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                          TONSIL INFECTIONS

             WHAT ARE TONSILS?

WHAT IS TONSILLITIS?

IS TONSILLITIS THE SAME AS STREP THROAT?

WHAT ARE THE RISKS OF RECURRENT STREP THROAT?

WHY DO THEY SWAB MY THROAT?

WHAT IF THE THROAT CULTURE IS NEGATIVE?

WHAT IS A STREP CARRIER?

SHOULD TONSILS BE REMOVED?

 

WHAT ARE TONSILS?

The tonsils are generally considered to be the two round asses at the back of the throat. However, there are other areas where “tonsils”are found. The adenoids are located in the back of the nose in an area called the nasopharynx. Because of this location, adenoids are called nasopharyngeal tonsils.

There also exists a mass of tissue at the back of the tongue called the lingual tonsils. All three tonsils are made of lymphoid tissue similar to the lymph nodes or glands on the sides of the neck. All lymphoid tissue serve as a defense against infection, but they may also become the site of recurrent or chronic infections.

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WHAT IS TONSILLITIS?

Tonsillitis (an infection of the tonsil tissue) is very rare in children under the age of 1-year-old. The frequency of infections then increases between the ages of 4 and 8 years. After this time, the rate of infections tends to decrease.

Most cases of tonsillitis, whether a fever is present or not, are caused by viruses. Because the symptoms of viral and bacterial tonsillitis are often so similar, it is sometimes difficult to determine the cause based upon the history and examination alone. Viral tonsillitis is generally considered a disease, which occurs gradually. Your child may have cold symptoms, fever, decreased appetite and loss of energy and then develop the sore throat. Hoarseness, coughing and a runny nose are also common. The tonsils may have mild redness or have ulcers and yellow plaques covering them. The lymph nodes in the neck are usually only mildly enlarged and tender. The entire illness does not usually last more than 5 days. The development of any complications is rare.

Acute Tonsillitis

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IS TONSILLITIS THE SAME AS STREP THROAT?

Streptococcal tonsillitis (Strep tonsillitis) is caused by a bacteria called Group A Streptococcus and is the most common bacterial tonsil infection in children. The streptococcal infection occurs throughout the entire throat and is not just limited to the tonsil area. Strep throat may continue to occur in children without tonsils, although the rate is much lower.

Strep tonsillitis tends to occur after the age of 3 years. Children will complain of headache, stomachache, vomiting and high fevers. These symptoms tend to occur quickly. The degree of sorethroat varies from extremely severe to no significant discomfort. The neck lymph nodes become very large and are usually very tender. Fevers may last up to 4 days with severely affected children remaining sick for up to 2 weeks. The tonsil appearance is as variable as in viral tonsillitis. Runny nose, cough, and hoarseness are rarely present. Complications are common which is why treatment with antibiotics is so important.

Strep tonsillitis is best treated with penicillin for 10 days. A single injection of antibiotics into the muscle is also an excellent therapy. Response to treatment is usually quick with a loss of fever in 24-48 hours.

Your child no longer has a contagious disease within a few hours of taking antibiotics.

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WHAT ARE THE RISKS OF RECURRENT STREP THROAT?

The Group A Streptococcus bacteria can cause two types of complications, infectious and non-infectious. The infectious complications are due to the direct spread of the bacteria while non-infectious complications are due to the release of harmful substances by the bacteria or by the bacteria causing changes in the immune system.

Some of the infectious complications include ear infections, sinus infections, lymph node infections and abscesses which form around the tonsil (a peritonsillar abscess), in the back of the throat (a retropharyngeal abscess) or deeper into the neck tissues (a parapharyngeal abscess).

Some of the non-infectious complications include Scarlet fever (skin rash due to harmful substances released), rheumatic fever (damaged heart muscle), and glomerulonephritis (damaged kidneys).

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WHY DO THEY SWAB MY THROAT?

The differentiation between viral tonsillitis and Strep tonsillitis is important to prevent possible complications. The history may give important clues but a swab of the back of the throat for a culture is a critical part of the evaluation.

Most pediatricians have the Rapid Strep detection test in their offices. This rapid test may miss up to 20% of true Strep infections. Therefore, if the rapid test is negative, a standard throat culture is recommended. Some children have green nasal drainage, tonsillitis and fever. Their cultures may grow bacteria other than the Group A Streptococcus. Although the infection is probably a complication of a viral tonsillitis, some of these children respond well to antibiotics.

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WHAT IF THE THROAT CULTURE IS NEGATIVE?

There is no specific treatment of viral tonsillitis. Pain control with Tylenol or Motrin, and increased fluid intake are the basic recommendations. Gargling with warm salt water solutions may also offer some relief of the throat pain.

 

WHAT IS A STREP CARRIER?

Usually antibiotics totally get rid of the bacteria, however in some children the symptoms totally go away, but the throat cultures stay positive. This is called a carrier state. Up to 15% of normal healthy children have the Group A Streptococcus bacteria which lives in the throat and does not cause disease at all. However, if a child is a carrier of the bacteria and has a history of rheumatic fever or has a brother or sister with a history of rheumatic fever, more intensive treatments may be necessary to totally get rid of the bacteria.

Carrier states, which do not require treatment, make the diagnosis of future tonsillitis episodes more difficult to make. Even if viral tonsillitis is present, the ever-present Strep bacteria almost demands antibiotic therapy to prevent the development of possible complications.

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SHOULD TONSILS BE REMOVED?

Tonsillectomy (the surgical removal of the tonsils) used to be performed frequently to prevent the complications of Strep tonsillitis. However, the availability of antibiotics markedly decreased the need for this surgical procedure. With more experience in the use of antibiotics, it has been noted that although Strep tonsillitis could be treated successfully with antibiotics, some children had frequent, recurrent infection causing repeated sickness despite adequate medical treatment.

Tonsillectomy is now utilized in this select group of children to reduce the number and severity of recurrent episodes of tonsillitis. Several groups of doctors have set guidelines for what is considered a significant number of infections.  Many insurance companies have adopted these guidelines. More information about tonsillectomy may be found in the Surgical procedures section of this site.

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The information provided on this web site is not intended to take the place of consultation with your physician. You should always consult a physician whenever you require diagnosis or treatment.


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