Tonsillitis

Tonsils and tonsillitis usually refer to the palatine tonsils – tonsils which sit in the folds of tissue coming off the soft palate, into the throat. The tonsils are collections of glandular tissue, which also occur in the back of the nose (adenoids), back wall of the throat (posterior pharyngeal wall) and back of the tongue (lingual tonsil). This glandular tissue has a function – it produces lymphocytes and antibodies in response to unwanted material, such as bacteria or viruses. It is thought tonsils were useful in days when food was often contaminated or rotten. Nowadays, many massive studies (e.g. the Scottish Tonsillectomy Audit) have shown that our quality of life only improves if the tonsils are removed, and that there is no evidence to suggest that tonsillectomy is in any way harmful to the patient. The other tonsil tissue tends to be less harmful than palatine tonsils, although it may still need treatment.

Tonsillitis and tonsils in general are linked with catarrhal symptoms, as with tonsilloliths (stones in the tonsils). Bursts of bad sore throats followed by grumbling throat pains usually represent acute on chronic tonsillitis, and can lead to all sorts of other symptoms, such as lethargy, malaise, joint pains, gastro-intestinal upsets etc. Often, large recurrently inflamed tonsils are associated with bad breath, a bad taste in the mouth, throat clearing, cough and snoring – all catarrhal symptoms. Tonsillitis is a very common illness, which generally starts in children, and can then burn itself out by the age of 8 or 9. Some people, however, continue to suffer with a variety of symptoms well into adult life. This can be exacerbated or triggered by glandular fever in their teens. Typically, patients complain of a bad sore throat, with a high temperature, the patient feels very unwell, and has painful glands in the neck. Several days off work or school is often required until the patient feels better – the whole episode can last up to 10 days or more.

Tonsillitis is diagnosed by taking a history and examining the patient. Classically it needs to be excluded from the milder and even more common condition of pharyngitis – which almost always occurs with colds and influenza. This non-specific sore throat tends to resolve after 3 or 4 days, and causes relatively mild symptoms.

Tonsillitis – the white lumps are caused by inflammatory exudate from the inflamed tonsils Almost everyone in the western world has suffered from acute tonsillitis at some stage in their life. It is very commonly associated with Epstein-Barr virus infection, “Glandular fever”. It is a debilitating condition, which often confines the patient to bed, with a high temperature, large glands in the neck, and feeling terrible. It usually goes on for about 7 days, often a few days off school or work is required. The treatment of acute tonsillitis is with fluid replacement, painkillers, anti-inflammatories and possibly antibiotics, although the latter’s clinical effectiveness is not totally clear cut.

Complications may occur, in particular local problems, such as the formation of an abscess behond the tonsil. This causes severe pain on one side, which usually radiates to the ear, it can be difficult to open the mouth (trismus) and patients are often dehydrated. This complication may require hospital admission for fluids to be given directly into the vein (a drip). Other complications are less common, sometime streptococcal bacteria of a dangerous type can enter the bloodstream during tonsillitis, leading to a variety of serious disorders, including kidney disease (acute glomerulonephritis) and heart disease (rheumatic heart disease).

If tonsillitis is recurrent, and/or affecting the patient’s quality of life, surgical treatment can be undertaken. This operation, called tonsillectomy, is often accompanied by adenoidectomy and possible grommet insertion in children. In people of this age group, the conventional, standard “dissection” tonsillectomy, essentially unchanged over 40 years, is the treatment of choice. This is because children tend not to suffer too much from the consequences of tonsillectomy, namely bleeding and infection, although very small or otherwise ill children may be better treated with the adult alternative – laser vapourisation tonsillectomy.

Intracapsular or inside-out ot extended tonsillotomy or laser vapourisation tonsillectomy. The key point of this procedure is that the tonsil capsule is generally left intact, so the florid blood supply is not exposed. This also leads to a dramatic reduction in postoperative pain levels. The downside is that a very small amount of tonsil tissue is left behind after surgery, although this is usually insignificant.

Otherwise known as extended laser tonsillotomy, or inside-out laser tonsillectomy, this technique has proven itself to be much less painful and prone to bleeding than the standard dissection technique. The main users of this procedure in the U.K. are The London Laser Clinic, with over 400 procedures having been performed, with a very low complication rate (0.25% bleeding). This procedure is particularly useful in patients over the age of about 12 years, in whom postoperative pain and complications are generally such a big issue.

Blood supply of the tonsils – branches of the lingual, facial and ascending pharyngeal arteries – themselves braches of the high flow carotid artery. More information regarding this “inside –out” procedure which removes >95% of the tonsils, is available at The London Laser Clinic.

The London Laser Clinic has more background information, and a number of treatment solutions for tonsillitis and sore throat; click here to visit the relevant LLC page.