Tonsillitis

Overview

Normally tonsils act as a filter by trapping germs that could otherwise enter into your airways and cause infection. Tonsils also help to make antibodies to fight against infection.[3]

Tonsillitis is basically most common, especially in children, may also affect adults.

Epidemiology of Tonsillitis

Tonsillitis, the inflammation of the tonsils, is a prevalent condition in India, particularly among children and young adults. While specific nationwide epidemiological data may be limited, various studies shed light on its occurrence and associated factors within the country.

• Prevalence: Studies suggest a high prevalence of tonsillitis in India, with estimates ranging from 10% to 30% among children. A study conducted in schoolchildren in Pune found a prevalence of 21.7%.

• Age Group: Tonsillitis is more common in children and young adults, with peak incidence between 5 and 15 years of age.

• Socioeconomic Factors: Lower socioeconomic status is associated with a higher risk of tonsillitis, possibly due to factors like overcrowding, poor hygiene, and malnutrition.

• Seasonal Variation: Tonsillitis tends to be more frequent during the monsoon and winter seasons, likely due to increased viral and bacterial infections during these periods.

• Etiology: The majority of tonsillitis cases in India are caused by viral infections, with bacteria such as Streptococcus pyogenes (Group A Streptococcus) being responsible for a significant proportion of cases, particularly in school-age children.

• Complications: While most cases of tonsillitis resolve without complications, some individuals may develop peritonsillar abscess, rheumatic fever, or post-streptococcal glomerulonephritis.[5][6]

Causes

[A] Acute Tonsillitis

Acute tonsillitis often affects school-going children, but also affects adults. Additionally, It is rare in infants and in persons who are above 50 years of age. [2]

Haemolytic streptococcus is the most commonly infecting organism. Other causes of infection may be staphylococci, pneumococci or H. influenzae. Lastly, These bacteria may, primarily infect the tonsil or may be secondary to a viral infection.[2]

[B] Chronic Tonsillitis

1.It may be a complication of acute tonsillitis. Pathologically, Micro-abscesses walled off by fibrous tissue have been seen in the lymphoid follicles of the tonsils.

2.Subclinical infections of tonsils without an acute attack.

3.Mostly affects children also young adults. Rarely occurs after 50 years.

4. Chronic infection either in sinuses or teeth may be a predisposing factor.[2]

Types

• Acute Tonsillitis:

  • Characterized by a sudden onset of sore throat, fever, and swollen tonsils.
  • Can be caused by both viral and bacterial infections.

• Recurrent Tonsillitis:

  • Refers to multiple episodes of acute tonsillitis within a specified time period (usually a year).
  • Frequency and severity of episodes can vary.

• Chronic Tonsillitis:

  • Persistent inflammation of the tonsils, often associated with a history of recurrent infections.
  • Symptoms may include persistent sore throat, bad breath, and enlarged tonsils with visible white spots (tonsillar crypts).[7]

Risk Factors

1.Cold drinks, cold water.

2.Ill-ventilated environment also overcrowding.

3.Close contact with infected person.

4.Preschool also middle age group children.

5.Compromised Immunity.

The Sign & Symptoms of Tonsillitis

Signs:

1. Often the breath is foetid and tongue coated.
2. There is hyperaemia of pillars, soft palate and uvula.
3. Tonsils red and swollen with yellowish spots of purulent material presenting at the opening of crypts (acute Follicular tonsillitis) or there may a whitish membrane on the medial surface of tonsil which can easily wiped away with a swab (acute membranous tonsillitis). In detail, The tonsils may enlarge and congested so much so that they almost meet in the midline along with some oedema of the uvula and soft palate (acute parenchymatous tonsillitis).[2]
4. The jugulodigastric lymph nodes enlarge also tender.[2]

Symptoms:

[A] Acute Tonsillitis

The symptoms vary with severity of infection. The predominant symptoms are i.e.:

1. Sore throat.
2. Difficulty in swallowing. The child may refuse to eat anything due to local pain.
3. Fever. It may vary from 38 to 40°C and may be associated with chills and rigors. Occasionally, a child presents with an unexplained fever and it is only on examination that an acute tonsillitis is discovered.[2]
4. Earache. It is either referred pain especially from the tonsil or the result of acute otitis media which may occur as a complication.
5. Constitutional symptoms. They are usually more marked than seen in simple pharyngitis and may include headache, body aches, malaise and constipation. There may be abdominal pain due to mesenteric lymphadenitis simulating a clinical picture of acute appendicitis.[2]

[B] Chronic Tonsillitis

1. Recurrent attacks of sore throat or acute tonsillitis.
2. Chronic irritation in throat with cough.
3. Thick speech, difficulty in swallowing and choking spells at night (when tonsils are large and obstructive).[2]

Diagnosis

[A] Physical Examination:

1. Tonsils may show varying degree of enlargement. Sometimes they meet in the midline (especially in chronic parenchymatous type).
2. There may be yellowish beads of pus on the medial sur- face of tonsil (specifically in chronic follicular type).
3. Tonsils are small but pressure on the anterior pillar expresses frank pus or cheesy material (chronic fibroid type).
4. Flushing of anterior pillars compared to the rest of the pharyngeal mucosa is an important sign of chronic tonsillar infection.
5. Enlargement of jugulodigastric lymph nodes is a reliable sign of chronic tonsillitis. During acute attacks, the nodes enlarge further and become tender.[2]

[B] Investigations:

1. CBC
2. CRP
3. Other if required

Complications

[A] Acute Tonsillitis

If not treated then may lead to i.e.

1. Chronic Tonsillitis
2. Peritonsillar abscess
3. Parapharyngeal abscess
4. Cervical abscess
5. Acute otitis media
6. Rheumatic fever
7. Acute glomerulonephritis
8. Subacute bacterial endocarditis

[B] Chronic Tonsillitis

1.Peritonsillar abscess

2.Parapharyngeal abscess

3.Retropharyngeal abscess

4.Intratonsillar abscess

5.Tonsillar cyst

6.Tonsillolith [3]

Treatment

[A] Acute Tonsillitis

1. Patient put to bed also encouraged to take plenty of fluids.

2. Analgesics (aspirin or paracetamol) give according to the age of the patient to relieve local pain and bring down the fever.

3. Antimicrobial therapy. Most of the infections are due to Streptococcus and penicillin is the drug of choice. Patients allergic to penicillin can treat with erythromycin. Antibiotics should continue for 7–10 days.[2]

[B] Chronic Tonsillitis

1. Conservative treatment consists of attention to general health, diet, treatment of coexistent infection of teeth.

2. Tonsillectomy indicate when tonsils interfere with speech, deglutition and respiration or cause recurrent attacks.[2]

Homoeopathic management of Tonsillitis:

• In general, The primary objective of Homoeopathy is to improve the defence mechanism of the disease person to repel disease attack and maintain good health, and to minimizes the persons susceptibility to common infections and common germ in our daily environment.
• Homoeopathic remedy help by reducing the inflammation also the enlarged tonsils back to normal size.
• Furthermore, It also helps in reducing the intensity, frequency and duration of the attacks of tonsillitis.
• We have more than 150 highly potent homoeopathic remedies for treating tonsillitis, they are selected after a detailed study of the patient’s unique and characteristic symptoms.[3]
• Homoeopathic treatment is based on individualization in which a doctor selects a medicine according to your/ patients constitution rather than matching only symptoms similarity, so before taking any homoeopathic medicine you have to firstly consult a homoeopathic physician for your concern problem’s, there are so many remedies work in this case but some of the few therapeutic indications of homoeopathic remedies in the cases of tonsillitis are as follows.

Some of the commonly used remedies and their indications are i.e.:

Apis Mellifica. [Apis]

Oedema is the watchword of this remedy. Useful in the simple form, not in the parenchymatous form, the throat is swollen both inside and outside. The superficial tissues alone are involved, not the parenchyma, which calls for Belladonna. Numerous points of beginning follicular secretion are present [4].

Lachesis. [Lach]

Dark angry looking parts. Swelling is very great and there is much tenderness extremely. Left tonsil with tendency to go to right, pains shoot to ear on attempting to swallow, aggravation from hot drinks. Peri-tonsillar abscess. It is also a very useful remedy for a severe form of rheumatic pain following tonsillitis. The pus degenerates and becomes thin and offensive.

Kali muriaticum. [Kali-m]

Almost a specific in follicular tonsillitis. No remedy has given the writer such satisfaction. Additionally, the throat has a gray look spotted, with white. It is a valuable remedy either in acute or chronic tonsillitis with much swelling. The 6x trituration is a reliable preparation.

Hepar Sulphur. [Hep. Sulp]

Where there are lancinating pains, splinter-like and much throbbing with rigors showing that abscess is on the point of forming and it is desired to hasten it Hepar will be well indicated. Parts extremely sensitive to touch. Pain shoot especially into ears [4].

Mercurius. [Merc.]

This remedy is rarely of service at the onset, but later in a more advanced stage than that calling of Hepar, when pus has formed; great swelling; whole fauces deep red; the tonsils darker than any other part; ulcers form; saliva tenacious; breath foul; pains less than Belladonna, but the general health is worse. Stinging pains and difficult breathing from the swelling. Pseudomembranous deposit on tonsils also pharynx.

Calcarea Phosphorica. [Calc-p]

In chronic enlargement of the tonsils in strumous children this remedy stands well in typical Calcarea cases. The tonsils are flabby, pale, there is a chronic follicular inflammation and impaired hearing. It’s efficacy in adenoid hypertrophy is well known.

Belladonna. [Bell]

This remedy is the chief one at the commencement, when the case has passed the stage where Aconite or Ferrum Phosphoricum  indicated. There is redness and swelling, but the deeper the redness and the more the swelling,Belladonna is less indicated. At the commencement of an attack, it exceeds Apis in value, as Apis only involves the mucous surface. The neck is swollen and stiff externally, ulcers form rapidly and the right side is worse. In the acute paroxysms of the chronic from Belladonna is very useful [4].

Dietary Recommendations:

• Soft Foods: During acute tonsillitis, prioritize soft foods that are easy to swallow. Examples include:
  • Soups and broths
  • Mashed potatoes
  • Yogurt
  • Applesauce
  • Ice cream
• Hydration: Encourage adequate fluid intake to prevent dehydration and soothe the throat. Warm liquids like herbal teas can be especially comforting.
• Avoid Irritants: Steer clear of spicy, acidic, or crunchy foods that may exacerbate throat discomfort.

Regimen Recommendations:

• Rest: Ample rest is crucial for recovery. Encourage the patient to avoid strenuous activity and get plenty of sleep.
• Warm Salt Water Gargles: Gargling with warm salt water several times a day can help reduce inflammation and provide temporary pain relief.
• Throat Lozenges: Medicated lozenges or hard candy can soothe the throat and alleviate discomfort.
• Humidifier: Using a humidifier in the bedroom can help keep the air moist, which can ease breathing and reduce throat irritation.
• Over-the-Counter Pain Relief: Consider using over-the-counter pain relievers like acetaminophen or ibuprofen to manage pain and fever.[9]

Important Note: This information is for educational purposes only. Consult a qualified healthcare professional for personalized advice on managing tonsillitis.

Do’s:

• Soft pliable foods like plain pasta, rice yogurt, puree also puddings is consume.
• Soups containing vegetables, pasta can take.
• Salt water gargling to soothe the throat
• Have plenty of fluids and rest
• Wash your hands with soap and water regularly to avoid spreading the infection
• Cover your mouth while coughing or sneezing

Don’ts:

• Avoid oily also fried foods
• Avoid cold food also drinks
• Dont close contact with infected persons
• Avoid self-medication and Over exertion

Reference

1. https://www.mayoclinic.org/diseases conditions/tonsillitis /symptoms-causes/syc-20378479#:~:text=Tonsillitis %20is%20inflammation%20of%20the,the %20sides%20of%20the%20neck.
2. Disease of EAR, NOSE, AND THROAT & HEAD AND NECK SURGERY 6^TH EDITIONS BY P.L Dhingra, Shruti Dhingra
3. https://www.slideshare.net/welcomecure/tonsillitis-41046282
4. Therapeutics from Zomeo ultimate LAN.
5. Prevalence of recurrent tonsillitis in school children. (2014) International Journal of Current Research, 6(08), 8181-8184.
6. Socioeconomic factors associated with recurrent tonsillitis in children. (2012) Indian Journal of Otolaryngology and Head & Neck Surgery, 64(3), 232-235.
7. Cummings Otolaryngology: Head and Neck Surgery, 7th Edition.
8. Pediatric Otolaryngology 4th Edition, by Bluestone, Stool, and Kenna, published in 2003 by W.B. Saunders Company
9. Book: Clinical Otolaryngology

Edition: 4th Edition

Authors: Michael Gleeson, Peter D. Bull

Year of Publication: 2001

Publisher: Butterworth-Heinemann