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Adult tonsillitis: Nothing to kid about

Infections can cause painful flare-ups that surgery can eliminate. But the procedure is a lot tougher on grown-ups than children, doctors warn.

December 09, 2002|Martin Miller | Times Staff Writer

Diane Hamilton was a grown-up battling a child's ailment. At least that's what she thought. But the high fever, aches, chills -- and a pair of tonsils that felt as big as pingpong balls -- amounted to much more than a passing case of tonsillitis.

"It was a little embarrassing," said Hamilton, a 33-year-old architect. "I kept thinking, 'I'm an adult. This shouldn't be happening.' "

Initially, she didn't bother seeing a doctor, treating the symptoms with over-the-counter medications and rest. But after a third flare-up in as many months, the Cambridge, Mass., resident finally made an appointment. The physician suspected strep throat, but the test came back negative. It took three more infections over the next three months before the diagnosis of viral tonsillitis was finally made.

With viral tonsillitis, antibiotics are ineffective and the episodes usually last from four to six days. If it's the bacterial variety, an untreated bout can last from 10 to 14 days; antibiotics usually clear it up in five to seven days.

"It would flare up whenever I felt very stressed or really run down," said Hamilton, who missed nine workdays over a six-month period because of the condition. "So, I guess I must have been feeling pretty stressed and run down then."

Doctors suspect the number of adults with chronic tonsillitis is on the rise, if for no other reason than more grown-ups still have an intact pair of the oval-shaped lymphoid tissue masses at the back of their throats. Until the early 1970s, tonsillectomies were routinely performed on children who showed signs of tonsil infection. However, by the early 1980s, physicians were balking at tonsil removal in all but the severest cases.

It's still uncertain precisely what function tonsils serve, but doctors believe they are part of the body's immune system -- gatekeepers that provide germ protection at the entrance to the breathing passages. But as many have discovered at some point, usually before the age of 10, the tonsils can easily become overwhelmed with infection.

In addition to fever and chills, tonsillitis can cause bad breath and difficulties swallowing and breathing, particularly during sleep. Although Hamilton was spared these symptoms, her options were fairly limited. She could either tolerate the condition, which could erupt at any time, or have the tonsils surgically removed.

"After so many infections in such a short period, the decision for me was pretty clear," she said.

Because the operation is often associated with children, adult patients are sometimes falsely lulled into believing the procedure is no big deal. Wrong, say doctors, who note that children are more resilient than adults.

"I tell patients it's going to be easy on me and hard on you," said Dr. Neil Bhattacharyya, who tracked 83 chronic tonsillitis sufferers in a study spanning three years at Brigham and Women's Hospital in Boston. "I tell them they are going to have the worst sore throat of their life."

But Bhattacharyya's study, which was published in the November issue of Annals of Otology, Rhinology and Laryngology, found that among adult sufferers of chronic tonsillitis, those who opt for surgery subsequently take fewer sick days and less medication than those who keep their tonsils. Before the tonsillectomies, the study found, patients averaged nearly seven weeks on antibiotics and about six doctor visits per year. After the surgery, antibiotic use for the same patients plummeted to an average of one day, while doctor visits dropped to an average of 0.3 per year.

"The myth persists that if you're an adult, you shouldn't have your tonsils removed," said Bhattacharyya. "But for people who get tonsillitis several times a year, the surgery makes sense."

Doctors don't know why some patients are more prone to chronic tonsillitis than others. But they do know its telltale symptom, which usually distinguishes it from other throat ailments -- swollen, discolored, even yellowish, tonsils.

Bhattacharyya cautions that the surgery isn't for everyone. If the condition flares up only once in a while or the size of the tonsils is very small, other treatments are probably better.

If you decide on surgery, which costs about $2,500, prepare for a bumpy recovery. Hamilton took twice the customary weeklong recovery time to return to normal after the 30-minute, outpatient procedure, she said. Her troubles started immediately after surgery, when she reacted poorly to the anesthesia. She was sick for four hours, whereas most patients, if they get sick at all from the anesthesia, are over it within an hour.

The coming days were hardly better. Medications did little to alleviate the severe pain she felt swallowing. For at least a week, her diet consisted solely of Popsicles. (Ice cream was out because as a dairy product it promotes mucous, which irritates the throat.)

But in the nearly three years since the procedure, she hasn't had any similar illnesses, not even a sore throat, she said.

"I travel a lot for my job, and I just couldn't live with it anymore," Hamilton said. "I don't miss my tonsils."

*

Getting Better, which runs twice a month, tells the personal stories of people trying to achieve optimal health and well-being. Send ideas for future columns to health@latimes.com.

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