You Ask , They Answer
Q
: What ’ s tonsillitis and its telltale signs ?
A
: Tonsillitis is an acute infection of the throat , located mainly on the sides where the palatine tonsils are located . There are actually several other tonsils in the throat ( e . g ., adenoids , tubal , lingual ) which can also be infected , but palatine tonsillitis is the common condition most people recognise and are familiar with . The infection can be viral ( the majority of cases ) or bacterial such as Streptococci . The lymph nodes of the neck can be enlarged in both viral and bacterial tonsillitis . The tonsils may swell , making swallowing painful and difficult . In rare cases , they can be so large that it becomes difficult to breathe . This can occur especially in glandular fever ( Epstein Barr Viral infections ).
Q
: What are the non-surgical approaches for treating it ?
A
: Pain relief , paracetamol , and antibiotics are often given to treat tonsillitis . Antibiotics should be reserved for patients who have failed to get better after 72 hours of other treatment or who have complications , such as a peri-tonsillar abscess ( a “ quinsy ”). Steroids are particularly good at relieving swelling and pain from tonsillitis but should be given under medical supervision due to the risk of medical adverse events . Amoxycillin should be avoided as an antibiotic , either on its own or in combination with clavulanic acid , due to the high risk of skin rashes and other reactions in patients with tonsillitis .
Q
: When is surgery to remove the tonsils required and which risks are associated with it ?
A
: Most countries have guidelines for the indications for a tonsillectomy . In Australia , more than seven infections in a year , five per year for two years , and three per year for three years are indications for surgery . Severe sleep disordered breathing from large tonsils ( and usually adenoids in children ) is now more common than recurrent infections . Whilst a single “ quinsy ” is no longer an absolute indication , two or more peri-tonsillar abscesses places a patient into a high-risk category for serious future issues , and surgery is recommended . A unilateral swelling or irregularity where cancer may be suspected requires urgent specialist assessment , and an urgent tonsillectomy may be recommended so tissue can be sent for biopsy . Recurrent tonsil stones or “ tonsilloliths ” causing halitosis is another increasing problem which can be cured by tonsil surgery .
Q
: Is tonsil reduction preferable to the complete removal of the tonsils ?
A
: Completely removing the tonsils exposes nerves , muscle , and blood vessels . This can result in bleeding , either within the first 24 hours ( primary haemorrhage ) or at 2-10 days following surgery ( secondary haemorrhage ). Pain following tonsillectomy can be severe and last for up to 10 days before return to normal activities . Reduction of the tonsils ( also called an “ intra-capsular tonsillectomy ”, “ tonsillotomy ”, or “ sub-total tonsil reduction ”) results in much less pain and bleeding . Primary haemorrhage is almost unheard of and readmission to hospital was 20 times less likely in a recent study from the UK . In an Australia study , children returned to normal activities on average after four days versus 11 days . Reoperation rates for subtotal tonsil surgery are about 2.5 percent - usually due to regrowth of the tonsil remnant left behind . The decision on what type of surgery is best should be discussed with your ENT surgeon although not all are trained in the sub-total technique , and it does take slightly longer to perform , requiring special probes which may not be available everywhere .
Dr Simon Carney
Dr Simon Carney is a Professor of Otolaryngology and Head & Neck Surgery at Flinders University in Australia and the director of Southern ENT , Flinders Private Hospital .
12 SEPTEMBER 2022 GlobalHealthAsiaPacific . com