Those pesky tonsils: what is tonsillitis and is it contagious?

Tonsils appear to be a leftover of evolution, but they’re still causing problems in the 21^st century. Professor Martin Anthony Birchall is here to explain what tonsils are, why we get tonsillitis, and how tonsillitis should be treated.

Tonsils: what are they?

There are some odd body parts that appear to have little or no function and go totally unnoticed until one day they develop problems. Examples are the appendix and the tonsils. What is the point of them?

The tonsils are small areas of lymph tissue (part of the immune system sitting on our mucus membranes). They may have an important role in new-born babies, but in older children and adults they’re simply occupying space.

Nonetheless, they have little pits in them which can gather food and debris which itself can be annoying (called tonsilloliths or “tonsil stones”). These pits can also be affected by viruses and bacteria and present as acute tonsillitis – often in association with the common cold or ‘flu’.

Treating tonsillitis

Perhaps up to a third of tonsillitis cases in children and young adults are due to bacteria of which a particularly troublesome form is called group A beta-hemolytic streptococcus (GABHS). Since this, rarely, can go on to cause annoying complications, which, even more rarely thankfully, can be severe, it is worth treating these patients with antibiotics.

If you see a primary care physician or GP to tell them you have tonsillitis, they should perform a throat swab to check for the presence of this bacterium and others. If present, this should be managed with antibiotics.

Most of the time, though, tonsillitis is caused by a viral infection and is self-limiting. Antibiotics aren’t going to work much – instead it should be targeted with over-the-counter pain killers, time off work, and plenty of fluids, plus or minus Netflix/good book.

The question arises, however, as to how much one should isolate oneself from friends, family and work colleagues if you have tonsillitis. The answer is that we would really recommend that you do stay at home and minimise social contact.

Should I have my tonsils removed?

In the UK, we perform fewer tonsillectomies than any other European country due to clear guidance in the NHS about when it is really necessary to refer, and in an effort to avoid possible complications of surgery.

However, it really is a judgement call, to be discussed between the sufferer and their ENT surgeon, as to exactly how many episodes of tonsillitis in a given year should trigger a referral for consideration of tonsillectomy and guidance varies from country to country. If you are getting a lot of episodes of genuine tonsillitis, with lots of time off work or education, or have suffered from complications, it would be worth consulting an ENT surgeon, at least to have a chat.

For adults, a tonsillectomy is no picnic – typically the throat is very sore afterwards for two weeks and 5% of people have some bleeding afterwards, though usually short-lived and small. However, for people who are really struggling with infections, losing time off work or college, and those suffering from sleep apnoea, it can be an important last resort with a high rate of cure.

Tonsils are silent passengers in our bodies that we usually only notice when they become infected. Perhaps in millennia to come the human race will evolve at the point where these extra leftovers of evolution, appendix, tonsils and all, are no longer an issue. For the time being, though, we’re stuck with these interesting – and mostly benign – passengers.