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Tonsillitis caused by strep infection is treated with antibiotics, which rapidly cures the infection.
Antibiotics cannot help in the case of a viral infection. Viral infections of the tonsils are therefore often treated only with supportive care – by making sure the patient gets bed-rest, stays well hydrated and that the fever is controlled.
A tonsillar abscess should be carefully drained. This procedure called needle aspiration is performed by an Ear Nose and Throat (ENT) specialist. The abscess may sometimes have to be cut open with a scalpel to drain the fluid.
Chronic hard secretions (tonsilloliths) in the crypts of the tonsils can be removed with a blunt probe or even an ear-bud. This also is done by an ENT specialist.
Medication
Bacterial infections of the tonsils (such as strep throat) can be effectively treated with antibiotics, for example penicillin or erythromycin. A doctor will prescribe an appropriate course of medication for acute tonsillitis or for an abscess.
Hypertrophic tonsils that are large enough to obstruct the airway can be treated with a long course of antibiotics. However, surgical removal remains the treatment of choice for this condition.
A mild painkiller such as paracetamol may be useful to ease the pain of tonsillitis. (CAUTION: do not give aspirin to a child. Aspirin has been linked to Reye's syndrome, a rare but serious condition.)
As with any antibiotics, once treatment begins, it is important to take the full prescribed course of medication. Discontinuing the antibiotics before the end of the course, even if the patient feels better, can result in regrowth of the bacteria.
Surgery
The surgical procedure to remove the tonsils is called a tonsillectomy. A tonsillectomy patient may need to be hospitalised for up to 24 hours. The throat will be sore for four or five days after the operation in children. The removal of the tonsils does not appear to have any adverse effect on children’s immunity to infection.
When is a tonsillectomy recommended?
In the past, tonsillectomies were performed far more frequently than they are now. These days, the trend is for doctors to only recommend surgery in cases where:
- The tonsillitis is severe and resistant to medication.
- The infection is recurrent and persistent with five or more definite episodes of tonsillitis in one year.
- The infection interferes significantly with everyday activities.
- Bad breath or tonsilloliths cause significant discomfort.
- There are serious complications as a result of infection or a high risk of such complications. These include tonsillar abscess or serious streptococcal complications such as rheumatic heart disease or nephritis.
- The tonsils are so greatly enlarged that they cause severe sleep problems (such as snoring and sleep apnoea), dental abnormalities, or difficulty in swallowing.
- The tonsil infection is accompanied by adenoid enlargement, causing recurrent ear infections, nasal obstruction, or sinusitis; and where these symptoms are resistant to medication.
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Reviewed by Prof Eugene Weinberg, Paediatrician Health24, February 2015.
