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Tonsillitis is an infection of the tonsils and will often, but not necessarily, cause a sore throat and fever.
Types
There are 3 main types of tonsillitis: acute, subacute and chronic. Acute tonsillitis can either be bacterial or viral in origin. Subacute tonsillitis (which can last between 3 weeks and 3 months) is caused by the bacterium Actinomyces. Chronic tonsillitis, which can last for long periods if not treated, is almost always bacterial.
Symptoms
Symptoms of tonsillitis include a severe sore throat (which may be experienced as referred pain to the ears), painful/difficult swallowing, headache, fever and chills, and change in voice causing a "hot potato" voice. Tonsillitis is characterized by signs of red, swollen tonsils which may have a purulent exudative coating of white patches (i.e. pus). There may be enlarged and tender neck cervical lymph nodes.
Causes
Tonsillitis may be caused by Group A streptococcal bacteria,[1] resulting in strep throat.[1] Viral tonsillitis may be caused by numerous viruses[1] such as the Epstein-Barr virus[1] (the cause of infectious mononucleosis)[2] or the Adenovirus.[1]
Sometimes, tonsillitis is caused by a superinfection of spirochaeta and treponema, in this case called Vincent's angina or Plaut-Vincent angina.[3]
Although tonsillitis is associated with infection, it is currently unknown if the swelling and other symptoms are caused by the infectious agents themselves, or by the host immune response to these agents. Tonsillitis may be a result of aberrant immune responses to the normal bacterial flora of the nasopharynx.
Treatment
Treatments of tonsillitis consist of pain management medications[4] and lozenges.[5] If the tonsillitis is caused by bacteria, then antibiotics are prescribed, with penicillin being most commonly used.[6] Erythromycin is used for patients allergic to penicillin.
In many cases of tonsillitis, the pain caused by the inflamed tonsils warrants the prescription of topical anesthetics for temporary relief. Viscous lidocaine solutions are often prescribed for this purpose.
Ibuprofen or other analgesics can help to decrease the edema and inflammation, which will ease the pain and allow the patient to swallow liquids sooner.[4]
When tonsillitis is caused by a virus, the length of illness depends on which virus is involved. Usually, a complete recovery is made within one week; however, some rare infections may last for up to two weeks.
Chronic cases may indicate tonsillectomy (surgical removal of tonsils) as a choice for treatment[7]
Additionally, gargling with a solution of warm water and salt may reduce pain and swelling.[8]
Complications
An abscess may develop lateral to the tonsil during an infection, typically several days after the onset of tonsillitis. This is termed a peritonsillar abscess (or quinsy). Rarely, the infection may spread beyond the tonsil resulting in inflammation and infection of the internal jugular vein giving rise to a spreading septicaemia infection (Lemierre's syndrome).
In chronic/recurrent cases (generally defined as seven episodes of tonsillitis in the preceding year, five episodes in each of the preceding two years or three episodes in each of the preceding three years),[9][10][11] or in acute cases where the palatine tonsils become so swollen that swallowing is impaired, a tonsillectomy can be performed to remove the tonsils. Patients whose tonsils have been removed are certainly still protected from infection by the rest of their immune system.
Bacteria feeding on mucus which accumulates in pits (referred to as "crypts") in the tonsils may produce whitish-yellow deposits known as tonsilloliths. These may emit an odour due to the presence of volatile sulfur compounds.
Hypertrophy of the tonsils can result in snoring, mouth breathing, disturbed sleep, and obstructive sleep apnea, during which the patient stops breathing and experiences a drop in the oxygen content in the bloodstream. A tonsillectomy can be curative.
In very rare cases, diseases like rheumatic fever[12] or glomerulonephritis[13] can occur. These complications are extremely rare in developed nations but remain a significant problem in poorer nations.[14][15]
References
- ^ a b c d e Putto A (1987). "Febrile exudative tonsillitis: viral or streptococcal?". Pediatrics 80 (1): 6–12. PMID 3601520.
- ^ Renn CN, Straff W, Dorfmüller A, Al-Masaoudi T, Merk HF, Sachs B (2002). "Amoxicillin-induced exanthema in young adults with infectious mononucleosis: demonstration of drug-specific lymphocyte reactivity". Br. J. Dermatol. 147 (6): 1166–70. doi:10.1046/j.1365-2133.2002.05021.x. PMID 12452866. -Renn studied 4 patients who where treated amoxicillin for throat infection and lymphadenopathy. Infectious mononucleosis was present in the patient’s blood due to trace of Epstein-Barr antibodies. The three tests performed where the patched test, intracutaneous test, and lymphocyte transformation test. The results of the patched test that pointed to amoxicillin as the caused of their rash were 1 out of 4 patients. The intracutaneous showed 2 out of 4 patients with positive results that pointed to amoxicillin. The LTT results showed 3 out of 4 that pointed to amoxicillin
- ^ Van Cauwenberge P (1976). "[Significance of the fusospirillum complex (Plaut-Vincent angina)]" (in Dutch; Flemish). Acta Otorhinolaryngol Belg 30 (3): 334–45. PMID 1015288. - fusospirillum complex (Plaut-Vincent angina) Van Cauwenberge studied the tonsils of 126 patients using direct microscope observation. The results showed that 40% of acute tonsillitis was caused by Vagina and 27% of chronic tonsillitis was caused by Spirochaeta
- ^ a b Boureau, F. et al. "Evaluation of Ibuprofen vs Paracetamol Analgesic Activity Using a Sore Throat Pain Model". Clinical Drug Investigation 17 year=1999: 1–8. - Boureau studied 113 patients who saw 19 physicians in France. Patients were give Ibuprofen 400mg or Paracetamol 1000mg randomly. Pain intensity, difficulty swallowing, and global pain relief were use to measure in hourly increments until 6 hours after patients first dose. The results showed that Ibuprofen better than Paracetamol in all three categories
- ^ Praskash, T. et al (2001). "Koflet lozenges in the Treatment of Sore Throat". The Antiseptic 98: 124–127. - The efficacy of Koflet Lozenges was evaluated by symptomatic relief of pain. The 48 patients were examined by the Physicians and given a scale rating from 0-3. 0 stating no signs and symptoms and 3 being the worse. The results showed patients with pharyngitis 95% of the patient with positive feedbacks. Tonsillitis patients and patients with both symptoms gave 100% positive feedbacks
- ^ Touw-Otten FW, Johansen KS (1992). "Diagnosis, antibiotic treatment and outcome of acute tonsillitis: report of a WHO Regional Office for Europe study in 17 European countries". Fam Pract 9 (3): 255–62. doi:10.1093/fampra/9.3.255. PMID 1459378. - 17 European Countries had a minimum of 10 physicians each that participated in a studied that involved 4094 patients that they had seen from Nov 1989 to May 1990. Sore throat, redness and swelling of tonsils, pus on tonsils, enlarge regional lymph nodes, or fever. Bacterial and serology test were performed to determined antibiotics usage. Antibiotics results had 2334 out of 3646 patient using penicillin. 343 out of the 3646 used amoxicillin and 554 out of 3646 used macrolides
- ^ Paradise JL, Bluestone CD, Bachman RZ, et al (1984). "Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials". N. Engl. J. Med. 310 (11): 674–83. PMID 6700642. - Paradise studied 187 children with tonsillectomy or tonsillectomy and adenoidectomy. 91 children were randomly put in surgical and non-surgical groups. The other 96 were place by parent’s choice. The results favored the surgical group on reoccurrence of throat infections during their initial and second year follow-up where the data was collected. While non-surgical groups did better in the long run. 13 out of the 95 surgical group encountered surgical complications after their second year follow up
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