While most cases of tonsillitis can be treated at home or by a primary care physician, emergency care may be needed in severe cases. Go to the emergency room if you or your child have extreme difficulty swallowing (i.e., cant swallow saliva), have difficulty breathing, or feel very sick. Intravenous fluids may be necessary for children who have become dehydrated because of their inability to swallow fluids.
Contact your doctor any time you or your child have a sore throat or other symptoms of tonsillitis that cause more than minor problems such as mild fever or headache. Call your doctor if pain relievers have not improved your fever, or if a sore throat is preventing you or your child from drinking an adequate amount of fluid. You should also call your doctor if other symptoms have not improved in 24 hours. In most cases, the doctor will recommend an office visit or self-care.
Most cases of tonsillitis improve within a few days. However, you can hasten recovery by resting and modifying your diet to avoid irritating your throat Table 02. Because a sore throat makes some foods hard to swallow, drink plenty of liquids, and eat soft, bland foods including soup, ice cream, and popsicles. Either warm (but not hot) fluids—such as tea with honey or hot chocolate—or very cold fluids such as milkshakes, can help soothe the throat. Soft drinks such as ginger ale are also acceptable, but avoid orange juice, lemonade, or other acidic drinks that could irritate the throat. Older children and adults can gargle every few hours with warm, salty water (use 1/4 teaspoon of salt in 4 oz of water). You can also use a cool-mist humidifier to increase the amount of moisture in the air.
You should stay in bed or pursue quiet activities as long as you are feeling unwell so that your body will have time to heal. Viral tonsillitis may last as little as 24 hours, and most people recover within a week.
Cases of bacterial tonsillitis may take longer to cure. Symptoms such as fever and sore throat usually improve within a week, although a complete recovery may take closer to two weeks. It is probably not be necessary to remain in bed after the first few days of treatment.
Over-the-counter medications can reduce pain and relieve fever. If you have viral tonsillitis, antibiotics will not help, and the condition will usually be left to run its course. In this case, use over-the-counter medications for pain relief.
Use a product such as acetaminophen or ibuprofen (i.e. Tylenol or Advil) for pain relief and fever reduction. Follow the dosage recommendations on the package, which are based on age and weight, or follow your doctor's instructions. Do not give products containing aspirin to children or teens unless your doctor recommends this type of medication. In this age group, aspirin is associated with a condition called Reye's syndrome, which is potentially fatal.
Throat lozenges may be used for adults and children over the age of four to reduce the discomfort of a sore throat. Hard candy such as butterscotch may have a similar soothing effect, but neither candy nor lozenges should be given to young children who may accidentally swallow them and choke.
Table 2. Self-Care for Tonsillitis
Drink warm or cold fluids Eat soft, bland foods Gargle with warm, salty water (adolescents and adults) Use acetaminophen or ibuprofen for pain relief and fever reduction Use throat lozenges or eat hard candy (not recommended for young children) Get plenty of rest Drink plenty of fluids to prevent dehydration
Your doctor is the best source of information on the drug treatment choices available to you.
Surgery to remove the tonsils, known as tonsillectomy, is performed infrequently, and mainly in cases where a patient has repeated, severe episodes of tonsillitis, or if bacterial tonsillitis does not respond to antibiotics. Having one's tonsils removed was once a childhood rite of passage. Today, however, tonsillectomies are rarely done because effective new drugs are now available for treating bacterial tonsillitis. In addition, doctors have developed a better understanding of the role of tonsils in the body's immune system, and no longer believe they should be routinely removed if they become infected.
A tonsillectomy may be recommended for an individual with chronic tonsillitis. A tonsillectomy may be necessary if you experience frequent episodes of tonsillitis within a year (five to seven episodes is usually the benchmark), or have five episodes a year for two straight years.
The tonsils may also be removed if they are large and are blocking the throat. Tonsils that are too large can cause breathing problems for children or adults, and a tonsillectomy is sometimes recommended to relieve this problem. Enlarged tonsils also may be removed if they seem to be causing a problem known as obstructive sleep apnea, which is a condition wherein breathing is blocked during sleep when the airway pulls shut. It can occur in children as well as in adults.
If tonsillitis is not effectively treated, it may lead to a condition called peritonsillar abscess, and require a tonsillectomy. A peritonsillar abscess is a collection of pus or infected material around the tonsils. It can occur when one or both of the tonsils become infected, and pus spreads from the tonsils to surrounding tissues. The condition can develop when antibiotics fail to cure an otherwise ordinary case of tonsillitis, or when tonsillitis improves, and then gets worse. Peritonsillar abscess may spread to the roof of the mouth, the neck, and the chest. The airway could then become obstructed, a situation requiring emergency treatment, which may include removing the tonsils. Peritonsillar abscess is infrequent, and is more common in adolescents and young adults than in children.
A tonsillectomy can be performed in the hospital or at an outpatient surgical facility. A tonsillectomy is usually done by an ear, nose, and throat specialist, or a general surgeon, often as same-day surgery. After administration of general anesthesia, the patient's mouth is held open to expose the tonsils. The tonsils are then grasped with clamps, pulled forward, cut free of surrounding tissue, and removed. The doctor will seal the blood vessels to stop the bleeding. The doctor may also remove another set of tonsillar tissues, called the adenoids, from the back of the upper part of the throat. The combined procedure is referred to as tonsillectomy and adenoidectomy.
In most cases, patients can go home several hours after surgery, although very young children (age three or under) or those with other medical problems typically require an overnight stay. The most common complication is bleeding, which may occur immediately after surgery or several days later. If bleeding occurs while you are at the hospital or outpatient center, you will be taken to the operating room for additional care. If minor bleeding occurs at home, try rinsing your mouth with ice water. Call the doctor or go to the emergency room if bleeding becomes excessive.
Side effects such as a sore throat, fever, nasal congestion, earaches, and moderate pain are likely for several days after a tonsillectomy. Consume easily swallowed foods and liquids such as custard, gelatin, pudding, ice cream, popsicles, and iced drinks for about a week after surgery. Gradually introduce more solid foods, but avoid crispy or sharp-edged foods such as bacon, toast, or chips until the throat is fully healed. Drink plenty of liquids to prevent dehydration, but do not serve citrus juices or acidic fruits that can cause irritation. Your doctor may prescribe antibiotics to prevent infection. For pain relief, the doctor may suggest acetaminophen or prescribe a pain medication. Do not use ibuprofen or aspirin, as they can increase the risk of bleeding.
A full recovery takes about two weeks. Children should rest in bed for several days, and gradually resume a normal schedule. During the recovery period, the pain may fluctuate. Contact your doctor if pain and other symptoms do not improve.
If eating is painful, you may experience weight loss. If your throat hurts, use the pain medication recommended by your doctor, and consume only easily swallowed foods. Any weight lost during the recovery period will usually be regained quickly once a normal diet is resumed.
Acupuncture may be used to treat tonsillitis pain. Acupuncture treatment may provide relief from the pain of tonsillitis, according to The World Health Organization, and may be one option to consider if conventional forms of treatment have not been successful. Many doctors can make referrals to certified acupuncturists, or identify organizations that can provide information and referrals. Although acupuncture is widely used in many parts of the world to treat a range of health problems, including tonsillitis, it is not known how widely acupuncture is used in the United States. Consult your doctor if you are considering acupuncture therapy to relieve the pain of tonsillitis.
With proper medication and self-care, most cases of tonsillitis will resolve within a week or two. Tonsillitis generally is cured within a week or two, particularly with plenty of rest and fluids. Chances of a full recovery are also increased when the full, 10-day course of antibiotics prescribed for bacterial tonsillitis is taken as directed. If bacterial tonsillitis is not treated, or if it is undertreated because all medication was not taken, there is an increased risk of rheumatic fever or kidney disease.
It probably will not be necessary to see a doctor for a follow-up visit unless complications develop, or if you or your child have had a tonsillectomy. If you or your child had a tonsillectomy, your doctor may want to follow up in a few weeks to make sure that healing has progressed. Since most cases of tonsillitis resolve on their own, however, you probably will not need to follow up with your doctor if you didn't have surgery. Call the doctor's office if your or your child's symptoms do not improve after a few days, or if the symptoms become worse.
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