Tonsillitis — inflammation of the tonsils — can be acute or chronic. The uncomplicated acute form usually lasts 4 to 6 days. The presence of proven chronic tonsillitis justifies tonsillectomy, the only effective treatment. Tonsils tend to hypertrophy during childhood and atrophy after puberty.
Tonsillitis generally results from infection with group A beta-hemolytic streptococci but can result from other bacteria or viruses or from oral anaerobes. It commonly affects children between ages 5 and 10.
Acute tonsillitis commonly begins with a mild to severe sore throat. A very young child, unable to describe a sore throat, may stop eating. Tonsillitis may also produce dysphagia, fever, swelling and tenderness of the lymph glands in the submandibular area, muscle and joint pain, chills, malaise, headache, and pain (frequently referred to the ears). Excess secretions may elicit the complaint of a constant urge to swallow; the back of the throat may feel constricted. Such discomfort usually subsides after 72 hours.
Chronic tonsillitis produces a recurrent sore throat and purulent drainage in the tonsillar crypts. Frequent attacks of acute tonsillitis may also occur. Complications include obstruction from tonsillar hypertrophy and peritonsillar abscess.
Diagnostic confirmation requires a thorough throat examination that reveals:
❑ generalized inflammation of the pharyngeal wall
❑ swollen tonsils that project from between the pillars of the fauces and exude white or yellow follicles
❑ purulent drainage when pressure is applied to the tonsillar pillars
❑ possible edematous and inflamed uvula.
Culture may determine the infecting organism and indicate appropriate antibiotic therapy. Leukocytosis is also usually present. Differential diagnosis rules out infectious mononucleosis and diphtheria.
Treatment for acute tonsillitis requires rest, adequate fluid intake, administration of ibuprofen or acetaminophen and, for bacterial infection, antibiotics. When the causative organism is group A beta-hemolytic streptococcus, penicillin is the drug of choice (another broad-spectrum antibiotic may be substituted). Most oral anaerobes also respond to penicillin. To prevent complications, antibiotic therapy should continue for 10 to 14 days.
Chronic tonsillitis or the development of complications (obstructions from tonsillar hypertrophy, peritonsillar abscess) may require a tonsillectomy, but only after the patient has been free from tonsillar or respiratory tract infections for 3 to 4 weeks.
❑ Despite dysphagia, urge the patient to drink plenty of fluids, especially if he has a fever. Offer a child ice cream and flavored drinks and ices. Suggest gargling with warm salt water to soothe the throat, unless it exacerbates pain. Make sure the patient and his parents understand the importance of completing the prescribed course of antibiotic therapy.
❑ Before tonsillectomy, explain to the adult patient that a local anesthetic prevents pain but allows a sensation of pressure during surgery. Warn the patient to expect considerable throat discomfort and some bleeding postoperatively. Watch for continuous swallowing, a sign of heavy bleeding.
❑ For the pediatric patient, keep your explanation simple and nonthreatening. Show him the operating and recovery areas, and briefly explain the facility routine. Most facilities allow one parent to stay with the child.
❑ Postoperatively, maintain a patent airway. To prevent aspiration, place the patient on his side. Monitor vital signs frequently, and check for bleeding. Immediately report excessive bleeding, increased pulse rate, or dropping blood pressure. After he’s fully alert and the gag reflex has returned, allow him to drink water. Later, urge him to drink plenty of nonirritating fluids, to ambulate, and to take frequent deep breaths to prevent pulmonary complications. Give pain medication as needed.
❑ Before discharge, provide the patient or his parents with written instructions on home care. Tell them to expect a white scab to form in the throat between 5 and 10 days postoperatively, and to report bleeding, ear discomfort, or a fever that lasts longer than 3 days.
Review other book chapters online related to Tonsil disorders:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X 
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