Tonsillitis is the inflammation of the tonsils, i.e., the structures located at the back of the throat, which protect the organism, produce antibodies, and prevent infections in the oral cavity and neighboring regions from spreading throughout the body.

Precisely because they function as a barrier, these structures are susceptible to infectious processes. When this occurs, the tonsils become inflamed, swollen, and painful and hinder the passage of food into the digestive tract.
Tonsillitis cannot do without a good diagnosis and adequate treatment. This is because an inadequately treated bacterial infection can evolve into rheumatic fever, with consequent cardiac complications in the future, or even be a precursor of kidney disease, nephritis.

Causes and symptoms of tonsillitis

Inflammation progresses with fever, chills, sore throat, poor appetite, bad breath, difficulty swallowing, and sometimes swollen glands in the neck and jaw, often much like a viral infection, such as mononucleosis. In cases caused by bacteria, there is usually a collection of pus in the tonsils. Besides fever, the only obvious sign in infants is often a refusal to eat.

Viruses and bacteria mainly cause tonsillitis, but there may be mixed processes and sometimes associations with fungi. Viruses are implicated in about 50% to 70% of inflammations, especially those that cause colds and flu, such as adenovirus. Among bacteria, the primary agents involved are staphylococci and streptococci, which also cause scarlet fever and are associated with the evolution of the disease into rheumatic fever.

These microorganisms are usually transmitted from one person to another through coughing, sneezing, and contamination of hands and objects by respiratory secretions. In addition, factors such as sudden changes in temperature, living with smokers, continuous exposure to air conditioning, and situations of lowered immunity may predispose the individual to develop tonsillitis.

Gastroesophageal reflux is also a significant cause of recurrent tonsillitis. The return of acidic contents from the stomach to the esophagus reaches the larynx, changes its characteristics, and the bacteria in the region take advantage of the increase.

Tonsillitis tests and diagnostics

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The diagnosis is clinical and depends on the patient’s history and throat examination. In general, the viral infection affects the oropharynx and pharynx, with greater involvement of the lymph nodes. On the other hand, a bacterial infection is characterized by an accentuated enlargement of the tonsils, frequently with the presence of pus plaques.

In case of doubt, some tests may be necessary, such as the rapid test for the investigation of streptococci in throat secretion and even culture, in which the collected biological material is placed on media suitable for developing bacteria.

Treatment and prevention of tonsillitis

Viral tonsillitis is treated only with analgesics and anti-inflammatory drugs, but bacterial tonsillitis does not dispense with antibiotics, usually derived from penicillin, such as benzathine penicillin and amoxicillin. Whatever the choice of antimicrobial, the administration of the drug cannot be interrupted when symptoms improve because there is a risk that the bacteria will remain in the body and lead to significant complications, such as rheumatic fever.

During an episode of tonsillitis, feeding should be based on the warm, liquid, and soft foods to facilitate swallowing. Lack of response to treatment of tonsillitis with viral features indicates possible bacterial involvement. For this reason, physicians usually initiate therapy with an anti-inflammatory and, if fever persists one or two days later, prescribe an antibiotic. Surgical removal of the tonsils, which has been used indiscriminately for several decades, is indicated only when the person has complicated bacterial tonsillitis or recurs several times in the same year.

It can be tough to avoid acquiring the microorganisms that cause respiratory tract infections, especially in school-age children. Still, some precautions help reduce the risk of developing tonsillitis, such as observing good hygiene habits, constantly washing hands and face well when arriving home and before meals, as well as avoiding air-conditioned environments, staying away from tobacco, and drinking plenty of fluids to keep the mucous membranes of the mouth, nose and throat well hydrated (the drier and more irritated they are, the more predisposed they will be to the action of microorganisms).

With repeated tonsillitis, it is essential to rule out the possibility of gastroesophageal reflux with a specialist. Finally, in any situation, it is crucial to avoid self-medication with anti-inflammatory drugs and antibiotics, which, if misused, can hinder treatment and aggravate the condition. The combination of sore throat and fever always requires a medical consultation at any age.