TONSILLITIS

INTRODUCTION

Tonsillitis is inflammation of the tonsils, two oval-shaped pads of tissue at the

back of the throat one tonsil on each side. Signs and symptoms of tonsillitis include
swollen tonsils, sore throat, difficulty swallowing and tender lymph nodes on the sides of
the neck. Most cases of tonsillitis are caused by infection with a common virus, but
bacterial infections also may cause tonsillitis. Because appropriate treatment for tonsillitis
depends on the cause, it's important to get a prompt and accurate diagnosis. Surgery to
remove tonsils, once a common procedure to treat tonsillitis, is usually performed only
when bacterial tonsillitis occurs frequently, doesn't respond to other treatments or causes
serious complications. Tonsils are the two lymph nodes located on each side of the back
of your throat. They function as a defense mechanism. They help prevent your body from
infection. When the tonsils become infected, the condition is called tonsillitis. Tonsillitis
can occur at any age and is a common childhood infection. It is most often diagnosed in
children from preschool age through their mid teens. Symptoms include a sore
throat, swollen tonsils, and fever. This condition is contagious and can be caused by a
variety of common viruses and bacteria, such as Streptococcal bacteria, which causes
strep throat. Tonsillitis caused by strep throat can lead to serious complications if left
untreated.
DEFINITION

Tonsillitis is an inflammation of the tonsils. The tonsils are a pair of soft tissue
masses located at the back of the mouth, with one on each side of the throat. The tonsils
are glands that form part of the immune system, and thus function to prevent infection
from potential bacterial or viral organisms that enter through the mouth and nose.

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CAUSES

Tonsillitis is most often caused by common viruses, but bacterial infections can also be
the cause.

The most common bacterium causing tonsillitis is Streptococcus pyogenes (group A

streptococcus), the bacterium that causes strep throat. Other strains of strep and other
bacteria also may cause tonsillitis.

1. Young age.

Tonsillitis most often occurs in children, but rarely in those younger than age 2.
Tonsillitis caused by bacteria is most common in children ages 5 to 15, while viral
tonsillitis is more common in younger children.

2. Frequent exposure to germs.

School-age children are in close contact with their peers and frequently exposed
to viruses or bacteria that can cause tonsillitis.

3. Epstein-Barr virus (EBV).

In one study showing that EBV may cause tonsillitis in the absence of systemic
mononucleosis, EBV was found to be responsible for 19% of exudative tonsillitis in
children.

4. Bacteria.

Anaerobic bacteria play an important role in tonsillar disease; most cases of

bacterial tonsillitis are caused by group A beta-hemolytic Streptococcus pyogenes
(GABHS); S. pyogenes adheres to adhesin receptors that are located on the tonsillar
epithelium; immunoglobulin coating of pathogens may be important in the initial
induction of bacterial tonsillitis.

5. Immunologic.

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 Local immunologic mechanisms are important in chronic tonsillitis; the
distribution of dendritic cells and antigen-presenting cells is altered during disease,
with fewer dendritic cells on the surface epithelium and more in the crypts and
extrafollicular areas.

PATHOPHYSIOLOGY

Due to etiological factors

Process of inflammation originate in to the tonsills

Hyperemia and edema with conversion of lymphoid follicle in to small

abscess which discharge in to crypts

Inflammatory crypts collects in the tonsillar follicle

Multiple white spot on inflamed tonsills

CLINICAL FEATURES

a.Fever.

The child may present with a fever of 101°F (38.4°C) or more.

b.Sore throat.

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 The child may also manifest a sore throat, often with dysphagia or
difficulty swallowing.

c. Hypertrophied tonsils.

Individuals with acute tonsillitis present with tender and inflamed tonsils;
exudate may also be visible on the tonsils.

d. Airway obstruction.

Airway obstruction may manifest as mouth breathing, snoring, sleep-disordered

breathing, nocturnal breathing pauses, or sleep apnea.

Tonsillitis most commonly affects children between preschool ages and the mid-teenage
years. Common signs and symptoms of tonsillitis include:

 Red, swollen tonsils

 White or yellow coating or patches on the tonsils

 Sore throat

 Difficult or painful swallowing

 Fever

 Enlarged, tender glands (lymph nodes) in the neck

 A scratchy, muffled or throaty voice

 Bad breath

 Stomachache, particularly in younger children

 Stiff neck

 Headache

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 DIAGNOSTIC FINDINGS

1. Complete blood count

Testing is indicated when group A beta-hemolytic Streptococcus pyogenes

(GABHS) infection is suspected.

2.Throat cultures.

Throat cultures are performed to diagnose tonsillitis and the causative organism.

3.Imaging studies.

For patients in whom acute tonsillitis is suspected to have spread to deep neck
structures (ie, beyond the fascial planes of the oropharynx), radiologic imaging using
plain films of the lateral neck or CT scans with contrast is warranted.

MANAGEMENT

A. Medical Management

Treatment of acute tonsillitis is largely supportive and focuses on maintaining adequate

hydration and caloric intake and controlling pain and fever.

a. Hydration.

Inability to maintain adequate oral caloric and fluid intake may require IV
hydration, antibiotics, and pain control; home intravenous therapy under the
supervision of qualified home health providers or the independent oral intake
ability of patients ensures hydration; intravenous corticosteroids may be
administered to reduce pharyngeal edema.

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 b. Management of airway obstruction.

Airway obstruction may require management by placing a nasal airway

device, using intravenous corticosteroids, and administering humidified oxygen;
observe the patient in a monitored setting until the airway obstruction is clearly
resolving.

c. Diet.

Hydration is important, and the oral route is usually adequate.

d. Activity.

Adequate rest for children with tonsillitis accelerates recovery.

B. Pharmacologic Management

Medications that are used to manage tonsillitis include antibiotics, anti-inflammatory

agents (e.g., corticosteroids), antipyretics and analgesics (e.g.,
acetaminophen, ibuprofen), and immunologic agents (e.g., gamma globulin).

1. Corticosteroids.

Corticosteroids have anti-inflammatory properties and cause profound

and varied metabolic effects; these agents modify the body’s immune response to
diverse stimuli; corticosteroids reduce inflammation, which may impair
swallowing and breathing.

2. Antibiotics.

Antibiotic therapy must be comprehensive and cover all likely pathogens

in the context of this clinical setting.

3. Immune globulins.

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 These agents are used to improve clinical aspects of the disease; it
stimulates immune cells, reducing the severity of infection.

4. Analgesics.

Pain and fever control are essential to quality patient care; analgesics with
antipyretic properties ensure patient comfort, promote pulmonary toilet, and have
sedating properties, which are beneficial for patients who experience pain.

C. Surgical management

1.Tonsillectomy.

Tonsillectomy is indicated for individuals who have experienced more

than six (6) episodes of streptococcal pharyngitis (confirmed by positive culture)
in 1 year, 5 episodes in 2 consecutive years, or 3 or more infections of tonsils
and/or adenoids per year for 3 years in a row despite adequate medical therapy, or
chronic or recurrent tonsillitis associated with the streptococcal carrier state that
has not responded to beta-lactamase–resistant antibiotics.

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 2.Adenoidectomy.

Because adenoid tissue has similar bacteriology to the pharyngeal tonsils

and because minimal additional morbidity occurs with adenoidectomy if
tonsillectomy is already being performed, most surgeons perform an
adenoidectomy if adenoids are present and inflamed at the time of tonsillectomy

D. Nursing management.

The major nursing care planning goals for a child with tonsillitis include:

 Preventing aspiration.
 Relieving pain, especially while swallowing.
 Improving fluid intake.
 Increase knowledge and understanding of postdischarge care and possible
complications.

Nursing Interventions

Interventions for the child are:

1. Prevent aspiration.

Place the child in a partially prone position with head turned to one side until the
child is completely awake; encourage the child to expectorate all secretions;
discourage the child from coughing; and keep the head slightly lower than the chest to
help facilitate drainage of secretions.

2. Relieve pain.

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 Apply an ice collar postoperatively; administer pain medication as ordered;
encourage the caregiver to remain at the bedside to provide soothing reassurance;
crying irritates the raw throat and increases the child’s discomfort; thus, it should be
avoided if possible.

3. Encourage fluid intake.

When the child is fully awake from surgery, give small amounts of clear fluids or
ice chips; avoid irritating liquids such as orange juice and lemonade; milk and ice
cream products tend to cling to the surgical site and make swallowing more difficult;
thus they are poor choices; and record intake and output until adequate oral intake is
established.

4. Provide family teaching.

Instruct the caregiver to keep the child relatively quiet for a few days after
discharge; recommend giving soft foods and nonirritating liquids for the first few
days; teach family members to note any signs of hemorrhage and notify the healthcare
provider; and provide written instructions and telephone numbers before discharge.

SUMMARY

As far we discussed about tonsillitis,its definition, causes,

pathophysiology,diagnostic findings and management in surgical, medical and nursing
aspects.

CONCLUSION

Tonsillitis is an inflammation of the tonsils. Tonsils are lumps of tissue on

both sides of the back of the throat that help the immune system protect the
body from infections. Inflamed tonsils get red and swollen and can cause a sore
throat.

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BIBLIOGRAPHY

1. .Rimple Sharma .(2017).Essentials of pediatric nursing. Jaypee brothers

medical publishers :Newdelhi
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ESSENTIAL OF PAEDIATRIC NURSING” 6th edition, published by
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3. Ghai O.P& Gupta piyush, Paul V.K.(2005) “GHAI ESSENTIAL
PAEDICTRICS” 6th edition, published by CBS publishers & distributors New
Delhi
4. AssumaBeevi, (2009) ''TEXT BOOK OF PEDIATRIC NURSING'' Ist edition,
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