Dr. Bigyan R. Gyawali, MS, MRCS (England), FICS, FACS
There has been a misconception regarding tonsils in Nepal. A frequently used term “Tonsil”, is often regarded as pain in the throat. Reluctance of people to see a doctor in Nepal, including in Kathmandu for minor symptoms such as sore throat, fever; and rampant use of antibiotics by the local medical shops has led to misuse of antibiotics and a misconception regarding the disease.
What is tonsil?
Tonsils are a pair of soft tissue mass located in our throat, designed to fight against infection.
So, you don’t need to worry if you have tonsils!!! The term “Tonsil” does not mean infection.
How does a normal tonsil look?
Normally tonsils are pink and symmetrical. It is not uncommon for tonsils to have an enlarged size. Sometimes, tonsils may be of asymmetrical in sizes, which should be consulted with ENT doctor.
What are common pathologies of tonsil?
- Tonsillitis which means an inflammation of the tonsil
- Tonsillar enlargement causing obstructive symptoms such as snoring, choking spells during sleep.
What are the common symptoms?
Acute pain in throat, fever, painful swallowing and enlarged tender nodules in neck. The tonsils will be red, congested with yellowish spots. Very young children who cannot complain of pain may present with fever, repeated crying and refusal to eat.
Enlarged tonsils may cause obstructive symptoms. This is common in children. The obstructive symptoms are difficulty in swallowing, breathing, snoring and/or apneic/ choking spells during sleep, drooling of saliva, day time sleepiness with poor school performance.
When to seek a doctor?
If you have any of the above symptoms, you must see a doctor.
Does sore throat always mean infected tonsils and need antibiotics?
Having a sore throat doesn’t always mean tonsillitis. There are other causes of throat pain such as viral pharyngitis, acid reflux, throat ulcers, etc and may not require antibiotics.
Why do tonsils get infected?
Tonsil, is an organ that fights against infection. Concentration of infective organisms in the tonsils results in tonsillitis.
Organisms commonly causing tonsillitis are viruses and bacteria.
Can tonsillitis affect the heart?
Not always. However, a bacterial infection with Beta-hemolytic Streptococcus can cause immune reaction in the body called Rheumatic fever, that can affect the heart. This should be treated with antibiotics and one should immediately see a doctor. Symptoms like joint pain, rashes or nodules in skin, abnormal body movements, palpitation, shortness of breath after sore throat are a sign of Rheumatic process. In Nepal streptococcal infections are mostly undetected and may lead to Rheumatic heart disease in children and teen-age adolescents. More common in females than in males.
When to remove Tonsils?
Tonsils should be surgically removed only when indicated. Although the surgery is done for various indications, the commonest ones are:
- Repeated attacks of tonsillitis
In children : >7 episodes/year or >5 episodes/year for 2 consecutive years or >3
episodes/year for 3 or more consecutive years
In adults : 3-5 episodes/year severe enough to impair ones day to day activities
- Tonsil enlargement causing obstructive symptoms such as snoring, choking, disturbed sleep, especially in children.
- 2nd episode of tonsillar abscess.
- Abnormally asymmetrical tonsils to rule out chances of malignancy – cancer.
Does removal of tonsils reduce immunity?
There are no adequate research to prove this so far. However, tonsillectomy should be done only when indicated.