Tonsillitis

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.

Indian epidemiology then other

[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]

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.

Pathogenesis refers to the development of a disease. It’s the story of how a disease gets started and progresses.

This is the entire journey of a disease, encompassing the cause but going beyond it.

Pathophysiology, on the other hand, focuses on the functional changes that occur in the body due to the disease. It explains how the disease disrupts normal physiological processes and how this disruption leads to the signs and symptoms we see.

Imagine a car accident. Pathogenesis would be like understanding how the accident happened – what caused it, the sequence of events (e.g., one car ran a red light, then hit another car). Pathophysiology would be like understanding the damage caused by the accident – the bent fenders, deployed airbags, and any injuries to the passengers.

In simpler terms, pathogenesis is about the "why" of a disease, while pathophysiology is about the "how" of the disease’s effects.

There are mainly three types as follows i.e.

[A] Firstly, Acute Tonsillitis

[B] Secondly, Chronic Tonsillitis

[C] Thirdly, Recurrent Tonsillitis

[A] Acute Tonsillitis

Primarily, the tonsil consists of i.e.

(i) Firstly, surface epithelium which is continuous with the oropharyngeal lining,

(ii) Secondly, crypts which are tube-like invaginations from the surface epithelium and

(iii) Thirdly, the lymphoid tissue.

Acute infections of tonsil may involve these components and are.[2]

1.Acute catarrhal or superficial tonsillitis i.e.

Here tonsillitis is a part of generalized pharyngitis also it is mostly seen in viral infections.

2.Acute follicular tonsillitis i.e.

In brief, Infection spreads into the crypts which become filled with purulent material, presenting at the openings of crypts as yellowish spots.

3.Acute parenchymatous tonsillitis i.e.

Here tonsil substance is affected. Additionally, Tonsil is uniformly enlarged and red.

4.Acute membranous tonsillitis i.e.

It is a stage ahead of acute follicular tonsillitis when exudation from the crypts coalesces to form a membrane on the surface of tonsil.[2]

[B] Chronic Tonsillitis

1.Chronic follicular tonsillitis i.e.

In brief, Here tonsillar crypts are full of infected cheesy material which shows on the surface as yellowish spots.

2.Chronic parenchymatous tonsillitis i.e.

There is hyperplasia of lymphoid tissue. Tonsils are very much enlarged and may interfere with speech, deglutition and respiration Attacks of sleep apnoea may occur. Besides this, Long-standing cases develop features of cor pulmonale.

3.Chronic fibroid tonsillitis

Tonsils are small but infected.[2]

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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]

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[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

[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]

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[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]

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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].

Do’s:

• Soft pliable foods like plain pasta, rice yogurt, puree also puddings is consume.
• Soups containing vegetables, pasta can take.[3]
• 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
• Avoid close contact with infected persons

Avoid self-medication and Over exertion

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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

Frequently Asked Questions

What is Tonsillitis?

It is an inflammation of the two oval shaped pads of the tissue called tonsil located at the back of the throat, caused by viral or bacterial infection.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Tonsillitis?

• Apis Mellifica
• Lachesis
• Kali muriaticum
• Hepar Sulphur
• Mercurius
• Calcarea Phosphorica
• Belladonna

What is the main causes Tonsillitis?

• Staphylococci
• Pneumococci
• H. influenzae

What are the symptoms of Tonsillitis?

• Breath is foetid and tongue is coated
• Hyperaemia of pillars, soft palate and uvula
• Tonsils are red and swollen
• Jugulodigastric lymph nodes are enlarged and tender
• Sore throat
• Difficulty in swallowing
• Fever

Give the types of Tonsillitis?

• Acute
• Chronic
• Recurrent