Generality
The inflamed tonsils are one of the most characteristic manifestations of tonsillitis . This problem occurs mainly in the pediatric age, but it can also affect adults.
In most cases, inflamed tonsils result from infections, as they easily come into contact with bacteria and viruses.
Tonsillitis involves swelling, redness, sore throat and pain when swallowing. Associated with this clinical picture, it is not uncommon for general malaise, fever, swollen lymph nodes in the neck, ear pain, bad breath and suppuration (plaque formation) to appear.
If the inflamed tonsils cause respiratory limitations or recurrent infections and are resistant to medical treatment, an indication is given to their removal ( tonsillectomy ).
What are
The inflamed tonsils are a clinical sign that results from an inflammatory process of the same ( tonsillitis ) and, possibly, of the surrounding tissues ( adenotonsillitis or pharyngotonsillitis ). The enlargement ( tonsillar hypertrophy ) and the inflammation of these structures are pathological conditions that are frequent especially in children . From these problems, respiratory problems and other complications can arise which should never be neglected.
Tonsils: short introduction
- The tonsils are two organs formed by lymphoid tissue, located at the sides of the throat, immediately behind and above the base of the tongue.
- When normal, the tonsils are barely visible and have a uniform pink color . Their ovoid shape is reminiscent of an almond.
- Being in a strategic position, the function of the tonsils consists in forming a first barrier against infections of the upper airways, especially important during childhood, when the immune system is still not very mature. Moreover, these structures favor the immunization towards the microorganisms coming from the outside, which penetrate through the nose and the mouth: when they are inflamed, the tonsils force the body to produce antibodies capable of neutralizing viruses and bacteria. Pharyngeal (or adenoid ) tonsils also participate in this defense against respiratory infections.
- In some cases, however, the task of the tonsils is less: after repeated bacterial or viral aggressions, these can become chronically inflamed or excessively increase in volume ( hypertrophy ) and turn, in turn, into an outbreak of infection for the whole body.
Causes
The inflamed tonsils recognize multiple causes. In most cases, this manifestation depends on an infection : the tonsils come easily in contact with bacteria and viruses, therefore they frequently encounter inflammatory processes.
Tonsillitis can be acute or chronic (if it is not treated properly, the tonsillar tissue is constantly sick).
The inflamed tonsils are a common manifestation especially among children aged between 2 and 6 years.
Bacterial tonsillitis
The bacterium most commonly responsible for inflamed tonsils is group A beta-hemolytic streptococcus . This pathogen is widespread: it appears, in fact, to be present asymptomatically in about one third of children. When the organism is weak or respiratory infections are in progress, Streptococcus multiplies causing high fever (up to 39-40 ° C), chills, bad breath, swelling, difficulty swallowing and whitish plaques in the throat.
Viral tonsillitis
As for viral agents, the inflamed tonsils depend, in most cases, on Adenovirus and Rhinovirus, responsible for most colds. Furthermore, in some cases, tonsillitis can be caused by Epstein Barr virus (mononucleosis).
Viral tonsillitis manifests as a red throat, swollen lymph nodes, and a few lines of fever. Generally, the disease undergoes spontaneous resolution.
Risk factors
Regardless of the cause, the inflamed tonsils are favored by:
- Low temperatures : the inflammation of the tonsils is more frequent in the winter period, due to exposure to cold and the greater risk of incurring in temperature changes. Furthermore, the colder temperatures tend to weaken the immune system, allowing viruses and bacteria to multiply more easily in the throat.
- Pediatric age : present from birth, the tonsils develop progressively and reach their maximum size at the age of 3-5 years. At the age of about 7, these organs undergo an involution process, reducing their size due to the physiological atrophy, which makes them barely visible during adolescence. In adulthood, the tonsils become practically inactive from the functional point of view. By increasing in volume, these structures are more likely to be infected and, due to their particular conformation, they become excellent deposits of infectious material.
Symptoms and Complications
On observation, the inflamed tonsils appear as two enlarged, reddened and swollen masses . In addition to hyperemia and tonsillar hypertrophy, when acute inflammation is in progress, yellow pus patches or whitish plaques in the throat can be seen on the surface.
The inflamed tonsils can be accompanied by extremely varied manifestations, including:
- Sore throat (pharyngodynia);
- Pain during swallowing (odinophagy);
- Halitosis (bad breath);
- Enlarged lymph nodes in the neck (cervical reactive lymphadenopathy);
- Reflex otalgia (pain radiated to the ear, supported by the common innervation);
- Contemporary inflammation of the adenoids.
Depending on the underlying cause, other symptoms associated with inflamed tonsils include:
- Fever more or less high (sign not always present in case of tonsillitis);
- Dysphagia (difficulty swallowing food);
- Headache;
- Dyspnea (difficult breathing);
- Sleep disorders;
- Changes in the vocal timbre;
- Anxious cough.
Usually, inflamed tonsils resolve completely, without leaving any damage, if diagnosed and treated properly.
Other times, the recurrence of tonsillitis can predispose to the development of complications.
In particular, in severe cases or if the disease is neglected, inflamed tonsils may involve:
- Chronic or recurrent nasopharyngitis;
- Inflammation of the middle ear (otitis);
- Sinusitis and respiratory infections (bronchitis or pneumonia);
- Respiratory disorders, especially during night rest, such as obstructive sleep apnea and snoring (in severe cases);
- Mastoiditis (inflammation of a skull bone);
- Peritonsillar abscesses (collections of purulent exudate inside or near the tonsils);
- Septicemia (widespread infection throughout the body).
Chronically inflamed tonsils can represent an infectious focus that can be responsible for diseases affecting other organs, such as eyes, joints, muscles, kidneys and heart. Although now rare occurrences, the possible complications at a distance are glomerulonephritis, rheumatic fever and endocarditis.
Tonsils inflamed: how long?
The inflammation of the tonsils of viral origin undergoes spontaneous resolution within 7-10 days, with a symptomatic peak in the first 48-72 hours. If the disorder depends on a bacterium and antibiotic therapy is started, the symptoms are reduced in about 5 days.
Diagnosis
The evaluation of inflamed tonsils can be performed by your primary care physician or otolaryngologist : the associated symptomatology is easily recognizable and the diagnosis of tonsillitis can be formulated after complete inspection of the upper airways and digestive tracts (oral cavity and throat).
The doctor also has the task of establishing in the disorder in place which pathogens are involved or not. In general, the various symptoms of bacterial infections, unlike in viral infections, tend to worsen (and not improve) after 48-72 hours.
To distinguish the causes of the inflamed tonsils, the patient can be subjected to an oropharyngeal swab which usually attests the presence of a bacterial infection by Streptococcus. This exam consists in taking a small amount of throat secretion with a sterile cotton coated stick: the liquid is then analyzed in the laboratory to identify the etiological agent in a few days. The request of the antispreptolysin titre (TAS) is fundamental to exclude group A beta hemolytic streptococcus infection and can be an indicator of tonsil inflammation even after some time.
If your doctor suspects that your tonsillitis is caused by mononucleosis or other viral agents, you will need specific blood chemistry tests .
When to seek medical attention urgently
The doctor must be consulted in a timely manner when the following conditions are met:
- Sore throat is particularly intense and there are many difficulties in breathing or swallowing;
- Fever exceeds 39 ° C;
- Tonsillitis does not resolve and does not tend to improve after five days of its onset;
- There is pain in the ear;
- The headache is intense and associated with repeated vomiting;
- The patient shows signs of mental confusion.
Treatment
As for the treatment, the options vary depending on the cause of the inflamed tonsils:
- If the basic problem is a bacterial infection, the doctor may indicate the intake of specific antibiotics aimed at selectively attacking the pathogen responsible for the disorder. An anti-pyretic drug may be associated with this therapy to combat fever. Normally, antibiotics prescribed by the doctor are sufficient to treat the problem of inflamed tonsils (acute bacterial tonsillitis). Sometimes, however, this therapy is not sufficient to eradicate the infection definitively and the patient may be subjected to 5-6 acute episodes (chronic tonsillitis) in the course of a year.
- When the origin is viral, the inflammation of the tonsils regresses and heals spontaneously within 7-10 days. In this case, it is possible to resort to a pharmacological treatment aimed at mitigating the symptoms. The doctor may indicate the intake of antipyretics and analgesics, such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs).
To alleviate the disorders associated with inflamed tonsils it can be useful:
- Rinse the throat with gargling using an antiseptic mouthwash or saline solution;
- Take plenty of fluids (fruit juices and herbal teas) and soft foods, preferably warm or cold.
Did you know that…
Until the tonsillitis persists it is good not to take drinks or foods that are too hot, as they increase local inflammation. On the contrary, having dinner or having lunch with an ice cream can be a relief.
When to remove the tonsils
Although these formations are useful during early childhood to prevent infections, the body has more effective means to fight bacteria and viruses. For this reason, if the tonsils grow in volume, are chronically inflamed and cause significant respiratory problems, the possibility of surgically removing them is considered.
Indications for tonsillectomy
- Inflammation of chronic or relapsing tonsils (more than 4-5 episodes of tonsillitis per year in school-age and adult children);
- Severe symptomatology (impediment to breathing through the nose, snoring, sleep apnea, etc.);
- Recurrent inflammation of the middle ear;
- Pharyngitis that repeats with a certain frequency;
- Risk of possible complications and suspicion of spreading the infection at a distance.
Tonsillectomy is a relatively simple operation that is performed under general anesthesia. In the week following the operation, it is normal to feel discomfort and pain in the affected area. However, if copious blood loss occurs, contact your nearest emergency room immediately.
Tonsillectomy can be associated with the removal of adenoids ( adenoidectomy ) which, like tonsils, are often subject to inflammation and enlargement.
