TONSILLITIS

Tonsillitis is an infection of your tonsils, two masses of tissue at the back of your throat.

Your tonsils act as filters, trapping germs that could otherwise enter your airways and cause
infection. They also make antibodies to fight infection. But sometimes, they get overwhelmed by
bacteria or viruses. This can make them swollen and inflamed.

Tonsillitis is common, especially in children. It can happen once in a while or come back again
and again in a short period.

There are three types:

● Acute tonsillitis. These symptoms usually last 3 or 4 days but can last up to 2 weeks.
● Recurrent tonsillitis. This is when you get tonsillitis several times in a year.
● Chronic tonsillitis. This is when you have a long-term tonsil infection.

Tonsillitis Symptoms

The main symptoms of tonsillitis are inflamed and swollen tonsils, sometimes severe enough to
make it hard to breathe through your mouth. Other symptoms include:

● Throat pain or tenderness

● Fever
● Red tonsils
● A white or yellow coating on your tonsils
● Painful blisters or ulcers on your throat
● Headache
● Loss of appetite
● Ear pain
● Trouble swallowing
● Swollen glands in your neck or jaw
● Fever and chills
● Bad breath
● A scratchy or muffled voice
● Stiff neck
PATHOPHYSIOLOGY
 ● The common cause of bacterial agents is Group A Beta Hemolytic Streptococcus.

DIAGNOSTIC TEST

Your doctor will do a physical exam. They’ll look at your tonsils to see if they’re red or swollen or
have pus. They’ll also check for a fever. They may look in your ears and nose for signs of
infection and feel the sides of your neck for swelling and pain.

● A throat swab. Your doctor will test saliva and cells from your throat for strep bacteria.
They’ll run a cotton swab along the back of your throat. This might be uncomfortable, but
it won’t hurt. Results are usually ready in 10 or 15 minutes. Sometimes, your doctor also
wants a lab test that takes a few days. If these tests are negative, a virus is what caused
your tonsillitis.
● A blood test. Your doctor may call this a complete blood cell count (CBC). It looks for
high and low numbers of blood cells to show whether a virus or bacteria caused your
tonsillitis.
● Rash. Your doctor will check for scarlatina, a rash linked to a strep throat infection.
TREATMENT (SURGERY)

● Tonsillectomy - is the surgical removal of the tonsils, two oval-shaped pads of tissue at
the back of the throat — one tonsil on each side. A tonsillectomy was once a standard
procedure to treat tonsils (tonsillitis) infection and inflammation. Today, a tonsillectomy is
usually performed for sleep-disordered breathing but may still be a treatment when
tonsillitis occurs frequently or doesn't respond to other treatments. A tonsillectomy may
also be necessary to treat breathing and other problems related to enlarged tonsils and
rare diseases of the tonsils. Recovery time for a tonsillectomy is usually at least ten days
to two weeks.

PRE-OP AND POST-OP CARE

Tonsillectomy Surgical Instructions

Before the Operation

● Complete any blood work or other doctor appointments promptly, as directed by your
surgeon.
● Do not take aspirin or ibuprofen-containing medications within seven days of the
operation.
● You may not eat or drink anything, including water, after midnight on the day of the
operation.
● You may, however, take medications with a sip of water on the day of the operation if
directed specifically by your doctor.

The Day of the Operation

● Arrive at the time given by the surgical center. This may be a while before your
operation, but arriving early is important as a lot needs to happen before the operation.
● Wear comfortable clothes that are easy to change.
● Do not wear jewelry, rings, or earrings of any kind.
● A child may bring a comforting toy or blanket.
● For adults, someone will need to drive you home after the operation, so arrange in
advance for that person to come with you or to be waiting at the hospital for you.
● Bring any papers, forms, or blood work requested by your surgeon.
● You should bring any medications you regularly take to the surgical center, especially
asthma inhalers.

Care After the Operation

● Activity
○ Limit to quiet activities for three days.
○ Children may return to school after one week.
○ Adults may return to work after three days if it does not involve strenuous
physical activity.
○ No gym, sports, heavy lifting, or brass/woodwind instruments for two weeks.
 ○ The stool may be tarry for a few days, initially from swallowed blood.
○ Avoid coughing, sneezing, clearing the throat, or blowing the nose vigorously for
two weeks.

● Diet
○ Start with clear liquids (water, non-citrus juices).
○ Then, advance to soft, mushy foods (noodles, pudding, apple sauce) for ten days
before resuming a regular diet.
○ Avoid spicy hot and temperature hot foods.
○ Avoid dry food like chips and toast.

● Vomiting
○ If vomiting occurs, stop feeding for 1 hour, then give clear liquids and advance
slowly to a regular diet.

● Medication
○ Take medications as prescribed by your surgeon. This may include pain
medication or an antibiotic.
○ Use the prescription pain medication regularly (every 4 hours usually) for the first
three days.
○ Eating may be easier if the pain medication is taken about one hour before a
meal.
○ After the third day, switch to Tylenol (acetaminophen), as directed on the bottle,
during the day, and use the prescription pain medication before sleep at night
and when waking in the morning.
○ No ibuprofen or aspirin for two weeks after the operation.
○ Throat and ear pain can be severe after a tonsillectomy. Take regular doses of
pain medicine as prescribed. Tylenol or the prescribed narcotic pain medicine
should be taken as instructed. 24 hours after your surgery, you may add
ibuprofen for pain control. NO Aspirin or other blood thinners must be taken for
two weeks after surgery. Chewing gum may help lessen muscle spasms and is
encouraged. Take an oral steroid, if prescribed; one on day 3 or 4 after surgery
may also help with pain.

● Voice
○ Often, the voice sounds abnormal, almost like “Donald Duck.” This is normal for
up to 3 to 4 weeks and then resolves.

● General
○ There may be slight bleeding from the nose on the first or second day.
○ Spitting up a small amount of blood is normal. This includes blood-tinged or
streaky saliva. More than a small amount is not normal.
○ A foul odor may come from the mouth or nose for 7 to 10 days during the healing
process. The antibiotic will lessen this smell.
 ○ Throat and ear pain are common after having the tonsils removed. In addition to
using the pain medicine, try placing a warm towel over the ear.
○ An ice pack on the neck may also help.
○ Consider using a humidifier while sleeping to help reduce mouth pain.
○ A fever of up to 101.5 for a few days is normal. If fever persists for over three
days or exceeds 101.5, please call the office.
○ The first 7 to 10 days can be full of “ups and downs.” You or your child will
sometimes seem pain-free and may even eat food you think would hurt the
throat. Later that day, you or s/he may be in great pain and refuse even liquids.
Use one of the medicines every four hours, and try cold drinks or Popsicles.
Things will get better!
○ It is usual for the back of the throat to look white for up to 2 weeks after surgery.

● Problems
○ If any bright red bleeding from the nose or mouth does not stop within two to
three minutes, you or your child should call your surgeon or be evaluated in the
nearest emergency room immediately.
○ Pain can lead to decreased liquid intake and dehydration. This can lead to more
pain and bleeding from the mouth. Focus on staying hydrated by drinking lots of
cool liquids.

Tonsillitis Treatments

Your treatment will depend in part on what caused your illness.

Medication
● If your tests find bacteria, you’ll get antibiotics. Your doctor might give you these drugs in
a one-time injection or pills you’ll swallow for several days. You’ll start feeling better
within 2 or 3 days, but taking all your medication is important.

Home remedies
- If you have a virus, antibiotics won't help, and your body will fight the infection
independently. In the meantime, you can try some home remedies:

● Get lots of rest

● Drink warm or very cold fluids to help with throat pain
● Eat smooth foods, such as flavored gelatins, ice cream, and applesauce
● Use a cool-mist vaporizer or humidifier in your room
● Gargle with warm salt water
● Suck on lozenges with benzocaine or other medications to numb your throat
● Take over-the-counter pain relievers such as acetaminophen or ibuprofen