TONSILLITIS AND ADENO-TONSILLECTOMY

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TONSILLITIS AND ADENO-TONSILLECTOMY

Tonsillitis is an inflammation of the tonsils in the mouth and will often, but not necessarily, cause a sore throat and fever.

Symptoms may also include pain in the tonsil area and inability to swallow and/or painful swallowing. White spots may also appear on the tonsils.

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, and is extremely painful.

Causes

Bacterial tonsillitis may be caused by Group A streptococcal bacteria, resulting in strep throat. Viral tonsillitis may be caused by numerous viruses such as the Epstein-Barr virus (the cause of glandular fever) or the Coxsackie virus.

Sometimes, tonsillitis is caused by a superinfection of spirochaeta and treponema, in this case called Vincent's angina or Plaut-Vincent angina.

Treatment

Treatment consists of painkillers and fluids; if caused by bacteria then antibiotics are also prescribed. Usually penicillin, or erythromycin if the patient is allergic to penicillin. Amoxicillin should not be used, unless bacterial infection has been microbiologically confirmed, because if mononucleosis is mistaken as tonsillitis and amoxicillin is given, a rash might develop and it may be wrongly assumed that the patient has developed an allergy to penicillins. Rest in a warm environment is advisable.

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.

One may consider a burst of steroids to help decrease the edema and inflammation thereby easing pain and allowing the patient to swallow liquids sooner.

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.

In chronic cases tonsillectomy (surgical removal of tonsils) may be indicated.

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)[2][3][4], 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 acumulates in pits (referred to as 'crypts') in the tonsils, produce whitish-yellow deposits known as a tonsilloliths. These "tonsil stones" emit a very pungent odor due to the presence of volatile sulphur compounds.

Tonsilloliths (or tonsil stones) which occur in the crypts of the tonsils can only be completely cured by tonsillectomy or by resurfacing the tonsil by laser, but practicing good oral hygiene and use of a water pick may help lessen the symptoms. It is still possible to get tonsiloliths after removal of the tonsils unless a complete tonsillectomy is performed.

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 or glomerulonephritis can occur. These complications are extremely rare in developed nations but remain a significant problem in poorer nations.

Source: wikipedia GFDL
 

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