Swollen Tonsils

1 Swollen Tonsils Summary

The tonsils are two lymphoid tissues located in the throat. They play an important role in immunity by helping to trap bacteria and viruses that gain access through the nose and mouth, and producing antibodies against them.

In most cases, enlarged tonsils do not cause any symptoms. Tonsils may be larger in size compared to others in some children, but this condition may be completely harmless.

Many causes lead to tonsil swelling. Enlargement of the tonsils is usually accompanied by enlargement of adenoids, which often affects breathing.

Some of the common symptoms of enlarged tonsils include:

  • Breathing through mouth: If your tonsils are enlarged, you may experience some difficulty breathing through the mouth, and if they are infected, chances are you will experience pain and discomfort when breathing through the mouth as well.
  • Inhibition of sound produced by nose: Enlarged tonsils will lead to inhibiting the sound you make when you breathe through your nose. While they will not block the airway, they can lead to acute discomfort and even pain, depending on the underlying cause of the enlargement.
  • A persistent runny nose: One of the signs of enlarged tonsils is a persistent runny nose. A runny nose is also indicative of tonsillitis, so you may want to consult an ear, nose, and throat doctor at the earliest.
  • Breathing associated with a particular sound: You may find yourself making a particular noise when breathing normally through your nose. This is on account of the enlarged tonsils, but once they return to normal, so should your breathing.
  • Recurrent ear infections: An infection or inflammation of the ear, nose, or throat area is bound to impact the other two, and similarly, with enlarged tonsils, you can expect to experience frequent earaches. A simple consultation with your physician will help you determine the underlying cause for the frequent earaches and get them treated right away.
  • Sound during sleeping: People breathe differently when asleep, so do not be surprised if you are making noise while sleeping because of your enlarged tonsils. These sounds should subside once they return to normal.
  • Difficulty in sleeping: As a result of the sounds you make when breathing through your nose, you may find it difficult to achieve a peaceful sleep. If you are a regular snorer, the change in noise pattern should not impact you much. However, if you are a light sleeper, even the slightest noise could keep you up. Consult your physician and see if they can prescribe a sleeping medication to help combat the lack of proper sleep.
  • Sleep apnea: This can occur when your normal breathing pattern gets interrupted on account of your enlarged tonsils. However, it should disappear once your tonsils return to normal.
  • Most cases of enlarged tonsils are harmless and may not even require treatment. However, in children, symptoms like a sore throat, pain while swallowing, lethargy, and restlessness warrant medical attention.

In adults, a high-grade temperature, skin rashes, persistent symptoms, dark-colored urine, difficulty breathing, and swollen joints are indicative of more serious health issues.

Some of the common causes of enlarged tonsils include:

Rarely, cancer of the tonsils may lead to their swelling.

If left untreated, swollen tonsils may lead to certain complications, including ear infections, sinus infections, loss of body weight, and sleep apnea.

Information on the number of episodes of a sore throat and other symptoms are useful in the diagnosis of the condition’s underlying cause. A nasopharyngoscope is used to view the back side of the throat and to visualize the size and structure of the tonsils. Symptoms like ceasing to breathe during sleep may be an indication of sleep apnea.

Antibiotics are used for treating infections that lead to swelling in the tonsils. In most cases, symptoms resolve within 24 hours after the start of medication. Steroid medications are sometimes used to control swelling in viral infection.

Nasal corticosteroid sprays and antihistamines are also suggested in the control of the symptom. When drugs are ineffective, a tonsillectomy (surgical removal of the tonsils) is recommended.

2 Causes

There are many possible causes for enlarged tonsils, some of the most common being:

  • Tonsillitis: Tonsillitis refers to an infection of the tonsils resulting in swelling and inflammation. It is most commonly seen in children and may recur often. It may be caused by bacterial or viral infections like:
  • Streptococcus
  • Influenza virus
  • Epstein-Barr virus
  • Enterovirus
  • Adenovirus
  • Parainfluenza virus
  • Herpes Simplex virus
  • Enterovirus
  • It is associated with other symptoms like bad breath, sore throat, swelling of the neck and jaw, scratchy voice, headache, earache, decreased appetite, and fever.
  • Strep throat: Strep throat is caused by a streptococcal bacterial infection and results in swollen tonsils on one side. It is common in children between 5-15 years, and patients may also have throat pain and inflammation in addition to swelling in the tonsils. The type and severity of symptoms of strep throat may vary. It can cause symptoms such as difficulty swallowing, decreased appetite, fever, headache, chills, and a red throat with white patches.
  • Peritonsillar abscess: Also known as quinsy, this condition is a serious complication of tonsillitis. It can cause swelling in the tonsils on one side and results from a collection of pus between the wall of the throat and tonsil, inducing an abscess. It is more common among adolescents and young adults. Quinsy may recur and is characterized by symptoms including swollen mouth, difficulty opening the mouth, changes in voice, difficulty swallowing, pain in the ear, and headache.
  • Common cold: A cold caused by different types of viruses like CMV and adenovirus may also result in swollen tonsils.
  • Mononucleosis: Also known as the kissing disease, mono is caused by a viral infection. The virus is transmitted through saliva, coughing, and sneezing. Although not as common as a cold, mono is also implicated in the enlargement of tonsils. Children with mono may have very few symptoms and it usually goes unnoticed. It is associated with other symptoms like fatigue, sore throat, swollen lymph nodes, swollen tonsils, headache, and skin rashes.
  • Measles: Measles is a respiratory infection caused by a virus. It is very contagious and spreads through infected mucus and saliva. A cough, fever, red eyes, runny nose, muscle aches, skin rashes, and sore throat are its symptoms. It also results in enlargement of the tonsils.
  • Cryptic tonsils: Also known as tonsil stones, this condition is characterized by the trapping of food particles, bacteria, and debris in the crypts of tonsils. It produces bad breath and appears as white beads on tonsils. It is often difficult to differentiate cryptic tonsils from strep throat, mainly because of the resemblance in their appearance. Cryptic tonsils become enlarged and often cause difficulty breathing, swallowing, and talking.
  • Abscesses around tonsils: Tonsillar abscess refers to a collection of pus behind the tonsils. Typical symptoms of the condition include difficulty swallowing, fever, swelling of tonsils, and sore throat. It is usually caused by the spread of bacteria. The abscess may bulge into the throat, causing difficulty swallowing.
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3 Diagnosis and treatment

Diagnosis of tonsillitis is based on a physical examination of the throat. A swab from the back of the throat is analyzed using cultures to identify the causative organism.

Signs and symptoms are the first steps in the diagnosis of strep throat. In addition, rapid antigen test and throat culture also are of help. A rapid antigen test is performed with a swab taken from the back of the throat.

The test detects the presence of strep bacteria by identifying the antigens on the organism. A throat culture is recommended even when the rapid antigen test is negative if the doctor suspects strep throat.

Treatment of tonsils depends on the cause of enlargement. A bacterial infection that causes tonsillitis is treated with antibiotics. The patient should be sure to take the full course of antibiotics, even if the symptoms resolve, so as to prevent a relapse, but if the tonsillitis is caused by a virus, antibiotics will not work, and your body will fight off the infection on its own.

Symptoms can be relieved by:

  • Gargling salt water: Gargling salt water can help relieve some of the symptoms associated with enlarged tonsils, like pain and discomfort. Make sure that the water is warm and salty before gargling. It should alleviate some of the symptoms right away.
  • Taking throat lozenges: Lozenges should help relieve the soreness and pain associated with enlarged tonsils. But lozenges only provide temporary relief and are not a cure. For effective treatment, consult your physician and get the condition treated immediately.
  • Over-the-counter painkillers: Over-the-counter pain killers can help relieve some of the more painful symptoms, but it should be noted that prolonged usage of pain killers can lead to kidney disorders and dehydration, among other health complications. Consult your physician before opting for an over-the-counter medication.
  • Warm drinks: Having warm drinks should help soothe your throat and provide some relief.
  • Humidifier: Using a humidifier will also help relieve some of the symptoms.
  • Eat smooth foods

For recurring tonsillitis, a tonsillectomy may be required. It is a surgical procedure in which the tonsils are removed. Strep throat infection is also treated using antibiotics. Home remedies, as suggested for tonsillitis, may be helpful in relieving throat discomfort.

In peritonsillar abscess, the pus is drained by lancing the abscess. This is usually followed by a course of antibiotics. Surgery is an option in the case of recurring peritonsillar abscess.
In children, home treatments may be helpful in relieving symptoms. These include:

  • Adequate rest: Children should have enough rest without talking too much to avoid irritation of inflamed tonsils. Since talking includes moving your tonsils, it is bound to exacerbate your child’s condition, so make sure that they get adequate rest, in silence.
  • Hydration: Have plenty of fluids to prevent dehydration. The fluid will also help keep the throat moist and relieve pain. Make sure that all fluids are warm or at least tepid to further soothe the enlarged tonsils and inflamed throat.
  • Have warm food and drinks: This will help relieve pain and soothe the inflamed throat. Make sure you consult your physician for an idea of the sort of food you can consume with your enlarged tonsils. But as a general rule, warm food and drinks help to soothe the throat and tonsils.
  • Gargle with salt water: Gargling warm salt water will soothe the throat and reduce pain.
  • Use an air humidifier or vaporizer: Dry air increases irritation of the throat and a humidifier keeps the air moist. Using a humidifier in your child’s room should enable them to rest comfortably while ensuring the air is moist and warm to avoid irritating the throat further.
  • Avoid use of irritants: Avoid the use of products that increase irritation of the throat for your child. These include smoke as well as chemicals present in cleaning materials. Make sure that all food prepared for your child is not spicy since it can further irritate the throat. Along with bland food, make sure you do not use products which can further worsen the condition.
  • Use over-the-counter medications: Many symptoms can be relieved by using over-the-counter medications such as ibuprofen and acetaminophen. But as always, consult a physician before you give your children these pain killers since they are known to be addictive and come with various side effects with prolonged usage.

The recovery period for children is about four hours. Children are allowed to go home, but complete recovery may take anywhere from a week to 10 days. Children may experience mild to severe throat pain, but it is very important for the child to get adequate rest and drink plenty of fluids. It may be difficult to eat anything during that time, but it is a pivotal part of the recovery.

Surgical removal of tonsils is generally suggested when the patient develops:

  • Obstructive sleep apnea: Obstructive sleep apnea is a serious condition that causes difficulty in breathing. Your doctor may advise surgery, and with it and the right treatment, you should be able to sleep peacefully without any further obstruction.
  • Extreme discomfort in breathing and swallowing: The condition can become so bad that you find it hard to even swallow your own saliva. It is at this point that the doctor may suggest surgery to remove the tonsils. With surgery, adequate treatment, and post-operative care, you should be as good as new.
  • Multiple throat infections: If you have developed multiple throat infections which are impeding your treatment for enlarged tonsils, your physician may suggest surgery to remove them. The procedure is simple enough and should not take long, and with adequate care and treatment, you should be back to normal.

Multiple throat infections are defined as more than six throat infections within a year. Tonsillitis can be prevented by staying away from people who have active infections. Washing hands often, particularly after coming into contact with someone who has infection, also helps in preventing the spread of the infection.

If left untreated, swelling and infection may spread to the area behind the tonsils. Hence, prompt treatment can prevent complications. Special care should be taken to prevent recurrence and further spread of infection.

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