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Tonsillitis  … should the infected tonsils stay or should they go? We investigate the ins and outs.

Tonsils are the two small masses of tissue at the back of the throat that fight infection caused by bacteria and viruses. An inflammation or infection of the tonsils is referred to as tonsillitis.


  • swollen red tonsils;
  • sore throat;
  • pain or discomfort when swallowing;
  • bad breath;
  • high temperature;
  • swollen neck glands;
  • and sometimes a change in the voice.

Read our article on other childhood illnesses that should not be ignored.

prevention and treatment

While bacterial infections can be treated with antibiotics, viral infections can only be managed with supportive care, hydration and temperature control.

Asked if there’s a way to avoid tonsillitis, GP Dr Dorianne Green, a GP,  says it’s “a luck-of-the-draw-type illness”.

Since tonsillitis is contagious, the nasal fluids from sneezing and droplets of spit from coughing are infectious enough to spread it. To reduce the risk of tonsillitis, ensure a healthy immune system by eating fresh fruit and vegetables, stay away from infected people, regularly wash your hands and don’t use the same eating utensils as an infected person. It’s also a good idea to replace toothbrushes after a bout of tonsillitis to avoid reinfection.

Cape Town-based ear, nose and throat specialist Dr Sharon Williams. says:“A decision to do a tonsillectomy is multifactorial; the potential benefits need to be weighed against the potential risks. There are a few absolute indications for a tonsillectomy – generally when there are significant risks if not attended to.” Williams gives the following indicators:

  • Largely swollen tonsils obstructing swallowing, breathing or both. Obstructive sleep apnoea: when the child stops breathing during sleep.
  • Complications such as a peritonsillar abscess.
  • A suspicion that the tonsils could be malignant.
  • If associated with systematic complications involving the kidneys or heart, or arthritis.
  • If the tonsillitis reoccurs six to seven times in a year, five or more times in two years or three or more times per year for three years.

Asked about the implications of tonsil removal, Dr Williams says: “Chronically infected tonsils are an additional burden on the child’s immune system. Once removed, that burden is eliminated”.

Tonsils and adenoids are the two largest lymphatic organs in the upper respiratory tract, but there are many other collections of lymphatic tissue in the naso- and oro-pharynx that continue to assist with immunity when the tonsils are removed.

a tonsillectomy – be prepared

  • Disclose your full medical history to the doctor, especially if either parent is prone to bleeding or has adverse reactions to anaesthetic.
  • Your child will undergo a general anaesthetic (with an anaesthetist on hand to monitor them) and the op should take 20 to 30 minutes.
  • Find out from your surgeon if you can stay in theatre until your child has fallen asleep. This is reassuring for young children.
  • Talk to your child about what they can expect before, during and after surgery.
  • Let your child take their favourite toy along. Make sure they have it when they fall asleep and when they wake up.
  • Children have very different reactions to an anaesthetic. They can wake up aggressive, angry or weepy. Prepare yourself for this and make sure that you’re with them when they wake up.
  • Prepare soft foods and have a ready supply of liquids. Liquids are important after surgery.

Chareen Boake