From the Guidelines
Tonsillectomy is recommended for treatment of adult obstructive sleep apnea (OSA) in the presence of tonsillar hypertrophy, as stated in the European Respiratory Journal 1. When considering the management of bilateral tonsillar enlargement in adults, it's crucial to assess the severity of symptoms and the underlying cause. For mild and asymptomatic cases, watchful waiting and symptomatic treatment may be appropriate. However, for symptomatic cases, especially those with suspected infection, antibiotics like amoxicillin-clavulanate or clindamycin may be prescribed, alongside anti-inflammatory medications such as ibuprofen to reduce pain and swelling. In severe cases, where there is significant airway obstruction, sleep apnea, or recurrent infections, tonsillectomy is a recommended intervention, particularly if tonsillar hypertrophy is present, as supported by the 2011 study in the European Respiratory Journal 1. Before proceeding with surgery, a thorough evaluation, including physical examination and possibly imaging studies, is necessary to rule out malignancy, especially in adults over 40 with asymmetric enlargement or other concerning symptoms. For postoperative pain management after tonsillectomy, a multimodal analgesic regimen including paracetamol, NSAIDs, dexamethasone, and opioids as needed, is recommended, as outlined in the 2021 guideline published in Anaesthesia 1. This approach aims to balance effective pain control with the potential risks of analgesic interventions. Recovery from tonsillectomy typically requires careful management, including a soft diet and adequate hydration, over a period of 10-14 days.
Key considerations in the management of bilateral tonsillar enlargement in adults include:
- Thorough evaluation to determine the underlying cause and severity of symptoms
- Symptomatic treatment for mild cases
- Antibiotics and anti-inflammatory medications for infectious cases
- Tonsillectomy for severe cases with significant symptoms or complications
- Comprehensive postoperative pain management using a multimodal approach
- Close monitoring during the recovery period to manage potential complications and ensure adequate hydration and nutrition.
From the Research
Bilateral Tonsils Enlargement in Adults
Bilateral tonsillar enlargement in adults can be caused by various factors, including viral or bacterial infections, and can lead to symptoms such as sore throat, difficulty swallowing, and upper airway obstruction.
- The management of bilateral tonsillar enlargement depends on the underlying cause and severity of symptoms.
- According to 2, tonsillitis is caused by a viral infection in 70% to 95% of cases, while bacterial infections account for 5% to 15% of cases in adults.
- Diagnosis of tonsillitis can be made using symptom-based validated scoring systems, such as the Centor score, and laboratory testing, including oropharyngeal and serum tests 2.
Treatment Approaches
Treatment for bilateral tonsillar enlargement in adults typically involves supportive care, including pain management and hydration.
- In cases of bacterial tonsillitis, antibiotic treatment may be necessary, with penicillin being the first-line antibiotic 2.
- For recurrent acute 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, 3.
- Tonsillectomy may be indicated in cases of recurrent acute tonsillitis, with a specific criteria of ≥7 episodes in the preceding year, ≥5 episodes in each of the preceding 2 years, or ≥3 episodes in each of the preceding 3 years 3.
Clinical Significance and Size Variation
Asymptomatic unilateral tonsillar enlargement is usually treated with systematic tonsillectomy under suspicion of malignancy, but most cases are benign pathologies 4.