Tonsillitis

Disease Description (Causes and Symptoms)

• Definition: Tonsillitis is a disease in which the tonsils (the tonsils of the oropharynx) develop acute inflammation caused by bacteria or viruses, resulting in tonsillar enlargement, pain, fever, and other symptoms. Pathophysiologically, inflammation, swelling, and exudate develop in the tonsillar tissue due to infection by pathogens, accompanied by a local lymphoid tissue response.
• Main causes: β-hemolytic streptococci (the most common bacterial cause), staphylococci, pneumococci, Haemophilus, anaerobic bacteria, and others; viruses (influenza, parainfluenza, respiratory syncytial virus (RSV), rhinovirus, coxsackievirus, echovirus, herpes simplex virus, etc.) are also common. Viral causes are more common in children, especially preschool-aged children, whereas the proportion of bacterial causes increases after school age.
• Main symptoms: Fever, chills, sore throat (difficulty or pain when swallowing), tonsillar enlargement and redness, purulent tonsillar exudate/white coating, enlarged cervical lymph nodes, general malaise, headache, and muscle aches. Symptoms usually improve within 4–6 days, but may persist or worsen if complications develop.
• Complications (注意): Peritonsillar abscess, otitis media, sinusitis, rheumatic fever and acute glomerulonephritis (mainly after streptococcal infection), difficulty breathing (due to severe enlargement or swelling), and, rarely, sepsis.

Treatment Methods

• Conservative treatment (in most cases)
  • Rest, adequate fluid intake, and soft foods
  • Antipyretic analgesics: Control pain and fever with acetaminophen (Tylenol) or NSAIDs (such as ibuprofen)
  • Gargling (with saline or warm salt water), throat sprays/lozenges (follow age restrictions)
• Antibiotics
  • Antibiotic treatment is recommended when bacterial streptococcal infection is suspected or testing (rapid antigen testing or culture) is positive.
  • First choice: Penicillins (oral penicillin V or amoxicillin) — excellent safety and effectiveness.
  • Penicillin allergy: Macrolides (azithromycin, erythromycin) or clindamycin (depending on the situation).
  • For severe infections requiring IV administration (such as dehydration, severe pain, or difficulty breathing), IV antibiotics are used after hospitalization.
• Complications and procedures
  • Peritonsillar abscess: Prompt drainage (needle aspiration or incision and drainage) + appropriate antibiotics
  • Tonsillectomy may be considered for recurrent or chronic tonsillitis, or functional problems caused by enlarged tonsils (sleep apnea, dental occlusion or facial bone development problems). General criteria for considering surgery (which vary according to clinical judgment): 3–4 or more recurrences within 1 year despite adequate medical treatment, or repeated episodes over 2–3 years. Some guidelines use criteria such as 7 episodes/1 year, 5 episodes/2 years, or 3 episodes/3 years.
• Precautions during treatment
  • Antibiotics are not effective for viral tonsillitis (symptom-relieving treatment is recommended).
  • Inform your doctor of any history of medication allergies and all medications currently being taken (especially anticoagulants).
  • Emergency treatment is required for severe difficulty breathing, inability to swallow (being unable to swallow even food or saliva), or excessive dehydration.

Checklist Before an Outpatient Visit (Items to Bring and Example Questions)

• Items to bring (when visiting the hospital)
  • A list of current medications (including prescription drugs, OTC medications, and supplements), and information about medication allergies
  • Previous medical certificates and recent test results (blood tests, previous throat culture or rapid antigen test results, etc.)
  • The timing and course of symptom onset (when they began, initial symptoms, and patterns of improvement or worsening)
  • Temperature records and pain severity (severity of difficulty swallowing and whether food and water can be consumed)
  • Frequency of previous tonsillitis recurrences and prior treatment (history of antibiotic use and whether tonsillectomy was performed)
  • Other underlying conditions (immunosuppression, heart disease, etc.)
• Examples of questions to prepare in advance for the doctor during an outpatient visit
  • How can bacterial tonsillitis be distinguished from viral tonsillitis?
  • What tests may be performed if necessary (rapid antigen test, culture, blood test, etc.)?
  • What medications (antipyretics or pain relievers) can I take right now?

Examples of General Questions to Ask the Doctor

• What are the expected side effects of this medication (the prescribed antibiotic), and what precautions should I take when taking it?
• Is an antibiotic definitely necessary for my current symptoms? If so, how long should I take it?
• What should I watch for to prevent complications (peritonsillar abscess, rheumatic fever, etc.)?
• When can I return to work or school? How long should I isolate or rest?
• What are the specific criteria for considering tonsillectomy? What are the advantages and disadvantages of the surgery, and how long is the recovery period?

Examples of Disease-Specific Questions

• "I have had tonsillitis recur 3–4 times in the past year. Do you recommend tonsillectomy? Please explain the specific criteria for making this decision and the expected benefits."
• "My throat rapid antigen test (or culture) was negative, but my symptoms are severe. How do you distinguish cases that require antibiotic treatment from cases where it is reasonable to wait and see?"
• "I have severe pain on one side of my throat (tonsil), cannot open my mouth well, have a hoarse voice, and have difficulty swallowing saliva. If a peritonsillar abscess is suspected, what emergency measures are needed?"

(Caution: If you have emergency symptoms such as immediate difficulty breathing, inability to swallow or drooling, high fever with worsening general condition, or severe, worsening one-sided neck or ear pain, visit an emergency room without delay or contact a medical professional immediately.)