Tonsillitis and Recurrent Throat Infections: When Surgery Is Considered

Understanding Recurrent Throat Infections

Tonsillitis occurs when the oval-shaped tissue pads at the back of the throat become inflamed due to viral or bacterial infections. While a single episode is manageable with rest and antibiotics, recurrent throat infection management becomes necessary when bouts occur several times a year. Chronic tonsillitis can lead to the formation of tonsil stones (tonsilloliths), persistent halitosis, and permanent swelling that may interfere with breathing or swallowing.

Causes of Frequent Tonsillitis

Frequent tonsillitis often stems from a combination of environmental factors and individual susceptibility to viral or bacterial pathogens. The most common causes of frequent tonsillitis include:

• Bacterial Reservoirs: Bacteria can become trapped deep within the tonsillar crypts, creating a chronic reservoir of infection that is difficult for antibiotics to fully eradicate.
• Biofilm Formation: Pathogens may develop protective biofilms, complex communities of microorganisms, that adhere to the tonsil tissue and increase resistance to the immune system.
• Viral Infections: Frequent exposure to common respiratory viruses, such as the Epstein-Barr virus or influenza, can repeatedly inflame the tonsils and weaken local defenses.
• Antibiotic Resistance: Overuse or incomplete courses of antibiotics can lead to the survival of resistant bacterial strains, making subsequent infections harder to treat.
• Anatomical Factors: Individuals with naturally large or highly fissured tonsils are more prone to trapping debris and bacteria, leading to chronic irritation.
• Environmental Irritants: Regular exposure to secondhand smoke, pollution, or allergens can cause chronic inflammation of the upper respiratory tract, predisposing the tonsils to infection.

When is a Tonsillectomy Necessary?

Determining when to move toward surgery involves specific clinical criteria. Most specialists follow the “Paradise Criteria,” which suggests that tonsillectomy considerations should begin if a patient experiences:

• Seven episodes in the last year.
• Five episodes per year for the last two years.
• Three episodes per year for the last three years.

Beyond frequency, surgery is often recommended if the infections are severe enough to cause febrile seizures, peritonsillar abscesses, or if enlarged tonsils result in obstructive sleep apnea. A throat infection specialist consultation is the best way to evaluate whether the risks of chronic inflammation outweigh the benefits of keeping the lymphoid tissue.

Surgical Tonsillectomy Treatment

Modern surgical treatment for tonsillitis is a routine outpatient procedure performed under general anaesthesia. During the operation, the surgeon removes the tonsil tissue using various methods, such as cold scalpel excision or thermal cauterisation. A tonsillectomy typically takes under an hour, and the patient can usually return home the same day. Some patients may need to stay overnight if complications arise.

Recovery and Post-Operative Care

The recovery process following a tonsillectomy typically spans about two weeks, during which patients must monitor for potential complications such as secondary haemorrhages. While in the hospital, nursing staff will provide close observation for signs of post-operative bleeding, which may include frequent swallowing or visible blood when lying on your side. Patients should expect a significant sore throat and potential earache for up to 14 days. Managing this discomfort is best achieved by taking prescribed painkillers roughly thirty minutes before meals. While initial nutrition should consist of soft foods and plenty of fluids, transitioning to solid foods as soon as possible is encouraged to promote faster healing of the throat tissues.

To ensure a successful recovery, it is vital to complete any prescribed antibiotic course, even if symptoms improve quickly, to prevent the development of antibiotic-resistant bacterial strains. Patients are advised to remain at home for seven to 14 days, avoiding strenuous physical activity and minimising contact with individuals who have contagious respiratory infections. During the first few days, you may also experience temporary halitosis (bad breath), which typically resolves as the surgical site heals.