Tonsillitis natural history
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Complications
An abscess may develop lateral to the tonsil during an infection, typically several days after the onset of tonsillitis. This is termed a peritonsillar abscess (or quinsy). Rarely, the infection may spread beyond the tonsil resulting in inflammation and infection of the internal jugular vein giving rise to a spreading septicaemia infection (Lemierre's syndrome).
In chronic/recurrent cases (generally defined as seven episodes of tonsillitis in the preceding year, five episodes in each of the preceding two years or three episodes in each of the preceding three years),[1][2][3] or in acute cases where the palatine tonsils become so swollen that swallowing is impaired, a tonsillectomy can be performed to remove the tonsils. Patients whose tonsils have been removed are certainly still protected from infection by the rest of their immune system.
Bacteria feeding on mucus which accumulates in pits (referred to as 'crypts') in the tonsils, produce whitish-yellow deposits known as tonsilloliths. These "tonsil stones" emit a very pungent odour due to the presence of volatile sulphur compounds.
Tonsilloliths which occur in the crypts of the tonsils can only be completely cured by tonsillectomy or by resurfacing the tonsil by laser, but practicing good oral hygiene and use of a water pick may help lessen the symptoms.
Hypertrophy of the tonsils can result in snoring, mouth breathing, disturbed sleep, and obstructive sleep apnea, during which the patient stops breathing and experiences a drop in the oxygen content in the bloodstream. A tonsillectomy can be curative.
In very rare cases, diseases like rheumatic fever or glomerulonephritis can occur. These complications are extremely rare in developed nations but remain a significant problem in poorer nations.
References
- ↑ "6.3 Referral Criteria for Tonsillectomy". Management of Sore Throat and Indications for Tonsillectomy. Scottish Intercollegiate Guidelines Network. 1999. ISBN 1-899893-66-0. Unknown parameter
|month=ignored (help); External link in|publisher=(help) - notes though that these criteria "have been arrived at arbitrarily" from:
Paradise J, Bluestone C, Bachman R, Colborn D, Bernard B, Taylor F, Rogers K, Schwarzbach R, Stool S, Friday G (1984). "Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials". N Engl J Med. 310 (11): 674–83. PMID 6700642. - ↑ Paradise J, Bluestone C, Colborn D, Bernard B, Rockette H, Kurschildren. (2002). Pediatrics. 110 (1 Pt 1): 7–15. PMID 12093941. Missing or empty
|title=(help) - this later study by the same team looked at less severely affected children and concluded "modest benefit conferred by tonsillectomy or adenotonsillectomy in children moderately affected with recurrent throat infection seems not to justify the inherent risks, morbidity, and cost of the operations" - ↑ Wolfensberger M, Mund M (2004). "[Evidence based indications for tonsillectomy]". Ther Umsch. 61 (5): 325–8. PMID 15195718. - review of literature of the past 25 years concludes "No consensus has yet been reached, however, about the number of annual episodes that justify tonsillectomy"