Tonsillitis and Adenoiditis

Illustration of inflamed tonsils.

• Tonsilsand adenoids are composed of tissues similar to thelymph nodesor glands.
• Acute tonsillitis is an infection of the tonsils caused by one of several types of bacteria orviruses.
• Chronic tonsillitis is a persistent infection of the tonsils and can cause tonsil stone formation.
• Signs and symptoms of tonsil or adenoid infection include the following:
  • Sore throat
  • Fever
  • Bad breath
  • Difficulty swallowing
  • Swollen lymph glands in the front of the neck
• Peritonsillarabscess(quinsy) is a collection of pus behind the tonsils.
• Obstruction tobreathingby enlarged tonsils and adenoids may causesnoringand disturbedsleeppatterns.
• Doctors treatbacterial infectionsof the tonsils and adenoids with antibiotics.
• Medical professionals diagnose tonsillitis and adenoid infections with a history and physical exam. Health care professionals may order a throat culture andrapid strep testin cases of suspected bacterial tonsillitis.
• Doctors may recommendtonsillectomyandadenoidectomy(surgical removal of the tonsils) for (1) repeated or persistent infections; (2) when serious complications of infection occur; and (3) when enlargement of the tonsils and adenoids causes breathing, swallowing, or dental problems.

扁桃体一nd adenoids are composed of tissues similar to the lymph nodes or glands found in the neck or other parts of the body. Together, they are part of a ring of glandular tissue (Waldeyer's ring) encircling the back of the throat.

• 扁桃体一re the two oval-shaped masses of tissue on either side of the back of the throat. Normal tonsils are usually about the same size and have the same pink color as the surrounding area. On their surfaces are little depressions, called crypts, which may appear deep and contain pus-filled pockets ortonsil stones.
• The adenoids are located high in the throat behind the nose and soft palate (the roof of the mouth) and unlike the tonsils, are not easily visible through the mouth. A tonsillectomy and an adenoidectomy (commonly referred to as a T & A) are surgical procedures performed to remove the tonsils and adenoids.

扁桃体一nd adenoids are part of the immune system thought to assist the body in its defense against incoming bacteria and viruses by helping the body form antibodies. However, this function may only be important during the first year of life. There is no evidence to support a significant role of the tonsils and adenoids in immunity. Medical studies have shown that children who have their tonsils and adenoids removed suffer no loss in their future immunity to disease or ability to ward off infections.

The most prominent symptom of tonsillitis and adenoid infection is asore throat(pharyngitis). Other signs and symptoms of tonsillitis and adenoid infection include the following:

1. Fever
2. Bad breath
3. Congestionandrunny nose
4. Swollen lymph nodesin front of the neck
5. Red,swollen tonsilswith patches of pus (white spots)
6. Painful swallowing (odynophagia) ordifficulty swallowing(dysphagia)
7. Loss of voice或低沉的声音
8. Headache
9. Abdominal pain
10. Coughing up blood
11. With enlarged adenoids, breathing through the nose may be difficult and symptoms may include:
    1. Breathing through the mouth, especially in children
    2. Noisy breathing in the day;snoringat night is often observed
    3. Nasal-sounding voice

When there is asore throatandcoldsymptoms such as congestion, runny nose,sneezing, andcoughing, the cause is most likely a virus. Viral infection of the tonsils or adenoids usually resolves without treatment within two weeks.

Sore throat with a sudden mild fever, without symptoms of anupper respiratory tract infection, may point to a bacterial infection called group A beta-hemolyticstreptococcus(GABHS). If these symptoms are present, see a doctor for diagnosis because of the risk ofstrep throat. Althoughstrep throatwill usually go away even without treatment, an untreatedstrepbacterial infection can lead to complications includingrheumatic fever, which can permanently damage theheart.

When there is a sore throat that does not affect the tonsils, medical professionals call this pharyngitis. When both the throat and the tonsils are affected, it's called pharyngotonsillitis.

Tonsillitis may or may not becontagious, depending on the cause. If the cause is viral, it is usually contagious, but this depends upon whether or not a person has been exposed to that particular virus before.Mononucleosis, a viral cause of sore throat, is contagious the first time a person comes in contact with the virus, usually in childhood or adolescence.

If the cause of the tonsillitis is bacterial, it is also contagious. For example,strep throatis highly contagious.

If the tonsillitis and enlarged adenoids are chronic or caused by a chronic condition, such assinusitis,hay feverorchronic rhinitis, it likely is not contagious.

The most common problems occurring with the tonsils and adenoids are

• acute,
• recurrent, or
• chronic infections and significant enlargement (hypertrophy).

Acute tonsillitis

Acute tonsillitis is an infection of the tonsils caused by one of several possible types of bacteria or viruses. Symptoms of acute tonsillitis can either come on suddenly, or be of a gradual onset of a sore throat usually accompanied by a fever.

Other signs and symptoms of acute tonsillitis include:

• Difficulty swallowing saliva
• Drooling
• Earpain与吞咽
• Bad breath
• Tonsil surface may be bright red or have a grayish-white coating (exudate).
• Lymph nodes in the neck may be swollen.
• Fever

Strepthroat is a specific type of infection caused by theStreptococcusbacteria. Strep tonsillitis can cause secondary damage to the heart valves (rheumatic fever) and kidneys (glomerulonephritis). It can also lead to a skinrash(for example,scarlet fever),sinusitis,pneumonia, andear infections.

TheEpstein-Barr viruscauses acute mononucleosis and can lead to a very severe throat infection characterized by the rapid enlargement of the tonsils, adenoids, and lymph nodes of the neck. It also causes extreme malaise andtiredness. The sore throat and gland swelling can last for one week to a month and does not respond to the usually prescribed antibiotics.

Chronic tonsillitis

Chronic tonsillitis is a persistent infection of the tonsils. Repeated infections may cause the formation of small pockets (crypts) in the tonsils, which harbor bacteria. Frequently, small foul-smelling stones develop within these crypts. These stones (tonsilloliths) may contain high quantities of sulfa. When crushed, they give off the characteristic rotten egg smell, which causes bad breath. They may also give a patient the sense of something caught in the back of the throat.

Peritonsillar abscess

A peritonsillar abscess is a collection of pus around the tonsils that pushes one of the tonsils toward the uvula (the prominent soft tissue dangling from the back of the upper throat). It is generally very painful and is associated with decreased ability to open the mouth. If left untreated, the infection can spread deep in the neck causing life-threatening complications andairwayobstruction.

Enlargement of (hypertrophic) tonsils and adenoids

Obstruction to breathing by enlarged tonsils and adenoids may cause snoring and disturbedsleeppatterns that may lead to sleep pauses orsleep apnea.

Other signs and symptoms include:

• Frequent awakening from sleep
• Restless sleep
• Nightmares
• Bedwetting
• Mood changes
• Excessive sleepiness
• 心problems

Some orthodontists believe chronic mouth breathing from large tonsils and adenoids causes improper alignment of theteeth(malocclusion).

慢性enlargement and infection of the adenoids may lead to infection of the air passages around the nose (sinusitis) or nasal drainage/obstruction, and/or may affect the Eustachian tube of the ears, leading to chronicear infections.

Physicians make a diagnosis of tonsillitis and adenoid infection based on a medical history and a physical exam.

If symptoms suggest strep throat, the doctor may order a throat culture or rapid strep test, which medical professionals perform by swabbing the back of the throat and checking for theStreptococcusbacteria. This can be performed in the doctor's office. If a physician suspects the Epstein-Barr virus, which can cause mononucleosis, as a cause for the tonsillitis, a blood test for mononucleosis may be done.

Strep throat is more likely if at least three of the following signs or symptoms are present:

• Fever
• White or yellow spots or coating on the throat and/or tonsils (tonsillar exudates)
• Red spots on the roof of the mouth (upper palette)
• Swollen or tender lymph nodes on the neck
• Absence of coughing or sneezing

Antibiotic treatment may be needed if a bacteria caused the infection. In more severe, recurrent tonsillitis or adenoid infection, or in chronic cases, surgery to remove the tonsils or adenoids (tonsillectomy or adenoidectomy) may be recommended to cure the condition.

Various antibiotics treat bacterial infections of the tonsils and adenoids. Tonsillitis caused by theStreptococcusbacteria can lead to serious complications. Once treatment begins, it is important to take the full course of antibiotics as prescribed because if you stop taking thedrugsbefore they are finished it can lead to adverse consequences and regrowth of the bacteria. Physicians consider surgical removal in situations resistant to medical therapy or in frequently recurrent tonsillitis infections.

Medical professionals often treat viral causes of tonsillitis or enlarged adenoids with only supportive care (hydration and control of fever) andover-the-counterpainmedications. Do not giveaspirinto a child or teen unless directed by a doctor due to the risk of a condition called Reye's syndrome. Antibiotics are not effective for viral infection of the tonsils.

A peritonsillar abscess should be drained either by removal of fluid with a needle and syringe (needle aspiration), cutting open with a scalpel (incision), or tonsillectomy. People can remove chronic stones in the tonsil with a clean finger or with a blunt probe. A long course of antibiotics may treat massive enlargement of the tonsils and adenoids causing airway obstruction, or even a brief course of steroids to reduce inflammation (cortisone-related medications, such asprednisoneandprednisolone).

If a doctor has diagnosed tonsillitis, some home remedies can help soothe the symptoms of a sore throat.

1. Throat sprays and lozenges: These can coat and moisturize the throat, and many have a topical anesthetic to relieve pain (consult a doctor before giving lozenges to young children; they can be a choking hazard)
2. Saltwater gargle: This helps clearmucusfrom the throat
3. Sipping warmbeveragessuch as tea with honey, or broth can be soothing
4. Eating cold foodssuch as ice cream or popsicles can help ease pain

Some alternative remedies may help ease tonsillitis symptoms.

5. Slippery elmin lozenge form may help with pain relief
6. Serrapeptaseis an enzyme that has anti-inflammatory properties and can help decrease pain and help with swallowing
7. Papainis an enzyme that can help treat inflammation
8. Andrographiscan help treat fever and sore throat symptoms

Consult your doctor before using any alternative remedies. Doctors do not recommend many of these home remedies for use in children or adolescents as most have not been scientifically evaluated.

Tonsillectomy and adenoidectomy are indicated in people with repeated or persistent infections, particularly if they interfere with everyday activities. The American Academy of Otolaryngology defines repeated infections in children as seven episodes in 1 year, five episodes in each of 2 years, or three episodes in each of 3 years.

Tonsillectomy and adenoidectomy are also warranted in situations where there is an enlargement of the tonsils and adenoids to such an extent that it causes severesleep problems(snoring and breath holding),sleep apnea, dental abnormalities, and difficulty swallowing. Adenoid enlargement alone, or in combination with tonsillar enlargement, can cause nasal obstruction, recurrentear infections, or sinusitis. If these conditions are resistant to medical therapy, surgery is indicated to cure them.

A significant episode of tonsillitis is defined by one or more of the following criteria: (1) a temperature greater than 101 F (38.3 C); (2) enlarged or tender neck lymph nodes; (3) pus material coating the tonsils; or (4) a positive strep test.

In adults, the severity, frequency, and hardship associated with repeated infections are considered more important than the absolute number. Chronic infections characterized by bad breath and/or tonsillar stones causing significant disability are also indicators for tonsillectomy.

Tonsillectomy and adenoidectomy are strongly considered in those patients who are suffering, or may suffer serious complications of infection. These include peritonsillar abscess, history of streptococcal complications (rheumaticheart disease, glomerulonephritis), or neck abscess. Suspicion ofcancer(malignancy) or tumor is a definite reason for surgery.

应该强调,所有决定或against removing the tonsils or adenoids are dependent upon the individual patient's particular situation. Additional factors, such as tolerance of antibiotics, concurrent medical problems, school achievement/progress, and family preferences are also important factors in the decision process.

A primary care provider (PCP) such as a family practitioner, an internist, or a child's pediatrician may diagnose and treat simple tonsillitis and adenoid infections. If your tonsillitis is severe enough that you go to an emergency department, you will be seen by anemergency medicinespecialist. If infections are severe, chronic, or recurrent, you may be referred to an otolaryngologist, also called an ear-nose-throat (ENT) specialist for further follow-up treatment or surgical removal of the tonsils and/or adenoids.