Tonsillitis
tonsillitis /ton·sil·li·tis/ (-li´tis) inflammation of the tonsils, especially the palatine tonsils.
tonsillitis
tonsillitis (tônˈ·s
·līˑ·tis),
tonsillitis (ton´silī´tis),
tonsillitis
Definition
Tonsillitis is an infection and swelling of the tonsils, which are oval-shaped masses of lymph gland tissue located on both sides of the back of the throat.
Description
The tonsils normally help to prevent infections. They act like filters to trap bacteria and viruses entering the body through the mouth and sinuses. The tonsils also stimulate the immune system to produce antibodies to help fight off infections. Anyone of any age can have tonsillitis; however, it is most common in children between the ages of five and 10 years.
Causes and symptoms
Tonsillitis is caused by viruses or bacteria that cause the tonsils to swell and become inflamed. A mild or severe sore throat is one of the first symptoms of tonsillitis. Symptoms can also include fever, chills, tiredness, muscle aches, earache, pain or discomfort when swallowing, and swollen glands in the neck. Very young children may be fussy and stop eating. When a doctor or nurse looks into the mouth with a flashlight, the tonsils may appear swollen and red. Sometimes, the tonsils will have white or yellow spots or flecks or a thin coating. Symptoms usually last four to six days.
Diagnosis
The diagnosis of tonsillitis is made from the visible symptoms and a physical examination of the patient. The doctor will examine the eyes, ears, nose, and throat, looking at the tonsils for signs of swelling, redness, or a discharge. A careful examination of the throat is necessary to rule out diphtheria and other conditions that may cause a sore throat. Since most sore throats in children are caused by viruses rather than bacteria, the doctor may take a throat culture in order to test for the presence of streptococcal bacteria. A throat culture is performed by wiping a cotton swab across the tonsils and back of the throat, and sending the swab to a laboratory for culturing. Streptococcus pyogenes, the bacterium that causes strep throat, is the most common disease agent responsible for tonsillitis. Depending on what type of test is used for strep, the doctor may be able to determine within a few minutes if S. pyogenes is present. The quick tests for strep are not as reliable as a laboratory culture, which can take 24-48 hours. If the results of a quick test are positive, however, the doctor can prescribe antibiotics right away. If the quick test results are negative, the doctor can do a throat culture to verify the results and wait for the laboratory report before prescribing antibiotics. A blood test may also be done to rule out a more serious infection or condition, and to check the white blood cell count to see if the body is responding to the infection. In some cases, the doctor
may order blood tests for mononucleosis, since about a third of patients with mononucleosis develop streptococcal infections of the tonsils.
The palatine, lingual, and pharyngeal tonsils.
(Illustration by Hans & Cassady, Inc.)
Treatment
Treatment of tonsillitis usually involves keeping the patient comfortable while the illness runs its course. This supportive care includes bed rest, drinking extra fluids, gargling with warm salt water, and taking pain relievers—usually NSAIDs—to reduce fever. Frozen juice bars and cold fruit drinks can bring some temporary relief of sore throat pain; drinking warm tea or broth can be soothing. If the throat culture shows that S. pyogenes is present, penicillin or other antibiotics will be prescribed. An injection of benzathine or procaine penicillin may be most effective in treating the infection, but it is also painful. If an oral antibiotic is prescribed, it must be taken for the full course of treatment, usually 10-14 days. If the patient has several episodes of severe tonsillitis, the doctor may recommend a tonsillectomy, which is the surgical removal of the tonsils.
Alternative treatment
Strengthening the immune system is important whether tonsillitis is caused by bacteria or viruses. Naturopaths often recommend dietary supplements of vitamin C, bioflavonoids, and beta-carotenes—found naturally in fruits and vegetables—to ease inflammation and fight infection. A variety of herbal remedies also may be helpful in treating tonsillitis. Calendula (Calendula officinalis) and cleavers (Galium aparine) target the lymphatic system, while echinacea (Echinacea
spp.) and astragalus (Astragalus membranaceus) stimulate the immune system. Goldenseal (Hydrastis canadensis), myrrh (Commiphora molmol), and bitter orange act as antibacterials. Lomatium dissectum and Ligusticum porteri have an antiviral action. Some of the homeopathic medicines that may be used to treat symptoms of tonsillitis include Belladonna, Phytolacca, Mercurius, Lycopodium, Lachesis, Hepar sulphuris, Arsenicum, or Rhus toxicodendron. As with any condition, the treatment and dosage should be appropriate for the particular symptoms and age of the patient.
Prognosis
Tonsillitis usually resolves within a few days with rest and supportive care. Treating the symptoms of sore throat and fever will make the patient more comfortable. If fever persists for more than 48 hours, however, or is higher than 102°F, the patient should be seen by a doctor. If antibiotics are prescribed to treat an infection, they should be taken as directed for the complete course of treatment, even if the patient starts to feel better in a few days. Prolonged symptoms may indicate that the patient has other upper respiratory infections, most commonly in the ears or sinuses. An abscess behind the tonsil (a peritonsillar abscess) may also occur. In rare cases, a persistent sore throat may point to more serious conditions, such as rheumatic fever or pneumonia.
Prevention
The bacteria and viruses that cause tonsillitis are easily spread from person to person. It is not unusual for an entire family or several students in the same classroom to come down with similar symptoms, especially if S. pyogenes is the cause. The risk of transmission can be lowered by avoiding exposure to anyone who already has tonsillitis or a sore throat. Drinking glasses and eating utensils should not be shared and should be washed in hot, soapy water before reuse. Old toothbrushes should be replaced to prevent reinfection. People who are caring for someone with tonsillitis should wash their hands frequently, to prevent spreading the infection to others.
Resources
Other
"Tonsillitis." Kids Health Page. 〈http://KidsHealth.org/parent/common/tonsillitis.html〉.
Key terms
Streptococcus pyogenes — A common bacterium that causes strep throat and can also cause tonsillitis.
Tonsillectomy — A surgical procedure to remove the tonsils if the patient has recurrent sore throats or throat infections, or if the tonsils have become so swollen that the patient has trouble breathing or swallowing.
Tonsils — Oval-shaped masses of glandular tissue located on both sides at the back of the throat. Tonsils act like filters to trap bacteria and viruses.
tonsillitis /ton·sil·li·tis/ (-li´tis) inflammation of the tonsils, especially the palatine tonsils.
follicular tonsillitis tonsillitis especially affecting the crypts.
ton·sil·li·tis (t n s -l  t s)n. Inflammation of a tonsil, especially the palatine tonsil. ton sil·litic (-ltk) adj. |
tonsillitis
[-ī′tis]
an infection or inflammation of a tonsil. Acute tonsillitis, frequently caused by Streptococcus infection, is characterized by severe sore throat, fever, headache, malaise, difficulty in swallowing, earache, and enlarged tender lymph nodes in the neck. Acute tonsillitis may accompany scarlet fever. Treatment includes systemic antibiotics, analgesics, and warm irrigations of the throat. Soft foods and ample fluids are given. Tonsillectomy is sometimes performed for recurrent tonsillitis or tonsillar abscess. See also acute tonsillitis, peritonsillar abscess, scarlet fever, strep throat.
observations Symptoms include a moderate to severe sore throat, lasting longer than 2 days; difficulty swallowing; pain referred to the ears; enlarged anterior cervical nodes; fever and chills; headache; muscle and joint pain; anorexia; increased secretions from the throat; enlarged, reddened, inflamed tonsils; pus or exudate on the tonsils; halitosis; and edematous or inflamed uvula. Symptoms often last 2 to 3 days after treatment is initiated. Diagnosis is made by direct inspection of the throat and tonsils, and throat cultures are used to identify the causative organism. If not treated, the following can occur: peritonsillar abscess, airway occlusion, rheumatic fever and subsequent cardiovascular disorders, kidney failure, or poststreptococcal glomerulonephritis.
interventions Treatment is directed at the symptoms. Antibiotics are given if the cause is bacterial. Analgesics are used for pain relief. Tonsillectomy is indicated for massive hypertrophy that restricts breathing or obstructs the airway. Adenoidectomy is indicated for hypertrophy of adenoids that obstruct nasal breathing.
nursing considerations Nursing care is focused on provision of comfort and rest. Warm, bland fluids or very cold fluids, saltwater gargles, and throat lozenges may alleviate throat discomfort. A cool mist vaporizer and adequate fluids keep mucous membranes moist. Postsurgical care is aimed at prevention of hemorrhage, prevention of aspiration of drainage, and control of pain. The child is positioned on side until fully alert to facilitate drainage of secretions and prevent aspiration. Suctioning is done with care to prevent trauma to the oropharynx. Frequent assessment for bleeding is done with direct visualization of the surgical site. Continual swallowing by child is an obvious sign of early bleeding. Coughing, clearing of throat, and nose blowing are discouraged and activity is limited to prevent hemorrhage. An ice collar may be applied to help alleviate discomfort from sore throat. Continuous pain control and mild sedation is necessary to prevent crying, which can irritate the operative site and promote hemorrhage. Parents should be educated about signs of hemorrhage and prevention (limiting activity, discouraging coughing, clearing throat, avoiding throat irritants, gargles). Instruction is given to treat any sign of bleeding as a medical emergency.
tonsillitis (tônˈ·s
·līˑ·tis),n condition characterized by inflammation of the tonsils, sore throat, swollen lymph nodes in the throat, and fever, usually caused by an infection.
)
Tonsillitis.
tonsillitis (ton´silī´tis),
n an inflammation of the tonsils.
tonsillitis, lingual,
n a form of tonsillitis at the posterior part of the base of the tongue in the lymphoid masses (lingual tonsils) located there.
)
Tonsillitis.
tonsillitis
inflammation and enlargement of a tonsil, especially the palatine tonsils.
follicular tonsillitis
tonsillitis especially affecting the crypts.
parenchymatous tonsillitis
that affecting the whole substance of the tonsil.
pustular tonsillitis
a variety characterized by formation of pustules.
tonsillitis
ENT Inflammation of the tonsils, often due to bacterial or viral infection, which may expand locally, causing pharyngitis. See Tonsillectomy.
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