CHRONIC TONSILLITIS AND ITS MANAGEMENT WHAT IS CHRONIC TONSILLITIS? Chronic tonsillitis is a persistent or recurrent inflammation of the tonsils, lasting for extended periods, often for more than three months. Unlike acute tonsillitis, which is a short-term condition, chronic tonsillitis can significantly affect one’s quality of life over time. CAUSES OF CHRONIC TONSILLITIS RECURRENT ACUTE INFECTIONS Multiple episodes of acute tonsillitis can eventually lead to a chronic condition. PERSISTENT LOW-LEVEL INFECTION Sometimes, a less aggressive but enduring infection can cause chronic tonsillitis. ENVIRONMENTAL FACTORS Exposure to irritants like tobacco smoke or pollution. IMMUNOLOGICAL FACTORS Weak immune responses can fail to clear previous infections, contributing to chronicity. CLINICAL PRESENTATION (SYMPTOMS) PERSISTENT SORE THROAT Mild but nagging pain, often worse in the mornings. HALITOSIS (BAD BREATH) Due to bacterial activity. LOW-GRADE FEVER May be intermittent. DIFFICULTY SWALLOWING Especially problematic with solid foods. SWOLLEN LYMPH NODES Often tender to touch, located in the neck. TONSIL STONES (TONSILLOLITHS) The term “tonsilloliths” refers to tonsil stones, which are calcified deposits that form in the crevices of the tonsils. Here’s some general information about them: They are formed when debris, such as food, dead cells, and other substances, get trapped in the nooks and crannies of the tonsils. Over time, this debris can harden or calcify, forming tonsil stones. They can vary in size and colour, often appearing as white or yellowish formations. DIAGNOSTIC MEASURES HISTORY-TAKING IN CHRONIC TONSILLITIS A detailed medical history is the cornerstone of diagnosing chronic tonsillitis effectively. Duration of Symptoms Understanding how long the patient has been experiencing symptoms helps distinguish between acute and chronic cases. Frequency of Episodes The number of times the symptoms have recurred over a specific period is vital for diagnosis. Severity of Symptoms Questions about pain levels, difficulty swallowing, and other symptoms help gauge the impact on the patient’s life. Associated Symptoms Queries about fever, bad breath, or tonsil stones could provide additional diagnostic clues. Treatment History Information about any previous treatments, including antibiotic use, is collected to determine their effectiveness or any patterns of resistance. Lifestyle Factors Exposure to environmental irritants like smoke or allergens, dietary habits, and oral hygiene practices may also be discussed. EXAMINATION IN CHRONIC TONSILLITIS Inspection The tonsils are visually inspected for size, colour, and the presence of exudates or tonsil stones. Palpation The area around the neck, particularly the lymph nodes, is palpated to check for tenderness or swelling. Throat Swab A culture may be taken from the tonsils to identify any bacterial infection. This helps in tailoring antibiotic treatment. Endoscopic Examination In some cases, a flexible endoscope may be used for a more detailed visual inspection, especially if there are symptoms suggesting deeper throat or nasal issues. Imaging Though rarely needed in chronic tonsillitis, imaging tests like X-rays or CT scans may be considered for complex cases or to rule out other conditions like tonsil tumours or enlarged styloid process. Total Blood Count (TBC) Blood tests can help identify markers of chronic inflammation or infection. Allergy Tests Depending on the initial findings, other tests like allergy panels might be considered. TREATMENT MODALITIES The management of chronic tonsillitis requires a multi-faceted approach that encompasses pharmaceutical treatment, lifestyle modifications, and, in some cases, surgical interventions. Here is how Dr Sandeep Uppal and his expert team at The ENT Clinic approach the treatment of this persistent condition. PHARMACEUTICAL TREATMENT Extended Antibiotic Therapy In cases where bacterial infection is identified, a longer course of antibiotics, often lasting several weeks, may be prescribed to eradicate the lingering infection. Anti-Inflammatory Medication Corticosteroids may be used for short periods to alleviate severe inflammation but are generally not recommended for long-term treatment due to potential side effects. Symptomatic Relief Over-the-counter pain relievers like paracetamol or ibuprofen may be suggested for controlling pain and discomfort. LIFESTYLE MODIFICATIONS Dietary Adjustments Eating soft, non-irritating foods can help reduce symptom severity. Hydration Adequate fluid intake, especially warm fluids like herbal teas, can offer relief. Oral Hygiene Maintaining good oral hygiene can prevent bacterial build-up and subsequent tonsil stones. Environmental Factors Avoiding irritants like tobacco smoke, alcohol and allergens can help in symptom management. FOLLOW-UP AND MONITORING Regular Check-ups Follow-up appointments are crucial for adjusting treatment plans and monitoring for potential complications. Symptom Journal Patients may be asked to maintain a record of symptom severity and frequency to gauge treatment efficacy. Self-care Techniques Instructions on warm saltwater gargles, proper brushing techniques, and dietary choices are often provided. SURGICAL MANAGEMENT: TONSILLECTOMY Tonsillectomy, the surgical removal of the tonsils, is often considered under specific conditions where medical treatment has failed, or the symptoms significantly impact quality of life. Dr Sandeep Uppal and his team at The ENT Clinic follow evidence-based guidelines to determine when a tonsillectomy is warranted. Here are some of the indications for tonsillectomy. Recurrent Acute Tonsillitis For recurrent throat infections, the American Academy of Otolaryngology–Head and Neck Surgery (AAO–HNS) guidelines* recommend tonsillectomy if a child has experienced: Seven or more episodes of tonsillitis in the past year. Five or more episodes per year for the past two years. Three or more episodes per year for the past three years. Documentation in the medical record for each episode of sore throat and one or more of the following: T>38.3 0C (1010F), neck lymph node enlargement, tonsillar exudate, or positive test for group A beta-hemolytic streptococcus. However, tonsillectomy may be considered for children who have fewer episodes than these criteria but have specific modifying factors, such as: Multiple antibiotic allergies. Periodic fever. Aphthous stomatitis, pharyngitis, and adenitis (PFAPA). History of more than one peritonsillar abscess. Chronic Tonsillitis When symptoms last for a prolonged period and significantly affect the patient’s quality of life. Obstructive Sleep Apnoea (OSA) According to AAO-HNS guidelines tonsillectomy is recommended for children with documented obstructive sleep apnea confirmed by overnight polysomnography. There’s also a recommendation to inquire about coexisting conditions that might improve after tonsillectomy, like growth retardation, poor school performance, enuresis, asthma, and behavioural problems. Peritonsillar Abscess (Quinsy) Usually, tonsillectomy is considered when the patient has had 2 episodes

ACUTE TONSILLITIS AND ITS MANAGEMENT Acute tonsillitis refers to a sudden inflammation or infection of the tonsils, which are the lymphoid tissues located at the back of the throat. This condition typically manifests as a painful, sore throat accompanied by other symptoms like fever. CAUSES VIRAL INFECTIONS Common cold viruses Influenza Epstein-Barr virus (often leading to infectious mononucleosis) BACTERIAL INFECTIONS Streptococcus pyogenes (most common) Staphylococcus aureus Haemophilus influenzae BONE REDUCTION These may include allergens, irritants, and weakened immune systems. CLINICAL PRESENTATION (SYMPTOMS) SEVERE SORE THROAT Often the primary complaint, making swallowing difficult and painful. FEVER AND CHILLS A sudden rise in body temperature with chills is common. MALAISE AND FATIGUE A general feeling of being unwell. HEADACHE General discomfort and headache may accompany. SWOLLEN TONSILS Visible swelling, often with a white or yellow coating. SWOLLEN LYMPH NODES Particularly in the neck area. DIAGNOSTIC MEASURES PHYSICAL EXAMINATION Dr Sandeep and his team will typically inspect the throat, mouth, and neck. THROAT SWAB CULTURE Dr Sandeep and his team may take a throat swab to identify the bacteria’s causing the tonsil infection and the most appropriate antibiotic to treat it. TOTAL BLOOD COUNT (TBC) To check for infection markers and rule out other conditions. RAPID ANTIGEN TEST Quick test to detect streptococcal bacteria. TREATMENT MODALITIES ANTIBIOTICS If bacterial in origin, antibiotics such as penicillin or amoxicillin are prescribed. SYMPTOMATIC RELIEF Over-the-counter analgesics like paracetamol for pain and fever. Lozenges and throat sprays may offer temporary relief. HYDRATION AND NUTRITION Adequate fluid intake is crucial. Soft foods to lessen irritation during swallowing. REST Adequate sleep and rest are essential for rapid recovery. HOSPITAL ADMISSION In severe cases when the fever is very high and patient is unable to swallow at all, the patient may need to be admitted for antibiotics, pain killers and fluids to be administered through the veins. Complications and Follow-up Untreated or inadequately treated acute tonsillitis can lead to complications like: Peritonsillar abscess Rheumatic fever Otitis media (middle ear infection) Regular follow-ups may be scheduled to ensure complete resolution of the infection and to monitor for any potential complications. TAKE IMMEDIATE ACTION ON ACUTE TONSILLITIS: SECURE YOUR WELL-BEING! Experiencing severe sore throat, fever, or swollen tonsils? Acute tonsillitis can cause significant discomfort and may affect your ability to eat and speak, often leading to more serious conditions if not treated promptly. Prompt intervention is key to recovery and preventing complications such as rheumatic fever or kidney inflammation. Don’t delay your health needs. Act swiftly to tackle the pain and inconvenience of acute tonsillitis. Reach out to Dr Sandeep for urgent care and effective treatment solutions. Book your urgent consultation to get back to health.