Tonsillitis

- When a person opens their mouth there's a lot of different things that you can see. Of course, you know the teeth, the lips, the tongue. You can see the back of the throat and this little dangling thing attached to the roof of your mouth, which is known as the Uvula. But there's a couple other things in here that you might not notice very commonly. In fact, one of the most important organs that help fight off infection are found in the mouth. These are the tonsils. The tonsils are commonly overlooked when you open up your mouth and that's probably because they're often small and hiding in between two arches. These tonsils right here, known as the Palatine tonsils, due to their location near the palate, or the roof of the mouth, are often small when we become adults. However, in kids, they're a little bit larger and they're used to help fight off infections. How do that do that? Well, you'll notice these tonsils have these little crevices that I've drawn in here. These little crevices are known as crypts. These little crypts, or crevices, are tiny little traps and allow different things to get stuck in them. For example, saliva, food; it's probably most accurate to refer to these as traps because they'll trap all of this food and often these little traps can trap bacteria or viruses that may have been travelling in little droplets. For example, if somebody sneezes, little droplets with virus or bacteria may be able to get into the mouth or they may enter through contact if a patient touches something infected and touches their mouth. But once these tonsils have trapped this bacteria or virus the immune system is called to action. These tonsils carry different immune cells that are used to fight off infection. They're very important in acquiring immunity from these infections. However, if the tonsils become infected themselves, if the bacteria or the virus goes out of control and can't be stopped by the immune system, then these tonsils may grow in size and become swollen. This is known as Tonsillitis, inflammation of the tonsils. "Itis" refers to inflammation and swelling and, of course, "tonsil" means tonsils. All this trapping and filtering of germs leaves the tonsils especially prone to infection. This can actually be a common occurrence in children, particularly children about three to seven years old as their immune system is still developing and also because they're touching different things and exploring different things and around other kids who may have infections. They are more likely than adults to develop Tonsillitis. Now, to give you an idea where the tonsils are, they're between two arches, the first of which I'm highlighting right here. This arch in the front is known as the Palatoglossal arch. "Palato" meaning the palate of the mouth, the roof of the mouth, and "glossal" refers to the glossus, which is the Latin term for tongue. So, an arch that connects the roof of the mouth to the tongue. The tonsils hide between this arch and this other arch in the back, which is known as the Palatopharyngeal arch. "Palato" again referring to the roof of the mouth and "pharyngeal" referring to the throat, the pharynx. Pharynx is the back of the throat. Actually, kind of as a side note, Tonsillitis can coincide with Pharyngitis. If the inflammation gets into the back of the throat, then patients will have Tonsillopharyngitis, inflammation of the tonsils and the back of the throat. Now there's also another set of tonsils that aren't visible in the mouth. These guys, and I'll move over here for this, are located near the nasal passage. This actually makes a lot of sense. When bugs and germs enter the mouth we want them to encounter this first line of defense, the tonsils. Those would be the Palatine tonsils. But also, if we inhale through our nose, we want the germs to encounter tonsils as well. So, not only do we have the Palatine tonsils right here, but we also have tonsils in our nasal passage, back over here. These are sometimes referred to as the Pharyngeal tonsils because they're in the back of the throat, but more commonly they're called the Adenoids. They act to fight germs that get through the nasal passage. Along with getting red and inflamed and enlarged, these tonsils, when they become enlarged, notice they can potentially block the nasal passage, making it difficult to breath air in through the nose. Redness, inflammation and enlargement of the tonsils may mean Tonsillitis. Another symptom that patients may have is called a tonsillar exudate. An exudate is a whitish or yellow fluid that can be found on the tonsils during an infection. This tonsillar exudate is from the immune system trying to fight off bacteria or a virus. In the process, cells of the immune system release chemicals that both cause damage to pathogens and damage to cells of our body. Some of the chemicals that they immune system release also open up blood vessels and, since tonsils are very vascular, this allows extra flow of fluid into the tonsils. A mix of this extra fluid accumulating, along with cellular debris and viral or bacterial debris, is called an exudate. What are the bugs and germs that cause Tonsillitis? Well, the most common cause of Tonsillitis is from viral infections. Virus that are commonly implicated in Tonsillitis are the viruses also implicated in the common cold. These include Rhiovirus; "Rhino," think of nose of a Rhino, Adenovirus, right, you can think Adenoids. The Adenovirus can cause it. Coronavirus; a "Corona," you can think of a crown, so something having to do with the head, and also Parainfluenza and Influenza and a couple others. In fact, there are many different viruses that can cause the common cold. These are just a couple common ones that I'm naming. That's actually why it's difficult to develop a vaccine to cure the common cold, 'cuz there's many different viruses that cause it. Though viruses are the most common cause of Tonsillitis, it's the bacteria that we often worry about. In adults a bacterial infection is much less likely. About 90% of Tonsillitis, if it's caused in adults, are from a virus. However, bacterial infections can be more common in children. There's one bug that's implicated that's especially nasty. This bacteria is known as Streptococcus pyogenes, also known as Group A Strep, or more commonly, Group A Strep can be referred to as a Strep throat. A Strep throat may be pharyngitis, infection of the back of the throat, along with Tonsillitis. Group A Strep commonly causes Tonsillopharyngitis. I highlight this bacteria because it's particularly known to cause some interesting complications. One of the more severe complications that can coincide with Tonsillitis is known as a Peritonsillar abscess. Peritonsillar abscess. An abscess is a collection of fluid that contains very nasty infective material. Because it's a collection of fluid it's actually very hard for the immune system to get at it. Abscesses need to be drained. Otherwise the infection may continue unimpeded by the immune system. Peritonsillar means "near the tonsils," so an abscess developing near the tonsils. This can be very serious because it develops quickly and can make breathing difficult, can cause severe pain, a severe infection with very high fever, and what's worse, this peritonsillar abscess, let's say this is an abscess, can spread behind the tissue to different parts of the body. Normally Tonsillitis is limited to the surfaces of the mucosa, or the surfaces of the throat, mouth and nasal passage, but if the abscess develops behind this tissue, behind this mucosa, also know as this wet surface, then it can travel into other spaces. Thus, a peritonsillar abscess really needs to be seriously considered and should be drained immediately. A Group A Strep infection can also lead to some other severe complications which may affect the heart, the joints or the nervous system, which would be the brain and the spinal cord. Another complication that can develop after a Strep throat infection is damage to the kidneys, which can lead to high blood pressure or bloody urination. For viruses, treatment is supportive but with a bacterial infection, antibiotics can be given. The good news is if antibiotics are given during a Group A Strep infection, then it can prevent these serious complications from occurring. Antibiotics should be given and taken for the full course of the treatment. Otherwise these symptoms, although rare, may develop.