Swollen tonsils a sign of infection

By Dr. Cory Couillard

Swollen tonsils are a common, self-limiting condition that can occur at any age but children are much more likely to suffer from the condition. Tonsils are integral parts of the immune system and rest in the back of the throat to help fight off infections.

Infectious viral or bacterial droplets that another person has breathed, coughed, or sneezed out can cause tonsillitis, or swelling of the tonsils. The most common cause of tonsillitis is a viral infection. Routine administration of antibiotics has no clinical value in the treatment of viral infections.

Viral tonsillitis will usually result in cold-like symptoms that include a runny or stuffy nose, sneezing, coughing, sore throat, fever, headache and difficulty swallowing. Children should not be prescribed aspirin because of the risk of Reye’s syndrome - a potentially life-threatening illness causing encephalopathy (brain damage) and fatty liver disease.

Tonsillitis often goes away in a few days and treatments are designed to manage symptoms. Gargling salt water, drinking warm liquids such as tea and broth and sucking on lozenges can help reduce the symptoms. For bacterial tonsillitis, the treatment generally consists of antibiotics such as penicillin or erythromycin.

Clinical diagnosis of tonsillitis is highly unreliable and most children simply grow out of getting tonsillitis. It was once standard practice to have a tonsillectomy, or removal of the tonsils, when a child had frequent sore throats. However, studies have shown this practice to have little actual value and the overall risk of the surgery outweighs potential benefits.

The location of the tonsils is in close proximity to a major artery. Normally the artery is behind the tonsilar tissue but in rare cases the artery travels directly through it. The risk of hitting this artery is a major concern and has caused many children to bleed to death.

Haemophilia and anaemia can increase the risk of bleeding after a tonsillectomy. The use of certain medications such as aspirin, ibuprofen, naproxen or prescription blood thinners like Coumadin (warfarin) can also increase the risk.

The best way to prevent tonsillitis is to avoid germs, bacteria, and viruses that cause the condition. Personal hygiene is important to prevent infections and frequent hand washing is the best way. Wash your hands often, and encourage your children to do the same.

Other precautionary measures include not sharing toothbrushes, eating utensils or drinking glasses. Covering the mouth when sneezing, coughing and avoiding close contact with anyone who is sick has also been shown to prevent tonsillitis.

Acute tonsillitis caused by the Epstein - Barr virus can also cause infectious mononucleosis. It is also called ‘kissing disease’ in teens and young adults because of its spread through saliva. Persons diagnosed with infectious mononucleosis should not exert themselves or engage in strenuous activity for a month due to the risk of splenic rupture.

Surgery is only recommended if a child has five or more episodes of tonsillitis in two years, and the illness is disrupting normal activities such as going to school and schoolwork. A doctor based on what is most clinically appropriate for the patient should make any decisions on treatments, including suitability for surgery.

Dr Cory Couillard is an international health columnist that works in collaboration with the World Health Organization's goals of disease prevention and global health care education. Views do not necessarily reflect endorsement.

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