How to fix a sore throat

Tonsils are fleshy pads located at each side of the back of the throat and tonsillitis is the inflammation of these pads.

Signs and symptoms include swollen tonsils, sore throat, difficulty swallowing and tender lymph nodes on the sides of the neck. Most tonsillitis cases are caused by infection with a common virus, but bacterial infections may also cause tonsillitis.

Because appropriate treatment for tonsillitis depends on the cause, it’s important to get a prompt and accurate diagnosis.

The role of tonsils and tonsil removal surgery

Surgery to remove tonsils, once a common procedure to treat tonsillitis, is usually performed only when it occurs frequently, doesn’t respond to other treatments or causes serious complications.

The tonsils are the immune system’s first line of defence against bacteria and viruses that enter your mouth. This may make the tonsils particularly vulnerable to infection and inflammation. The tonsil’s immune system function declines after puberty which is the reason why there are rare cases of tonsillitis in adults.

Tonsillitis can be a medical emergency if there is:

• A sore throat with fever.
• A sore throat that doesn’t go away within 24 to 48 hours.
• Painful or difficult swallowing.
• Extreme weakness, fatigue or fussiness.
• Difficulty breathing.
• Extreme difficulty swallowing.
• Excessive drooling.

Symptoms

Tonsillitis usually affects children between preschool ages and the mid-teens. Common signs and symptoms include:

• Red, swollen tonsils.
• White or yellow coating or patches on the tonsils.
• Sore throat.
• Difficult or painful swallowing.
• Fever.
• Enlarged, tender glands (lymph nodes) in the neck.
• A scratchy, muffled or throaty voice.
• Bad breath.
• Stomach ache.
• Neck pain or a stiff neck.
• Headache..

In infants, who are unable to describe how they feel, signs of tonsillitis may include:

• Drooling due to difficult or painful swallowing.
• Refusal to eat.
• Unusual fussiness. It’s important to get the right diagnosis if your child has symptoms indicating tonsillitis.

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Causes and risk factors

Tonsillitis is most often caused by common viruses, but bacterial infections can also be the cause. The most common bacterium causing tonsillitis is Streptococcus pyogenes.

Tonsillitis most often affects children, and the type caused by bacteria is most common in children aged five to 15.

This is because school going children are in close contact with their peers and are exposed to viruses or bacteria that can cause tonsillitis.

Complications

Inflammation or swelling of the tonsils from frequent or chronic tonsillitis can cause complications such as:

• Disrupted breathing during sleep (obstructive sleep apnoea).
• Infection that spreads deep into surrounding tissue (tonsillarcellulitis).
• Infection that results in a collection of pus behind a tonsil (peritonsillar abscess).
• Rheumatic fever, a serious inflammatory condition that can affect the heart, joints, nervous system and skin.
• Complications of scarlet fever, a streptococcal infection characterised by a rash.
• Inflammation of the kidney (poststreptococcal glomerulonephritis).
• Post-streptococcal reactive arthritis, a condition that causes inflammation of the joints.

Prevention

The germs that cause viral and bacterial tonsillitis are contagious. Therefore, the best prevention is to practise good hygiene. Teach your child to:

• Wash his or her hands thoroughly and frequently, especially after using the toilet and before eating.
• Avoid sharing food, drinking glasses, water bottles or utensils.
• Replace his or her toothbrush after being diagnosed with tonsillitis.
• Keep your child at home when he or she is ill.
• Teach your child to cough or sneeze into a tissue or, when necessary, into his or her elbow.
• Teach your child to wash his or her hands after sneezing or coughing.

Diagnosis

To diagnose tonsillitis, your health practitioner will:

• Use a lighted instrument to look at your child’s throat and likely his or her ears and nose, which also may be sites of infection.
• Check for a rash known as scarlatina, which is associated with some cases of strep throat.
• Gently feel (palpating) your child’s neck to check for swollen glands (lymph nodes).
• Listen to his or her breathing with a stethoscope.
• Check for enlargement of the spleen (for consideration of mononucleosis, which also inflames the tonsils).
• Do a throat swab to get a sample of the secretions.
• Take blood for a full blood count test.

Treatment

There are non-medical interventions that help to keep the infection at bay. If there’s no improvement.  Take your child to a doctor. These may include:

• Getting enough rest and sleep.
• Giving your child water to keep their throat moist and prevent dehydration.
• Providing comforting foods and warm liquids like soup, tea or warm water with honey.
• Preparing a salt-water gagle. If your child can gargle, a salt-water gargle of 1/2 teaspoon of table salt in a cup of warm water can help soothe a sore throat. Have your child gargle the solution and spit it out.
• Offering lozenges. Children older than four can suck on lozenges to relieve a sore throat.
• Keeping your home free of cigarette smoke and cleaning products that cause irritation.

Antibiotics

If tonsillitis is caused by a bacterial infection, your doctor will prescribe antibiotics. Penicillin taken orally for 10 days is the most common treatment.

If your child is allergic to penicillin, your doctor will prescribe an alternative antibiotic. Your child must take the full course of antibiotics as prescribed, even if the symptoms go away.

Failure to take all the medication as directed may result in the infection worsening or spreading to other parts of the body.

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