Tonsillitis

The tonsils are two pads of glandular (lymphatic) tissue which lie at the back of the throat as indicated in the adjacent diagram. 


Together with the adenoids they constitute Waldeyer's ring and it is felt that they are important for presenting ingested bacteria and viruses to your immune system early in life.

Unfortunately the tonsils can become infected giving rise to "tonsillitis" with the following symptoms:

  • sore throat
  • red swollen tonsils
  • pain on swallowing
  • fever
  • headaches
  • swollen glands in the neck
  • difficulty opening the mouth

Children can also complain of a stomach ache which can be caused by swelling of the lymph nodes in the abdomen. 

Tonsillitis is often caused by a virus, but secondary bacterial infection is common.  A number of bacteria is implicated, but the commonest is Group A Streptococcus.

Bacterial tonsillitis may progress to abscess formation around the tonsil, which is also known as a quinsy.  This is also associated with high temperature and difficulty opening the mouth, and the collection may need to be drained.  

Treatment

Antibiotics are usually very successful in settling tonsillitis, but repeated bouts of tonsillitis can be prevented by tonsillectomy.  This surgery is performed while you are asleep and involves removal of the tonsils through the mouth.  This is a very successful operation and can significantly improve a patient's quality of life.  As with every operation there are certain risks which are associated with it, such as post-operative bleeding, but these are extremely rare (less than 1%), however, it is not unusual for patients to have a sore throat following surgery for up to 10-14 days. 

Single Use Instruments

Before sterilisation techniques were improved there was a theoretical risk that the prion (agent responsible for mad cow disease) could be transferred between patients on instruments, which had been used to remove lymphatic tissue. Although there were no recorded cases of this ever having happened, and this remains the case, there was a move towards use of single use instruments. Of necessity these were poorer quality than instruments previously used and inevitably problems arose. Notably there was an increased rate of bleeding and this was felt to be due to the diathermy tips (instruments used to stop bleeding) being less fine than previously. When this was picked up in a National Audit the risk was considered to be considerably greater than the theoretical risk of prion transmission and surgeons returned to using finer, multiple use instruments.