THE TONSILS

THE TONSILS

 

Symptoms of tonsillitis
The symptoms of tonsillitis include:
 • White or yellow spots of pus on the tonsils
 • Sore throat – although some children complain of pain in their tummy, rather than a sore throat
 • Swollen lymph glands under each side of the jaw
 • Pain when swallowing
 • Fever
 • Bad breath.

Complications of tonsillitis

When tonsillitis is caused by bacteria (about 15 per cent of all tonsil infections), it is usually a streptococcus bacterium. It is not easy to tell when tonsillitis is caused by bacteria – your doctor may do a throat swab (gently rubbing sterile cotton wool on a stick over the tonsil) and send it for testing.

There are many viruses that can cause tonsillitis. Antibiotics do not help if the tonsillitis is caused by a viral infection.

Complications of tonsillitis

Tonsillitis can lead to a number of complications, including:

• Chronic tonsillitis – infection of the tonsils which does not clear up. The person may go on feeling unwell and tired
• Secondary infections – the infection can spread to the person’s nose, sinuses or ears
• Glue ear (otitis media) in children – the adenoids are part of the same group of lymph nodes as tonsils. When the adenoids swell up (usually when the tonsils are also large), they can block the Eustachian tube, which goes from the back of the throat to the middle ear. This is the thin tube that you push air along when you ‘pop’ your ear. If this tube stays blocked most of the time, sticky fluid forms in the middle ear which interferes with hearing. This is called a glue ear
• Quinsy – if the infection spreads into the tissue around the tonsils, an abscess can form in the throat, also known as a peri-tonsillar abscess. This causes severe pain and can interfere with swallowing and even breathing. Antibiotics may help, but sometimes an operation is needed to drain the abscess

Treatment of tonsillitis

Because most attacks of tonsillitis are caused by viruses, most of the treatment is aimed at helping to relieve the symptoms such as pain and fever. Paracetamol can help and the person should rest. Most children with tonsillitis do not feel well and it hurts them to swallow. Try cool drinks (cold drinks can hurt), ice blocks and ice cream. Don’t worry if a child stops eating for a day or two. Usually, they pick up quickly when the infection has gone.

For tonsillitis that is caused by bacteria, antibiotics are prescribed.

Tonsillectomy

If attacks of tonsillitis become frequent and severe, or cause complications, your doctor might suggest an operation, known as tonsillectomy.

Reasons for tonsillectomy can include:

• Recurrent bouts of tonsillitis accompanied by pain, discomfort and high temperature
• Chronic tonsillitis that doesn’t clear up with antibiotics
• Frequent ear infections associated with tonsillitis
• Breathing difficulties due to enlarged tonsils
• Abscesses forming in the throat (peri-tonsillar abscesses or quinsy)
• A child failing to thrive because of difficulty in swallowing due to frequent infection and enlargement of their tonsils.

Medical issues to consider before tonsillectomy

Before doing a tonsillectomy, your doctor will give you a complete physical check-up. The tonsil pad has a large blood supply, and special note will be taken whether you have any abnormal bleeding tendencies. Your doctor will check to see if your tonsils are actively inflamed and, if so, will prescribe antibiotics for a few weeks to control the infection before the surgery.

Tonsillectomy procedure

A tonsillectomy is performed under general anaesthesia. The surgeon props open the person’s mouth and clamps their tonsils with special instruments. The glandular tissue is contained inside a skin lining which the surgeon cuts using scalpel, scissors, laser or an electric current (electrocautery). The surgeon then removes the tonsils. Each tonsil pad has a substantial blood supply, so electrocautery is often used to fuse the blood vessels and reduce the risk of haemorrhage.

Immediately after a tonsillectomy operation

After the operation you can expect:

• When you wake up, you will be lying on your side – this is to prevent choking if any bleeding occurs from the tonsil pad
• A sore throat
• Pain-relieving medication, if necessary
• The nursing staff will regularly check your pulse, blood pressure, breathing rate and your throat for any signs of bleeding
• For the first four hours after the operation, you will probably not be allowed to have any food or liquids
• You may find it difficult to eat or drink, but you will be encouraged to do so – the more often you use your throat, the better
• You can expect a hospital stay of just one day or so.

Complications of tonsillectomy

Possible complications of tonsillectomy include:

• The pain may ease within two days or so, but may flare up again up to six days after the operation. You may also have ear pain.
• There can be excessive bleeding (haemorrhage) from your tonsil pads. Most cases of haemorrhage occur within one week of surgery.
• The scabs that form on the wounds may give you a bad taste in your mouth.

Self-care after tonsillectomy

Be guided by your doctor about how to care for yourself at home, but general suggestions include:

• Do not smoke.
• Avoid vigorous exercise immediately after the operation.
• Usually, you should have a week or so at home before returning to work or school.
• Avoid crowded, enclosed areas (such as cinemas) for at least one week, to reduce the risk of infection.
• Your sore throat may last for two to three weeks, but try to get back to your normal diet as soon as possible – avoid sticking to a jelly and ice cream diet.
• Some foods can cause irritation and pain – avoid sour drinks (such as citrus fruit juices), spicy foods and roughly textured foods for about 10 days.
• Avoid taking aspirin, since this pain-relieving medication can cause bleeding. Only take medications recommended by your doctor or surgeon.

Long-term outlook after tonsillectomy

A tonsillectomy won’t lower the risk or frequency of problems such as upper respiratory tract infections (the common cold), chest infections, laryngitis, middle-ear infections, sinusitis or nasal allergies. However, it will stop the tonsillitis and allow you to swallow more easily. You will probably lose your bad breath, if that was a problem.

Things to remember

• The tonsils sit at the back of the mouth and are part of the body’s immune system.
• The most common cause of tonsillitis is viral infections.
• Operating to take out your tonsils may help if you get frequent infections, but the operation is complicated and may be unsafe.
• After tonsillectomy, your sore throat may last for two to three weeks, but try to get back to your normal diet as soon as possible – avoid sticking to jelly and ice-cream.

Function

These immunocompetent tissues are the immune system's first line of defense against ingested or inhaled foreign pathogens. Tonsils have on their surface specialized antigen capture cells called M cells that allow for the uptake of antigens produced by pathogens. These M cells then alert the underlying B cells and T cells in the tonsil that a pathogen is present and an immune response is stimulated.  B cells are activated and proliferate in areas called germinal centres in the tonsil. These germinal centres are places where B memory cells are created and secretory antibody (IgA) is produced.
Recent studies have provided evidence that the tonsils produce T lymphocytes, also known as T-cells, in a manner similar to, but different from, the way the thymus does.
Clinical significance
Tonsils can become enlarged (adenotonsillar hyperplasia) or inflamed (tonsillitis) and may require surgical removal (tonsillectomy). This may be indicated if they obstruct the airway or interfere with swallowing, or in patients with frequent recurrent tonsillitis. However, different mechanisms of pathogenesis for these two subtypes of tonsillar hypertrophy have been described,and may have different responses to identical therapeutic efforts. In older patients, asymmetric tonsils (also known as asymmetric tonsil hypertrophy may be an indicator of virally infectedtonsils, or tumors such as lymphoma or squamous cell carcinoma.
Tonsillitis is a disorder in which the tonsils are inflamed (sore and swollen). The most common way to treat it is with anti-inflammatory drugs such as ibuprofen, or if bacterial in origin, antibiotics, e.g. amoxicillin and azithromycin. Often severe and/or recurrent tonsillitis is treated by tonsillectomy.
A tonsillolith is material that accumulates on the tonsil. They can range up to the size of a peppercorn and are white/cream in color. The main substance is mostly calcium, but they have a strong unpleasant odor because of hydrogen sulfide and methyl mercaptan and other chemicals.
Tonsil enlargement can affect speech, making it hypernasal and giving it the sound of velopharyngeal incompetence (when space in the mouth is not fully separated from the nose's air space).Tonsil size may have a more significant impact on upper airway obstruction for obese children than for those of average weight.
As mucosal lymphatic tissue of the aerodigestive tract, the tonsils are viewed in some classifications as belonging to both the gut-associated lymphoid tissue(GALT) and the mucosa-associate lymphoid tissue(MALT). Other viewpoints treat them (and the spleen and thymus) as large lymphatic organs contradistinguished from the smaller tissue loci of GALT and MALT.

Palatine tonsil

The palatine tonsils are located at the back of the throat. One tonsil is located on the left side of the throat and the other is located on the right side. The tonsils play a role in protecting the body against respiratory and gastrointestinal infections.
Each tonsil consists of a network of crypts (pits) that store cells used to fight infection. The tonsils contain B cells, a type of white blood cell that fights infections. They also produce antibodies against polio, streptococcal pneumonia, influenza, and numerous other infections. Antibodies are proteins that help the body identify and attack harmful invaders.
The tonsils also contain several types of T cells, which are white blood cells that destroy cells infected with viruses and help the body build immunity to infectious organisms.
Tonsillitis occurs when bacterial or viral organisms cause inflammation of the tonsillar tissue. This results in fever, difficulty swallowing, sore throat, ear pain, loss of voice, and throat tenderness. Recurrent tonsillitis sometimes results in the need for a tonsillectomy. During this procedure, a surgeon removes the palatine tonsil tissue. This may lessen the frequency of new infections.
The tonsils (palatine tonsils) are a pair of soft tissue masses located at the rear of the throat (pharynx). Each tonsil is composed of tissue similar to lymph nodes, covered by pink mucosa (like on the adjacent mouth lining). Running through the mucosa of each tonsil are pits, called crypts.

 

The tonsils are part of the lymphatic system, which helps to fight infections. However, removal of the tonsils does not seem to increase susceptibility to infection. Tonsils vary widely in size and swell in response to infection.

Tonsil Conditions

• Acute tonsillitis: A bacteria or virus infects the tonsils, causing swelling and a sore throat. The tonsil may develop a gray or white coating (exudate).
• Chronic tonsillitis: Persistent infection of the tonsils, sometimes as a result of repeated episodes of acute tonsillitis.
• Peritonsillar abscess: An infection creates a pocket of pus next to the tonsil, pushing it toward the opposite side. Peritonsillar abscesses must be drained urgently.
• Acute mononucleosis: Usually caused by the Epstein-Barr virus, “mono” causes severe swelling in the tonsils, fever, sore throat, rash, and fatigue.
• Strep throat: Streptococcus, a bacterium, infects the tonsils and throat. Fever and neck pain often accompany the sore throat.
• Enlarged (hypertrophic) tonsils: Large tonsils reduce the size of the airway, making snoring or sleep apnea more likely.
• Tonsilloliths (tonsil stones): Tonsil stones, or tonsilloliths, are formed when this trapped debris hardens, or calcifies.

Tonsil Tests

• Throat (pharynx) swab: A doctor rubs a cotton swab on the tonsils and throat and sends the swab for tests. Usually this is done to check for bacteria such as Streptococcus.
• Monospot test: A blood test can detect certain antibodies, which can help confirm that a person’s symptoms are due to mononucleosis.
• Epstein-Barr virus antibodies: If a monospot test is negative, antibodies in the blood against EBV might help diagnose mononucleosis.

Tonsil Treatments

• Antibiotics: Tonsillitis due to bacterial infection can be cured with antibiotics.
• Abscess drainage: A peritonsillar abscess generally must be punctured with a needle, to allow the infection to drain and heal.
• Tonsillectomy: In cases of tonsils that are too large or repeatedly infected, surgery to remove them may be necessary.