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Disclaimer

This movie is an educational resource only and should not be used to manage your health. All decisions about the management of Tonsillitis must be made in conjunction with your Physician or a licensed healthcare provider.

Multimedia Health Education

TONSILLITIS

MULTIMEDIA HEALTH EDUCATION MANUAL

TABLE OF CONTENTS

SECTION CONTENT


TONSILLITIS

2 . Overview of Tonsillitis a. Symptoms of Tonsillitis

b. Diagnosis

3 . Treatment Options a. Conservative Treatmentb. Surgical Introduction

c. Surgical Treatmentd. Post Operative Precautions e. Risks and Complications

INTRODUCTION

Tonsillitis is a common infection of the tonsils, glands located in the back of the throat. When tonsillitis recurs frequently, your doctor may recommend surgery. Surgery to remove the tonsils and possibly the adenoids is one of the most common major surgeries performed on children. It is also occasionally performed on adults.


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Tonsillectomy, the removal of the tonsils, is often done at the same time as an Adenoidectomy, the removal of the adenoids. However, either operation may be performed without the other depending on the patient’s needs. When the two operations are combined, it is frequently referred to as T&A surgery.

In order to learn more about Tonsillitis, it is important to understand the normal anatomy of the tonsils and adenoids and surrounding structures.

Normal Anatomy

Tonsils are lymph nodes located at the back of the throat next to the tongue. There are two tonsils, one on each side of the throat. Tonsils are comprised of soft lymphatic tissue and are part of the lymphatic system, our body’s defense system against infection.

Unit 1: Normal Anatomy


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TonsilsAdenoids UvulaEustachian Tubes

Tonsils

(Fig. 1)

(Refer fig. 1)

(Fig. 2)

Their purpose is to assist in fighting infection by acting as a filter for bacteria and viruses entering the body through the nose and mouth.

(Refer fig. 2)

AdenoidsAdenoids are paired, lymph nodes located behind the nose. You cannot see the adenoids when looking into your mouth. Adenoids are also part of the lymphatic system and assist the body to fight infection.

(Fig. 3)(Refer fig. 3)

Unit 1: Normal Anatomy


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UvulaThis is the small piece of soft tissue that hangs down from the roof of the mouth at the back of the throat.

(Refer fig. 4)

(Fig. 4)

Eustachian Tubes The Eustachian tubes connect the middle ear to the back of the nose and help to maintain equal pressure inside the ear. The tubes can become blocked if the adenoids are swollen from infection. Blocked Eustachian tubes contribute to middle ear infections.

(Refer fig. 5)

(Fig. 5)

Unit 2: Overview of Tonsillitis


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Symptoms of Tonsillitis

Tonsillitis is a common infection of the tonsils that causes severe sore throat and fever. Tonsillitis makes it very painful to swallow. The tonsils will appear red and swollen and may have white pus spots on the surface. Often, the patient loses their appetite and has decreased fluid intake as swallowing is so painful. Other symptoms that can be experienced with tonsillitis include cough, headache, muscle aches, and chills.

Tonsillitis can be classified as:Acute: Acute Tonsillitis is usually caused from a virus but may be from bacterial causes. A common bacteria that causes tonsillitis is Streptococci and when diagnosed is referred to as Strep Throat.

Chronic: This is frequent, recurring tonsillitis and is usually caused from bacteria.

Diagnosis

The following will be performed by your doctor:

Medical History: Your doctor will ask you questions about past diagnoses, symptoms you are experiencing, and current medications.

Physical Examination: Your doctor will look inside your mouth and throat to assess the tonsils. Lymph nodes in the neck will be felt for swelling and tenderness.

Tests your doctor may order include:

A sterile swab of the throat secretions is collected and sent off to the lab to assess for streptococcal bacteria, Strep throat.

Strep Test

Blood TestsA CBC (complete blood count) may be ordered to help identify the cause of your infection.

Unit 3: Treatment Options


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Conservative TreatmentOnce your doctor confirms a diagnosis of bacterial tonsillitis you will be prescribed a course of antibiotics to treat the infection.

You will usually experience improvement of symptoms in about 2 to 3 days after beginning your antibiotics.

It is important that you finish taking all of the antibiotics even after your symptoms subside and you are feeling better, otherwise, the infection can recur.

Occasionally, some patients require more than one course of antibiotics to completely rid themselves of the infection.

Your doctor may prescribe a topical anesthetic to help relieve the pain.

Warm, salt water gargles also help with decreasing throat pain.

Get plenty of rest and fluids to help your body to heal.

Warm liquids such as clear soups, broths, and tea help with throat discomfort.

Your doctor may tell you to administer NSAID’s, non-steroidal anti-inflammatory medications, such as acetaminophen or ibuprofen, to minimize pain and swelling. NEVER administer aspirin to a child younger than 12 as this can cause a rare but serious disorder called Reyes Syndrome.

Keep your child home for at least 24 hrs after beginning antibiotics to prevent the spread of infection to others.

If tonsillitis is caused by a viral infection, antibiotics will not be ordered as they do not cure viral infections. Often the patient recovers at home in about a week but occasionally recovery can take up to two weeks. Conservative treatment measures such as those listed above are used to keep the patient comfortable.

Surgical IntroductionIf your doctor diagnoses chronic tonsillitis due to frequently recurring infections, they will refer you to an Otolaryngologist, an ENT surgeon, to be evaluated for surgery to remove your tonsils and possibly adenoids.

Other Indications for Tonsil and/or Adenoid surgery include:

Frequent episodes of acute tonsillitis

Frequent middle ear infections caused by blocked eustachian tubes and swollen adenoids Tonsillitis unresponsive to antibiotic therapy



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Peritonsillar abscess, an abscess around the tonsils. Left untreated, peritonsillar abscess can cause a very serious infection of the blood called septicemia.

Hearing loss with possible speech impairment from blocked eustachian tubes and swollen adenoids

Sleep apnea, a condition causing interrupted breathing while asleep, due to enlarged tonsils or adenoids

Abnormally large tonsils

The goal of surgery is to reduce the number of throat and ear infections and improve airway obstruction.

There are many surgical methods utilized for T&A surgery. Traditionally, tonsils and adenoids are removed with heating devices that burn the tissues. For this learning module we will focus on bipolar radiofrequency (RF) ablation, also called the Coblation method. The Coblation method utilizes gentle radiofrequency energy and normal saline to dissolve and remove tonsils and adenoids while leaving healthy surrounding tissue virtually unharmed.

The special RF devices use less heat than traditional lasers or electro surgery tools and offer the surgeon improved precision.

Advantages of the Coblation method over traditional methods can include:Less pain Minimal blood loss during surgery Less damage to surrounding tissues

Faster return to normal diet Less nausea

Less swelling

Faster healing

Make sure to discuss with your surgeon the various options available and their preference for your particular situation.

Surgical Procedure

The patient is positioned on the operating table on their back with the shoulders elevated on a small pillow to hyperextend the neck.

(Continued in next page)

(Refer fig. 6 to 13)



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A mouth gag is used to keep the mouth open for the surgeon to have a clear view and room to work.

(Fig. 6)

(Fig. 7)

(Fig. 8)

(Fig. 9)

If adenoidectomy is indicated, this will be performed before the removal of the tonsils.

Adenoidectomy is accomplished through the mouth or nose with no external sutures.

Your surgeon places a small flexible tube through the nose into the mouth to retract the palate. Using a mirror through the mouth, your surgeon is able to visualize the adenoids behind the nasal cavity.




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(Fig. 10)

The adenoids are carefully released from the surrounding tissue and removed using a special surgical wand that emits radiofrequency waves and saline (salt water) causing tissue dissection while minimizing damage to surrounding tissues.

(Fig. 11)

(Fig. 12)

(Fig. 13)

Next, your surgeon will perform the tonsillectomy through the mouth using the special surgical wand to dissolve the target tissue and remove the tonsils.

Once your surgeon has removed all the tonsil tissue, the instruments and mouth gag are removed.




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Post Operative Guidelines

Your surgeon will give you guidelines to follow depending on the type of surgery performed and the surgeon’s preference.

Common post-operative guidelines include:-

You will need someone to drive you home after surgery due to the drowsy effects of the anesthesia.

You will be given pain medications to manage your pain. It is normal to have a sore throat after surgery for 1 week, occasionally up to 2 weeks.

You will probably be given antibiotics to prevent infection. Make sure to finish all your pills and do not drink alcohol as this interferes with their effect.

Avoid dairy products such as milk and ice cream as they can coat the throat and interfere with healing.

Do not use aspirin or ibuprofen products as these can cause bleeding to occur. Children under 12 should never be given aspirin due to the potential for Reyes Syndrome.

Get plenty of rest. Children should be kept home for at least one week to avoid possible infections from other children.

You should avoid strenuous activity as well as bending and lifting for 1-2 weeks after surgery as this may cause bleeding.

Sleep with your head elevated on extra pillows.

Do not smoke as smoking delays healing and increases your risk of developing complications.

Risks and Complications

As with any major surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery takes place.

Complications can be medical (general) or specific to T&A surgery. Medical complications include those of the anesthetic and your general well being. Almost any medical condition can occur so this list is not complete. Complications include:

(Continued in next page)



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Allergic reactions to medications

Blood loss requiring transfusion with its low risk of disease transmission

Heart attacks, strokes, kidney failure, pneumonia, bladder infections

Complications from nerve blocks such as infection or nerve damage

Serious medical problems can lead to ongoing health concerns, prolonged hospitalization, or rarely death.

Complications are rare after T&A surgery, but unexpected events can follow any operation. Your surgeon feels that you should be aware of complications that may take place so that your decision to proceed with this operation is taken with all relevant information available to you.

Possible complications following T&A surgery can include the following:

Bleeding: Significant bleeding is uncommon. Frequent swallowing may be a sign of bleeding from the surgery site in children. Check the mouth frequently for the first few days after surgery for any signs of bleeding. Report any abnormal bleeding to your surgeon.

Infection: Report fever of 38.5 C or 101.0 F or higher. Report foul smelling, greenish yellow drainage as well as increasing pain or unresolved vomiting to your surgeon. Antibiotics will be prescribed to treat the infection.

Unit 3: Disclaimer

Although every effort is made to educate you on tonsillitis and take control, there will be specific information that will not be discussed. Talk to your doctor or health care provider about any concerns you have about tonsillitis.

Disclaimer

SummaryA good knowledge of this procedure will make the stress of undertaking the procedure easier for you to bear. The decision to proceed with the procedure is made because the advantages of the procedure outweigh the potential disadvantages. It is important that you are informed of these risks before the procedure.


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TONSILLITIS

multimedia health education · tonsillitis is a common infection of the tonsils that causes ... or...

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