At the back of our throats exists two areas of lymphoid tissues, located on either sides of our throat and are known as tonsils. Tonsils are our first line of defence. They act as a filter, ensuring that germs do not enter our airways and cause infection. They not only stop these germs, but also produce antibodies to fight these germs if required. However, in situations where there is an overwhelming amount of microbes or bacteria or virus, the tonsils themselves catch the infection. This infection causes the tonsils to enlarge and become inflamed, leading to enlarged tonsils, also known as tonsillitis. Tonsillitis is more common in children as compared to adults.
Symptoms of Enlarged Tonsils
The main symptom of enlarged tonsil is inflammation and swelling of the tonsils. Some other symptoms are as stated below:
Redness of the tonsils
A white or yellow coating on the tonsils indicating puss formation
In bigger infections, blisters or ulcers on the throat
Pain while swallowing or breathing through the mouth
Hoarseness of voice, like one has a cold
Snoring at night
Giving preference to breathing through the mouth instead of the nose
Jaw and neck tenderness due to swollen lymph nodes
Swollen lymph nodes
Loss of appetite, mainly due to the swelling and ulcers
Ear pain and infections
Swollen glands in the neck or jaw area
Bad breath, also known as halitosis
Difficulty opening the mouth
In some severe cases, it can also pose serious health issues, like:
Difficulty in breathing or swallowing: Due to the extreme pain associated with swallowing, the desire to eat or drink might go down drastically. This is more risky in children as it might become a cause for malnutrition and extreme dehydration. Breathing can also become very difficult if the tonsils swell and block the air passage.
Ear infections and loss of hearing: Enlarged tonsils and adenoids can result in chronic ear infection. This infection might block the Eustachian tubes, resulting in permanent loss of hearing
Sinus infection: Recurring sinus infection can be caused by enlarged tonsils
Obstructive sleep apnea: This is a condition in which the patient is not able to breathe for brief periods of time in their sleep. This leads to a reduced amount of blood flow in the body. Enlarged tonsils are a big contributor to this condition. Sleep apnea poses serious health risks like:
Congestive heart failure
High blood pressure
If the patient suffers from sleep apnea, tonsillectomy may be considered as the ideal solution.
What are the causes of Enlarged Tonsils?
Viral or bacterial infections are the main causes of enlarged tonsils. However, the most common reason is virus infection. Various virus and bacteria can be cause tonsils (Enlarged). They are stated below:
Streptococcus pyogenes is the bacterium that is the most common bacteria to cause enlarged tonsils. It is the most common cause of strep throat
The common cold virus, adenoviruses, herpes simplex virus
Rhinovirus – the most common infectious viral agent in humans
Mononucleosis caused by Epstein-Barr virus (EBV) causing gland swelling and extreme fatigue. This is the same virus that causes glandular fever
Para influenza virus
Tonsillitis can be contagious if it is caused by these microbes. Steps should be taken to ensure that the infection does not spread.
In addition to these microbes, tonsils can also become enlarged due to:
Abscess around the tonsils
Cryptic tonsils in which food particles get trapped in the tonsils
Cancer (in very rare cases)
Diagnosis of Enlarged Tonsils
To determine which of the above causes are causing the enlarged tonsils, doctors ask the number of instances of sore throat in the past couple of years.
To view the back of the nose and throat, doctors might insert a flexible viewing tube through the nose.
Doctors also look at the jaw and neck to check of swelling of lymph nodes.
They also check the breathing to see if it’s clear or not, and how severely are they affected by tonsils.
Throat Swab: Doctors can also get a throat swab culture or a rapid strep test. This test involves swabbing the back of the throat with a cotton swab. These tests are able to confirm a bacterial infection but not a viral one. Usually, the doctor can look at the physical symptoms, along with the report to ascertain if it’s a viral infection or not.
Monospot test: If the infection is due to mononucleosis, then the body produces the necessary antibodies to fight the infection. This test can detect the requisite antibodies to confirm the source of infection
Blood cell count: this test is done to test the number of blood cells of a particular type. This test is usually done if the other tests are inconclusive.
Treatment for Enlarged Tonsils
The treatment for the Enlarged Tonsils varies significantly based on the source of the enlargement.
If the swelling is caused by allergies, the doctors might prescribe nasal corticosteroids or antihistamines. It can be in spray form and through oral intake respectively.
If the swelling is caused by a bacterial infection, doctors may prescribe antibiotics. Depending on the severity of the infection, the antibiotics can be given as single shot or for oral consumption for a week or ten days. One thing to note here is to complete the medicine course suggested by the doctor. Even though the medication will help you feel better in a couple of days, but completing the course will ensure that our infection is gone for good.
If the tonsillitis is due to a viral infection, there is no treatment. Our body produces antibodies which will automatically heal the infection over time. In the meantime, however, there are home remedies that one can do to feel a little less discomfort. These include:
Get enough sleep. Rest is the best form of cure for viral infections
Drink a lot of fluids to ease the throat pain, preferably warm drinks
Eat smooth foods that will not irritate your throat any further
Use a humidifier or take steam
Gargle with warm water. Add salt for immediate relief
Take over-the-counter pain relievers such as acetaminophen or ibuprofen
Avoid irritants like smoke or any other substance that will irritate the throat further
Use throat lozenges
In extreme viral infection cases doctors might also prescribe steroids to reduce the swelling, but only if the situation cannot be controlled by home remedies. Steroids have a lot of side effects and we should not subject our bodies to it if it can be avoided.
If the infection is fierce or is recurring and the treatments mentioned above are not effective, doctors may recommend surgery. The surgical removal of adenoids is called adenoidectomy and the surgical removal of tonsils known as tonsillectomy. Both the surgeries can be done during the same operation.
Tonsils are an integral part of the immune system and it would be best if they are treated rather than removed. The function of adenoids is the same as tonsils, it being a first line of defence against germs that enter our bodies. It is a type of tonsil present in our body that is not visible externally.
These operations are extremely common and can greatly benefit the patient if they are suffering from one of the following:
Obstructive sleep apnea
Difficulty in breathing and talking
Frequent throat infections. Throat infections are considered frequent if you have had:
More than seven episodes of enlarged tonsils in the previous year
More than five episodes of tonsils each year, in the past two years
More than three episodes of tonsils each year for the past three years
There are various methods that can be employed to perform the procedure:
Conventional scalpel: This is the traditional method to remove tonsils, using a scalpel.
Lasers: It is done under general anaesthesia and is only a 15 minute procedure. This procedure might lead to slight post operative bleeding. This is not recommended for children.
Radio frequency ablation: This procedure using radio waves can be performed in doctor’s chambers itself. Here, the procedure is recurring as the tonsils are gradually shrunk by radiation.
Electro cauterization: this method either burns, cuts or evaporates the tonsil. This is relatively free of any type of bleeding, However, the post operative stage is more painful for this procedure
Ultrasonic energy: Also known as harmonic scalpel. This method uses energy from ultrasound to vibrate the blade. It is also blood free and is less painful that electro cauterization.
Bipolar radiofrequency ablation: this is more complicated procedure than the radio frequency method mentioned above. This procedure disrupts the molecular build of the tonsils and gets rid of the entire tonsils. IT is a slightly more complicated process, but the recovery period goes very smoothly
Microdebrider: This procedure is used only for partial tonsillectomies. The obstructive part of the tonsils is shaved off. Less painful post surgery.
Enlarged Tonsils: Post Surgery Recovery
Surgery is usually followed by pain in the throat ranging from mild to severe. Doctors will prescribe medicine to ease the pain.
Take the medicine prescribed to help with the pain
Drink lots of fluids
Eat smooth food items that are easy to swallow and cold, like ice-cream, gelatos
Keep your upper body elevated
Tonsillectomy and adenoidectomy do not decrease the recurrence or severity of cough and cold. These operations should be done at least two weeks after all infection has been cleared. The person should not have been taking any aspirin for these two weeks.
The chances for surgical complication are low in these operations but one must be aware. Please visit the doctor if you experience any of the following post operation discomforts:
Nausea or vomiting
Difficulty in breathing or swallowing
If you don’t urinate for 8 hours or more post operation
Enlarged Tonsils Complications to look out for:
Quinsy: Also known as peritonsillar abscess is the accumulation of pus next to the tonsils. It is a very painful situation to be in. If not treated on time, it may lead to a situation where the pus will need to be withdrawn by conducting a small operation.
Strep throat: Strep throat is caused by the bacteria streptococcus IQ. Strep tonsillitis can cause rheumatic fever (secondary damage to heart valves) and glomerulonephritis (secondary damage to kidneys. Strep throat can also cause other complications like skin rash, pneumonia, sinus and ear infections.