Tonsillar Hypertrophy

Tonsillar Hypertrophy: Causes & Symptoms

The tonsils are located at the back of your throat. They are part of the upper respiratory tract (trachea) and they filter out bacteria, viruses, fungi and other foreign particles from your airways. Your tonsils play a crucial role in helping keep your lungs clean. If they become inflamed or infected then it may cause symptoms such as coughing up blood, fever, cough fits or even pneumonia.

In fact, if you have asthma, allergies or other breathing problems, your tonsils may become inflamed. Other reasons why your tonsils might get irritated include:

Overuse of antibiotics (for example for strep throat) which irritate them.

Exposure to certain chemicals like those found in cleaning products or cigarette smoke.

Being exposed to moldy food and water.

Certain medications, including some over the counter medicines.

Coughing up blood due to an infection or inflammation of the tonsils.

Symptoms of Tonsillitis: Aching, pain and/or swelling in your throat, windpipe or trachea (wind pipe). These symptoms usually occur within 2-3 days after exposure to something irritating such as dust mites, pollen or dirt. Sometimes these symptoms will appear several weeks before the irritation occurs.

A high temperature or fever (fever is not uncommon but should not be more than 38 degrees Celsius).

The tonsils may become visible and swollen if you look in a mirror and the side and back of your throat. In some cases, they may even bleed.

You may also experience difficulty swallowing and the voice may sound different.

A cough that lasts for more than 2-3 weeks.

If left untreated, tonsillitis can lead to complications such as:

Pneumonia (lung infection).

Ear infection.

Inflammation of the tissue surrounding the tonsils (peritonsillar abscess). This may require surgery to drain the pus from behind the tonsil. Sometimes the entire tonsil will need to be removed.

Facial swelling (angioedema) and difficulty swallowing. This may be a sign of a more serious condition called hereditary angioneurotic edema (HANE).

Chronic tonsillitis is a likely precursor to cancer of the tonsil (tonsil cancer). Although this is quite rare, regular visits to the doctor to check for pre-cancerous cells and early treatment can prevent this from developing.

The most common symptoms of tonsillitis include:

The appearance of the tonsils (which may be swollen or red), which can be seen when looking in a mirror, especially when swallowing.

Fever or feeling feverish.

Sore throat.

Swollen lymph nodes in the neck.

White patches on the tonsils (these may be visible when looking in a mirror or through a microscope).

Bad breath or halitosis.

Difficulty swallowing.

Earache or infection of the ears.

Tonsillitis in children.

Coughing up blood or sometimes a small amount of bloody mucus (clear-whitish, stringy).

Difficulty pronouncing words clearly and trouble talking.

Hoarse voice or loss of voice.

Reduced sense of taste and smell.

Difficulty breathing or shortness of breath.

Acute tonsillitis is a medical emergency which may require hospitalisation or treatment with antibiotics by a doctor. If you suspect that you or someone else is suffering from acute tonsillitis, you should seek medical help immediately.

What are the types of tonsillitis and how are they classified?

Acute Tonsillitis: This is the most common type of tonsillitis and is usually caused by a virus. Acute tonsillitis can also be caused by bacteria or both bacteria and viruses (bacterial infections tend to be more severe and last longer). The condition usually starts with a sore throat, fever, headache, fatigue and loss of appetite. Other symptoms may also include earache, difficulty swallowing and/or discharges from the nose or ears. Tonsillitis of this type usually lasts between 1-2 weeks and can be treated at home using over the counter painkillers such as paracetamol (acetaminophen) and ibuprofen (Advil, Motrin, etc…) as well as taking plenty of fluids (Fruit juices such as orange juice are good for sore throats).

Chronic (Recurrent) Tonsillitis: This is when a person suffers from repeated bouts of tonsillitis and symptoms occur more frequently than in acute tonsillitis. The reason for this is usually because the tonsils have not been treated properly and/or due to other medical conditions that a person may suffer from such as allergies, asthma or recurring attacks of tonsillitis. If you suffer from at least three bouts of tonsillitis within a year you may be suffering from recurring tonsillitis and should see your doctor as soon as possible.

Peritonsillar Abscess: This occurs when a collection of pus has formed around the tissue surrounding the tonsil (peritonsillar space) and is caused by a severe case of tonsillitis that has not been treated. This condition requires immediate medical attention as the collection of pus is likely to spread to other parts of the body (the danger of this happening is higher in people who suffer from diabetes or HIV). Symptoms include difficulty breathing, fever, severe pain around the jaw, neck and throat as well as a loss of Appetite. If you experience any of these symptoms you should seek immediate medical treatment .

Peritonsillar Cellulitis: This is the same condition as Peritonsillar Abscess except that no collection of pus has formed. Instead there is a build up of white blood cells around the tonsil which causes adjacent parts of the throat to become swollen along with causing pain. Again this condition requires immediate medical attention and like peritonsillar abscess can be life threatening if left untreated.

What are the risk factors and causes of tonsillitis?

Many people believe that tonsillitis is caused by a virus which simply lies dormant in the tonsils until the virus becomes active again causing an outbreak of tonsillitis. This belief may have started because it seems to come on suddenly without warning and goes away just as suddenly when the infection has run its course. There are however, several other factors that cause this condition and they are listed below.

Bacterial Infection: As already mentioned above, tonsillitis is usually caused by a virus however it can also be caused by a bacteria which is ingested into the body (usually by food or water). Bacteria that are ingested cannot directly infect the tonsils themselves and so must find an indirect way to do this. They do this through infecting parts of the throat such as the palate (roof of the mouth), Pharynx (throat) or nose. Bacteria in these areas then produce a poison (toxin) that causes the surrounding throat tissue to become inflamed and swollen (this is what causes the sore throat). This condition is known as Quinsy.

Viral Infection: The viruses that are responsible for tonsillitis can be picked up by anyone at anytime and are usually spread through close contact with an infected person (coughing, sneezing, etc…). These viruses find their way into the tonsils and begin to replicate themselves which causes the condition known as Tonsillitis.

What are the symptoms of tonsillitis?

As already mentioned, tonsillitis tends to cause a sore throat, however it can also cause bad breath and a generally feeling of being unwell. The symptoms can be very similar to those of strep throat however they tend to be less severe than those caused by strep throat. The following is a list of symptoms that may indicate you have tonsillitis.

Sore throat

Swollen tonsils

Bad Breath

Difficulty swallowing

Difficulty breathing

The symptoms listed above are also common to other medical conditions therefore if you experience any of them you should seek the advise of a doctor immediately. If you experience severe difficulty breathing or a combination of the above mentioned symptoms you should call an ambulance immediately.

How is tonsillitis treated?

Treating tonsillitis is usually a simple procedure and your doctor will have you either take penicillin or an equivalent for a period of 10 days. You will probably be placed on a different antibiotic, in addition to the penicillin, called amoxicillin. This will be in the form of pills which you will have to take for a total of 10 days.

Your doctor will most likely advise you of other symptoms that may indicate that you are suffering from an infection. This may be in the form of a pus filled abscess, high fever or severe pain. If you experience such symptoms you should seek medical attention immediately.

Aside from taking the antibiotics your doctor may also advise you to get a tonsillectomy where they will remove your tonsils. This is only recommended in severe cases of tonsillitis where the patient has suffered from repeated infections. If you have had your tonsils removed it is important that you still take the amoxicillin regularly for 10 days to ensure all of the infection has been cleared from your body.

If you suffer from frequent tonsillitis attacks, or if the antibiotics do not clear up the infection completely, your doctor may advise a tonsillectomy as an option.

Sources & references used in this article:

Tonsillotomy in children with tonsillar hypertrophy by O Densert, Hilmi Desai, Alf Eliasson, Lone … – Acta oto …, 2001 – Taylor & Francis

Intracapsular partial tonsillectomy for tonsillar hypertrophy in children by PJ Koltai, CA Solares, EJ Mascha, M Xu – The Laryngoscope, 2002 – Wiley Online Library

Obstructive sleep apnea associated with tonsillar hypertrophy in adults by WC Orr, RJ Martin – Archives of internal medicine, 1981 – jamanetwork.com

Microbiology of obstructive tonsillar hypertrophy and recurrent tonsillitis by IH Kielmovitch, G Keleti, CD Bluestone… – … –Head & Neck …, 1989 – jamanetwork.com

Radiofrequency treatment of tonsillar hypertrophy by RL Plant – The Laryngoscope, 2002 – Wiley Online Library