Tonsillitis: what types are there and how they should be treated

Tonsillitis is an inflammation of the tonsils or tonsils, which are defense organs located on both sides of the throat. This inflammation usually has an infectious, viral or bacterial cause and is acquired by direct contact (saliva and contaminated objects) or through the air (coughing and sneezing).

The most frequent cause of tonsillitis are viruses, of which there are hundreds of them: adenovirus, influenza and parainfluenza viruses, Epstein-Barr virus (infectious mononucleosis), enterovirus or herpes viruses, among others. As for bacteria, the most common is streptococcus pyogenes, but there are a large number of bacteria that can cause tonsillitis, even sometimes it is a combination of several germs.

Types of tonsillitis

There are several types of tonsillitis. The most common is acute infectious tonsillitis, which may be viral or bacterial. When this infection occurs repeatedly, it is called recurrent tonsillitis.

There are also cases in which the inflammation is chronic, resulting in a considerable and permanent increase in the size of the tonsils known as tonsillar hypertrophy, or the accumulation of a whitish material in the tonsils, which is called caseous tonsillitis.

Tonsillitis: symptoms

In acute tonsillitis, the incubation period from the time a person becomes infected until symptoms appear is difficult to establish due to the great variety of microorganisms that can cause it, and can range from a few hours to a week. This infection produces sore throat when swallowing, fever, appearance of cervical ganglions and general malaise; sometimes there is also headache or tummy ache. Tonsils have a very reddened appearance, sometimes with the presence of pus plaques or a kind of whitish membranes on their surface.

Chronic tonsillitis gives persistent discomfort in the throat, sometimes with loss of appetite and tiredness, and may have permanently swollen glands or even produce an infection in other organs of the body. If the tonsils are large they can create obstructive respiratory and sleep problems, as well as alterations in the development of the palate and placement of the teeth. In caseous tonsillitis there are usually episodes of pain and halitosis.

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Treatment for tonsillitis

It is advisable to see a specialist in Otolaryngology to confirm the diagnosis and establish an appropriate treatment. There are rapid tests to detect the presence of streptococcus, which would require antibiotic treatment, but only in bacterial infections should a specific antibiotic be taken. In this case, it is also important to complete the prescribed days of treatment to avoid relapses, although in 3-4 days the symptoms usually improve.

Antipyretic analgesics are also prescribed to relieve pain and fever, which is the symptomatic treatment given in viral tonsillitis.

It is recommended to take soft food at room temperature. There are various types of gargles that can improve the symptoms of tonsillitis (salt, honey, thyme,…). Diluted antiseptic mouthwashes help to avoid the colonization of germs in the throat. Acidic juices or hard foods should be avoided as they can further inflame the throat.

The person suffering from acute tonsillitis should rest at home, at least for the duration of the fever, in order to receive treatment and reduce the spread of the disease. Frequent hand washing of the patient and caregivers is equally important.

In recurrent infections or obstructive problems, surgery may be necessary. Complete removal of the tonsils is called tonsillectomy while reduction is called tonsillotomy or tonsilloplasty and can be performed by various techniques (laser, radiofrequency, electric scalpel, …).

Although not frequent, acute tonsillitis can be complicated by the formation of phlegmons or abscesses around the angina or in the neck nodes, and rheumatic fever with cardiac, renal or articular involvement. In chronic tonsillitis, obstructive sleep apnea syndrome may occur, as well as dental malposition and swallowing problems.

Danger signs in these infections are high fever, difficulty swallowing or breathing, or the appearance of a red rash on the skin.