About Sore Throats

Sore throats are common and not always due to tonsillitis. Most acute sore throats are viral in origin. It is often difficult to tell the difference between viral and bacterial infections. Most patients recover within one week.

The most common bacterial cause is due to bacteria called group- A beta-hemolytic Streptococcus. (“Strep throat”).Infection with bacteria can rarely lead to complications such as quinsy, (tonsil abscess) nephritis (kidney inflammation) and rheumatic fever, (heart and joint inflammation).Antibiotics (e.g. penicillin for 10 days) will reduce the rate of complications, but the number of patients needed to treat to prevent one episode of a complication is large.

The commonest cause of chronic sore throat in adults is chronic pharyngitis, which is non-infective (E.g. smoking, alcohol, gastro-oesophageal reflux disease (GORD) = acid indigestion).In acute bacterial tonsillitis, the patient is usually unwell, with large tonsils covered in white matter called exudates, a fever and sometimes headache and swollen glands in the neck. Other causes, such as glandular fever (particularly in teenagers) may cause a similar appearance. Ampicillin or amoxicillin may cause an unpleasant skin rash if glandular fever is the cause of the infection; penicillin is usually prescribed, as this does not produce this effect. Glandular fever is also known as infectious mononucleosis.

The indications for routine tonsillectomy remain controversial. Family, medical and social factors may play a part in the decision process. Despite the absence of high-level scientific evidence to support tonsillectomy, patient and parent satisfaction rates are high for the health benefits following surgery.

Frequently asked questions

What are the tonsils and what is their purpose?

The tonsils form part of the upper food and air passage immune sampling system in early childhood. They help to establish systemic immunity, but probably become redundant after the age of three or four years.

Why do they cause problems?

Like the appendix, they may become acutely or chronically inflamed or infected.

When is tonsillectomy considered?

Generally for recurrent infections, airway obstruction causing breathing and eating difficulties or rarely, when a tumour is suspected.

Can you tell the difference between viral and bacterial tonsillitis?

This is not possible clinically, and treatment depends on severity of pain and general features (e.g. fever and swollen glands). Viral infections, e.g. infectious mononucleosis may be more severe than bacterial streptococcal tonsillitis.

How is glandular fever managed?

This depends on severity. If the systemic symptoms are severe with difficulty swallowing, severe pain and high fever, admission to hospital for intravenous antibiotics and steroids is indicated. Glandular fever may cause inflammation of the liver and of the joints.

Is there an age limit (both upper and lower) that tonsillectomy will be considered?

The small risk of preoperative or post-operative blood loss means that tonsillectomy is generally avoided in children under 15kg weight, approximately three years of age. There is no absolute upper age limit, if the patient is generally fit and the indications for surgery are appropriate.

How are the tonsils removed in the 21st century?

The standard technique remains cold dissection with instruments and ties to the bleeding points. This is a safe technique, although the blood loss at the time of surgery may be higher and this is a consideration for small children having the operation. Many other techniques are available. Electric diathermy and Coblation dissection have the advantage of less blood loss at the time of surgery, but a slightly higher secondary bleed rate for some surgeons. The laser has fallen out of favour because of the much higher post-operative pain.

Is it true that not all the tonsil tissue is removed?

All the pharyngeal tonsil is removed at the time of tonsillectomy.

What is the recovery time after surgery? Is there a difference in adults and children?

It is wise to allow a two week convalescence period. Children do seem to recover more quickly than adults, although the recovery is very variable for both groups.

What are the risks of tonsillectomy?

The risk of most concern is bleeding, either during the operation or during the recovery period. The risk is about 2-5%.

Pain in the throat and ears is usual and requires effective analgesia. Paracetamol, ibuprofen and codeine are common combination painkillers after tonsillectomy.

What are the risks of tonsillectomy?

The risk of most concern is bleeding, either during the operation or during the recovery period. The risk is about 2-5%. Pain in the throat and ears is usual and requires effective analgesia. Paracetamol, ibuprofen and codeine are common combination painkillers after tonsillectomy. Some surgeons routinely prescribe antibiotics. Anesthetic complications are rare. Damage to the teeth is a potential complication.

Is there any long-term risk to having your tonsils removed?

There is no good evidence that tonsillectomy reduces immune function or makes people more prone to chest infections. If possible, it is probably wise to avoid tonsillectomy in children less than three years of age as the tonsils may be functioning to help establish their immunity.

What makes you decide to remove the adenoids at the same time?

The adenoid is usually removed for symptoms of upper airway obstruction with tonsillectomy. It may also be removed to help treat glue ear at the same time as grommet insertion. As these are common conditions, more than one of these procedures may be indicated in a child at the same time.

What exactly is a quinsy, and how should they be managed?

A quinsy is an abscess that forms around the tonsil. Initially there is a swelling of the tissue around the tonsil and then the abscess forms. Generally, admission for fluids and antibiotics by a drip is required. If the abscess is pointing it may be lanced with local anesthesia.