Introduction

Most of us might have experienced a sore throat once in our lives. A simple home remedy, like gargling with salty water or any other medication, might have relieved us instantly. But what if this pain is persistent? What if it is so severe that it makes it difficult to breathe? This might be due to Tonsillitis, which is an inflammation of the oval-shaped tissues around the throat, generally known as tonsils. This article answers almost all of your questions regarding the age-related severity of tonsillitis.

What are tonsils?

The soft, oval-shaped, squishy masses on either side of the throat are called tonsils. Tonsils are part of the immune system and possess white blood cells that fight against germs entering the body through the mouth and nose. Tonsils contain lymph nodes and help trap bacteria or viruses.

Types of tonsils

Most people think of the tonsils as only those situated at the back of the throat (Palatine tonsils). But actually, three types of tonsils are present in our face that form the Waldeyer's ring.

1. Palatine tonsils: These are well-known tonsils found at the back of the throat. These can be seen when you open your mouth without any medical aid
2. Adenoids: Adenoids are located at the back of the nose, far above the throat and can be seen with the help of a rhinoscope. (Rhinoscope is a narrow tube used to examine the inside of the nose and throat)
3. Lingual Tonsils: These are situated further back on the tongue

All three tonsils form a ring-like opening (Waldeyer’s ring), which helps prevent germs, bacteria, and viruses from entering the body through the mouth, nose and throat.

Tonsillitis, adults and children

If the tonsils become infected, they enlarge and become tender, resulting in a painful throat, and this is called tonsillitis. Both bacteria and viruses are common causes of tonsillitis.

Infected and Swollen tonsils are not contagious, but the viruses or bacteria that cause the infection may be transmitted from person to person, through food, utensils and close contact.

Bacterial tonsillitis generally causes severe symptoms when compared to viral tonsillitis. Viral Tonsillitis usually disappears within a week, whereas bacterial tonsillitis takes around 10 days to heal and may need antibiotic treatment for proper management.

Severity, children and adults?

Children get tonsillitis more frequently compared to adults. They are regularly exposed to germs while playing around with other children and participating in school activities with their classmates. Hence, tonsillitis becomes more common in children aged between 5-15 years. Tonsils in children are more active as immune system, which fights infections, is still developing. Hence, we observe tonsillitis more commonly in children.

On the contrary, as kids grow up and become adults, the tonsils shrink in size and become less active. But the immune system develops strongly, making the tonsils unessential. Hence, tonsillitis is less common in adults. Moreover, children are less careful about hygiene compared to adults; their tonsils are more exposed to bacteria and viruses, making them even more vulnerable to inflammation.

Common symptoms of tonsillitis

• Swollen and red tonsils
• Sore throat
• Fever & chills
• Difficulty in swallowing
• Bad breath 
• Scratchy voice
• Burning sensation at the throat 
• Snoring, poor sleep
• Feeling tired

But in young children who cannot describe how they are suffering, symptoms of tonsillitis may include:

• They drool uncontrollably as they feel pain when swallowing
• They refuse to eat anything due to throat pain
• They cry uncontrollably, and it becomes hard to console them due to unexpressed pain

Common risk factors

Many causes of tonsillitis in children and adults are common but differ in some key aspects, which are discussed as follows:

In children

1. Underdeveloped immune system
2. Children are more likely to be exposed to bacteria and viruses in school or day care environments
3. Poor hygienic practices
4. Common infections like the cold and flu also trigger tonsillitis in children

In adults

1. Developed immune system, but less active tonsils
2. Poor hygienic practices can cause tonsillitis even in adults
3. Infections like mononucleosis (also known as kissing disease, a contagious viral infection transmitted through Saliva) can cause tonsillitis
4. Non-infectious factors like smoking or environmental irritants (allergen chemicals/pollutants in the work area) can cause tonsillitis
5. A weakened immune system due to other secondary health conditions can cause tonsillitis

Complications due to tonsillitis

• Obstructive sleep apnea: Swollen tonsils can obstruct the airway and cause difficulty in breathing that leads to poor sleep. This can be observed mostly in children
• Peritonsillar abscess: If tonsillitis is left untreated, infected fluid (pus) may develop between one of the tonsils and the throat wall, leading to severe throat pain, fever, headache, difficulty in swallowing, etc. This condition is generally seen in adults
• Tonsillar cellulitis: In some cases, bacteria that infect the tonsils can spread into surrounding tissues, eventually causing pus and further complications. If tonsils are left untreated for a long time, this can happen. It is also mostly seen in adults
• Dehydration: Due to throat pain, children are unable to eat or drink anything, which can result in dehydration

Rare complications caused by tonsillitis

• Scarlet fever: It mainly affects children aged 5-15 years. It is caused by the toxin released by “Streptococcus pyogenes” bacteria that leads to red blotches, sore throat and high fever
• Rheumatic fever: It leads to joint inflammation, causing pain and disruption in body movements. Adults rarely experience this
• Glomerulonephritis: In this condition, the tiny blood vessels in the kidneys, called Glomeruli, which act as filters, become inflamed and trigger vomiting. This condition is very rare and can be seen in adults

Note: The most common bacterium that causes tonsillitis is ‘Streptococcus pyogenes’, ‘group A streptococcus’. Tonsillitis caused by this bacterium can be referred to as strep throat. It usually goes away within a week, but it is better to use antibiotics to avoid being contagious for 2-3 weeks, which may lead to further complications as discussed above.

Treatment for tonsillitis

• Mild tonsillitis does not necessarily need treatment, it may get better on its own
• Bacterial tonsillitis may require antibiotic treatment, less often tonsillectomy
• If the person is dehydrated due to tonsillitis, they also need intravenous fluids
• If the person suffers from severe throat pain, medication for pain is also prescribed along with the inflammation treatment

What is tonsillectomy, and why is it needed?

Tonsillectomy is a surgical procedure to remove the tonsils. This is more common in children than in adults.

Various reasons for tonsillectomy are

• If tonsillitis is getting frequent
• If antibiotics are not sufficient to cure bacterial tonsillitis
• If the tonsils are too big and cause difficulty in breathing and swallowing

After tonsillectomy, one can stay up to one day in a hospital and be discharged. It can take one or two weeks to recover completely from the surgery.

Preventive measures to avoid tonsillitis

• The best preventive measure to be followed is to maintain good hygiene, especially among children
• Children must wash their hands thoroughly after using the toilets and before eating
• Avoid sharing food and things, like utensils, water bottles, tissues, etc
• Replace children’s toothbrushes after being diagnosed with tonsillitis
• Teach the child to sneeze and cough using tissues and to wash their hands afterwards
• Don’t send the child to school until they are fully recovered
• Drink a lot of fluids and try to take soft foods
• Saltwater gargling helps to relieve a sore throat quickly

When to seek medical help

If the following symptoms are experienced, one must see a doctor.

• Has a sore throat with a high fever
• Suffer from a sore throat even after 24-48 hours
• Feels difficulty in swallowing 
• Feels difficulty in breathing, needs immediate medical attention.
• Feels extreme weakness
• Has excessive drooling (dropping of saliva uncontrollably), probably in small children

Summary

Tonsillitis is the inflammation of the tonsils, i.e. soft, oval-shaped, squishy masses on either side of the throat. Tonsillitis can affect both children and adults, but it is more common in kids due to their weaker immune system and poor hygienic practices.

Common symptoms, like sore throat, fever, difficulty in swallowing, and poor sleep due to breathing obstruction, are seen in both groups. But the risk factors might be different.

Prevention is always better than a cure. Hence, don’t let tonsillitis interfere with your child’s health or daily activities. Early diagnosis and timely care can make a big difference, as they allow the patient to recover fast and avoid further serious complications.

Treatment can be antibiotic-based, along with painkillers. The removal of tonsils may be considered in extremely severe cases.