What is Tonsillitis in Children?
Tonsillitis is an infectious-allergic inflammatory process that affects the lymphoid tissue of the tonsils. Tonsillitis in children is one of the most common diseases. The disease occurs most often in children aged 5 to 10 years and young people aged 15 to 25 years. Tonsillitis can be repeated several times a year.
The tonsils are located in the back of the throat on both sides. Tonsils act as filters, “catching” microbes that could get into the respiratory tract and cause infection. The tonsils produce antibodies to fight the infection, but sometimes the tonsils themselves can become infected. The tonsils infected with bacteria or viruses inflame and grow. This condition is called tonsillitis.
There are children who are at risk, first of all, children with immunodeficiency and having a genetic predisposition.
Causes of Tonsillitis in Children
Bacterial and viral infections cause tonsillitis. A common cause is streptococcus bacteria. Other infections include: adenoviruses, influenza virus, Epstein-Barr virus, parainfluenza viruses, enteroviruses, herpes simplex virus.
Pathogenesis during Tonsillitis in Children
Tonsillitis has an acute and chronic form. In the acute form, the oropharyngeal tissue is damaged, where an inflammation center is formed. Most often the acute form of tonsillitis develops after acute respiratory viral infection, which contributes to the penetration of infections and bacteria (for example, streptococcus). ARVI reduces the protective function of the tonsils.
Most often chronic tonsillitis occurs after relapses. If a person is not fully recovered, the disease becomes chronic. Causes of chronic tonsillitis: anatomical, topographical and histological features of the tonsils, the presence of vegetative conditions in the crypts of microflora. The presence of chronic diseases in the cavities of the mouth, nose and paranasal sinuses (caries, sinusitis, etc.) leads to infection of the tonsils. All this contributes to the occurrence and course of chronic tonsillitis.
If a sore throat is caused by a viral infection, then the symptoms are often associated with a cold.
If tonsillitis appears against the background of the Coxsackie virus, then small blisters develop in the tonsils and palate.
In infectious mononucleosis (most common in adolescents) in patients with tonsils increase, they appear purulent plaque.
When streptococcal infection of the tonsils often grow and become covered with bloom, there is pain in the throat, fever, bad breath.
Unusual bacteria may be involved including gonococcal infection. HIV-infected children often have ENT diseases.
Symptoms of Tonsillitis in Children
The acute period is characterized by pain when swallowing or yawning, intoxication, high temperature.
The main symptoms of tonsillitis are inflammation and swelling of the tonsils, which in severe cases can block the airways. Other symptoms include sore throat, redness of the tonsils, white and yellow tonsils on the tonsils, painful blisters and sores on the throat, hoarseness and loss of voice, headache, loss of appetite, pain in the ears, difficulty in swallowing or breathing through the mouth, fever, chills, bad breath, sometimes nausea, vomiting, abdominal pain, ear pain, swollen lymph nodes.
Diagnosis of Tonsillitis in Children
In order to diagnose tonsillitis in a child, the doctor, first of all, collects anamnesis, conducts a visual examination of the child, and palpation of the cervical lymph nodes. The doctor conducts pharyngoscopic vision (visual examination of the pharyngeal mucosa).
The patient is assigned a laboratory examination: a blood test, urine, bacterial inoculation of material from the pharynx to the flora (the doctor carefully swabs around the back of the throat around the tonsils; this method allows you to detect a bacterial infection, but not a viral infection).
Tonsillitis in children requires a differential diagnosis so that the doctor can distinguish the disease from chronic pharyngitis, tonsil tuberculosis.
Additionally, the following tests can be assigned to the child: ECG, echoCG, ultrasound of the kidneys, X-ray of the paranasal sinuses, blood culture for sterility, and tuberculin tests.
Treatment of Tonsillitis in Children
Treatment of tonsillitis is not difficult and depends partly on the cause of the onset. In most cases takes up to 7 days. The patient is attributed to bed rest a warm drink and a sparing diet, excluding fatty and spicy foods. If a child eats little and drinks, he will develop dehydration, which may be manifested by another symptom: headache, fatigue, exhaustion of the body.
Local therapy aims to relieve symptoms. It includes: washing the lacunae of the tonsils with antiseptics (iodinop solution, chlorophilipta), treating the tonsils and the posterior pharyngeal wall (lugol, fukortsin), rinsing (herbal decoction, warm water with one spoonful of salt), inhalation, using antiseptic aerosols (ingalipt), resorption tablets with antimicrobial action (septolete, pharyngosept).
Painkillers help relieve painful symptoms (ibuprofen, paracetamol).
Physiomethods are prescribed to some patients: laser therapy, ultraphonophoresis, microwave therapy, UHF.
When treating children, it is very important to observe the dosage in accordance with the instructions for the preparations and the prescription of the doctor, especially for antibiotics, which are prescribed only in severe cases. Antibiotics are rarely prescribed to children, since in most cases antibiotics cause side effects in children, such as abdominal pain, diarrhea, rash, and poor health. Antibiotics are prescribed for severe symptoms, when the clinical signs of the disease do not disappear and the immune system is weakened. Under these conditions, the antibacterial course is 10 days (penicillin, erythromycin). During the course of antibiotics, the relief of symptoms may occur already after 3-4 days, but it is very important to go through the whole course of treatment.
Inpatient treatment is required only for very severe or persistent cases of bacterial tonsillitis, when treatment does not respond to oral antibiotics. In these cases, intravenous administration of antibiotics is shown, which are injected directly into the vein.
Tonsils are an important part of the immune system throughout life, so it’s best to avoid their removal. In exceptional cases, a surgical method of treatment is used – tonsillectomy (surgery to remove the tonsils). In most cases, tonsillectomy is recommended to reduce the likelihood of recurrence of tonsillitis, and only if the patient has the following indicators:
- The ineffectiveness of conservative treatment
- Five or more tonsillitis cases per year
- Repeated symptoms throughout the year
- Complications of the internal organs
- Paratonsillar abscess
Most tonsillectomy techniques involve using a conventional scalpel to remove the tonsils, however there are many alternatives to this traditional method. Increasingly, doctors are using methods such as lasers, radio waves, ultrasound, or electrocoagulation.
Like all surgeries, each has its own advantages and disadvantages. When choosing a removal method, it is important to discuss options with the surgeon in order to choose the most suitable for the child.
Tonsillectomy is performed under general anesthesia, lasts from 30 to 45 minutes. The operation is carried out in several ways:
- Extracapsular tonsillectomy is the most common method where surgical blades are used to excise the tonsil. Allows you to remove the tonsils with their capsule and open paratonsillar purulent foci (infiltrates, abscesses).
- Diathermy – is used to destroy the tissue around the tonsils and remove the tonsils. Diathermy uses radiofrequency energy, which is directed directly to the tissue. Radio frequency energy may be bipolar or monopolar. Diathermy is sometimes used as an adjunct to extracapsular tonsillectomy.
- Ablation – this method works by analogy with diathermy, only when it uses a lower temperature (60 ºC). This method is considered less painful than diathermy.
- Laser tonsil excision of the tonsils is used to minimize tissue swelling and reduce the likelihood of bleeding.
- Excision of the tonsils with ultrasonic waves is a similar method to laser excision. Characterized by minimal damage to the tissues surrounding the tonsils and small blood loss.
- Biopolar radiofrequency ablation (coblation) is the use of radiofrequency bipolar energy converted to ion dissociation of radiofrequency energy. The operation is accompanied by minimal tissue trauma, characterized by a short recovery period and the minimum number of complications. Currently considered the most promising method of intervention on the tonsils.
All these methods are similar in terms of safety, results and recovery, so the type of operation is selected individually. As a rule, the patient can leave the hospital on the same day already 4 hours after the operation. Full recovery takes from 10 to 14 days.
The postoperative period most often the patient experiences pain at the site of the operation, such pain can persist for up to 7 days, so painkillers are prescribed for children. Children who have had tonsils removed should not attend school or kindergarten for about two weeks. This is necessary to reduce the risk of infection from other children.
After removal of the tonsils, swallowing is difficult at first. However, it is important to eat exactly solid foods in order to recover faster. Children need to drink plenty of fluids, but avoid sour (for example, orange juice) carbonated drinks, as they will irritate the throat.
The patient should monitor the hygiene of the mouth, regularly brushing his teeth, and rinsing the mouth to prevent infection in the throat.
Postoperative bleeding is a fairly frequent complication of tonsillectomy. This can occur within the first 24 hours after surgery or be repeated within 10 days after the procedure. Statistics show that bleeding occurs in about 1 child out of 100.
Small bleeding is usually not a cause for concern, because in most cases it disappears by itself. Gargling with cold water often helps stop the bleeding, as cold blocks blood vessels.
Sometimes the bleeding can be more severe, causing the children to cough up blood. With such a cough, you should immediately contact the doctor. Extensive bleeding may require surgical treatment or blood transfusions.
Complications of tonsillitis
Complications of tonsillitis include: otitis media (usually found in children under 5 years of age), sinusitis. If the cause of the disease was streptococcal bacteria, the patient may develop rheumatism, glomerulonephritis.
In rare cases, children increase weight after surgery. Complications of tonsillectomy include otitis media and hemorrhage.
Prevention of Tonsillitis in Children
Since a wide range of viruses and bacteria can cause tonsillitis, the best prevention is to follow basic sanitary and hygienic precautions, which are especially important. Children need to:
- Avoid close contact with other people who are sick.
- It is often reminded of the importance of proper hand washing, especially when there are people around.
- You can not share toys, dining items with already ill children.
- Teach children to cover their mouths when coughing or sneezing, while using a handkerchief or tissue paper so that germs do not fall on their hands. The task of parents to show children how to use a scarf and blow their noses. It is best to use disposable paper shawls.
- Use hand sanitizer after transport, before eating, if it is not possible to use water and soap.
- Parents should not smoke near the child, as this reduces his immunity.