Tonsillitis: Symptoms, Treatment and When Tonsils Should Be Removed

A sore throat is one of the most common reasons children miss school and adults miss work. Most clear up in a few days. But when the throat keeps getting sore again and again, families start asking whether the tonsils should come out.

What is tonsillitis?

The tonsils are two small glands at the back of the throat, one on each side. They help the body fight germs, especially in young children. When they get infected and swollen, it's called tonsillitis. It's very common in children, but teenagers and adults get it too. It spreads through coughs, sneezes and shared cups or food.

Symptoms

• Sore throat and pain when swallowing

• Red, swollen tonsils, sometimes with white or yellow spots

• Fever and chills

• Tender lumps in the neck

• Bad breath, headache or ear pain

• A hoarse or muffled voice

• In young children: refusing food, drooling, tummy ache or unusual crankiness

Viral or bacterial?

Most tonsillitis comes from viruses, the same ones that cause colds. Some comes from bacteria, most often Group A Streptococcus (strep throat).

	More likely viral	More likely bacterial
Cough and runny nose	Often present	Often absent
Fever	Mild to moderate	Often higher
Tonsil spots	Sometimes	Often white or yellow patches
Neck glands	Mild	Often tender and swollen

You can't be sure by looking. A doctor may do a throat swab to decide whether antibiotics are needed.

Treatment

At home

• Rest and drink plenty of fluids. Warm drinks and soups can soothe the throat.

• Offer soft foods that are easy to swallow.

• Older children and adults can gargle with warm salt water.

• Use fever and pain medicines only as your doctor advises. Doses for children depend on weight, so ask your doctor or pharmacist.

• Don't give aspirin to children.

• Keep your child home until the fever is gone, and until they've had at least 24 hours of antibiotics if those were prescribed.

Antibiotics

Antibiotics help only when bacteria are the cause. They don't work on viruses. If your doctor prescribes them, finish the full course even if your child feels better after 2 days. Stopping early can let the infection return, and untreated strep infection can rarely lead to rheumatic fever, which can damage the heart. Don't start antibiotics on your own.

Get help now: See a doctor the same day if your child can't swallow fluids, is drooling, has a stiff neck or a very high fever, or has severe one-sided throat pain with trouble opening the mouth (this can be an abscess). Signs of dehydration, such as very little urine and a dry mouth, also need prompt care. Go to the emergency room if breathing is difficult.

When should tonsils be removed?

Removal of the tonsils is called tonsillectomy. Doctors usually consider it when:

• Infections are very frequent. A rule doctors commonly use is about 7 or more well-documented episodes in one year, 5 or more a year for 2 years, or 3 or more a year for 3 years.

• There has been an abscess next to the tonsil (quinsy), especially more than once.

• Large tonsils cause breathing problems at night, such as loud snoring, pauses in breathing or poor sleep.

• Large tonsils make swallowing difficult.

• One tonsil is much bigger than the other or looks unusual, and the doctor wants to rule out a growth.

Your doctor will look at the whole history first. Keeping a note of each sore throat, with dates and fever, helps a lot. The adenoids, similar glands behind the nose, are sometimes removed at the same time when they block the nose or cause repeated ear infections.

How tonsil surgery is done

It's done under general anaesthesia, so the patient is asleep. The surgeon removes the tonsils through the mouth, with no cut on the neck or face. It usually takes 30 to 45 minutes, and many patients go home the same day or after one night. Surgeons use different techniques, and yours will explain which one they use and why.

Recovery

• Throat pain lasts about 7 to 10 days and can spread to the ears. Use only the medicines your surgeon prescribes.

• Start with cool liquids and soft food like curd, mashed food and khichdi. Avoid hard, spicy, sharp or very hot food until healed. Drinking enough water helps healing.

• Children usually need 10 to 14 days off school. Adults need about 1 to 2 weeks.

• White patches in the throat are normal during healing. They aren't infection.

• Bad breath is common for a week or so.

Get help now: Go to the emergency room now if you see fresh red blood from the mouth, if blood is vomited, or if your child won't drink at all. Bleeding is uncommon, but it can happen in the first day or around day 5 to 10, when the scabs come off.

Risks

As with any surgery, there are risks. The main ones are bleeding, pain, dehydration because swallowing hurts, infection and, rarely, anaesthesia problems. Your surgeon and anaesthetist will explain them before surgery.

Common questions

Will immunity be weaker after tonsil removal? No. The body has many other defences, and studies haven't shown a lasting harm to immunity.

Can adults get tonsillitis? Yes, though less often than children.

How long does tonsillitis last? Most cases get better in 3 to 7 days. If it lasts more than a week, or gets worse, see a doctor.

Can it be prevented? Not always. Regular handwashing, not sharing cups and spoons, and staying away from people with a sore throat all help.

Have questions or want to see a specialist? For appointment and queries, call 8156929292. AXTEN HOSPITALS - HONEST SURGERY, HONEST CARE.