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Ear, nose & throat

Tonsils: surgery indicated only in the case of recurrent inflammations

March 15, 2018

A simple sore throat, along with other symptoms, can indicate a disease affecting two small “cushions” of tissue in the oral cavity, at the base of the tongue: it is “tonsillitis, or inflammation of palatine tonsils”, adds Dr. Luca Malvezzi, an otorhinolaryngologist and specialist in cervical facial surgery at Humanitas. Although tonsillectomy, i.e. the removal of these organs, was once quite frequent in the case of tonsillitis, today surgery is only used under certain conditions. But how do you recognize tonsillitis and how is it treated?


Throat plates

The palatine tonsils are positioned on the sides of the uvula and have a vertical diameter of two to three centimeters: “They are lympharyngeal organs placed at oropharynx level. Until the age of 10-12 years they complete our immune system, since it can be the site of recurring inflammations, frequently supported by streptococcus,” recalls Dr. Malvezzi.

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Therefore, tonsillitis is very frequent in children and rarely diagnosed in adults. But what are the symptoms? In case of inflammation, the palatine tonsils swell and redden, and they can also be covered by whitish areas, commonly called “plaques”. Pain in the throat (pharyngodynia) is accompanied by difficulty in swallowing and pain in the ear (reflected opalgia) caused by the common innervation of the ninth cranial nerve – glossopharyngeal. Fever also characterizes the infection.


In case of suspected tonsillar streptococcal infections, in addition to a swab, a blood sample is useful for the measurement of TAS (Title Anti Streptolisin). A very high TAS suggests an eradicating penicillin therapy or tonsillectomy.


Pharmacological therapy and surgery

At the onset the symptoms of this inflammation can be wrongly assessed by the patient: “In the initial phase, the symptoms of tonsillitis are superimposed on that of pharyngitis, the latter of viral origin. When there is less than a striking clinical picture with high fever and “plaques” it is best to wait before taking antibiotics. In fact, viral inflammations are fleeting, running out in about 72 hours. Fever should only be treated with paracetamol if it exceeds 38°, being itself a defensive strategy to kill the virus,” warns Dr. Malvezzi.


Pharmacological therapy for the treatment of tonsillitis may include the use of antibiotics: “When necessary, the antibiotic must be taken with an adequate daily dosage and for an appropriate period of time. Incorrect antibiotic therapies can result in episodes of close-up tonsillitis that can negatively affect a premature surgical decision. In case of high fever, severe pain, major difficulty in swallowing and opening the mouth, a development towards a phlegmon or tonsillar abscess should be suspected. In these cases, a specialist evaluation is recommended.


The specialist will be able to indicate the surgical treatment, but only in well-selected cases: “Although tonsillectomy, or the surgical removal of palatine tonsils, was common practice in the past, today there is a greater restriction in surgical indications. An intervention of tonsillectomy is proposed in the case of repetitive tonsillitis, three or more annual episodes, for three or more consecutive years. In adulthood tonsils do not have any protective role, so much so that in most cases the inactivity of this organ translates into its involution and atrophy,” concludes the specialist.

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