How is Tonsillitis Treated?
Tonsillitis treatment is given based on whether it is caused by a virus or bacteria.
- Viral tonsillitis : A tonsillitis caused by a virus can usually be managed without the use of antibiotics. The body will recover normally in 7 - 10 days.
- Bacterial tonsillitis requires a course of antibiotic treatment.
Among the beta-lactam antibiotics, Pencillin is the most common antibiotic prescribed for group A Streptococcus bacteria. Recommended dose is given for 10 days and must be completed to cure the tonsillitis infection thoroughly. Failure to complete the treatment may make it spread to other parts of the body causing further complications.
For children under 12 years of age and for chronic recurrent tonsillitis, cephalosporins (also a class of beta-lactam antibiotics) are more effective.
An alternative to the long-term penicillin therapy is the short-term therapy
with azithromycin (20 mg/kg) for three days or clarithromycin and cephalosporin for five days. However it has not been evaluated whether the short-term therapies are effective in preventing the late complications of rheumatic fever and glomerulonephritis,
Hospitalization may be required in severe cases if the fever does not subside within the stipulated number of days. A continuous intravenous supply of fluids and antibiotics will help retain fluids and control pain.
Tonsillectomy, or surgical removal of the tonsils, is usually performed only as a last resort. Surgery is an option to treat
- Frequently recurring tonsillitis that causes complications like obstructive sleep apnea, or difficulty in breathing or swallowing
- Chronic tonsillitis
- Bacterial tonsillitis that does not respond to antibiotic treatment or
- Peritonsillar abscess formed around the tonsils
Tonsillectomy is performed using a scalpel under a general anesthetic and the tonsils are removed from the wall of the throat, and the blood vessels attached to them are tied off. It is also known as a “total” or “extra-capsular” tonsillectomy.
One surgical method is the Cold Dissection method that uses a raspatory or a course file and the scissors to dissect the infected tonsils from the tonsil bed. The blood vessels feeding the tonsils are pinched off and then selectively ligated or coagulated with bipolar forceps. Bleeding is stopped by pressing a dry swab into the tonsil bed for about 1 minute.
Coblation advanced technology: This method involves the use radiofrequency energy and saline to create a plasma field that effectively dissociates the molecular bonds of the target tissues.
Tonsillectomy is an outpatient procedure, unless complications arise during surgery. Recovery period is usually 7 to 14 days. Drawbacks are post operative pain and bleeding. Surgical procedures that reduce the bleeding are continuously evaluated.
Of late, surgeons have reverted to a safer procedure Tonsillotomy or the partial removal of the tonsils. Only the portion bulging into the throat or medial portions of the tonsils are removed in this procedure.
This procedure has a lower hemorrhage rate, shorter procedure time, and more rapid recovery to a pain-free state. A long-term follow-up done indicated that partial removal of the tonsils is as effective as total tonsillectomy for the long-term management of children suffering from sleep disordered breathing.
In the case of peritonsillar abscess (PTA), an alternate option to tonsillectomy is to drain it either by a needle and syringe or by incision - cutting it with a scalpel and allowing the pus to drain.