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What is tonsillitis, and do I need a tonsillectomy?

Caused by either a virus or bacteria, tonsillitis is a general term used to describe any infection involving the tonsils.

Viral tonsillitis, which might accompany a cold or influenza, is typically less painful with mild symptoms:

  • Low-grade fever
  • Cough
  • Sneezing
  • Runny nose
  • Sore throat
  • Generalized adenopathy (lymph node swelling)

Bacterial tonsillitis, which is often caused by strep (or group A streptococcus), may have different symptoms and is treated with antibiotics. If streptococcus is the cause of the tonsillitis infection and is left untreated, it could cause kidney problems, scarlet fever or rheumatic fever.

The symptoms of streptococcal tonsillitis often include:

  • Fever
  • Severe throat pain
  • Adenopathy 
  • White patches on the tonsils
  • Malaise (fatigue)

Because streptococcus tonsillitis (or “strep throat”) is contagious and requires medical treatment, it’s important for you to see a doctor if you are experiencing any of the above symptoms.

To confirm strep throat, your primary caregiver will swab the back of the patient’s throat. After about 15 minutes, the test will come back either positive or negative. Even if it is negative, the physician will send a culture for the swab to the lab for culture. Those results generally come back within 24 to 48 hours.  If the result is positive, antibiotics may be prescribed at that time.

When should I consider having a tonsillectomy?

Tonsil infections, especially those caused by group A streptococcus, can be painful as well as disruptive to your life. Because of the illness and recovery time, it could cause you to miss multiple days of work or school. 

Does the occasional infection mean you need to have your tonsils removed? Not necessarily. If your life is being disrupted because you are having multiple bacterial infections a year, then you might strongly consider having a tonsillectomy. 

A tonsillectomy — or removal of the tonsils — is the most common medical procedure in the United States. With tonsillitis, a tonsillectomy is generally considered an elective surgery because a tonsil infection isn’t life-threatening. However, the necessity for a tonsillectomy is greater in cases involving sleep apnea or enlarged tonsils.   

There are some general criteria for having a tonsillectomy due to reoccurring tonsillitis: 

  • Five to seven infections in a year
  • Five infections in two years
  • Three infections in three years
  • Greater than two weeks or more of missed school or work in one year
  • Abscess from a strep infection
  • Chronic sore throat with persistent halitosis (bad breath) or tonsillolithiasis (tonsillar stones)

If you meet any of the above criteria, you should consult with your doctor about having a tonsillectomy.

The surgery will not prevent sore throats, but it will prevent sore throats from tonsillar infections. That also means there will be a reduction in missed work and school days and an increase in quality of life.   

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