What is Tonsillitis?

The tonsils are a pair of tissue membranes located on either side of the back of the throat.  Tonsillitis occurs when these become infected.

Infection in children is usually caused by streptococcus bacteria, but can also be viral.  It can occur at any age but is very common in childhood.

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Pathophysiology of Tonsillitis

The tonsils form part of the immune system, acting as the first line of defence against bacteria and viruses entering the mouth.  They produce white blood cells such as T helper cells to help the body to fight off infection.

  • An inflammatory infection caused by the invasion of the mucous membranes by microorganisms.
  • Tonsils have crypts where bacteria and viruses can become stuck when they enter the mouth.  This causes an immune response.
  • Blood vessels will become leaky to allow white blood cells to arrive at the site of infection.  This also causes extra fluid in the tonsils aiding in inflammation.
  • Macrophages engulf and eliminate the antigen.
  • Macrophages and dendritic cells are antigen-presenting cells and mark the antigen for destruction by T helper cells.
  • Dendritic cells take a sample of the antigen to the lymph nodes where antibodies are produced by lymphocytes to fight it.
  • IgE cells bind to the antigen and then bind to mast cells making them release histamine.  This causes swelling of the tonsils and surrounding areas.
  • White spots can appear on the tonsils caused by inflammatory exudate collecting in crypts of the tonsils
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Symptoms of Tonsillitis

  • Sore Throat - caused by inflammation of the tonsils and surrounding areas.
  • Difficulty swallowing - due to enlarged tonsils caused by inflammation
  • Fever - body temperature raises in response to presence of infection.  Pyrogens influence the hypothalamus to increase metabolic reactions.
  • Tonsils red and swollen - caused by inflammation of the tonsils.
  • Tonsils have white/yellow spots - caused by inflammatory exudate collecting in the crypts of the tonsils
  • Deviation of uvula - infected tonsils become swollen and push against the uvula causing the uvula to also become red and swollen.
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Treatment of Tonsillitis

  • Antibiotics - If bacterial to clear up infection
  • Fluids (Oral or IV) - IV fluids may be given if tonsils are too swollen to tolerate oral fluids.  Fluids should be encouraged as those with tonsilitis may not drink enough due to pain and this can lead to dehydration.
  • Antipyretics - to reduce fever
  • Analgesia - to reduce pain
  • Tonsillectomy - If tonsillitis is severe or reoccurring, a surgical procedure is given to surgically remove the tonsils and prevent repeat infection.
  • Throat irrigations or gargles - gargling with salt water can relieve sore throat symptoms
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