Tuesday, 28 January 2014

Managing tonsillitis in children and adults (2) BY ROTIMI ADESANYA

Recently, a father rushed his five-year-old son to the emergency room of one of the public hospitals in Lagos. The son was down with fever which was high grade, associated with chills and rigour (shivering).

The boy was given anti-malarial drugs and pain reliever; he was also sent to the hospital laboratory for malaria and infection test. His blood sample was collected and the dad was told to come back the next day for the result.

When the boy got home, the temperature climbed higher than it was at the hospital, and he started vomiting copiously and jerking.

He was rushed to a private hospital where I was called to see him. After thorough examination, it was found that he had acute tonsillitis, which was giving him the very high fever.

He was admitted, placed on intravenous antibiotics and discharged home on oral medications after two days of achieving stable, normal temperature. By then also, he had started playing with the people around him in the hospital. A repeat test at the private hospital did not show malaria parasitemia. In other words, the child did not have malaria.

The import of this is that children with high fever may not have malaria, though malaria is a major cause of fever in our environment. Other major causes in children include tonsillitis, adenoid enlargement, otitis media, urinary tract infection, and other sources of infection in the child’s body.

Is your child having fever? Seek medical help! Do not over treat for malaria.

Last week, I defined tonsillitis as simply the inflammation or infections of the tonsils, which are two oval-shaped tissues located at the back of the throat. Tonsillitis is believed to be a very common childhood ailment, but it also affects adults.

The symptoms include pain in the throat, which is sometimes severe and may last more than 48 hours; the throat pain may also lead to pain whenever the victim tries to swallow anything, including saliva.

Other symptoms are redness of the tonsils, painful blisters or ulcers on the throat, stiff neck, inability to turn neck left or right, ear pain, chills and fever, headache, hoarseness or loss of voice or changes in the voice.

Loss of appetite, breathing through the mouth, swollen glands in the neck or jaw area, and bad breath are other inconveniences of tonsillitis; while children may complain of nausea, vomiting, and abdominal pain.

The concluding part today will be briefly on the treatment options available in our environment

Treatment

The treatment comprises a combination of steps to relieve the symptoms, medication to attack the cause and surgery to totally remove the cause if need be.

Conservative treatment: Non-drug treatment, which is a combination of steps to relieve the symptoms, include rest, drinking plenty of water and fluids, avoiding smoking and exposure to cigarette smoke, steam inhalation (this can help relieve a blocked nose).

Avoiding social contact and staying away from work, especially if feeling unwell; avoiding spicy foods; gargling with lukewarm, salted water; sucking on an ice cube or a throat lozenges for children over five.

Drinking warm water or tea with honey and lemon can also be simple and effective home remedies.

Medication: When it comes to medication, it has been found that antibiotics are only effective in treating tonsillitis if the cause is bacterial. In the case of viral infections, antibiotics may actually aggravate the condition. Hence, the treatment of viral tonsillitis is usually restricted to relieving the symptoms.

A throat culture helps to pinpoint whether the cause is bacterial or viral.

There are medicines you can take to help manage the symptoms of tonsillitis. These include paracetamol and ibuprofen. However, aspirin should not be given for pain or fever to children younger than 16 years, as it may cause serious side effects. This is because Reye’s syndrome, which can affect brain function and cause liver damage, has been associated with aspirin use in children.

Surgery: The surgery is called tonsillectomy, and it is performed by an ENT (Ear, nose and throat) surgeon. It is performed through the mouth, and no stitches are left on the face or chin or neck and surgery is not expensive.

ENT surgeons may consider tonsillectomy for people (especially children) who have: recurring bouts of severe tonsillitis, airway blockage that disturbs sleep (obstructive sleep apnea) due to enlarged tonsils or adenoids — an infection that produces pus in the tissue around the tonsils (peritonsillar abscess, also known as quinsy).

Concluded.

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