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 of peritonsillar abscess, recurrent tonsillitis with an episode of peritonsillar infection, or when an acute abscess forms around the tonsil and does not respond to drainage or medical treatment.
Difficulty Swallowing
When enlarged tonsils obstruct the passage of food.
Failure to Thrive in Children
Poor weight gain reduced physical activity, and developmental delays may be due to severe cases of tonsillar hypertrophy affecting nutrition and growth.
Tonsil Stones (Tonsilloliths)
When tonsil stones recur frequently and cause pain, discomfort or bad breath.
Suspected Malignancy
Unilateral tonsil enlargement, persistent sore throat, enlarged neck glands and unexplained weight loss may be signs of tonsil cancer. When there is a suspicion of a malignant process, immediate tonsillectomy is performed for diagnostic and therapeutic purposes.
Speech and Dental Issues
When enlarged tonsils are implicated in causing or exacerbating impaired speech articulation or dental problems such as malocclusion.
*Ron B. Mitchell et al. Clinical Practice Guideline: Tonsillectomy in Children (Update) Otolaryngology–Head and Neck Surgery 2019, Vol. 160(1S) S1–S42, American Academy of Otolaryngology–Head and Neck Surgery Foundation 2018.
COMBAT CHRONIC TONSILLITIS: TAKE CHARGE OF YOUR WELLNESS NOW!
Are you battling with sore throats, difficulty swallowing, or persistent throat infections? Chronic tonsillitis can be more than just a nuisance—it may impact your speech, nutrition, and overall comfort. Both children and adults can experience the drawbacks of this condition, which if left untreated, can lead to further health issues, including sleep disturbances and infection spread.
Don’t let chronic tonsillitis diminish your quality of life. It’s time to take a stand!
Seek Expert Care for Throat Health. Join forces with Dr Sandeep and explore a path to better throat health and comfort. Arrange your appointment with Dr Sandeep for specialized guidance and treatment pathways.