Sore throat – is it tonsillitis?

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The crying child, tugging at its ear and running a high temperature is a common occurrence, and can be the signs of tonsillitis. Add to that a change in the child’s voice and you have almost a 100 percent chance that this is tonsillitis.

It is such a common complaint that most of us got our tonsils yanked when we were about three years old. However, adults can get tonsillitis too.

The tonsils are interesting little (or in some cases, not so little) glands. They live in the back of the throat and can become acutely infected which we call Acute Tonsillitis, or can carry a low grade infection for many months or even years, known as Chronic Tonsillitis.

The infecting organism is also of interest and can be a Virus, or Chlamydia, or bacteria such a Streptococcus or Staphylococcus, Mycoplasma, Fungi or Parasites. Another interesting snippet is that the most likely organism varies with the age of the owner of the rotten tonsils. In the 2-7 year olds it is Haemophilus influenzae which is the culprit, while in the 8-14 year olds it is Staphylococcus aureus and after that it becomes a mixed bag.

With an acute tonsillitis, when you look inside the mouth there will be two “strawberry” shaped masses in the back of the throat. They may even have little white follicles on them, like strawberries. They can get so big that they will even meet in the midline, displacing the uvula, the little ‘clapper’ that hangs down in the center of your throat. Pain radiating up to the ears is another frequent symptom, and the younger ones can run temperatures over 40 degrees C which is a worry for most Mums. Another symptom of an acute attack is bad breath, so if Junior can knock over the cat with one breath, have a look at his tonsils!

An appropriate antibiotic settles the acute attack fairly quickly, but it is very necessary to make sure the child takes the full course of medicine. With the more chronic attacks, the pain is less, the temperature is less, but the patient does not feel well, and antibiotic treatment is usual. Of course, it is necessary to identify the causative organism, and a tonsilar swab is usually taken to identify the nasty little blighter. It is also important to treat the other symptoms, such as pain and the elevated temperature, and paracetamol is the drug of choice for this.

When I was a child (in the days of hardship before ballpoint pens and cellophane paper) one good attack of tonsillitis was enough to have you prostrate under the surgeon’s knife, but these days we are a little more circumspect.

The US Center for Disease control recommends if there have been fewer than seven episodes of recurrent throat infection in the past year or fewer than five episodes per year in the past 2 years or fewer than three episodes per year in the past 3 years, watchful waiting is preferred over tonsillectomy.

Tonsillectomy is indicated for recurrent throat infection of at least seven episodes in the past year or at least five episodes per year for 2 years or at least three episodes per year for 3 years with documentation of one or more of the following: temperature above 38.3°C, cervical glands enlarged, tonsillar exudate, and/or positive test for Group A â-hemolytic streptococcus (GABHS).

Tonsillectomy may be considered in children who do not meet the above criteria but have multiple antibiotic allergies/intolerances, (periodic fever, aphthous stomatitis, pharyngitis, and adenitis), or a history of peritonsillar abscess.

So despite all our advances in pediatric medicine, tonsillitis is still with us, and will be for many years to come yet.