Tonsillitis – a rite of passage?


I lost my tonsils when I was three years of age. I can still see the anesthetists hairy arms through my tears as I was restrained on the trolley. I won’t claim PTSD (Post traumatic stress disorder) but I think my parents could have got me better prepared. A lot of promises of ice cream would have helped.

I thought about tonsils as a friend just had her tonsils out. This is nothing extraordinary as most of us got our tonsils yanked when we were about three years old. However, my friend who has children of her own is obviously a little older than a toddler.

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 you will often hear the child’s voice change, and when you look inside the mouth there will be two “strawberry” shaped masses in the back of the throat. They will 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. 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 and Dads. 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 tonsillar 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. With more than 10 acute attacks in 12 months we would recommend tonsillectomy, or if there was a continuous low grade chronic infection, again the advice was to yank the offending organs.

I am sure my friend will feel better after having her chronically infected tonsils removed – after she has got over the acute effects of surgery!

Ice cream helps.