Dr. Heena Desai
TONSILITIS:
Definition:
Tonsillitis is inflammation of the tonsils, two oval-shaped pads of tissue at the back of the throat — one tonsil on each side. Signs and symptoms of tonsillitis include swollen tonsils, sore throat, difficulty swallowing and tender lymph nodes on the sides of the neck.
Description:
Most cases of tonsillitis are caused by infection with a common virus, but bacterial infections also may cause tonsillitis.
Because appropriate treatment for tonsillitis depends on the cause, it's important to get a prompt and accurate diagnosis. Surgery to remove tonsils, once a common procedure to treat tonsillitis, is usually performed only when tonsillitis occurs frequently, doesn't respond to other treatments or causes serious complications.
Symptoms
Tonsillitis most commonly affects children between preschool ages and the midteenage years. Common signs and symptoms of tonsillitis include:
In young children who are unable to describe how they feel, signs of tonsillitis may include:
When to see a doctor
It's important to get an accurate diagnosis if your child has symptoms that may indicate tonsillitis.
Call your doctor if your child is experiencing:
Get immediate care if your child has any of these signs:
Causes
Tonsillitis is most often caused by common viruses, but bacterial infections also can be the cause.
The most common bacterium causing tonsillitis is Streptococcus pyogenes (group A streptococcus), the bacterium that causes strep throat. Other strains of strep and other bacteria also may cause tonsillitis.
Why do tonsils get infected?
The tonsils are the immune system's first line of defense against bacteria and viruses that enter your mouth. This function may make the tonsils particularly vulnerable to infection and inflammation. However, the tonsil's immune system function declines after puberty — a factor that may account for the rare cases of tonsillitis in adults.
Risk factors
Risk factors for tonsillitis include:
Complications
Inflammation or swelling of the tonsils from frequent or ongoing (chronic) tonsillitis can cause complications such as:
Strep infection
If tonsillitis caused by group A streptococcus or another strain of streptococcal bacteria isn't treated or if antibiotic treatment is incomplete, your child has an increased risk of rare disorders such as:
Prevention
The germs that cause viral and bacterial tonsillitis are contagious. Therefore, the best prevention is to practice good hygiene. Teach your child to:
To help your child prevent the spread of a bacterial or viral infection to others:
Diagnosis
Your child's doctor will start with a physical exam that will include:
Throat swab
With this simple test, the doctor rubs a sterile swab over the back of your child's throat to get a sample of secretions. The sample will be checked in the clinic or in a lab for streptococcal bacteria.
Many clinics are equipped with a lab that can get a test result within a few minutes. However, a second more reliable test is usually sent out to a lab that can often return results within several hours or a couple of days.
If the rapid in-clinic test comes back positive, then your child almost certainly has a bacterial infection. If the test comes back negative, then your child likely has a viral infection. Your doctor will wait, however, for the more reliable out-of-clinic lab test to determine the cause of the infection.
Complete blood cell count (CBC)
Your doctor may order a CBC with a small sample of your child's blood. The result of this test, which can often be completed in a clinic, produces a count of the different types of blood cells. The profile of what's elevated, what's normal or what's below normal can indicate whether an infection is more likely caused by a bacterial or viral agent. A CBC is not often needed to diagnose strep throat. However, if the strep throat lab test is negative, the CBC may be needed to help determine the cause of tonsillitis.
Treatment
At-home care
Whether tonsillitis is caused by a viral or bacterial infection, at-home care strategies can make your child more comfortable and promote better recovery.
If a virus is the expected cause of tonsillitis, these strategies are the only treatment. Your doctor won't prescribe antibiotics. Your child will likely be better within seven to 10 days.
At-home care strategies to use during the recovery time include the following:
Antibiotics
If tonsillitis is caused by a bacterial infection, your doctor will prescribe a course of antibiotics. Penicillin taken by mouth for 10 days is the most common antibiotic treatment prescribed for tonsillitis caused by group A streptococcus. If your child is allergic to penicillin, your doctor will prescribe an alternative antibiotic.
Your child must take the full course of antibiotics as prescribed even if the symptoms go away completely. Failure to take all of the medication as directed may result in the infection worsening or spreading to other parts of the body. Not completing the full course of antibiotics can, in particular, increase your child's risk of rheumatic fever and serious kidney inflammation.
Talk to your doctor or pharmacist about what to do if you forget to give your child a dose.
Surgery
Surgery to remove tonsils (tonsillectomy) may be used to treat frequently recurring tonsillitis, chronic tonsillitis or bacterial tonsillitis that doesn't respond to antibiotic treatment. Frequent tonsillitis is generally defined as:
A tonsillectomy may also be performed if tonsillitis results in difficult-to-manage complications, such as:
A tonsillectomy is usually done as an outpatient procedure, unless your child is very young, has a complex medical condition or if complications arise during surgery. That means your child should be able to go home the day of the surgery. A complete recovery usually takes seven to 14 days.
Preparing for your appointment
If your child is experiencing a sore throat, difficulty swallowing or other symptoms that may indicate tonsillitis, you'll likely start with a visit to your family doctor or your child's pediatrician. You may be referred to a specialist in ear, nose and throat disorders.
Your doctor is likely to ask you a number of questions about your child's condition. Be prepared to answer the following questions:
Do symptoms seem to affect his or her sleep?
Has your child been exposed to anyone known to have strep throat?
Questions you may want to ask your doctor include the following:
COMMON COLD IN BABIES:
Definition:A common cold is a viral infection of your baby's nose and throat. Nasal congestion and a runny nose are the main signs of a cold.
Description:
Babies are especially likely to get the common cold, in part because they're often around older children. Also, they have not yet developed immunity to many common infections. Within the first year of life, most babies have six to eight colds. They may have even more if they're in child care centers.
Treatment for the common cold in babies involves easing their symptoms, such as by providing fluids, keeping the air moist and helping them keep their nasal passages open. Very young infants must see a doctor at the first sign of the common cold to make sure croup, pneumonia or other more serious illnesses aren't present.
Symptoms
The first signs of the common cold in a baby are often:
Other signs and symptoms of a common cold in a baby may include:
When to see a doctor
Your baby's immune system will need time to mature. If your baby has a cold with no complications, it should resolve within 10 to 14 days. Most colds are simply a nuisance. But it's important to take your baby's signs and symptoms seriously. If symptoms don't improve or if they worsen, it's time to talk to your doctor.
If your baby is younger than 3 months of age, call the doctor early in the illness. In newborns, it's especially important to make sure that a more serious illness isn't present, especially if your baby has a fever.
If your baby is 3 months old or older, call the doctor if your baby:
Seek medical help immediately if your baby:
Causes
The common cold is an infection of the nose and throat (upper respiratory tract infection) that can be caused by one of more than 200 viruses. Rhinoviruses are the most common.
A cold virus enters your baby's body through his or her mouth, eyes or nose.
Once infected by a virus, your baby generally becomes immune to that virus. But because so many viruses cause colds, your baby may have several colds a year and many throughout his or her lifetime. Also, some viruses don't produce lasting immunity.
Your baby can be infected with a virus by:
Risk factors
A few factors put babies at higher risk of a common cold.
Complications
These conditions can occur along with a common cold:
Prevention
There's no vaccine for the common cold. The best defense against the common cold is commonsense precautions and frequent hand-washing.
Simple preventive measures can help keep the common cold at bay.
Diagnosis
If your baby is younger than 3 months of age, call his or her doctor early in the illness. In newborns, it's especially important to make sure that a more serious illness isn't present, especially if your baby has a fever.
In general, you don't need to see the doctor if your older baby has a common cold. If you have questions or if your baby's symptoms worsen or don't go away, it might be time to see the doctor.
Your baby's doctor can generally diagnose a common cold by your baby's signs and symptoms. If your doctor suspects your baby has a bacterial infection or other condition, he or she may order a chest X-ray or other tests to exclude other causes of your baby's symptoms.
Treatment
There's no cure for the common cold. Most cases of the common cold get better without treatment, usually within a week to 10 days, but a cough may linger for a week or more. Antibiotics don't work against cold viruses.
Try to make your baby more comfortable with measures such as making sure he or she drinks enough fluids, suctioning nasal mucus and keeping the air moist.
Over-the-counter (OTC) medications generally should be avoided in babies.
Fever-reducing medications
You can use OTC fever-reducing medications if a fever is making your child uncomfortable. However, these medications don't kill the cold virus. Fever is a part of your child's natural response to the virus, so it may help to allow your child to have a low-grade fever.
For treatment of fever or pain in children, consider giving your child infants' or children's over-the-counter fever and pain medications such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others). These are safer alternatives to aspirin.
For children younger than 3 months old, don't give acetaminophen until your baby has been seen by a doctor. Don't give ibuprofen to a child younger than 6 months old or to children who are vomiting constantly or are dehydrated. Use these medications for the shortest time. If you give your child a pain reliever, follow the dosing guidelines carefully. Call your doctor if you have questions about the right dosage for your baby.
Children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition, in such children.
Cough and cold medications
Cough and cold medications aren't safe for infants and young children. OTC cough and cold medicines don't treat the underlying cause of a child's cold and won't make it go away sooner ⸺ and they can be dangerous to your baby. Cough and cold medications have potentially serious side effects, including fatal overdoses in children younger than 2 years old.
Don't use over-the-counter medicines, except for fever reducers and pain relievers, to treat coughs and colds in children younger than 6 years old. Also consider avoiding use of these medicines for children younger than 12 years old.
Lifestyle and home remedies
Most often, you can treat an older baby's cold at home. To make your baby as comfortable as possible, try some of these suggestions:
Preparing for your appointment
If you need to see your baby's pediatrician or family doctor, here's some information to help you get ready for your baby's appointment.
What you can do
Make a list of:
For a common cold, some questions to ask the doctor include:
Don't hesitate to ask other questions you have.
What to expect from your doctor
Your baby's doctor is likely to ask you questions, including:
Your doctor will ask additional questions based on your responses and your baby's symptoms and needs. Preparing and anticipating questions will help you make the most of your time with the doctor.
EAR INFECTION(MIDDLE EAR):
Definition:
An ear infection (sometimes called acute otitis media) is an infection of the middle ear, the air-filled space behind the eardrum that contains the tiny vibrating bones of the ear. Children are more likely than adults to get ear infections.
Description:
Because ear infections often clear up on their own, treatment may begin with managing pain and monitoring the problem. Sometimes, antibiotics are used to clear the infection. Some people are prone to having multiple ear infections. This can cause hearing problems and other serious complications.
Symptoms
The onset of signs and symptoms of ear infection is usually rapid.
Children
Adults
Common signs and symptoms in adults include:
When to see a doctor
Signs and symptoms of an ear infection can indicate several conditions. It's important to get an accurate diagnosis and prompt treatment. Call your child's doctor if:
Causes:
An ear infection is caused by a bacterium or virus in the middle ear. This infection often results from another illness — cold, flu or allergy — that causes congestion and swelling of the nasal passages, throat and eustachian tubes.
Role of eustachian tubes
The eustachian tubes are a pair of narrow tubes that run from each middle ear to high in the back of the throat, behind the nasal passages. The throat end of the tubes open and close to:
Swollen eustachian tubes can become blocked, causing fluids to build up in the middle ear. This fluid can become infected and cause the symptoms of an ear infection.
In children, the eustachian tubes are narrower and more horizontal, which makes them more difficult to drain and more likely to get clogged.
Role of adenoids
Adenoids are two small pads of tissues high in the back of the nose believed to play a role in immune system activity.
Because adenoids are near the opening of the eustachian tubes, swelling of the adenoids may block the tubes. This can lead to middle ear infection. Swelling and irritation of adenoids is more likely to play a role in ear infections in children because children have relatively larger adenoids compared to adults.
Related conditions
Conditions of the middle ear that may be related to an ear infection or result in similar middle ear problems include:
Risk factors
Risk factors for ear infections include:
Complications
Most ear infections don't cause long-term complications. Ear infections that happen again and again can lead to serious complications:
Prevention
The following tips may reduce the risk of developing ear infections:
Diagnosis
Your doctor can usually diagnose an ear infection or another condition based on the symptoms you describe and an exam. The doctor will likely use a lighted instrument (an otoscope) to look at the ears, throat and nasal passage. He or she will also likely listen to your child breathe with a stethoscope.
Pneumatic otoscope
An instrument called a pneumatic otoscope is often the only specialized tool a doctor needs to diagnose an ear infection. This instrument enables the doctor to look in the ear and judge whether there is fluid behind the eardrum. With the pneumatic otoscope, the doctor gently puffs air against the eardrum. Normally, this puff of air would cause the eardrum to move. If the middle ear is filled with fluid, your doctor will observe little to no movement of the eardrum.
Additional tests
Your doctor may perform other tests if there is any doubt about a diagnosis, if the condition hasn't responded to previous treatments, or if there are other long-term or serious problems.
What a diagnosis means
Treatment
Some ear infections resolve without antibiotic treatment. What's best for your child depends on many factors, including your child's age and the severity of symptoms.
A wait-and-see approach
Symptoms of ear infections usually improve within the first couple of days, and most infections clear up on their own within one to two weeks without any treatment. The American Academy of Pediatrics and the American Academy of Family Physicians recommend a wait-and-see approach as one option for:
Some evidence suggests that treatment with antibiotics might be helpful for certain children with ear infections. On the other hand, using antibiotics too often can cause bacteria to become resistant to the medicine. Talk with your doctor about the potential benefits and risks of using antibiotics.
Managing pain
Your doctor will advise you on treatments to lessen pain from an ear infection. These may include the following:
Antibiotic therapy
After an initial observation period, your doctor may recommend antibiotic treatment for an ear infection in the following situations:
Children younger than 6 months of age with confirmed acute otitis media are more likely to be treated with antibiotics without the initial observational waiting time.
Even after symptoms have improved, be sure to use the antibiotic as directed. Failing to take all the medicine can lead to recurring infection and resistance of bacteria to antibiotic medications. Talk with your doctor or pharmacist about what to do if you accidentally miss a dose.
Ear tubes
If your child has certain conditions, your child's doctor may recommend a procedure to drain fluid from the middle ear. If your child has repeated, long-term ear infections (chronic otitis media) or continuous fluid buildup in the ear after an infection cleared up (otitis media with effusion), your child's doctor may suggest this procedure.
During an outpatient surgical procedure called a myringotomy, a surgeon creates a tiny hole in the eardrum that enables him or her to suction fluids out of the middle ear. A tiny tube (tympanostomy tube) is placed in the opening to help ventilate the middle ear and prevent the buildup of more fluids. Some tubes are intended to stay in place for four to 18 months and then fall out on their own. Other tubes are designed to stay in longer and may need to be surgically removed.
The eardrum usually closes up again after the tube falls out or is removed.
Treatment for chronic suppurative otitis media
Chronic infection that results in a hole or tear in the eardrum — called chronic suppurative otitis media — is difficult to treat. It's often treated with antibiotics administered as drops. You may receive instructions on how to suction fluids out through the ear canal before administering drops.
Monitoring
Children who have frequent infections or who have persistent fluid in the middle ear will need to be monitored closely. Talk to your doctor about how often you should schedule follow-up appointments. Your doctor may recommend regular hearing and language tests.
Preparing for your appointment
You'll likely begin by seeing your family doctor or your child's pediatrician. You may be referred to a specialist in ear, nose and throat (ENT) disorders if the problem has persisted for some time, is not responding to treatment or has occurred frequently.
If your child is old enough to respond, before your appointment talk to the child about questions the doctor may ask and be prepared to answer questions on behalf of your child. Questions for adults will address most of the same issues.
INFLUENZA:
Definition:
Influenza is a viral infection that attacks your respiratory system — your nose, throat and lungs. Influenza is commonly called the flu, but it's not the same as stomach "flu" viruses that cause diarrhea and vomiting.
Description:
For most people, the flu resolves on its own. But sometimes, influenza and its complications can be deadly. People at higher risk of developing flu complications include:
Though the annual influenza vaccine isn't 100% effective, it's still your best defense against the flu.
Symptoms
At first, the flu may seem like a common cold with a runny nose, sneezing and sore throat. But colds usually develop slowly, whereas the flu tends to come on suddenly. And although a cold can be a bother, you usually feel much worse with the flu.
Common signs and symptoms of the flu include:
When to see a doctor
Most people who get the flu can treat themselves at home and often don't need to see a doctor.
If you have flu symptoms and are at risk of complications, see your doctor right away. Taking antiviral drugs may reduce the length of your illness and help prevent more-serious problems.
If you have emergency signs and symptoms of the flu, get medical care right away. For adults, emergency signs and symptoms can include:
Emergency signs and symptoms in children can include:
Diagnosis:
Your doctor will conduct a physical exam, look for signs and symptoms of influenza, and possibly order a test that detects influenza viruses.
During times when influenza is widespread, you may not need to be tested for influenza. Your doctor may diagnose you based on your signs and symptoms.
In some cases, your doctor may suggest that you be tested for influenza. He or she may use various tests to diagnose influenza. Polymerase chain reaction (PCR) testing is becoming more common in many hospitals and labs. This test may be done while you're in your doctor's office or in the hospital. PCR testing is more sensitive than other tests and may be able to identify the influenza strain.
It's possible to have a test to diagnose both influenza and COVID-19. You may have both COVID-19 and influenza at the same time.
Treatment
Usually, you'll need nothing more than rest and plenty of fluids to treat the flu. But if you have a severe infection or are at higher risk of complications, your doctor may prescribe an antiviral drug to treat the flu. These drugs can include oseltamivir (Tamiflu), zanamivir (Relenza), peramivir (Rapivab) or baloxavir (Xofluza). These drugs may shorten your illness by a day or so and help prevent serious complications.
Oseltamivir is an oral medication. Zanamivir is inhaled through a device similar to an asthma inhaler and shouldn't be used by anyone with certain chronic respiratory problems, such as asthma and lung disease.
Antiviral medication side effects may include nausea and vomiting. These side effects may be lessened if the drug is taken with food.
Most circulating strains of influenza have become resistant to amantadine and rimantadine (Flumadine), which are older antiviral drugs that are no longer recommended.
Lifestyle and home remedies
If you do come down with the flu, these measures may help ease your symptoms:
To help control the spread of influenza in your community, stay home and keep sick children home until the fever has been gone for 24 hours. Avoid being around other people until you're feeling better, unless you're getting medical care. If you do need to leave your home and get medical care, wear a face mask. Wash your hands often.
BRONCHITIS:
Definition:
Bronchitis is an inflammation of the lining of your bronchial tubes, which carry air to and from your lungs. People who have bronchitis often cough up thickened mucus, which can be discolored. Bronchitis may be either acute or chronic.
Description:
Often developing from a cold or other respiratory infection, acute bronchitis is very common. Chronic bronchitis, a more serious condition, is a constant irritation or inflammation of the lining of the bronchial tubes, often due to smoking.
Acute bronchitis, also called a chest cold, usually improves within a week to 10 days without lasting effects, although the cough may linger for weeks.
However, if you have repeated bouts of bronchitis, you may have chronic bronchitis, which requires medical attention. Chronic bronchitis is one of the conditions included in chronic obstructive pulmonary disease (COPD).
Symptoms
For either acute bronchitis or chronic bronchitis, signs and symptoms may include:
If you have acute bronchitis, you might have cold symptoms, such as a mild headache or body aches. While these symptoms usually improve in about a week, you may have a nagging cough that lingers for several weeks.
Chronic bronchitis is defined as a productive cough that lasts at least three months, with recurring bouts occurring for at least two consecutive years.
If you have chronic bronchitis, you're likely to have periods when your cough or other symptoms worsen. At those times, you may have an acute infection on top of chronic bronchitis.
When to see a doctor
See your doctor if your cough:
Causes
Acute bronchitis is usually caused by viruses, typically the same viruses that cause colds and flu (influenza). Antibiotics don't kill viruses, so this type of medication isn't useful in most cases of bronchitis.
The most common cause of chronic bronchitis is cigarette smoking. Air pollution and dust or toxic gases in the environment or workplace also can contribute to the condition.
Risk factors
Factors that increase your risk of bronchitis include:
Complications
Although a single episode of bronchitis usually isn't cause for concern, it can lead to pneumonia in some people. Repeated bouts of bronchitis, however, may mean that you have chronic obstructive pulmonary disease (COPD).
Prevention
To reduce your risk of bronchitis, follow these tips:
Diagnosis:
During the first few days of illness, it can be difficult to distinguish the signs and symptoms of bronchitis from those of a common cold. During the physical exam, your doctor will use a stethoscope to listen closely to your lungs as you breathe.
In some cases, your doctor may suggest the following tests:
Treatment
Most cases of acute bronchitis get better without treatment, usually within a couple of weeks.
Medications
Because most cases of bronchitis are caused by viral infections, antibiotics aren't effective. However, if your doctor suspects that you have a bacterial infection, he or she may prescribe an antibiotic.
In some circumstances, your doctor may recommend other medications, including:
Therapies
If you have chronic bronchitis, you may benefit from pulmonary rehabilitation — a breathing exercise program in which a respiratory therapist teaches you how to breathe more easily and increase your ability to exercise.
Lifestyle and home remedies
To help you feel better, you may want to try the following self-care measures:
Preparing for your appointment
You're likely to start by seeing your family doctor or a general practitioner. If you have chronic bronchitis, you may be referred to a doctor who specializes in lung diseases (pulmonologist).
What you can do
Before your appointment, you may want to write a list that answers the following questions:
You might also want to bring a family member or friend to your appointment. Sometimes it can be difficult to remember all the information provided. Someone who accompanies you may remember something that you missed or forgot.
If you've ever seen another physician for your cough, let your present doctor know what tests were done, and if possible, bring the reports with you, including results of a chest X-ray, sputum culture and pulmonary function test.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as: