difficulty in speaking, body pain and malaise are common symptoms of tonsillitis. The surface of the tonsil is bright red with or without a grayish-white coating. The lymph nodes in the neck may be swollen.

Tonsillitis caused by the beta hemolytic streptococcus bacteria group A can cause secondary damage to the heart valves, rheumatic fever, and kidneys problems like glomerulonephritis.

The symptoms of tonsillitis mimic symptoms of many common upper respiratory tract diseases. So how is diagnosis confirmed?
True, the symptoms of tonsillitis are shared by many other infections. Clinical examination of the patient is the most important diagnostic tool to confirm tonsillitis. An enlarged tonsils that is infected, is congested with blood, serum and fluid tissues; hence it looks red and angry, not pink. Secondly, we can see the product of infection, like fibrin deposition, pus spots or some membranes and pseudo-membrane like structures. Thirdly, when we palpate at the lower jaw level from outside, we can feel the tonsils lymph nodes as being enlarged and tender. We do a swab culture test to identify the causative organism, particularly the strain of bacteria causing it so that we direct treatment against that particular organism.

How is tonsillitis treated?
If the infection is mild with a little fever and throat congestion, we may only use simple analgesics, vitamin C and warm drinks and soups. But most often, tonsils are infected with pus collection. So Antibiotics form the first line of treatment in such cases. However, if the tonsillitis is on account of the beta hemolytic streptococcus group A bacteria, penicillin is the best medication to be used. The course is for a duration of at least 10 days.
What about patients who are allergic to penicillin?

In that case we prescribe substitutes which are as effective in dealing with the infection.
When is a tonsillectomy or surgery to remove tonsils, indicated?
The thumb rule in the treatment of tonsillitis is: do not go in for surgery unless you are left with no other option and unless you know that the benefits from removal of tonsils will far outweigh the harm caused by infected or enlarged tonsils. The indications for surgery are in the trio of situations when the person gets frequent, severe, acute bouts of tonsillitis – once every month or every second month for two or more years. Secondly when the tonsils are so enlarged that they interfere with the physiological functions of breathing, swallowing and speaking. Finally, if malignancy is found in the tonsils, they are removed and sent for laboratory testing.

Will a tonsillectomy eliminate sore throats?
Surgery will not eliminate throat infections, but will eliminate tonsil infections only.

What are the complications of surgery?
As with any other surgery, risks include complications from anaesthesia, bleeding and infection. Bleeding can occur during and after surgery, even after 7 – 10 days following surgery. Also, clots can form at the site of surgery which can travel down to the larynx and cause larengeal obstruction which is a very serious condition. Additionally, there can be trauma to adjacent tissues but chances of this occurring are minimal in the hands of experienced surgeons.

Will removal of tonsils compromise immunity since one of the defense mechanism is not there now?
Theoretically it looks like that but practically this is not so because it is not only the tonsils which are responsible for the local and systemic immunity; there are other organs which perform this function as well.

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