Tonsillitis is a common condition that mostly affects children starting school or nursery. Dr Howard Lee examines the causes, symptoms and treatments

The tonsils and adenoids are masses of tissue that are very similar to the lymph nodes or 'glands' - usually easy to feel - found in the neck, groin or armpits. The tonsils are at the back of the throat, on each side, and the adenoids are high in the throat, hidden behind the nose and the roof of the mouth - and usually not visible through the mouth without special instruments.

What do our tonsils do?
The exact role played by tonsils in the body's immune system is not really known, but they certainly do help to fight diseases during the early part of our life as they contain germ-killing cells. Positioned near the entrances to the breathing passages, they can more easily catch the incoming, infection-producing germs. The main activity of the tonsils and adenoids occurs during the first few years of life, and it becomes less important as we get older, which is why doctors tend to delay any surgical treatment for as long as possible.

What is tonsillitis?
This is the term for infection of the tonsils - which may be caused by either viruses (85 per cent, and generally in young pre-school children) or bacteria (15 per cent, and usually older children or adults). This is a natural event linked to the proper functioning of the tonsils and quite often the symptoms are the same no matter which germ is causing the infection. The neck 'glands' may also be involved, in either type, becoming swollen and painful, together with an accompanying pharyngitis, which is an infection of the surrounding throat tissues.

Bacterial tonsillitis can be treated with antibiotics, but viral infections are not affected by antibiotics and any unnecessary use can make the situation worse.

How do kids get it?
All forms of tonsillitis, whether caused by bacteria or viruses, are contagious illnesses that usually spread from person to person by contact with the throat or nasal fluids of someone who is already infected, especially from coughing or sneezing. Some of the causative bacteria can, in fact, be carried by children without there being any symptoms of tonsillitis; this can be the case in up to 20 per cent of school-age children.

What is chronic tonsillitis?
Despite any antibiotic treatments in bacterial tonsillitis infections, recurrent tonsillar infections can sometimes continue and lead to persisting enlargement of the tonsils - a condition called chronic tonsillitis.

The tonsils can be so large that they can partially block proper breathing - and if the adenoids are also involved, additional blocking difficulties occur at the back of the nose. This in turn may also cause frequent, secondary infections, which involve the middle ear - medial otitis.

Chronic tonsillitis can sometimes lead to a very severe condition called peritonsillar abscess, where a collection of pus and dead tissue forms a swelling within the throat and tonsillar tissues. This can cause an acute blocking of the breathing tubes and may need emergency surgical treatment.

When is tonsillectomy needed?
When antibiotic treatments, supportive measures and other non-surgical treatments for recurrent tonsillitis are no longer effective, then tonsillectomy and/or adenoidectomy - surgical removal of the tonsils and/or adenoids - is often recommended.

Each individual is different, but past research shows that tonsillectomy or adenoidectomy, or both, is a beneficial form of treatment for those who have had six to seven infections in one year or two to three infections each year for more than a few years. In these cases, chronic infections can often cause secondary infection in other areas, especially the middle ear.

The operation is carried out under general anaesthetic, and requires only a 24- to 48-hour hospital admission in most cases. Apart from the usual anaesthetic 'risks', there is the associated risk of bleeding from the site where the tonsils were removed. This can occur immediately following the operation or up to ten days afterwards, when the scab covering the operation site falls off. The amount of bleeding in most cases is very small, and causes no problems, but about one to two per cent of patients may have bleeding severe enough to require a further visit for emergency treatment.

What about recovery?
There is always a very sore throat. Sometimes this can become severe enough to prevent swallowing - even of liquids - and there is always a need to prevent dehydration. Soreness will be helped by the use of a suitable liquid analgesic medicine and by sucking ice or sipping iced drinks, etc. There is no evidence that any special diet is required, but obviously soft foods will go down more easily.

Some children can have vomiting or develop a high temperature - which can be indicative of a secondary infection - and this can also lead to pain in the ears, as occurred during the bouts of tonsillitis. In these cases, antibiotic treatment may be necessary once again.