What is Tonsillitis?

Tonsillitis is an infection involving inflammation of the tonsils. There are two tonsils, situated on either side of the back of the throat and they form part of the body’s immune system. Like the rest of the immune system they contain special cells to trap and kill bacteria and viruses travelling through the body. When the main site of infection is within the tonsils they swell, become red and inflamed and may show a surface coating of white spots.

Tonsillitis is extremely common in children and young people but it can occur at any age. The characteristics of the disease are pain in the throat, trouble swallowing, fever, glandular enlargenment in the neck and in severe conditions, trismus (difficulty opening the mouth).

How do we contract Tonsillitis?

Whether due to viruses or bacteria, the infection is spread from person to person by airborne droplets, hand contact or kissing hence the term “kissing disease”. It is typically seen in young people but can on occasion effect the older adult, in these cases other possible causes need to be investigated.

There are many different individual viruses and bacteria that can potentially cause tonsillitis e.g. the Epstein-Barr virus, which causes glandular fever. The streptococcus group A is the most common cause of tonsillitis and sore throats – often known as ‘strep throat’. The incubation period between picking up the infection and the disease breaking out is two to four days – sometimes it can be less. Tonsillitis is usually a self-limiting condition, i.e. it gets better without treatment, and generally there are no complications.

Rarely pus can collect just deep to the tonsil itself as a result of infection. This typically produces one sided throat discomfort severe difficulty swallowing and often trismus (difficulty opening the mouth). This is referred to as a “Quinsy” and requires medical intervention.

Signs and symptoms of tonsillitis

• Sore throat.
• Pain or discomfort when swallowing.
• Inability to swallow oral secretions.
• Tonsils may be coated or have a covering of white spots on them.
• Fever.
• Trismus (difficulty opening the mouth).
• Glands in the neck and at the angle of the jaw may be swollen and painful.
• Loss or change in voice.
• In children, tonsillitis may include symptoms that appear less focused on the throat, such as poor feeding, runny nose, ear pain, and a slight fever.

Treatment

1. Visit to the general practitioner (GP) who may commence a course of appropriate antibiotics and analgesia, with advice on oral intake, hygiene and to return if condition does not improve.
2. If the condition does not improve the GP should refer the patient either to a local ear, nose and throat (ENT) referral clinic or to accident and emergency (A&E) for review and treatment by an ENT specialist.
3. If there is an inability to swallow the oral secretions the patient will need to be admitted for a minimum of 24 hours for re-hydration, pain relief and intravenous (IV) antibiotics and reviewed on a daily basis.

Inpatient monitoring

• Visual examination of the tonsils.
• Blood tests, including the mono-spot test to rule out glandular fever.
• Insertion of a venflon for administration of fluids and IV antibiotics.
• Regular temperature check
• Routine observations including oxygen saturation monitoring.
• Analgesia for pain relief both regular and as required. This is also to assist in reducing any above normal temperature. Paracetamol is the most common one given.
• Aspiration if thought to be a quinsy by a trained practitioner.
• If oral medication is not suitable then intra-muscular (IM) or per rectum (PR) should be prescribed.
• Fan therapy if necessary but taking care not to reduce the pyrexial patients temperature too suddenly.
• Documentation of fluid and oral intake.
• Ongoing reviews of care delivered and appropriate alterations, depending on patient response and results of investigations undertaken.

Within 24 hours of analgesia, IV fluids and antibiotics the patient often makes a dramatic recovery and is suitable for discharge home.

The patient is ready for discharge when;

• They are apyrexial
• Are managing adequate oral fluids and diet.
• Their pain is controlled on oral analgesia.
• Any investigations are complete and show no other underlying condition that requires immediate investigation / treatment.

What happens when discharged?

• The patient will continue on a course of oral antibiotics, which must be completed otherwise the infection may return.
• A seven-day supply of appropriate analgesia will be prescribed.
• Verbal and written advice on areas such as dietary advice, when to return to work & refraining or cessation of smoking and oral hygiene should be given to the patient or carer once discharged.
• If the patient suffers from tonsillitis i.e. 3-4 episodes annually and it affects work/ school attendance, they should be offered a tonsillectomy and if agreed, added to the ENT waiting list.
• A copy of their discharge letter will be given to the patient and one posted to their GP.
• They should be advised if their symptoms return they should see their GP and if appropriate the GP will refer them back to the hospital.

Tonsillectomy

What is a Tonsillectomy?

Recurrent tonsillitis, quinsy, obstructive sleep patterns in children are all indications to remove the tonsils in the form of a tonsillectomy.
This procedure is performed under general anaesthetic. Post-operatively patients require regular analgesia and strongly encouraged to continue eating and drinking to speed up their post-operative recovery.
Having a tonsillectomy generally requires an overnight stay in hospital.