What is tonsillitis?
The palatine tonsils are part of the lymphatic system and are therefore part of the body’s defense system. The surface of the palatine tonsils is covered with immune cells, which trigger an immune reaction on contact with viruses, bacteria or allergens.
As tonsillitis is not notifiable, there are only rough estimates of the number of cases in Switzerland. However, it is known that angina is one of the most common respiratory diseases – especially in children and adolescents.
Causes: How does tonsillitis develop?
Acute tonsillitis is often triggered by viruses. Adenoviruses, influenza or Epstein-Barr virus(Pfeiffer’s glandular fever) are among the most common pathogens. Bacteria can also be the cause, for example streptococci. Both viruses and bacteria can be transmitted via droplet infection (coughing, sneezing). Certain bacteria are transmitted sexually, such as chlamydia and gonococci.
Symptoms: How does tonsillitis manifest itself?
The typical accompanying symptoms of inflamed tonsils are severe sore throat to the point of being unable to swallow and fever. Angina often also causes a feeling of fatigue. The palatine tonsils are swollen and reddened. A feeling of tightness (“angina”) may develop in the throat. Coatings are often found on the surface of the tonsils. Other symptoms may include slurred speech, bad breath and, in children, often abdominal pain or nausea and vomiting.
Diagnosis: How is tonsillitis diagnosed?
The diagnosis is made clinically, the tonsils present with inflammatory changes, and painful lymph nodes can often be felt in the neck. In addition, the inflammation values in the blood can be examined, which are usually elevated.
The symptoms and clinic often do not allow a clear distinction to be made between a viral or bacterial infection. Depending on the clinic and the symptoms, a smear test is carried out. To do this, wipe the almonds with a cotton bud. Streptococci can be detected directly on site, with a specific rapid test providing a result within minutes. If other bacteria or viruses are sought, the swab must be sent to the laboratory, where analyses are carried out and any pathogens are only detected within a few days.
How does tonsillitis progress?
As tonsillitis is associated with pain and therefore also with restricted drinking and eating, the primary aim is to relieve the symptoms quickly. Pain medication can be prescribed for this purpose. Make sure you drink enough fluids. Treatment with antibiotics is not always indicated, especially in the case of tonsillitis caused by viruses, these have no effect at all.
Treatment with antibiotics will be discussed with you if bacteria can be detected in the smear, if the clinical findings are highly suggestive or if there is a suspicion of abscessing suppuration around the tonsils (so-called peritonsillar abscess).
Formation of a tonsil abscess (peritonsillar abscess)
In rare cases, an accumulation of pus forms around a tonsil (peritonsillar abscess). Clinically, there is a one-sided increase in symptoms with severe pain and restricted mouth opening. Inspection reveals a clear swelling in the area of the palatal arch on the affected side. The treatment of a peritonsillar abscess always requires surgical relief of the accumulation of pus, which can be performed under local anesthesia or, in rare cases, under general anesthesia.
Tonsillectomy: removing the tonsils
Removal of the palatine tonsils (tonsillectomy) is a routine procedure. In this case, both palatine tonsils are usually removed under general anesthesia. The procedure takes about 30 minutes. After the operation, the patient stays in hospital for two nights. Until the wound area has healed (approx. two to three weeks), there is a risk of secondary bleeding that should not be underestimated. In the event of bleeding after tonsillectomy, immediate consultation with an ear, nose and throat specialist is always necessary to assess the situation. A small bleeding vessel can often be sclerosed with electric forceps after local anesthesia; in rare cases, hemostasis under general anesthesia is necessary. Also worth mentioning is the painful post-operative phase until the wound has healed, whereby treatment with painkillers is essential.
For the above-mentioned reasons, the indication for a tonsillectomy must be strictly defined. In the case of recurrent tonsillitis or peritonsillar abscesses or severely enlarged tonsils without inflammation, surgery may be discussed, especially if the enlarged tonsils lead to problems sleeping (obstructive sleep apnea syndrome).
