Conditions: Throat Infection (pharyngitis)

The throat (pharynx) is a common site of infection. Symptoms may range from a nuisance to severe pain and/or blockage of the airway. Tonsils, adenoids, and lingual tonsils are a part (but not all) of the throat.

Pharyngitis

Pharyngitis means inflammation of the pharynx, typically due to infection. Because the inflammation is uncomfortable, this condition is often called a “sore throat.” Although infection of the pharynx is often located specifically in the adenoids, tonsils, or lingual tonsils, and when this is the case, the specific terms “adenoiditis,” “tonsillitis,” or “lingual tonsillitis” may be used, the term “pharyngitis” is simply used to indicate the more general area, the pharynx, is infected.

Viral versus bacterial is a relevant question for a sore throat. Essentially, a sore throat of less than one week’s duration is statistically likely to be viral, for which no antibiotics are given. An exception is when a throat swab for Strep (Streptococcus bacterium) is positive, which indicates starting antibiotics.

tonsils and adenoids

Tonsils (formally known as palatine tonsils) are the bulges on each side of the throat when you look in the mirror.  Adenoids (formally nasopharyngeal tonsil) are the same type of tissue located at the very back of the nose and the top of the throat, rendering them out of sight without special instruments. Lingual tonsils are the same type of tissue located on the back of the tongue. What do they do and why are they present? These structures are rich in immune system cells, but their immune function seems to be complete very early in life (probably before birth).  To date, there are no studies that demonstrate a significant clinical impact of tonsillectomy or adenoidectomy on the immune system, but tonsils, adenoids, and the lingual tonsils, often cause health problems, with infections, airway blockage, or tumors. Despite consisting of the same type of tissue, their anatomic differences account for their different potential health problems, with the adenoids relating to recurrent ear infections, frequent mucus discharge in children, and blockage of the nasal airway, while the tonsils potentially blocking air from the nose and mouth. So, one answer to the question, “what do they do” is “potentially cause problems, though they do not cause problems in everyone.”

Infection of the tonsils, adenoids, and lingual tonsils, is common, and may be due to viruses or bacteria. Most viral infections come and go within a week with little intervention needed. One exception is mononucleosis, which is caused by the Epstein Barr Virus (EBV). Bacterial infections may also come and go relatively quickly without treatment, but have greater potential to persist after a week and thus a key clinical indicator of whether a tonsil, adenoid, or lingual tonsil infection is bacterial is whether it has persisted for greater than a week or so. Antibiotics (specifically antibacterials) have no effect on a viral infection, yet over-use of such antibiotics has many downsides, including risk of allergy or other side effects as well as promoting drug resistance. This is why antibiotics are reserved for infections that persist for a week or longer, as these infections are more likely to be bacterial.

Mononucleosis (“mono”)

Mononucleosis (properly termed infectious mononucleosis), is an infection caused by the Epstein–Barr virus (EBV). Most people are infected by the virus as children, when the disease produces few or no symptoms. In young adults, the disease often results in fever, sore throat, enlarged lymph nodes in the neck, and tiredness. Most people recover in two to four weeks; however, feeling tired may last for months. The liver or spleen may also become swollen, and potential rupture of the spleen with abdominal trauma is the reason for restricting activities like contact sports in this situation.

Mononucleosis is primarily spread through saliva but can rarely be spread through semen or blood. Spread may occur by objects such as drinking glasses or toothbrushes or through a cough or sneeze. Those who are infected can spread the disease weeks before symptoms develop. Mono is primarily diagnosed based on the symptoms and can be confirmed with blood tests for specific antibodies. The monospot test is still sometimes used for convenience, but generally not recommended due to poor accuracy.

There is no vaccine for EBV yet. Infection can be prevented by not sharing personal items or saliva with an infected person. Mono generally improves without any specific treatment. Symptoms may be reduced by drinking enough fluids, getting sufficient rest, and taking pain medications such as acetaminophen and ibuprofen. If the tonsils become so swollen that breathing is impaired, corticosteroids (e.g. prednisone) may be used.

Mononucleosis most commonly affects those between the ages of 15 to 24 years in the developed world, and younger in the developing world. In those between 16 and 20 it is the cause of about 8% of pharyngitis. About 45 out of 100,000 people develop infectious mono each year in the United States. Nearly 95% of people have had an EBV infection by the time they are adults.

Bacterial superinfection

A superinfection is a second infection superimposed on an earlier one, especially by a different microbe, that is resistant to the treatment being used against the first infection. In the pharynx, the most common scenario is when a virus causes pharyngitis, and then bacteria take advantage of one’s decreased defenses to set up a bacterial infection. This transition from one infection to another may be apparent by a change in symptoms, such as having a sore throat that is improving around day 3-5 but then worsens again thereafter.