Tonsillitis is a pathology that encompasses infections of the palatine tonsils. They can be of viral or bacterial cause, but viral tonsillitis is more frequent.
There is a specific type of viral tonsillitis very frequent in children, which is the tonsillitis that occurs in the context of mononucleosis, also known as “kissing disease”. This type of tonsillitis has its origin in the cytomegalovirus or Epstein Barr virus, and the common symptoms range from general malaise and joint pain, to the appearance of lymph nodes throughout the body, among other symptoms. On many occasions, this pathology passes unnoticed as a simple tonsillitis. However, in older children and adults it is a very striking condition.
Generally, the most common bacteria involved in tonsillitis are beta hemolytic streptococci, staphylococci and pneumococci. However, it is sometimes difficult to differentiate between them. Thus, a clinical history is useful, as well as clinical examination, rapid tests for streptococci and sometimes even cultures and blood tests.
Symptoms of tonsillitis
The most frequent symptoms of tonsillitis are:
- Fever
- Sore throat
- Swollen tonsils
- Nodes in the neck
- Pain when swallowing, especially with hard or hot foods
- Muscle and joint pain
There are some specific forms of tonsillitis that have their own characteristics. This is the case of mononucleosis, which usually presents many lymph nodes throughout the body, allowing palpation of a somewhat larger spleen or liver. It can also be the case of herpetic tonsillitis, which usually causes sores on the tonsils and palate.
Treatment for tonsillitis
In any case, treatment depends on the cause. Generally, however, there is an increasing tendency to be a conservative treatment, limiting the use of antibiotics.
In viral cases, i.e. the most frequent, the treatment is symptomatic. That is to say, the treatment is focused on controlling the symptoms (fever, pain, general malaise…), through the use of antipyretics and anti-inflammatory drugs. Antibiotics should not be taken when it is a viral infection, because the only thing it does is to increase the levels of bacterial resistance to antibiotics.
On the contrary, when it is a bacterial infection, the recommended treatment is antibiotics, which must be prescribed by doctors, complying with the established days.
Even so, the most recent studies recommend limiting the use of antibiotics, because they have side effects that can be avoided when treating tonsillitis. The use of antibiotics should be limited to those patients who have added risks, such as children with heart disease, low defenses due to previous treatments and other diseases or specific situations.
When is tonsillectomy recommended?
Tonsillectomy, which consists of removing the tonsils, was a very common technique many years ago when access to antibiotics was more limited than it is today. It was used mainly to avoid rheumatic complications, which severely affected the kidneys and heart.
However, surgery is only useful when the origin of tonsillitis is bacterial. Nowadays, a series of criteria are followed to establish when a patient should be operated on. These criteria, known as the Paradise Criteria, are based on the number of episodes of bacterial tonsillitis the patient has per year.
Following these criteria, tonsillectomy is recommended in the following cases:
- When 7 episodes occur in a year.
- When 5 episodes occur in two years
- When there are 3 episodes per year in the last 3 years.
However, these criteria should always be used taking into account the following:
- Each case must be personalized
- Tonsil surgery presents risks
- Quality of life improves in the short term after surgery, but this effect is less clear in the long term.
- Removing tonsils will not prevent pharyngitis or colds.
Therefore, it is advisable to personalize each case before deciding that surgical treatment is the most appropriate method to treat tonsillitis.