Chronic Tonsillitis: To Remove or Not Remove Tonsils?

1. Etiology

Tonsillitis – inflammation of palatine tonsils, most commonly caused by:

• Viruses (70-80% cases):
  • Adenoviruses
  • Rhinoviruses
  • Epstein-Barr virus (infectious mononucleosis)
• Bacteria (15-30%):
  • Group A β-hemolytic streptococcus (GAS) – most dangerous
  • Staphylococcus aureus
  • Less common: pneumococci, H. influenzae

2. Symptoms

Common manifestations:

• Severe sore throat worsening with swallowing
• Enlarged and reddened tonsils
• White or yellow coating/pus on tonsils
• Swollen cervical lymph nodes

Additional symptoms:

• Fever (up to 39-40°C in bacterial form)
• Headache, weakness
• Hoarseness (if larynx involved)

Chronic tonsillitis:

• Periodic exacerbations (2-3 times yearly)
• Bad breath
• Low-grade fever (37-37.5°C)

3. Diagnosis

1. ENT examination:
   • Pharyngoscopy (tonsil assessment)
2. Lab tests:
   • CBC (leukocytosis in bacterial infection)
   • Rapid strep test
   • Throat culture
3. Additional:
   • ASO (antistreptolysin-O) if streptococcal infection suspected

4. Treatment

Viral tonsillitis:

• Warm fluids
• Gargling (chamomile, furacilin)
• Antipyretics (paracetamol, ibuprofen)

Bacterial tonsillitis:

• Antibiotics (10-day course):
  • Penicillins (amoxicillin) – first-line
  • Macrolides (azithromycin) if penicillin allergy
• Local antiseptics (Hexoral, Tantum Verde)

Surgical treatment (chronic cases):

• Tonsillectomy

5. Prevention

• Oral hygiene
• Immune support (hardening, vitamins)
• Timely dental/nasal disease treatment
• Avoiding hypothermia

6. When to See a Doctor?

• Sore throat >3 days
• Fever >38.5°C
• Breathing/swallowing difficulty
• Rash appearance
• Dehydration signs

7. How to Prevent Tonsillitis?

• Regular handwashing
• Avoid sick contacts
• Don’t share utensils
• Maintain home air humidity

 When to Remove Tonsils?

✅ Indications for Tonsillectomy

1. Recurrent infections:
   • 7+ sore throats/year
   • 5+/year for 2 years
   • 3+/year for 3 years
2. Complications:
   • Peritonsillar abscess
   • Rheumatic fever
   • Post-streptococcal glomerulonephritis
3. Other:
   • Sleep apnea (enlarged tonsils)
   • Chronic bad breath
   • Suspected cancer

❌ When to Keep Tonsils?

• Viral infections (rare episodes).
• No systemic complications.
• Good response to conservative treatment (washing, physiotherapy).

Note:

• Children <5-6 years: tonsils are important for immunity.
• Adults >40: surgery is riskier.

Alternatives:

• Laser ablation
• Cryotherapy