The tonsils (palatine tonsils) are a pair of soft tissue masses located at the rear of the throat (pharynx).

Each tonsil is composed of tissue similar to lymph nodes, covered by pink mucosa (like on the adjacent
mouth lining). Running through the mucosa of each tonsil are pits, called crypts.

tonsil,  small mass of lymphatic tissue located in the wall of the pharynx at the rear of the throat
of man and other mammals. In man the term is used to designate any of three sets of tonsils,
most commonly the palatine tonsils. These are a pair of oval-shaped masses protruding from
each side of the oral pharynx behind the mouth cavity. The exposed surface of each tonsil is
marked by numerous pits that lead to deeper lymphatic tissue. Debris frequently lodges in the
pits and causes inflammation, a condition called tonsillitis. The function of the palatine tonsils is
thought to be associated with preventing infection in the respiratory and digestive tracts by
producing antibodies that help kill infective agents. Frequently, however, the tonsils themselves
become the objects of infection, and surgical removal (tonsillectomy) is required. Usually,
children are more prone to tonsillitis than adults, for the structures tend to degenerate and
decrease in size as one gets older.

Another major tonsillar pair is the pharyngeal tonsils, more commonly known as adenoids. These
are diffuse masses of lymphatic tissue located on the top wall of the nasal pharynx. Enlargement
of these tonsils may obstruct breathing through the nose, interfere with sinus drainage, and lead
to sinus and middle ear infections. When the nasal respiratory passage is blocked, mouth
breathing becomes necessary. Continued mouth breathing puts stress on the developing facial
bones in children and may cause facial deformities. Surgical removal, often in conjunction with a
tonsillectomy, is frequently recommended in children. The adenoids tend to decrease in size
during adulthood.

The third pair of tonsils are the lingual tonsils, aggregations of lymphatic tissue on the surface
tissue at the base of the tongue. The surface of this tonsil has pits leading to lower lymphatic
tissue as in the other two tonsil types, but these pits are effectively drained by small glands
(mucous glands), and infection is rare.

Definitions

Tonsillitis is inflammation of the pharyngeal tonsils. The inflammation usually extends to the adenoid and the
lingual tonsils; therefore, the term pharyngitis may be used interchangeably. Pharyngotonsillitis and
adenotonsillitis are considered equivalent for the purposes of this article. Lingual tonsillitis refers to isolated
inflammation of the lymphoid tissue at the tongue base.

A "carrier state" is defined by a positive pharyngeal culture of group A beta hemolytic Streptococcus pyogenes
(GABHS), without evidence of an antistreptococcal immunologic response.

Pathophysiology
Viral or bacterial infections and immunologic factors lead to tonsillitis and its complications.

Frequency
United States

Tonsillitis is a common illness. Nearly all children in the United States experience at least one episode of
tonsillitis. Pharyngitis accompanies many upper respiratory tract infections.
Between 2.5% and 10.9% of children may be defined as carriers. The mean prevalence of carrier status of
school children for group A Streptococcus, a cause of tonsillitis, was 15.9% in one study.3,4

Children accounted for approximately one third of 45,000 peritonsillar abscess episodes estimated by Herzon
et al to occur in the United States in 1995.5

International

Recurrent tonsillitis was reported in 11.7% of Norwegian children in one study and estimated in another study
to affect 12.1% of Turkish children.6

A family history of atopy and of tonsillectomy may predict the occurrence of tonsillitis in their children.

Mortality/Morbidity
Because of improvements in medical and surgical treatments, complications associated with tonsillitis,
including death, are rare.7 Historically, scarlet fever was a major killer at the beginning of the 20th century, and
rheumatic fever was a major cause of cardiac disease and mortality. Although the incidence of rheumatic fever
has declined significantly, cases that occurred in the 1980s and early 1990s support concern over a resurgence
of this condition.

Age
Tonsillitis most often occurs in children; however, the condition rarely occurs in children younger than 2 years.
Tonsillitis caused by Streptococcus species typically occurs in children aged 5-15 years, while viral tonsillitis is
more common in younger children.

Peritonsillar abscess (PTA) usually occurs in teens or young adults but may present earlier.

Clinical

History
The patient's history determines the type of tonsillitis (ie, acute, recurrent, chronic) that is present.

 Acute tonsillitis
o Individuals with acute tonsillitis present with fever, sore throat, foul breath, dysphagia
(difficulty swallowing), odynophagia (painful swallowing), and tender cervical lymph nodes.
o Airway obstruction may manifest as mouth breathing, snoring, nocturnal breathing pauses, or
sleep apnea.
o Lethargy and malaise are common.
o Symptoms usually resolve in 3-4 days but may last up to 2 weeks despite adequate therapy.
 Recurrent tonsillitis is diagnosed when an individual has 7 episodes in 1 year, 5 infections in 2
consecutive years, or 3 infections each year for 3 years consecutively.
 Individuals with chronic tonsillitis may present with chronic sore throat, halitosis, tonsillitis, and
persistent tender cervical nodes.
 Children are most susceptible to infection by those in the carrier state.
 Individuals with peritonsillar abscess (PTA) present with severe throat pain, fever, drooling, foul breath,
trismus (difficulty opening the mouth), and altered voice quality (the "hot potato" voice).
Physical
Physical examination should begin by determining the degree of distress regarding airway and swallowing
function. Examination of the pharynx may be facilitated by opening the mouth without tongue protrusion,
followed by gentle central depression of the tongue. Full assessment of oral mucosa, dentition, and salivary
ducts may then be performed by gently "walking" a tongue depressor about the lateral oral cavity. Flexible
fiberoptic nasopharyngoscopy may be useful in selected cases, particularly with severe trismus. The images
below depict the oral examination.

Examination of the tonsils and pharynx.

Oral mucosal examination.
Physical examination in acute tonsillitis reveals fever and enlarged inflamed tonsils that may have exudates as
seen in the image below.

Acute bacterial tonsillitis is shown. The tonsils are enlarged and inflamed with exudates.
The uvula is midline.

Group A beta-hemolytic Streptococcus pyogenes and Epstein-Barr virus (EBV) can cause tonsillitis that may be
associated with the presence of palatal petechiae. Group A beta-hemolytic Streptococcus (GABHS) pharyngitis
usually occurs in children aged 5-15 years.

Open-mouth breathing and voice change (ie, a thicker or deeper voice) result from obstructive tonsillar
enlargement.

 The voice change with acute tonsillitis is usually not as severe as that associated with peritonsillar
abscess (PTA).
 In peritonsillar abscess (PTA), the pharyngeal edema and trismus cause a hot potato voice.

Tender cervical lymph nodes and neck stiffness are observed in acute tonsillitis.

Examine skin and mucosa for signs of dehydration.

Consider infectious mononucleosis (MN) due to EBV in an adolescent or younger child with acute tonsillitis,
particularly when tender cervical, axillary, and/or inguinal nodes; splenomegaly; severe lethargy and malaise;
and low-grade fever accompany acute tonsillitis.

 A gray membrane may cover tonsils that are inflamed from an EBV infection as seen in the image
below. This membrane can be removed without bleeding.


Tonsillitis caused by Epstein-Barr infection (infectious mononucleosis). The

enlarged inflamed tonsils are covered with gray-white patches.

 Palatal mucosal erosions and mucosal petechiae of the hard palate may be observed.

An individual with herpes simplex virus (HSV) pharyngitis presents with red, swollen tonsils that may have
aphthous ulcers on their surfaces. Herpetic gingival stomatitis, herpes labialis, and hypopharyngeal and
epiglottic lesions may be observed.

Physical examination of a peritonsillar abscess (PTA) almost always reveals unilateral bulging above and
lateral to one of the tonsils. Trismus is always present in varying severity. The abscess rarely is located
adjacent to the inferior pole of the tonsil.

 Inferior pole peritonsillar abscess (PTA) is a difficult diagnosis to make, and radiologic imaging with a
contrast-enhanced CT scan is helpful.
  Tender cervical adenopathy and torticollis (neck turned in the cock-robin position) may be present.
 Ipsilateral otalgia may be observed.

Causes

 Most episodes of acute pharyngitis and acute tonsillitis are caused by viruses such as the following:
o HSV
o EBV
o Cytomegalovirus
o Other herpes viruses
o Adenovirus
o Measles virus
 One study showing that EBV may cause tonsillitis in the absence of systemic mononucleosis found
EBV to be responsible for 19% of exudative tonsillitis in children.
 Bacteria cause 15-30% of pharyngotonsillitis cases. Anaerobic bacteria play an important role in
tonsillar disease.
o GABHS causes most bacterial tonsillitis.
o S pyogenes adheres to adhesin receptors that are located on the tonsillar epithelium.
o Immunoglobulin coating of pathogens may be important in the initial induction of bacterial
tonsillitis.
 Organisms such as Mycoplasma pneumoniae, Corynebacterium diphtheriae, and Chlamydia
pneumoniae rarely cause acute pharyngitis.
 Arcanobacterium haemolyticum is an important cause of pharyngitis in Scandinavia and the United
Kingdom but is not recognized as such in the United States. A rash similar to that of scarlet fever
accompanies A haemolyticum pharyngitis.
 Neisseria gonorrhea may cause pharyngitis in sexually active persons.
 A polymicrobial flora consisting of both aerobic and anaerobic bacteria is observed in core tonsillar
cultures from cases of recurrent pharyngitis.
o Children with recurrent GABHS tonsillitis have different bacterial populations than do children
who have not had as many infections. Other competing bacteria are reduced, offering less
interference to GABHS infection.
o Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae are the
most common bacteria isolated in recurrent tonsillitis.
o Bacteroides fragilis is the most common anaerobic bacterium isolated in recurrent tonsillitis.
o The microbiology of recurrent tonsillitis in children and adults is different: adults show more
bacterial isolates, with a higher recovery rate of Prevotella species, Porphyromonas species,
and B fragilis  organisms , while children show more GABHS. Also, adults more often have
bacteria that produce beta-lactamase.
 A polymicrobial bacterial population is observed in most cases of chronic tonsillitis, with alpha- and
beta-hemolytic streptococcal species, S aureus, H influenzae, and Bacteroides species identified.
o One study, based on bacteriology of the tonsillar surface and core in 30 children undergoing
tonsillectomy, suggests that antibiotics prescribed 6 months before surgery do not alter the
tonsillar bacteriology at the time of tonsillectomy.8
o A relationship between tonsillar size and chronic bacterial tonsillitis is believed to exist. This
relationship is based on both the aerobic bacterial load and the absolute number of B and T
lymphocytes.
o H influenzae is the bacterium most often isolated in hypertrophic tonsils and adenoids.
 o With regard to penicillin resistance or beta-lactamase production, the microbiology of tonsils
removed from patients with recurrent GABHS pharyngitis is not significantly different from the
microbiology of tonsils removed from patients with tonsillar hypertrophy.
 Local immunological mechanisms are important in chronic tonsillitis.
o The distribution of dendritic cells and antigen-presenting cells is altered during disease, with
fewer dendritic cells on the surface epithelium and more in the crypts and extrafollicular areas.
o Study of immunologic markers may permit differentiation between recurrent and chronic
tonsillitis. Such markers in 1 study indicated that children more often experience recurrent
tonsillitis, while adults requiring tonsillectomy more often experience chronic tonsillitis. 9
 A polymicrobial flora is isolated from peritonsillar abscesses. Predominant organisms are the
anaerobes Prevotella, Porphyromonas, Fusobacterium, and Peptostreptococcus species; major
aerobic organisms are GABHS, S aureus, and H influenzae.
 Radiation exposure may relate to the development of chronic tonsillitis. A high prevalence of chronic
tonsillitis was noted following the Chernobyl nuclear reactor accident in the former Soviet Union.
 Overcrowded conditions and malnourishment promote tonsillitis.
 What are the tonsils?
 The tonsils are located in the back of the throat. They are part of a group of lymphoid tissue
that collect bacteria and viruses that cause upper respiratory tract (nose and throat)
infections. They also help to produce proteins (immunoglobulins) that help the body fight
infections. Although the tonsils have a role in helping treat infection, the tonsils can become
part of the infection as well. When this happens, removal of the tonsils will improve your
child's health. Removal of the tonsils has not led to an increase in infections or a loss of
immune (disease fighting) function. This is because there are hundreds of other lymph nodes
in the head and neck that perform the same function.
 Where are the tonsils?
 Actually, there are four areas of tonsil tissue located in the back of the throat The tissue
referred to as the "tonsils" is located on either side of the back of the mouth. The second area
of tonsil tissue is located behind the nose, and is called the ADENOID. The fourth area of tonsil
tissue is located behind the tongue; it does not usually cause any difficulties and is rarely ever
removed.
 What is tonsillitis?
 Tonsillitis is an infection of the tonsils. This infection usually involves the back of the throat as
well (pharyngitis). This infection is uncommon in children less than one year old. It is seen
most frequently in children four to seven years of age, and continues less frequently
throughout late childhood and adult life.
 What are some of the causes of tonsillitis?
 In about 85% of cases, viruses are the most common cause of tonsillitis. The second most
common cause is a bacteria known as Streptococcus (Group A Beta hemolytic Streptococcus),
otherwise known as "strep throat". Other bacteria can cause tonsillitis, but much less
frequently.
 What are the symptoms of tonsillitis?
 Tonsillitis usually results in a sore throat and difficulty swallowing. The throat visibly looks
inflamed (red). In younger children, refusal to eat may be noted. Fever, headache, earache,
and enlarged and tender glands in the neck may also be experienced.
 How is tonsillitis treated?
 It is important to have your primary care doctor determine if the cause of the infection is viral
or bacterial.
 Viral tonsillitis is primarily treated with bed rest, Tylenol (acetomenophen) for fever and pain
relief, and lots of fluids. Antibiotics do not help treat this type of infection.
 Streptococcal tonsillitis does require the use of antibiotics, primarily to help get rid of the
infection quickly and prevent complications. Complications can include an infection in the
bloodstream, heart problems, rash, and others.

What are some reasons that you may be referred to an ear, nose and throat
specialist for evaluation of tonsil removal (TONSILLECTOMY)?
 Tonsillitis can become difficult to treat (chronic tonsillitis) or infections may recur frequently.
This can result in fatigue, poor weight gain, poor school attendance among other things.
 Occasionally an abscess or collection of pus may develop around the tonsils and needs to be
drained.
 The tonsils can become so enlarged (tonsillar hypertrophy) that your child may have difficulty
breathing (especially at night) or difficulty swallowing.
 If enlargement of only one tonsil occurs, this may be suggestive of a malignancy (cancer) and
needs to be removed for biopsy.
 These are the most common indications for removing the tonsils. However, each child is
evaluated based on their unique history.

Kids - Tonsils and Tonsillitis in Children

Email

Written by seofriends on Feb-22-09 1:17pm

From:  easyatkinsrecipes.blogspot.com

By Melinda Mahrer
Tonsils are two tissue balls located at the back of the throat. They play a vital role and are an
important part of the body's infection fighting mechanism by helping to fight germs and diseases.
Tonsils deal with the germs before they reach mouth, throat, or sinuses. When these infection
fighters are infected by viruses or bacteria.

The symptoms of tonsillitis are: as the time passes, eating, drinking and swallowing things become
difficult. The pain can be accompanied with fever, aching and headache. The tonsils can be seen
too. Just open the mouth wide open and the two masses of tissues at the either side of the throat are
tonsils. They are usually dark pink in color, but when they get infected they turn red. A white or
yellow coating can also be formed on the tonsils. There is an obvious change in voice as it becomes
hoarser. The infected child can also develop bad breath. The infected kid can also get abdominal
pain and can throw up what he eats. Tonsillitis is caused by both bacterial infection and viral
infection. Bacterium known as streptococci causes infections which require special treatment.

When the child gets tonsillitis, the parent should give lots of fluids to drink. Smooth food should be
consumed to ease the pain caused by swallowing coarse, crunchy, and hard food. Food like soups,
ice creams, applesauce, and gelatin are a good option. Spicy food should also be avoided. A
humidifier or cool mist vaporizer can be placed in the child's room as that will make breathing more
easily. The kid must be given maximum rest and complete bed rest for at least two days is
recommended. The bacteria and viruses cause tonsillitis to spread by sneezing, coughing or
touching. The infected child must cover his/her mouth while coughing and sneezing. A disposable
tissue can be used instead of a towel or handkerchief. Things such as utensils, towel, clothing, etc.
of the sick kid should be separated so that the rest of the family doesn't get affected.

The doctor inspects the tonsils using a wooden stick known as tongue depressor, which will lower
the tongue, so that the doctor can have a good look at the tonsils. After that the doctor checks the
ears and nose. Heartbeat will be checked. If the doctor suspects strep, he/she will take a sample of
saliva from the back of the throat using a long cotton swab, which can gag up the child a bit. After a
day or two the results are received. Some doctors conduct a similar test known as rapid strep test,
which give results within few minutes. Antibiotics are given when the test results come positive for
strep. The bacteria get killed only when the course is completed and the correct dosage is taken at
correct time.

If virus is the cause of infection, there is no medicine for it and instead the body is capable of fighting
the virus on its own. When the tonsils infection becomes frequent and the child finds it difficult to
breath because of tonsillitis, it is recommended to get the tonsils removed. But it is the last resort
after all other treatments do not do the trick, because tonsils are very important to the body's
immune system.

The tonsils are taken out by surgery known as tonsillectomy. After the surgery, the child won't suffer
from sore throat and breathing problems anymore. The surgery won't even leave any scars. A day
before the surgery, the child cannot eat or drink, to keep the child from throwing up during the
operation. The operation is very short and last for only twenty minutes. Because of the anesthesia,
the child won't feel a thing during the operation. And during the surgery, the tonsils are removed
using an electric cautery, which is a burning tool, or a cutting tool. After the surgery, the child is given
lots of fluids and after a day soft foods can also be given.

Close contact with an infected person is the main risk factor for tonsillitis. Droplets of disease-causing
agents (pathogens) pass through the air when an infected person breathes, coughs, or sneezes. You may
then become infected after breathing in these droplets. Infection can also occur if pathogens get on the
skin or on objects that come in contact with the mouth, nose, eyes, or other mucous membranes.
Nasal obstruction causes you to breathe through your mouth, which increases the risk of tonsillitis.
Recommended Related to Oral Health
Tartar (Dental Calculus) Overview
From the time you were a child, you've known that it's important to brush and floss your teeth regularly. Doing so prevents tartar
buildup and keeps your teeth and gums healthy. But, you may not know exactly what this evil substance called tartar is, or how it
ends up on your teeth. Oral health is intricately linked to your overall well-being. So it's important to understand what leads to the
formation of tartar. It's also important to know how to prevent its build-up and how it should be removed...

Read the Tartar (Dental Calculus) Overview article > >

Although there is no proof that exposure to cigarette smoke can cause tonsillitis, children who live with a
smoker have a higher incidence of tonsillectomy, which is a surgical procedure to remove the tonsils.1

Pathophysiology
Local inflammatory pathways result in oropharyngeal swelling, oedema, erythema, and pain. Rarely, the swelling may
progress to the soft palate and uvula (uvulitis), or inferiorly to the region of supraglottis (supraglottitis).

http://www.youtube.com/watch?v=SLsksXViX5Q

http://www.youtube.com/watch?v=Zybk5qR5NXg