Tonsillitis in Children
Tonsillitis is an infection of the tonsils. It is caused by either a virus or bacteria (usually the bacteria known as streptococcus) Tonsillitis mostly occurs in young children.
Tonsils and Adenoids
The tonsils are a pair of lymphoid tissue located of the mouth on both sides of the throat. The adenoids are similar to the tonsils but are located in the upper portion of the throat behind the nose (Nasopharynx).
Tonsils and adenoids protect against germs during early childhood by producing antibodies.. By attacking bacteria and viruses, antibodies play an important role in the body’s immune system. The problem is that in the process of protecting the body, the tonsils and adenoids can become infected themselves.
As children grow and develop, the tonsils and adenoids eventually begin to shrink and are probably no longer important in protecting against disease-causing organisms. Even in young children, removal of infected tonsils or adenoids does not seem to weaken the body’s defenses. There are many other tissues in the body that are part of the immune system. These tissues, known as lymphoid tissues, also make antibodies to fight against infection.
When tonsils become so enlarged that a child’s voice changes, it is called “hot potato” voice. This is one sign that the tonsils should be removed.
The Symptoms of Tonsillitis
The main symptom of tonsillitis is a sore throat.
Tonsillitis can occasionally become serious. For example, infection may spread beyond the tonsil to form an abscess (Quinsy), which is a localized collection of pus.This almost always, develops on one side only, and usually in adults rather than children.
Another type of abscess, one that develops mainly in young children, is a retropharyngeal (behind the throat) abscess. This usually causes high fever and great difficulty in swallowing. If detected very early, peritonsillar or retropharyngeal abscesses can sometimes be treated successfully with antibiotics. In most cases, however, surgery is required to drain the abscess.
Complications-rare these days
The most serious complication of tonsillitis is rheumatic fever, which often is accompanied by rheumatic heart disease. Rheumatic fever develops only if the tonsillitis is due to a type of bacterium known as group A beta hemolytic streptococcus. It also usually occurs only in children who have had repeated infections that have not been adequately treated with antibiotics.
Another complication of streptococcal tonsillitis is a type of kidney disease known as acute glomerulonephritis. However, whether glomerulonephritis can be prevented by early antibiotic treatment of streptococcal tonsillitis is not clear.
A common complication of tonsillitis is infection of the lymph nodes in the neck, known as cervical Lymphadenitis. This type of infection can usually be successfully treated with antibiotics. Occasionally the infection progresses, an abscess forms, and surgery is required to drain it.
Other possible complications of tonsillitis include middle-ear infections (otitis media) and sinus infections. More often, however, these infections develop at the same time as, or independently of, tonsillitis.
Tonsillitis – Treatment
Treatment of tonsillitis aims to relieve its symptoms.
It is not always necessary to identify the exact cause of tonsillitis before beginning treatment.
Tonsillitis caused by streptococcus bacteria must be treated with penicillin or other suitable antibiotics like cephalosporin in order to prevent the development of rheumatic fever. For children who are allergic to penicillin, other suitable antibiotics are available.
Tonsillitis due to viruses, like other infections due to viruses, does not respond to any currently known antibiotics.
Paracetamol may relieve sore throat and other symptoms of tonsillitis. Aspirin is best avoided in children of any age because of the risk of Reye’s syndrome.
Tonsillitis may sometimes be due to other types of bacteria that also may respond to antibiotic treatment. Judgments about such treatment should be left to your doctor.
Tonsillectomy is the surgical removal of the tonsils.
Tonsillectomy is definitely required when the tonsils are so large they obstruct breathing, swallowing or both. Before surgery, however, antibiotics should be tried, perhaps for as long as a month, to see whether your child’s condition can be improved. Children with obstructing tonsils commonly sleep restlessly and may have periods during sleep when breathing stops for seconds at a time because of blockage of the airway (Sleep apnea).There will be loud snoring too. I
Tonsillectomy also is justified if your child is having repeated bouts of infection, to the point that everyday activities are substantially disrupted despite adequate antibiotic treatment. It is indicated in children who have developed at least 5 bad episodes of throat infection in 1 year i.e. Fever of 101 degrees F (38.3 degrees C) or higher, Enlarged or tender lymph nodes in the neck., A pus-like coating, known as exudates, covering the tonsils or the surrounding throat area. And Evidence that the infection is streptococcal in origin.
Tonsillectomy is indicated in those who had Peritonsillar abscess (quinsy); the infection causes a painful throat, high temperature, headache, impaired speech, drooling, and swollen tender lymph glands in the neck. Not all experts believe that surgery is called for following a single case of peritonsillar abscess. Often, no further difficulty develops once the condition is successfully treated. However, following a second peritonsillar abscess, tonsillectomy is definitely indicated.
The Operation of Tonsillectomy
In children, removal of either the tonsils or the adenoids requires a general anesthetic.
The mouth is held open to expose the tonsils.
The tonsils are grasped with clamps and pulled toward the middle of the mouth. The tonsils are removed by gentle dissection of the surrounding tissues.
Bleeding is controlled either by pressure, sutures, clamps or ties, or with use of electrocautery, a procedure in which heat is applied to blood vessels to seal the ends that have been cut during surgery.
If the adenoids are to be removed, this is done using a specially designed instrument called curette that passes through the mouth and into the upper part of the throat behind the nose, where the adenoids lie.
Your child will likely experience moderate nasal congestion and drainage, a sore throat, and earaches for a few days after surgery. Allow about two weeks for full recovery. During this time, keep your child from engaging in strenuous physical activity.
It is best for a parent to be at the bedside when the child wakes up from surgery.
Be prepared for your child to experience substantial pain while swallowing for the first day or two. Swallowing may continue to be somewhat painful for 5-7 days.
Use Pareacetamol to relieve pain. Aspirin should not be used.
When your child’s appetite returns, encourage him or her to eat and drink. Many children find it more comfortable to swallow warm liquids than cold ones.
Your child should rest for 2 or 3 days, and then resume normal activities gradually. Have your child avoid vigorous exercise for two weeks after surgery. Bathe or shower your child as usual.
Following tonsillectomy, swallowing tends to be quite painful for the first day or two and somewhat painful for 4 or 5 days. Nonetheless, you should encourage your child to eat and drink as soon as any postoperative nausea has subsided. Many children find it more comfortable to swallow ice cream or cold drinks.
Back to School
Usually, children can return to school (and adults to work) about a week after surgery. However, if there have been any complications or if your child does not feel perfectly well, return to school should be delayed accordingly. Rest at home not only helps recovery from surgery but also helps to minimize contact with other children who may have contagious respiratory infections.
As with any operation, there is always a small risk associated with general anesthesia.
Bleeding from the operation site may occur immediately after surgery, or several days later when the crust that has formed at the operative site drops away. Bleeding usually can be readily controlled, but occasionally requires a return to the operating room for more intensive treatment. Rarely, blood transfusion may be required.
The risk of bleeding can be minimized by avoiding surgery during and immediately following episodes of infection and by avoiding the use of aspirin to control pain following surgery, as aspirin can reduce the blood’s ability to clot.
The main symptoms of adenoiditis are nasal stuffiness and nasal discharge. In this respect, adenoiditis is not really distinguishable from the common cold. In children who develop a common cold, the adenoids become inflamed as part of the illness.
Snoring is a common symptom. Child can have sleep disturbance and cessation of sleep for a brief period (Sleep Apnea)
If persistent it can lead to sinusitis and most importantly otitis media causing ear ache, fever and hearing loss.
Symptomatic- usually base their treatment on the nature of the clinical symptoms. Antibiotics, Nasal decongestant, Systemic decongestants are given for 5-7 days. A small and short course of steroid will be very good to relive the symptoms
Surgery – Adenoidectomy
Surgical removal of the adenoids is appropriate when the adenoids are so enlarged that your child consistently has difficulty breathing through the nose, and the condition is not substantially improved by antibiotic treatment.
Removal of the adenoids is also appropriate in children who have had persistent otitis media (infection or fluid in the middle-ear), even after having surgery to place grommets in the ears.
In my experience of 35 years of ENT practice, must have removed thousands of Tonsils and Adenoid. I have operated in 3 Generation of people. I haven’t seen any one who were adversely affected by its removal. So why keep on having a miserable life with horrible Tonsils, go for Surgery. Its simple and nothing to worry about.