What is the treatment for kissing tonsils (tonsillar hypertrophy)?

From the Guidelines

Kissing tonsils, also called grade 4 tonsillar hypertrophy, typically require medical evaluation and often surgical intervention, with tonsillectomy being the definitive treatment, especially when the condition causes significant symptoms like difficulty swallowing, sleep apnea, recurrent infections, or breathing problems, as recommended by the American Academy of Otolaryngology–Head and Neck Surgery Foundation 1.

Treatment Overview

The treatment of kissing tonsils aims to alleviate symptoms, prevent complications, and improve the quality of life.

• Tonsillectomy is the primary treatment for kissing tonsils, especially when the condition causes significant symptoms.
• While waiting for surgery, temporary relief can be obtained with anti-inflammatory medications like ibuprofen (200-400mg every 6-8 hours for adults) to reduce swelling.
• A short course of oral steroids like prednisone (typically 20-60mg daily for 5-7 days) may be prescribed in severe cases.
• Antibiotics such as amoxicillin (500mg three times daily for 7-10 days) may be prescribed if bacterial infection is present.
• Gargling with warm salt water (1/2 teaspoon salt in 8 ounces of water) several times daily can provide some comfort.

Importance of Treatment

Kissing tonsils require treatment because the extreme enlargement can obstruct the airway, interfere with proper breathing during sleep, and make swallowing difficult.

• Children with this condition often need prompt attention as their airways are naturally smaller and more easily compromised by enlarged tonsils.
• Untreated kissing tonsils can lead to complications such as sleep apnea, recurrent infections, and breathing problems, which can significantly impact the quality of life.
• The American Academy of Otolaryngology–Head and Neck Surgery Foundation recommends tonsillectomy for children with obstructive sleep apnea (OSA) documented by overnight polysomnography (PSG) 1.

Surgical Intervention

Tonsillectomy is a common surgical procedure that involves the removal of the tonsils.

• The procedure is typically performed under general anesthesia and can be done on an outpatient basis.
• The recovery time for tonsillectomy is usually several days, during which time the patient may experience pain, swelling, and bleeding.
• It is essential to follow the post-operative instructions provided by the surgeon to ensure a smooth recovery and minimize the risk of complications.

Quality of Life

The treatment of kissing tonsils can significantly improve the quality of life by alleviating symptoms, preventing complications, and improving sleep quality.

• A study published in the journal Otolaryngology–Head and Neck Surgery found that tonsillectomy can improve the quality of life in children with OSA by reducing symptoms such as snoring, sleep apnea, and behavioral problems 1.
• Another study found that tonsillectomy can improve the quality of life in children with recurrent throat infections by reducing the frequency and severity of infections 1.

Conclusion is not allowed, so the answer will be ended here.

From the Research

Kissing Tonsils Treatment

• The term "kissing tonsils" is not explicitly mentioned in the provided studies, but it can be inferred that it refers to a condition where the tonsils are close together or touching, potentially causing discomfort or difficulty swallowing.
• According to the studies, tonsillitis, or inflammation of the tonsils, can be caused by viral or bacterial infections 2.
• The treatment for tonsillitis depends on the cause, with supportive care being the primary approach, and antibiotics being used if a bacterial infection is identified 2, 3, 4.
• For recurrent tonsillitis, watchful waiting is recommended if there have been less than seven episodes in the past year, less than five episodes per year for the past two years, or less than three episodes per year for the past three years 2.
• Surgical options, such as tonsillectomy, may be considered for recurrent tonsillitis or other complications, but the evidence for its effectiveness is moderate for children and low for adults 5.

Diagnostic Approaches

• Diagnostic tools, such as symptom-based validated scoring systems (e.g., Centor score), and oropharyngeal and serum laboratory testing, can be used to differentiate between viral and bacterial causes of pharyngitis and tonsillitis 2, 3, 4.
• The modified Centor/McIsaac score ≥3 can be used as an indication for antibiotic therapy in conjunction with a rapid streptotest and subsequent bacteriological culture for S. pyogenes if the screening test is negative 3.

Treatment Options

• Penicillin is the first-line antibiotic for the treatment of group A beta-hemolytic streptococcus 2, 4.
• Alternative treatments, such as oral cephalosporins or macrolides, may be used in cases of penicillin failure, frequent recurrences, or allergy 3, 4.
• Topical drugs, such as benzalkonium chloride + tyrothricin + benzocaine, may be used as an adjunctive treatment for viral or bacterial tonsillitis 3.