Q. How to prevent frequent episodes of tonsillitis?

Answered by Dr. Shyam Kalyan N and medically reviewed by iCliniq medical review team.


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Hi doctor,

I am suffering with tonsillitis for past three years. Nearly four months back, my tonsils got swollen. Followed by that the right tonsil remains the same and the left got subsided.

In these four months, I had few episodes of pain in my ear. Also the glands in my right side of neck got swollen. I had Azithromycin, Erythromycin, Penicillin and Clavamax but the swelling of the tonsil and the glands did not go down?

What should I do to prevent further episode? Does the cold temperature affect the tonsils?

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Dr. Shyam Kalyan N
Allergy Specialist, Otolaryngology (E.N.T

Hi, Welcome to icliniq.com.

With the conversation we had, I understand that you are an 18 year old male suffering from tonsillitis and you have been having acute exacerbation of the tonsillitis now. Due to the infection, you suffer from ear pain and swollen neck glands.

You seem to be suffering from chronic tonsillitis. This resulted in episodes once a while leading to throat pain, difficulty in swallowing, ear ache, neck swelling, fever, etc.

Tonsils are lymphoid organs which act as portals to remove offending agents like bacteria. However, in some individuals they themselves become the cause of infection.

Infection from enlarged tonsils can spread to nose, ear or further down as throat infection which will cause great discomfort to the patients.

Also, because of the same patient suffers from loss of days at work place or school or college.

For your condition, I would suggest you to go ahead with tonsillectomy operation. This operation removes both the tonsils.

It is done under general anesthesia and is done through the mouth. There will not be any incision outside.

The reasons why I suggest you to go for the tonsillectomy operation are that,

  • You have been suffering from this problem since 3 years.
  • Last 3 or 4 months you have been having it continuously.
  • Multiple courses of various antibiotics you have taken without much relief.
  • You get frequent throat pain and ear aches which affects your work or studies.

Few episodes of tonsillitis in a year can be successfully managed using medicines. However, in your case tonsillectomy operation is ideal as I explained above.

In the meantime till we decide for surgery, please follow the instructions and suggestions I have given below.

  1. Do hot saline gargling thrice daily.
  2. Drink plenty of hot fluids (3 to 4 liters of hot water daily).
  3. Take plenty of green leafy vegetables.

Some precautions to be taken are,

  • Avoid dust, smoke and cold winds while travelling.
  • Avoid sleeping straight under fan or air conditioner.
  • Avoid cold drinks and oily spicy foods.

It is true that cold climate can result in increased susceptibility to tonsillitis. Cold winds accompanied by consumption of road side or outside food can increase the chance of infection.

Always use boiled water and desist from drinking water from local places.

When tonsils are enlarged, the infection can move through the eustachian tube into the ear, complicate the condition and cause decreased hearing or ear discharge.

Sometime the tonsils can cause referred pain to the ear though the infection may be restricted to throat.

Lymph fluid from tonsils drains into neck nodes, more particularly the jugulodigastric node below the angle of jaw.

Hence, the tonsillar infection will also infect the node and cause neck swelling. The swelling will resolve once the tonsillitis is cured.

Investigations to be done:

If the symptoms do not recede then please do the following tests.
1. Complete blood count including but not restricted to ESR (erythrocyte sedimentation rate), platelet and lymphocytes.
2. Absolute eosinophil count.
3. Throat swab for culture and sensitivity.

Differential diagnosis:

1. Tonsillolith.
2. Acute Follicular Tonsillitis.
3. Acute Parenchymatous Tonsillitis.

Probable diagnosis:

Acute exacerbation of chronic tonsillitis.

Treatment plan:

I suggest you the following medications; however a complete and thorough physical examination is required to make a definitive diagnosis and prescribe the apt medication.
1. Take a stronger antibiotic, like Cefixime 200 mg, twice a day for 5 days.
2. Take an antibiotic that against anaerobic organisms, like Tinidazole or Ornidazole for 3 days after consulting with your doctor.
3. Take anti-inflammatory enzymes like trypsin-chymotrypsin tablet before food daily thrice for 2 days (Chymoral forte).
4. Take pain killers if necessary (Paracetamol 650 mg twice a day).
5. Hot salt water gargling daily three to four times and steam inhalation.
6. Follow the general instructions and precautions explained above.
If the treatment does not help, you may need hospitalization and intravenous administration of medicines. Also a throat swab is necessary in such cases to ascertain if any dangerous strain of bacteria has caused the infection.

Regarding follow up:

For further information consult an ENT otolaryngologist online.---> https://www.icliniq.com/ask-a-doctor-online/ENT-Otolaryngologist

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