Tonsillitis and Tonsillectomy Explained via 3D Medical Animation

What are tonsils?

At the back of your throat, two masses of tissue called tonsils act as filters, trapping germs that could otherwise enter your airways and cause infection. They also produce antibodies to fight infection. But sometimes the tonsils themselves become infected. Overwhelmed by bacteria or viruses, they swell and become inflamed, a condition known as tonsillitis. The condition is usually treated through tonsillectomy.

3D Medical Animation - Normal vs Infamed Tonsils with Symptoms

Tonsillitis is common, especially in children. The condition can occur occasionally or recur frequently. In children, symptoms may also include Nausea, Vomiting and Abdominal pain.

What are the causes of Tonsillitis?

Left: Streptococcus (strep) bacteria; Right: Tonsils causing viruses

Bacterial and viral infections can cause tonsillitis. A common cause is Streptococcus (strep) bacteria. Other common causes include:

• Adenoviruses
• Influenza virus
• Epstein-Barr virus
• Parainfluenza viruses
• Enteroviruses
• Herpes simplex virus

What are the treatments available for Tonsillitis?

Treatment for tonsillitis will depend in part on the cause. To determine the cause, your doctor may perform a rapid strep test or throat swab culture. Both tests involve gently swabbing the back of the throat close to the tonsils with a cotton swab. A lab test can detect a bacterial infection. A viral infection will not show on the test, but may be assumed if the test for bacteria is negative. If tests reveal bacteria, treatment will consist of antibiotics to cure the infection. Antibiotics may be given as a single shot or taken 10 days by mouth. Although symptoms will likely improve within two or three days after starting the antibiotic, it's important to take all of the medication your doctor prescribes to make sure the bacteria are gone. Some people need to take a second course of antibiotics to cure the infection. If the tonsillitis is caused by a virus, antibiotics won't work and your body will fight off the infection on its own.

How is tonsillitis treated?

Treatments for tonsillitis vary from doing nothing to surgically removing the tonsils (tonsillectomy). When caused by a virus, Tonsillitis often goes away in a few days and treatments are designed to manage symptoms. This includes gargling salt water, drinking warm liquids such as tea and broth, sucking on lozenges, and taking over-the-counter pain killers such as acetaminophen. For bacterial tonsillitis and strep throat, treatment generally consists of antibiotics such as penicillin or erythromycin. The most serious and invasive treatment is tonsil removal, or tonsillectomy. This is only recommended when a doctor finds something seriously wrong with the tonsils such as long-lasting recurring infections that do not respond to other treatments. Adults with recurrent sore throats may benefit from having a tonsillectomy in the short term, but the overall longer term benefit is still unclear. An adeno-tonsillectomy, which provides improvement in the upper airway of children, may in turn lead to improvement of the lower airways of children, especially those with bronchial asthma.

Is a surgery required for tonsillitis?

Tonsils are an important part of the immune system throughout life, so it is best to avoid removing them. However, if tonsillitis is recurrent or persistent, or if enlarged tonsils cause upper airway obstruction or difficulty eating, surgical removal of the tonsils, called tonsillectomy, may be necessary. Most tonsillectomy procedures involve using a conventional scalpel to remove the tonsils; however there are many alternatives to this traditional method. Increasingly doctors are using techniques such as lasers, radio waves, ultrasonic energy, or electrocautery to cut, burn, or evaporate away enlarged tonsils. As with all surgeries, each of these has benefits and drawbacks. When considering the procedure, it's important to discuss your options with the surgeon to select the most appropriate one for your child.

What are the precautions to be taken when having tonsillitis?

You need to take:

• Rest
• Pain relievers; Paracetamol ( stronger pain killers may be necessary with advice from your doctor)
• Adequate water/ liquids
• Medication as prescribed even if the symptoms improve in two to three days

What are the precautions to be taken after tonsillitis surgery (tonsillectomy)?

• Avoid going to crowded places for 10 days
• Take food and adequate liquids
• Pain relievers that you need to take regularly will be precribed
• If there is high fever or bleeding from the throat, see your doctor immediately
• Have a check-up in two to four weeks

The recovery from tonsillectomy is a very painful period, often the worst pain people can recall, so please be understanding and patient with yourself, or the patient you are caring for. There are generally two periods to recovery, the first severe and the second less so, before returning to normal health. The first period lasts 5-7 days in children and 7-10 days in those over about twelve years old, and is the time the throat is “re-growing” its covering. If you look at the throat then, it is red and white and swollen, especially the uvula that hangs down in the middle of the throat. The second period lasts another 5-7 days in children or 7-10 days in those over twelve years old and has less pain, although you will still find that yawning, coughing, and sneezing will cause sharp twinges of pain. During this time the swelling improves and the tissue looks gray. Dehydration is the biggest enemy of the recovery period. It will increase the pain, increase the risk of bleeding or infection, and delay the healing. It usually happens because the pain of swallowing keeps the patient from drinking enough liquids. Therefore, the key is to force fluids, and that works best when pain control is maximized. This means alternating liquid Ibuprofen (Advil® or Motrin®) with liquid narcotic (Tylenol® with codeine or Lortab®). Each medicine can be taken every 6 hours, so the patient will be taking one of them every three hours, going back and forth between the two. You may find it helpful to take pain medicine during the night, especially if the patient awakens. These are usually best taken with some other liquid or soft food because they can be irritating to the stomach. The worst pain is usually in the morning, especially beginning a day or two after the operation. Please be aware that no combination of medicines will eliminate the pain – the patient will need to continue eating/drinking in spite of the remaining discomfort. A topically sprayed Chloroseptic® (OTC) also helps some patients. Bleeding can occur in 5-7% of patients. It may come from the nose, the mouth, or be vomited or coughed up. Depending upon the situation your doctor may recommend that this be observed at home or in the emergency room. In a small number of cases, it may require treatment in the emergency department or operating room. The patient should not be more than 20 minutes from the hospital for the first ten days. The most likely time for bleeding is 5-7 days after the operation, although it may occur at any time. Do not panic. Remember that the patient should only have liquids or soft foods for the first ten days. Any liquid or soft food is safe, but most people will prefer cold over warm, and most find acidic things (citrus, carbonated soda or tomato products) will be more irritating. Favorites among the patients are popsicles, ice cream, sherbet, jello, pudding, applesauce, yogurt, eggs, potatoes, pasta, and soups. Definitely avoid hard, crunchy and chewy foods – they will increase the risk of bleeding. Remember, no strenuous activity for 10 days following the operation. (this includes no lifting of more than 10 pounds). Since moisture helps soothe the healing throat, a room humidifier (hot or cold) is suggested when the patient is sleeping.

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