Dr Grant replies: Yes, I understand how you feel. Some conditions like tonsillitis or appendicitis are more common in children but can still happen in adults.
The problem is the recovery time from tonsillitis as an adult can take longer than a child and this often means extended time off work/from college.
There comes a point when tonsillectomy seems like a good long-term option and the decision to go ahead really is part of a shared decision-making process between you, your GP and the ENT surgeon.
In order to be referred for consideration of tonsillectomy you need proper documentation of the frequency and impact of recurrent tonsillitis on your quality of life.
The tonsils are part of the immune and lymphatic systems. The immune system is part of your defence against infection and help prevent the formation of abnormal cells. Various types of white blood cells, cytokines, antibodies, bone marrow and the spleen, lymph nodes, thymus gland and tonsils form part of the immune system.
The lymphatic system is like a support structure for the immune system and involves a network of lymph nodes, organs and vessels that helps store, transport, filter and drain the immune cells around the body. The tonsils are made of lymphoid tissue covered by respiratory epithelium. Tonsils are contained within their own fascia which is space between the tonsil and the pharyngeal muscle that can accumulate pus and become a very painful peritonsillar abscess.
There are three main types of tonsils – the palatine (ones you can see at the back of your throat), the adenoids (located behind the nose) and the lingual tonsils (at the base of the tongue). When the tonsils become infected, the term used is tonsillitis. If the back of the throat or oropharynx becomes infected, the term used is pharyngitis.
In clinical practice it is difficult to distinguish between tonsillitis and pharyngitis or when both become infected, termed pharyngotonsillitis. Hence, all these words tend to be used interchangeably.
The Paradise criteria for tonsillectomy was developed in 1984 and are still used to discuss the need for surgery
Chronic tonsillitis refers to the presence of infection and/or inflammation of the oropharynx or tonsils for at least three months.
It is assumed that multiple factors combine to cause recurrent pharyngotonsillitis. One factor is repeated bacterial infections with group A strep and possibly being in a chronic strep ‘carrier state’. It is estimated that group A strep infection in adults accounts for approximately 10pc of cases of pharyngitis. Inadequate antibiotic treatment and/or antibiotic resistance is another factor, or indeed reinfection from close contacts.
The anatomy of the tonsils may contribute, such as large tonsils or those with deep crypts where bacteria can hide and form biofilms (protective barrier against antibiotic treatment) making infection harder to treat. Immune system immaturity in children and weaker immune response in adults who may have subtle dysfunction or dysregulation can be contributing factors. Post-viral immune dysregulation is sometimes seen after Epstein-Barr virus infection. Some patients may have an element of gastro-oesophageal reflux disease, asthma or allergies that contribute to recurrent tonsillitis.
Regardless of the underlying causes, recurrent acute pharyngitis and chronic tonsillitis are the most common indications for tonsillectomy in adults. Other reasons include chronic tonsillar enlargement contributing to sleep disorders or obstructive sleep apnoea.
The Paradise criteria for tonsillectomy was developed in 1984 and are still used to discuss the need for surgery.
The criteria states that if a patient suffers three episodes yearly for ≥3 years, or five episodes yearly for two years, or seven episodes in one year, then tonsillectomy should be considered.
Patients should be suffering from a significant reduction in quality of life caused by recurrent or chronic pharyngotonsillitis.
The Scottish intercollegiate guideline network (SIGN) is more flexible and has broader clinical practice guidelines that include additional indications.
Dr Jennifer Grant is a GP with Beacon HealthCheck
