Treat inflamed tonsils early to prevent complications

KUALA LUMPUR - A sore throat is often regarded as a common health problem, with sufferers usually advised to gargle with salt water or drink warm water mixed with honey.

However, not all sore throats can be relieved by such remedies, particularly when the condition is a symptom of tonsillitis or inflammation of the tonsils.

More commonly experienced by children, tonsillitis can also affect adults. According to a specialist, patients should consult a doctor for an accurate diagnosis as tonsillitis can be caused by either bacteria or viruses, each requiring a different approach to treatment.

The right treatment can also speed up recovery, help prevent complications and reduce the risk of recurrent infections.

DO NOT IGNORE SYMPTOMS

According to Sunway Medical Centre Velocity consultant ear, nose and throat (ENT) and head and neck surgeon Dr David Yee Leong Wai, most cases of tonsillitis are mild and usually resolve within a few days to a week with appropriate treatment.

However, he added, patients should not take their symptoms lightly as certain warning signs require immediate medical attention.

These include difficulty swallowing to the extent that the patient is unable to eat or drink, difficulty breathing or unusual breathing sounds, significant swelling on one side of the throat, difficulty opening the mouth (trismus), drooling due to an inability to swallow, persistent high fever, and a worsening sore throat despite treatment.

Dr David said these symptoms could indicate a complication known as a peritonsillar abscess, which is a collection of pus around the tonsils that can obstruct the airway and requires urgent treatment by an ENT specialist.

"Besides the accumulation of pus around the tonsils, patients are also at risk of dehydration due to difficulty eating or drinking caused by swelling and pain in the throat.

"For tonsillitis caused by Streptococcus bacteria, if left untreated, the body’s immune system can produce a response that can damage other organs, including the heart, joints and kidneys. Although such complications are rare, they must be prevented through early diagnosis and appropriate treatment,” he said.

FUNCTIONS OF TONSILS

The tonsils are two fleshy masses of lymphoid tissue located at the back of the throat and play an important role as part of the body’s immune defence system.

"Lymphoid refers to tissues, organs or cells associated with the lymphatic system that function as part of the body’s defence or immune system.

"In this context, the tonsils serve as the body’s first line of defence, helping to prevent bacteria, viruses and other microorganisms from entering the body through the mouth,” explained Dr David.

He said the tonsils also stimulate the production of immune cells and antibodies, particularly during childhood. However, their role becomes less significant as the immune system matures, as other lymphoid tissues in the body take over some of their immune defence functions.

Dr David added that tonsillitis is commonly caused by viral or bacterial infections.

Apart from a sore throat, people with tonsillitis usually experience red and swollen tonsils, difficulty swallowing, fever, swollen glands in the neck and, in some cases, white patches or pus on the surface of the tonsils.

"However, not everyone with a sore throat has tonsillitis as a sore throat can be caused by various other conditions, including viral infections, allergies, acid reflux, or irritation from cigarette smoke and air pollution.

"In other words, all patients with tonsillitis have a sore throat, but not everyone with a sore throat has tonsillitis,” he said.

VIRAL INFECTIONS

Dr David also said that an estimated 70 to 80 percent of tonsillitis cases are caused by viral infections, while only a small proportion of the remaining cases are caused by bacterial infections.

"For most cases of viral infection, patients only require supportive care such as adequate rest and fluid intake, as well as appropriate medication to relieve the symptoms.

"However, bacterial infections, particularly those caused by Group A Streptococcus, require antibiotic treatment as the bacteria is among the causes of tonsillitis,” he added.

The bacteria commonly live on the skin and in the human throat and can spread easily through respiratory droplets, such as when an infected person coughs or sneezes, as well as through direct skin-to-skin contact.

Dr David said the risk of tonsil infection or inflammation can increase due to several contributing factors, including exposure to infected individuals, poor hand hygiene, a weakened immune system, crowded environments, as well as exposure to cigarette smoke and air pollution.

Elaborating, he said tonsillitis can generally be divided into three types based on the duration and frequency of infections: acute, recurrent and chronic.

Acute tonsillitis refers to inflammation of the tonsils that develops suddenly and usually resolves within a week.

"Recurrent tonsillitis refers to frequent episodes of tonsil infection and inflammation, occurring five to seven times or more within a year, to the extent that they affect the patient’s daily activities and may require referral to a medical specialist.

"Chronic tonsillitis, meanwhile, refers to inflammation that persists for more than three months. Patients typically experience prolonged symptoms such as recurrent mild sore throat, bad breath, as well as tonsils that remain red and swollen,” he added.

He said each type of tonsillitis requires a different treatment approach depending on the underlying cause, severity and frequency of infection. Hence, examination and assessment by a doctor are important to determine the most appropriate treatment for each patient.

TREATMENT

Dr David also said that the current approach to treating tonsillitis is increasingly individualised, with treatment tailored to each patient’s condition and needs rather than relying on a one-size-fits-all approach.

He said ENT specialists would assess several key factors before determining the most appropriate treatment, including the frequency of tonsillitis episodes, the severity of each infection, and its impact on the patient’s quality of life and daily activities.

When tonsillitis is caused by a viral infection, treatment is generally supportive and aimed at relieving symptoms and speeding up recovery. This may include taking painkillers or fever-reducing medication, gargling with warm salt water and getting adequate rest.

However, if a doctor determines that the infection is bacterial, particularly one caused by Streptococcus, antibiotics may be prescribed based on the clinical assessment.

"Patients are also advised to complete the prescribed course of antibiotics even after their symptoms have improved to ensure the infection is fully treated and reduce the risk of complications.

"For cases involving complications such as airway obstruction, difficulty eating or drinking, or severe throat pain, hospitalisation may be required for monitoring and further treatment,” he said.

He said tonsillectomy, or surgical removal of the tonsils, may be considered for patients who experience recurrent episodes of tonsillitis that significantly affect their daily lives.

According to Dr David, studies have also shown that patients with recurrent tonsillitis who meet the criteria for surgery generally experience a significant reduction in the frequency of sore throats following the procedure.

However, he stressed that undergoing a tonsillectomy does not mean a person will never experience a sore throat again as it can also be caused by various other factors, including health conditions unrelated to the tonsils. - BERNAMA