Angina tonsillaris – Tonsillitis

The medical term angina tonsillaris is used to describe an inflammation of the tonsils – and is more commonly known as tonsillitis. A similar condition, known as angina of the salpingopalatine fold, is an inflammation of the lymphatic tissue at the back of the throat. The tonsils are located where the mouth meets the throat and serve to catch pathogens and germs that enter the both via the nose and mouth. This makes them an important part of the immune system. Children are more susceptible to tonsillitis than adults. As we get older, the likelihood of developing tonsillitis recedes – which is why even recurrent cases of tonsillitis, even several times per year, do not necessarily require removal of the tonsils.

What are the causes of tonsillitis?

The pathogen that causes tonsillitis is transmitted via droplet infection – in saliva or nasal secretions when talking, sneezing or coughing. In most cases, the cause is bacterial; viral infections are a less common cause. If tonsillitis is caused by a bacterial infection, it can usually be traced to streptococci. In extremely rare cases, tonsillitis can also be caused by a fungus. A weakened immune system can also contribute to contracting tonsillitis. The issue of whether the condition is caused by a virus or bacteria is important: a bacterial infection can be treated with antibiotics while a viral infection cannot. However, it is difficult for doctors to differentiate between a virus and bacteria. A throat swab can provide clarity, though it may take several days to analyse. While a quick test for streptococci only takes a few minutes, the results are not as conclusive. Tonsils being coated in a white or yellow mass can be an indicator of either viral or bacterial infection, so is of no help in identifying the cause. Tonsillitis can occur either on its own or as a result of another illness. These other conditions include:

Glandular fever (also known as mononucleosis or simply “mono”)
Scarlet fever
Tuberculosis
Diphtheria

What are the symptoms of tonsillitis?

Tonsillitis normally comes on rather suddenly. The main symptom is severe pain when swallowing. Other typical symptoms include:

Reddened, swollen tonsils, often with a white-yellow coating
High fever
Swollen lymph nodes below the ears
Headaches
Halitosis (bad breath)
Loss of appetite, lethargy

Depending on its severity, tonsillitis usually lasts around one to two weeks. In many cases, it is not only the tonsils but also the back of the throat that is inflamed (pharyngitis). A typical symptom of tonsillitis is that, while the initial fever may recede relatively quickly, the sore throat and swollen tonsils may persist somewhat longer.

What are the potential complications that tonsillitis can cause?

Complications due to tonsillitis are rare. One fairly uncommon complication is a peritonsillar abscess: a pus-filled pocket that forms in the vicinity of the inflamed tonsil. Indications of an abscess include severe pain on one side of the throat when swallowing, difficulty opening the mouth and ear pain. Other potential complications of tonsillitis include inflammation of the middle ear (otitis media) or the kidneys (nephritis). In both cases, treatment with antibiotics may be necessary. Tonsillitis caused by streptococci can also lead to rheumatic fever. The symptoms of rheumatic fever include painful swelling of the joints and a high fever. Medications containing penicillin can prevent this complication which, nowadays, is extremely rare.

When should you consult a doctor?

In general, our immune system is capable of handling tonsillitis on its own – no matter whether bacteria or a virus is the cause. You should visit a doctor if: You have such difficulty swallowing that you can barely ingest anything at all

You are finding it hard to breathe
Your symptoms show no sign of improving
You experience unusual symptoms (e.g. skin rash)

Treatment

Painkillers

Pain medication often prescribed to treat tonsillitis symptoms includes ibuprofen, acetylsalicylic acid (aspirin) and paracetamol. While these medications can alleviate the symptoms, they will not help to accelerate recovery. It is vital that you observe the dosage instructions on the packaging, as too low a dose will fail to achieve the desired effect. Targeted painkillers in the form of gargle solutions, sprays or pastilles – which often contain antiseptic ingredients – can also be used, though they are not recommended.

Antibiotics

Doctors may also prescribe antibiotics for tonsillitis if the symptoms are very pronounced or the patient is particularly distressed. Antibiotics are only effective against bacterial infections – which, as previously mentioned, are not easy to diagnose. Studies of patients with sore throats have shown that antibiotics can shorten the time symptoms are present by around one day. However, much more is known about the side effects of antibiotics, which can include skin rashes, indigestion and vaginal yeast infections. For this reason, it is crucial to balance the potential benefits carefully against the risks. If your doctor prescribes you antibiotics to treat tonsillitis, it is important that you complete the course; that is to say, you should not stop taking them abruptly just because your symptoms have improved if the pack is only half empty. Taking the full course also prevents bacteria from developing resistances that allow them to become immune to antibiotics; it also helps to prevent the inflammation from returning.

Home remedies

One tried-and-tested home remedy for tonsillitis is a quark compress. This involves applying quark – a type of curd cheese – directly onto the neck and holding it in place with a dry cloth wrap. Once applied, the patient should stay well wrapped-up in bed for at least half an hour. Quark is supposedly able to keep inflammation at bay – or “draw it out” of the tissue. Another home remedy for tonsillitis – and other infections at the back of the throat – is oil pulling or oil swishing, which is said to catch toxins and pathogens. To do this, wash your mouth with a tablespoon of virgin olive oil as soon as you get up, ideally before breakfast. The oil changes colour to become yellow or white; you should spit it down the toilet after 15-20 minutes. Afterwards, it is important to rinse your mouth and throat out well and to clean your teeth to make sure that any toxins or pathogens released by the oil are ejected from the body. Gurgling with sage tea or salt water can also be helpful – both are said to have anti-inflammatory and disinfectant properties. The most important thing, whatever treatment you try, is to drink plenty of fluids, look after yourself and avoid smoking!

Tonsillectomy

A tonsillectomy is an operation to excise (remove) both tonsils. If the tonsils are enlarged, it is only possible to reduce their size. During the tonsillectomy, the patient lies on their back with their head tipped backwards. The procedure is relatively quick and is often considered routine, even though complications are common. It is carried out under general anaesthetic for children and under local anaesthetic for young people and adults. An inpatient stay of two to three days is usually required for children and people with an elevated risk of secondary haemorrhaging. A tonsillectomy is usually recommended when:

A person suffers from tonsillectomy more than five times per year in two consecutive years
A person’s tonsils are so enlarged that they impair breathing

What are the reasons against a tonsillectomy?

While tonsillectomy used to be recommended at a relatively early stage for people suffering tonsillitis several times per year, today doctors are increasingly reticent to propose the procedure due to the risk of heavy bleeding. This is true for small children in particular: while they generally suffer from tonsillitis more frequently, they are also the group most at risk of serious complications following tonsillectomy. As small children have a lower blood volume, heavy bleeding is more likely to have fatal consequences than for adults. They are also more likely to inhale blood. Children may also experience secondary haemorrhaging even several weeks after the operation, so should always sleep close to their parents or guardians following a tonsillectomy. The risk of heavy bleeding – which requires another corrective operation– is around 1-4%. It should not be forgotten that our tonsils are an important part of our immune system. The consequences of their removal on the human body has not yet been fully researched. The efficacy of tonsillectomies in reducing the incidence of throat infections is also disputable. On the one hand, studies have shown that children who had their tonsils removed suffered from a sore throat less often in the following 2-3 years. After that, however, the studies showed no difference compared to other children. Many believe that the tendency to fall ill with tonsillitis falls as we grow older – no matter how past cases are treated. No meaningful studies have been conducted to date regarding the benefits of tonsillectomies for adults.

Treatment for chronic tonsillitis

Chronic tonsillitis (duration: longer than three months) denotes a condition where bacteria have permanently settled on the tonsils. The causes of this could include the patient not completing a course of antibiotics or only partial removal of the tonsils. The severity of the symptoms can differ, ranging from barely noticeable to very severe. Permanently swollen lymph nodes in the neck and persistent halitosis are typical symptoms. Chronic tonsillitis is treated in a similar manner to the acute form of the illness while simultaneously strengthening the immune system – such as by using homeopathic methods. If the patient shows no sign of improvement or if their symptoms are severe, complete removal of the tonsils is often recommended.

Sources

Patient information from the BMJ Group: Tonsillitis. Web publication date: 16 March 2011. http://clinicalevidence.bmj.com

BMJ Group: Tonsillitis – Key Points. Web publication date: 26 October 2009. http://clinicalevidence.bmj.com Patient information from the German Society for General Practice/Family Medicine (DEGAM): Sore throat. 2009.

http://www.awmf.org/uploads/tx_szleitlinien/053-010_S3_Halsschmerzen_Patienten_10- 2009_12-2013.pdf [in German]

Patient information from the BMJ Group: Tonsillitis. Web publication date: 16 March 2011. http://clinicalevidence.bmj.com

http://www.awmf.org/uploads/tx_szleitlinien/053-010_S3_Halsschmerzen_Patienten_10- 2009_12-2013.pdf [in German]

Autor: Katharina Miedzinska, MSc