Wednesday, 3 August 2011

Tonsilitis

Originally posted on my other blog  Enjoying Life and Loving It

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My husband suffers from chronic tonsillitis.  It recurs 3-4 times every month and just this month, his chronic tonsillitis went for more than 2 weeks.   He has difficulty swallowing not only solid food but including the watery and even liquid ones.  He said it is too painful as his tonsils are sore, swollen, inflamed, and even enlarged and have pus on both nodules.  His tonsillitis was (“maybe”) triggered and aggravated by my cough.  We are planning to have his tonsils removed because it has always been causing him pain and too much discomfort.  The Singaporean doctor who saw him last week recommended he goes for tonsillectomy.  Since then, I’ve been searching for tonsillectomy services here inSingaporeand in thePhilippines.  We have to compare prices, affordability, accessibility, and quality of the service.

As starters, I have done some researches about tonsillitis to better understand it and I am sharing these information I have gathered with you.  Please take note that I am no medical expert.   This is just a summary of my research and should you wish to read further on the subject, you may refer to my sources of information at the bottom.  Reader’s discretion is necessary.

 

What is Tonsillitis?

Tonsillitis refers to the swelling and inflammation of the tonsils most commonly caused by viral or bacterial infection.   Tonsils are the two glands in the back of the  throat. They are referred to as lymph nodes and they form part of the lymphatic system.  As part of our body’s immune systemt they serve as our first line of defense to help protect us from infections by trapping germs coming in through the mouth and nose.

Tonsillitis explained by Wikipedia.org:  Under normal circumstances, as viruses and bacteria enter the body through the nose and mouth, they are filtered in the tonsils.[7][8] Within the tonsils, white blood cells of the immune system mount an attack that helps destroy the viruses or bacteria, and also causes inflammation and fever.[7][8] The infection may also be present in the throat and surrounding areas, causing inflammation of the pharynx.[9] This is the area in the back of the throat that lies between the voice box and the tonsils”.

What are the Types of Tonsillitis?

Bacterial tonsillitis  – tonsillitis that is caused by bacterial infection.  This is discussed in further details under causes of tonsillitis

Viral tonsillitis  – tonsillitis that is caused by viral infection.  This is discussed in further details under causes of tonsillitis

Acute Tonsillitis  :  Acute tonsillitis is caused by both bacteria and viruses and will be accompanied by symptoms of ear pain when swallowing, bad breath, and drooling along with sore throat and fever. In this case, the surface of the tonsil may be bright red or have a grayish-white coating, while the lymph nodes in the neck may be swollen  (source : http://en.wikipedia.org/wiki/Tonsillitis )

Chronic Tonsillitis :  is a persistent infection of the tonsils and can cause tonsil stone formation. It is considered chronic when there is a seven episodes of tonsillitis in the preceding year, five episodes in each of the preceding two years or three episodes in each of the preceding three years  ( sources : http://www.medicinenet.com/adenoids_and_tonsils/article.htm  and http://en.wikipedia.org/wiki/Tonsillitis )

Cryptic Tonsillitis & Chronic Cryptic Tonsillitis:   Cryptic tonsillitis occurs when the tonsils contains small pockets and pits called crypts. These crypts may trap food particles and form small white-colored growths called tonsilliths (more commonly known as “tonsil stones”). Tonsil stones are thought to be made up of bacteria and dead cells and usually have quite an unpleasant odor.   (source : http://www.associatedcontent.com/article/351467/cryptic_tonsillitis.html )

 

What are the Causes of Tonsillitis?

There are two causes of tonsillitis, that is viral and bacterial.  Regardless of the cause, the infection is transmitted/spread from one person to another through social contact, such as contact to airborne droplets from sneezing, hand contact, or kissing.

Most of the time, tonsillitis is caused by a viral infection. Here some of the known viral causes of tonsillitis:

1) common cold viruses (adenovirus, rhinovirus, influenza, coronavirus, respiratory syncytial virus)

2) Epstein-Barr virus, which is the cause of glandular fever (infectious mononucleosis),

3) herpes simplex virus, cytomegalovirus, or HIV.

For Bacterial tonsillitis, here are some common causes:

1) Streptococcus pyogenes-the organism that causes strep throat. If left untreated, strep throat may lead to a more serious condition called rheumatic fever, which can affect the heart several years later.  Strep throat causes only about 30% of tonsillitis in children only 10% of tonsillitis in adults.

2)  Less common bacterial causes include: Staphylococcus aureus, Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, pertussisFusobacterium, diptheria, syphillis, and gonorrhea.

3)  Sometimes, tonsillitis is caused by an infection of spirochaeta and treponema, in this case called Vincent’s angina or Plaut-Vincent angina

What are the Symptoms of Tonsillitis in General?

1. Sore throat that lasts longer than 48 hours

2. Pain with and difficulty swallowing

3. Difficulty feeding (in babies)

4. Fever and chills

5. Tenderness / stiffness of the jaw,  throat, and neck areas (swollen lymph glands)

6.  Redness and soreness of the tonsils and throat (inflamed)

7. Headache

8. White / yellow / green patches on the tonsils

9. Ear pain

10. Nausea and vomiting

11. Changes in the voice (hoarseness) and/or loss of voice

12. Nasal congestion / Runny nose

13. Cough

14. Abdominal pain

15. Redness of the eyes

16. body ache (flu)

Acute tonsillitis is caused by both bacteria and viruses and will be accompanied by symptoms of ear pain when swallowing, bad breath, and drooling along with sore throat and fever. In this case, the surface of the tonsil may be bright red or have a grayish-white coating, while the lymph nodes in the neck may be swollen.

Possible Complications:

Usually a throat infection, such as tonsillitis, causes no trouble and only lasts about a week.  But the following complications can arise.

  • A secondary infection may occur in the middle ear or sinuses.

  • If the sore throat is due to a streptococcus infection, there may be a rash (scarlet fever).

  • Peritonsillar abscess or abscess in other parts of the throat that may need surgical drainage (Quinsy throat).

  • Rheumatic fever and related cardiovascular disorders

  • Kidney failure

  • Blocked airway from swollen tonsils

  • Dehydration from difficulty swallowing fluids

  • Pharyngitis – bacterial

  • In very rare cases, diseases like rheumatic fever or a particular kidney disease (glomerulonephritis) can occur. This is much less commonly observed now than it was several decades ago.


Medical Exams / Tests to Diagnose Tonsillitis:

The doctor  will look in the mouth and throat for swollen / inflamed / enlarged tonsils, or white/yellow/green spots are present on them,   as well as they check the jaw and neck for any swollenness and tenderness of the lymph nodes.  The doctor may order diagnostic tests to identify the cause of the infection that requires a swab of the secretions of the throat and maybe a blood sample. In some cases, the doctor may start antibiotic treatment without tests.

Tests that may be done include:

  • Blood count

  • Mononucleosis test

  • Rapid strep test

  • Throat swab culture


Treatments Available for Tonsillitis

1) If the tonsillitis is caused by bacteria, it is treated with antibiotics,  penicillin or amoxicillin (clindamycin or amoxicillin-clavulanate)  or a macrolide such as erythromycin if the person is allergic to penicillin. If antibiotics are prescribed, it’s important to complete the full course, or the infection may not be cured.   The antibiotics may be given once as a shot, or taken for 10 days by mouth.Antibiotics are advisable for immunocompromised patients, eg those receiving chemotherapy.

2) If the tonsillitis is caused by a virus infection need only be treated with paracetamol (eg Calpol, Panadol) to bring the temperature down. Aspirin (eg Disprin) is also useful, but should not be given to children under 16 years of age, unless on the advise of a doctor.  Aspirin has been linked to Reye syndrome.

3) Surgery to remove the tonsils, tonsillectomy,  may be necessary for those patients suffering from repeated, severe infections (five or more per year) that refuse to respond to treatment and significantly interfere with their school or work schedule. But it’s now a relatively uncommon operation compared to previous practice.

4)  Other treatments include:

  • Drink cold liquids or suck on popsicles

  • Drink fluids, especially warm (not hot), bland fluids

  • Gargle with warm salt water

  • Suck on lozenges (containing benzocaine or similar ingredients) to reduce pain (these should not be used in young children because of the choking risk)

  • Take over-the-counter medications, such as acetaminophen (Tylenol) or ibuprofen to reduce pain and fever.


5) There are some alternative medical treatments and natural home remedies to be considered also please check my post on the Natural Remedies for Tonsillitis

How much does a Tonsillectomy cost in the  Philippines and in Singapore?

The price in Singapore for tonsillectomy varies from one hospital to another :  Gleneagles and Mount Elizabeth hospital offers tonsillectomy at a price of SG$ 4,000-$6,500;  Tan Tock Seng, Changi General, and other public hospitals here in Singapore charge around SG $ 2,400 +++.  These prices are just for the surgery alone and are exclusive of doctors fee, anesthesiologist fee, and other hospital bills.  Please check again with these hospitals for current surgery fees and the like related to tonsillectomy.  You may want to check with KK women’s and Children’s hospital, Natiional University Hospital, and Raffles Hospital for tonsillectomy services.

Prices of Tonsillectomy in thePhilippinesare are as follows:

1) St. Lukes Medical Center  :   P 30,000 – 40,000 plus doctors fee, anesthesiologist fee, and other hospital bills

2) PhilippineGeneralHospital– no surgery fee.  Just pay for the doctors fee, anesthesiologist fee, and other hospital bills that will amount to almost P40,000. The hospital also offer surgery for  “charity”.  I am not sure about the requirements or how to avail of this free tonsillectomy

3) Other hospitals in Manila offering tonsillectomy services:  Manila Doctor’s Hospital, The Medical City, Asian Hospital and Medical Center, Makati Medical, etc.

-Sharosem(30July2011)
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For further readings, please check my sources/references below :



1) Medline plus http://www.nlm.nih.gov/medlineplus/medlineplus.html

2) http://www.emedicinehealth.com/tonsillitis/article_em.htm

3) http://en.wikipedia.org/wiki/Tonsillitis

4) http://www.netdoctor.co.uk/diseases/facts/tonsillitis.htm

5) http://www.associatedcontent.com/article/351467/cryptic_tonsillitis.html

6) http://www.livestrong.com/article/9377-cure-chronic-cryptic-tonsillitis/

7) http://www.medicineonline.com/articles/A/2/Acute-Tonsillitis/Tonsillitis.html

8) http://www.cks.nhs.uk/sore_throat_acute#

9) http://www.diseasesatoz.com/tonsillitis.htm

10) Costs for Tonsillectomy were requested from the  hospitals mentioned

1 comment:

  1. [...] Having a sore throat causes discomfort in a person let alone having tonsillitis where in the 2 glands at the back of the throat are not only sore, but swollen, inflamed, and even enlarged (as the case of my husband Frederick)  It does not only cause pain  when swallowing it also sometimes cause pain in the ears.  To know more about tonsillitis, please check my post about tonsillitis at Tonsilitis [...]

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