Angina: when the throat hurts

Parents are likely to hear this sentence more often in the near future: «Mummy, my throat hurts!» If a sore throat is accompanied by difficulty swallowing and a fever, you are often dealing with tonsillitis. Alongside flu-like infections and bronchitis, tonsillitis, also known as angina, is one of the most common respiratory diseases in children and adolescents.

«Most tonsillitis is caused by viruses,» says Christa Relly, senior physician for infectiology at the Children's Hospital in Zurich. Although the number of cases is particularly high in the winter months, angina is in season all year round. As with influenza, the pathogens are transmitted by droplets, i.e. through coughing or sneezing.

It is not unusual for children to contract angina several times a year.

However, there is also the bacterial infection caused by group A streptococci. The doctor explains the difference as follows: «In the viral variant, a sore throat and swollen, inflamed tonsils are often accompanied by a cold, cough or conjunctivitis. Bacterial angina, on the other hand, is characterised exclusively by a sore throat, pain on swallowing and fever.»

There is no vaccination

The risk of infection could be reduced by avoiding contact with people who are ill. «But this is of course only possible to a limited extent with children at school and kindergarten,» says Christa Relly. Incidentally, there is no vaccination against tonsillitis, as angina can be triggered by a large number of different pathogens. It is therefore not unusual for children to become infected several times a year.

«The highest level of immunological activity occurs between the ages of three and ten,» explains Nicolas Gürtler, Head of Paediatric Oto-Rhino-Laryngology at the University Children's Hospital Basel. During this period, a child is already immunocompetent, i.e. it has a functioning immune system, but does not yet have the immune experience of an adult. The palatine tonsils are at their largest during this time, but will recede over the years.

«The palatine tonsils are part of Waldeyer's pharyngeal ring. This is part of the immune system of the pharyngeal mucosa and is the entry point for pathogens entering through the nose or mouth,» says Gürtler. If the pathogens enter the tissue of the tonsils, this triggers what is known as an immune response. In other words, the body reacts to the viruses or bacteria, for example with a fever.

What relieves the pain of angina

«There are children who get angina five to six times a year and get over it well. Others catch it less often, but suffer more from the symptoms,» says Jacqueline Schneiter, a paediatrician from Männedorf. The reason why some children and adolescents seem to be more susceptible to angina than others is not clear.

«Gargling solutions with sage tea and lozenges are often sufficient as initial measures for viral infections,» says Jacqueline Schneiter. However, many children, even older ones, have difficulties gargling. Therefore, only those children who are already practised at gargling and already know how to do it from brushing their teeth should gargle. Pain-relieving throat sprays can also be used for older children. Classic medicines such as paracetamol and ibuprofen, alternating if necessary, help to alleviate the pain.

Proven household remedies are tea blends made from sage or lime blossom, which can be bought in pharmacies or supermarkets. A spoonful of honey in a warm drink masks the slightly bitter sage flavour and also has a disinfectant effect. But be careful: honey should only be given to children over the age of twelve months, as it can contain germs that the digestive system of babies cannot yet tolerate.

Antibiotics - yes or no?

If the symptoms do not subside after a few days despite all home remedies and a fever is also present, medical clarification is advisable.

«It's important to pay attention to the child's general condition,» says Jacqueline Schneiter. Is my child drinking enough? Can the fever be brought down? Is the medication improving the symptoms? These are all questions that help paediatricians to correctly assess the condition of their young patients.

If the tonsils are very often inflamed, it may be advisable to have them surgically removed.

«If angina is suspected, I first inspect the mouth and feel whether the lymph nodes in the neck are enlarged or even causing pain,» explains the paediatrician. Whether an antibiotic needs to be taken is decided on a case-by-case basis. In the case of a bacterial infection with a high temperature lasting for days and severely swollen tonsils, there is sometimes no way around it. An improvement often occurs just two days after the first dose. How long the antibiotic should continue to be taken must be clarified with the doctor treating you.

Removal of the tonsils

However, antibiotics are of no use for viral inflammations; the only thing that helps is to cure and drink (sage) tea. The good news is that, whether viral or bacterial, the illness usually heals on its own after seven to ten days.

If the tonsils are very often inflamed and have to be repeatedly treated with antibiotics, it may make sense to have them surgically removed. «This procedure is still one of the most common operations in children,» says ENT specialist Nicolas Gürtler. In addition to repeated inflammation, severely enlarged tonsils can also be an argument in favour of removal or correction. «If the tonsils are too large, this can lead to a narrowing of the upper airways, which can lead to a drop in oxygen levels during sleep,» explains Gürtler. It is not possible to generalise about when an operation is necessary. All factors must be taken into account and the decision made together with the parents and child.

The operation itself is a routine procedure and is performed under general anaesthetic. It usually takes 30 minutes and, if there are no complications, the child can return home after about two days in hospital. For the next three weeks after the procedure, the child should avoid anything that could lead to an increase in blood pressure in order to prevent secondary haemorrhaging. This includes sport, hot baths or spending too much time in the sun.

After about ten days, the child can return to nursery or school. Before that, you should avoid contact with people who have a cold in order to prevent infection.

Viral angina still possible

And afterwards? No tonsils, no worries? It's not quite that simple, but: «After a complete removal of the palatine tonsils, you should at least no longer have any bacterial tonsillitis,» says Nicolas Gürtler. However, viral pharyngitis can still occur. Inflammation of other tonsils, such as the lingual tonsil, is also still possible, but rather rare.

«Other disadvantages that occur later in life have not yet been proven,» says Gürtler. In addition, partial removal of the palatine tonsils, known as tonsillotomy, is also carried out nowadays in order to preserve the function of the tonsils - this is common practice, especially in the case of large palatine tonsils and sleep disorders.

A small consolation for those who are affected: children can enjoy lots of ice cream after a tonsillectomy. Ideally, however, only flavoured water ice cream without fruit acid, which would only irritate the sore area unnecessarily.