About Tonsillitis

The tonsils are tissues that respond to antigens entering through the mouth and nose and mainly produce and secrete antibodies to defend the surface of the mucosa. These tonsils begin to grow from birth, are most active immunologically between the ages of 4 and 10, and then gradually regress after puberty.

What we commonly refer to as the tonsils are the palatine tonsils, which are round structures on both sides of the uvula when looking into the mouth. In addition, there are the lingual tonsils, which have an irregular shape at the back of the tongue; the pharyngeal tonsils, or adenoids, around the area behind the uvula and soft palate where the nasal cavity opens; and the tubal tonsils around the opening of the Eustachian tube, the passage connected to the ear. Because they form a ring-like structure around the passages through which air enters via the nose and mouth, they respond to antigens entering through the air. In this way, the tonsils take directly exposed antigens into the tissue, trigger an immune response, and produce and secrete immunoglobulin A. Tonsillitis is a general term for inflammation in these structures.

Causes and Symptoms

1. Acute tonsillitis It occurs due to bacterial or viral infection of both tonsils. The most common causative organism is beta-hemolytic streptococcus, but there are various other causative organisms such as staphylococci and pneumococci, and several viruses such as influenza virus, parainfluenza virus, and coxsackievirus can also cause tonsillitis.

It generally occurs in adolescence or young adulthood and develops after exposure to cold or heat, or after a cold. Symptoms vary depending on the virulence of the bacteria and the patient’s resistance, but in most cases a sore throat occurs after a sudden high fever and chills, with painful swallowing, and systemic symptoms such as headache, generalized weakness, and joint pain appear, then improve after 4–6 days.

2. Chronic tonsillitis When acute tonsillitis recurs, or when there are no acute symptoms but ongoing discomfort due to chronic inflammation of the tonsils, it is called chronic tonsillitis. In most cases, acute tonsillitis symptoms recur frequently, and the incidence of systemic infections or upper respiratory infections may increase. The causative organisms are similar to those in acute tonsillitis, but gram-positive bacteria are more common.

Patients with chronic tonsillitis may have symptoms of recurrent acute tonsillitis, but the most common symptom is chronic sore throat. In addition, dysphagia may occur, and bad breath may be reported.

3. Tonsil stones The surface of the tonsils has many crater-like indentations, and deposits of various sizes and hardness can form in these areas. Bacteria or food debris can accumulate in these crevices and, when affected by bacteria, change into a hard, stone-like form.

Tonsil stones are common in adults and can cause sore throat or a foreign-body sensation. Patients may say that there is a foul odor in the mouth and that a foul-smelling white lump has come out of the mouth, and at that time a white mass may also be seen if the tonsils are examined closely.

Treatment involves removing the stones if needed and providing conservative treatment such as gargling, but if oral odor and foreign-body sensation due to tonsil stones are severe, surgical treatment should be considered.

4. Hypertrophy of the palatine tonsils and adenoids The tonsils are organs that rapidly enlarge in childhood and gradually regress as one becomes an adult. The adenoids reach their largest size around age 3, the palatine tonsils are largest around age 5, and after age 12–13 they regress and become difficult to see. The exact cause of abnormal tonsil or adenoid hypertrophy is unclear, but it is thought to be due to repeated infections.

This concludes the information on tonsillitis. In the next post, we will look at the complications and diagnosis of tonsillitis.

Source: Korea Disease Control and Prevention Agency, National Health Information Portal