TONSILLITIS/TONSILLECTOMY

Tonsillitis refers to “inflammation” of the tonsils and possibly the adenoids. Tonsillectomy is the surgical removal of the tonsils.

Tonsillitis is most common among children greater than two years old and usually occurs in children 5-15 years of age.  It is typically caused by the bacteria Streptococcus Pyogenes (“strep throat”) which is spread by human contact.  Some individuals are asymptomatic carriers of this bacteria. Viral tonsillitis is more common in younger children. Tonsillitis can be acute, recurrent, or chronic and under certain conditions can lead to a peritonsillar abscess.  Tonsillectomy is a surgical procedure performed through the mouth to remove the tonsils.  Adenoids (pharyngeal tonsils) are commonly removed at the same time.

WHAT ARE TONSILS?
The two masses of tissue located in the back of the throat are “tonsils.”  The tonsils (unlike the adenoids) are visible through the mouth without the use of special instruments. Tonsils and adenoids are similar to the lymph nodes found in the neck, groin and armpits.  Lymph nodes are areas of the body where immune cells sample foreign invaders such as bacteria and viruses.

EFFECTS OF TONSILLITIS
Sore throat, enlarged tonsils with obstructed breathing and sleep disturbances, persistent bad breath and/or foul taste, and swallowing problems are the most common symptoms of tonsillitis.

Most Common Symptoms of Acute, Recurrent & Chronic Tonsillitis:

• Acute Tonsillitis (often “strep throat”) involves fever, sore throat, foul breath, difficulty swallowing (dysphagia), painful swallowing (odynophagia), and tender cervical lymph nodes.  Swollen tonsils can cause snoring, nocturnal breathing pauses and sleep apnea, and rarely acute airway obstruction.  Lethargy and malaise are also common concerns.  Symptoms may resolve in a few days but can and often do last two weeks or longer in spite of therapy.  Rarely, strep throat can lead to problems of the heart valves (Rheumatic Fever) and kidneys.
• Recurrent Tonsillitis is diagnosed after a patient has experienced multiple episodes of acute tonsillitis within 6-12 months.
• Chronic Tonsillitis involves having a “chronic sore throat”, halitosis (bad breath), periodic fevers, and possibly cervical lymph nodes that are persistently tender.
• Peritonsillar Abscess involves severe throat pain, fever, drooling, foul breath, difficulty opening the mouth (trismus), and a “hot potato” voice which sounds muffled.  This occurs when the bacteria causing the tonsillitis escapes into deeper tissues of the throat and neck.

CAUSES OF TONSILLITIS
Streptococcus Pyogenes (GABHS) is the most common bacterial cause of acute tonsillitis.  In some individuals, particularly adults, chronic or acute tonsillitis may be caused by atypical bacteria which are not identified by routine throat cultures.  Viruses may also cause acute pharyngitis (inflammation of the throat and tonsils).

TREATMENTS FOR TONSILLITIS
Dr. Gunnlaugsson uses the typical treatment of tonsillitis first.  This involves antibiotics, fluid replacement, and pain management.  Severe cases sometimes require hospitalization - particularly if there is “airway obstruction” or severe dehydration.  Chronic or recurrent cases usually require surgical removal of the tonsils (tonsillectomy).  Patients with large tonsils, particularly children, which are obstructing the airway and causing sleep disturbances also benefit from tonsillectomy.

Tonsillectomy is usually performed as an outpatient procedure.  Patients under the age of three or children with other medical disorders are sometimes kept in the hospital for 24 hours after the procedure.  Patients can be expected to have a sore throat for 7-14 days following the procedure and this is controlled with pain medication.  Postoperative bleeding from a tonsillectomy is a known complication which can be expected in 1-3% of patients.  The bleeding usually occurs from a healing scab in the back of the throat becoming dislodged.  To prevent this, patients are advised to follow a strict soft diet for 2 weeks following the procedure.  If bleeding occurs, the office should be notified and the patient should be brought to the emergency room.  Occasionally, a second operative procedure will be necessary to stop the bleeding. 

While the tonsils and adenoids act as lymph nodes in fighting infections, there are no damaging effects to the body in removing them.  Patients are not at an increased risk of infections if these tissues are removed.