Inflammation of the tonsils, or tonsillitis, can be acute or chronic. The uncomplicated acute form usually lasts 4 to 6 days and commonly affects children between ages 5 and 10. The presence of proven chronic tonsillitis justifies tonsillectomy, the only effective treatment. Tonsils tend to hypertrophy during childhood and atrophy after puberty.
Tonsillitis generally results from infection with group A beta-hemolytic streptococci but can result from other bacteria or viruses or from oral anaerobes.
Acute and chronic tonsillitis have different signs and symptoms.
The acute form of tonsillitis commonly begins with a mild to severe sore throat. A very young child, unable to complain about a sore throat, may stop eating. Tonsillitis may also produce dysphagia, fever, swelling and tenderness of the lymph glands in the submandibular area, muscle and joint pain, chills, malaise, headache, and pain (frequently referred to the ears).
Excess secretions may elicit the complaint of a constant urge to swallow; the back of the throat may feel constricted. Such discomfort usually subsides after 72 hours.
The chronic form of tonsillitis produces a recurrent sore throat and purulent drainage in the tonsillar crypts. Frequent attacks of acute tonsillitis may also occur. Complications include obstruction from tonsillar hypertrophy and peritonsillar abscess.
Diagnostic confirmation requires a thorough throat examination that reveals:
❑ generalized inflammation of the pharyngeal wall
❑ swollen tonsils that project from between the pillars of the fauces and exude white or yellow follicles
❑ purulent drainage when pressure is applied to the tonsillar pillars
❑ possible edematous and inflamed uvula.
Culture may determine the infecting organism and indicate appropriate antibiotic therapy. Leukocytosis is also usually present. Differential diagnosis rules out infectious mononucleosis and diphtheria.
Effective treatment of acute tonsillitis requires rest, adequate fluid intake, administration of acetaminophen and, for bacterial infection, antibiotics.
When the causative organism is group A beta-hemolytic streptococcus, penicillin is the drug of choice (another broad-spectrum antibiotic may be substituted). Most oral anaerobes will also respond to penicillin. To prevent complications, antibiotic therapy should continue for 10 to 14 days.
Chronic tonsillitis or the development of complications (obstructions from tonsillar hypertrophy, peritonsillar abscess) may require a tonsillectomy, but only after the patient has been free of tonsillar or respiratory tract infections for 3 to 4 weeks.
❑ Despite dysphagia, urge the patient to drink plenty of fluids, especially if he has a fever. Offer a child ice cream and flavored drinks and ices. Suggest gargling to soothe the throat, unless it exacerbates pain. Make sure the patient and parents understand the importance of completing the prescribed course of antibiotic therapy.
❑ Before tonsillectomy, explain to the adult patient that a local anesthetic prevents pain but allows a sensation of pressure during surgery. Warn the patient to expect considerable throat discomfort and some bleeding postoperatively.
❑ For the pediatric patient, keep your explanation simple and nonthreatening. Show the child the operating and recovery rooms, and briefly explain the hospital routine. Most facilities allow one parent to stay with the child.
❑ Advise the patient not to take aspirin or medications containing aspirin for 7 to 10 days before surgery to decrease the risk of bleeding.
❑ Postoperatively, maintain a patent airway. To prevent aspiration, place the patient on his side.
❑ Monitor vital signs frequently, and check for bleeding. Be alert for excessive bleeding, increased pulse rate, dropping blood pressure, or frequent swallowing.
❑ After the patient is fully alert and the gag reflex has returned, allow him to drink water.
❑ Urge the patient to drink plenty of nonirritating fluids.
CLINICAL TIP: Encourage oral intake. Tell the patient to begin with cool liquids; advance to a soft, bland diet as tolerated; and to avoid citrus juices and highly spiced foods.
❑ Encourage the patient to ambulate and to take frequent deep breaths to prevent pulmonary complications. Give pain medication as needed.
❑ Before discharge, provide the patient or parents with written instructions on home care. Tell the patient to expect a white scab to form in the throat between 5 and 10 days postoperatively and to report bleeding, ear discomfort, or a fever that lasts longer than 3 days.
❑ Tell the patient that aspirin and medications containing aspirin are contraindicated postoperatively.
❑ Instruct the patient to avoid coughing or excessive clearing of the throat, which can irritate the throat and cause increased bleeding.
❑ Tell the patient that blood-tinged mucus is normal for 5 to 7 days after surgery.
Review other book chapters online related to Tonsil disorders:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5 
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