What is Tonsillitis?
The tonsils are thought to have an immunological function in the first 18 months of life but thereafter have no useful function and are surplus to requirement. Seen under the low-power microscope, the tonsil has deep clefts which reach to the inside of the tonsil and harbour numerous bacteria. Every now and again, these bacteria can become virulent and give rise to an episode of tonsillitis. The bacteria invade the surrounding tissues and give rise to sore throat and associated symptoms can include fever, general malaise and inspection of the tonsils reveals white spots with sometimes pus-like material emanating from the crypts of the tonsils. As a result of the acute episode, the body builds up a defence with an increase in white blood cells and together with treatment with antibiotics, the acute infection usually settles after seven to ten days.
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In some patients, the bacteria remain quite active and give rise to persistent sore throat symptoms with acute exacerbations (chronic tonsillitis)
The common organisms causing this infection are Streptococcus and Staphylococcus.
Causes and Treatment
Bacterium may then reside dormant in the depths of the tonsil until the next occasion. Treatment of these infections is with appropriate antibiotics. In an ideal world, a throat swab would be taken in the outpatient setting but a course of broad-spectrum antibiotics such as Penicillin V is started pending the throat swab result.
There are now guidelines as to the surgical management of recurrent tonsillitis and usually if a patient has a history of four or more episodes in a 12-month period for two consecutive years, then this fulfils the criteria for tonsillectomy. However, this guideline is not set in stone and patients with very mild symptoms but frequent episodes can sometimes be observed whereas patients with few episodes but are more severe and result in much time loss from work or school may benefit from tonsillectomy.
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Typical appearances of bacterial tonsillitis with white spots on the surface of enlarged tonsils. They can sometimes meet in the middle giving rise to difficulty in breathing and swallowing
Tonsillitis due to glandular fever viral infection. Notice the continuous film of white debris as opposed to isolated spots which differentiate this from bacterial tonsillitis