Tonsillitis and Homeopathic Management

Dr Beenadas

Tonsilitis
The tonsils are areas of lymphoid tissue on either side of the throat.
Most commonly, the term “tonsils” refers to the palatine tonsils/faucial tonsils that can be seen in the back of the throat.
These lymphoid tissue forms a complete ring of tonsilar tissue and lines  entire throat – Waldeyer’s tonsillar ring.
The tonsils act as part of the immune system to help protect against infection – upper respiratory tract infections.

Tonsils – 4 types.
Tonsils in humans include, from superior (top) to inferior (bottom):

• “Pharyngeal tonsils“ /  Adenoids-Roof of pharynx
• Tubal tonsils -Roof of pharynx
• Palatine tonsils / faucial tonsils-Sides of oropharynx
• Lingual tonsils -Behind terminal sulcus (tongue) 

1. Pharyngeal /  nasopharyngeal tonsil /  Adenoids
They are a mass of lymphoid tissue situated at the very back of the nose, in the roof of the nasopharynx, where the nose blends into the mouth.

In children, they make a soft mound in the roof and posterior wall of the nasopharynx, just above and behind the uvula.

Adenoid hypertrophy,

• Can obstruct airflow, so that breathing through the nose requires an uncomfortable amount of work, and inhalation occurs instead through an open mouth.
• Adenoids can also obstruct the nasal airway enough to affect the voice without actually stopping nasal airflow altogether.

Adenoid facies
Enlargement of adenoids, especially in children, causes an atypical appearance of the face, often referred to as adenoid facies.

2. Tubal tonsil
It is located posterior to the opening of the pharyngotympanic tube into the nasopharynx.

3. Lingual tonsils
The lingual tonsils extend to the top (dorsal) surface of the tongue further back down throat.

4. Palatine tonsils
Palatine tonsils/ faucial tonsils, are the tonsils that can be seen on the left and right sides at the back of the throat, at the entrance to the upper respiratory and gastrointestinal tracts

Functions of palatine tonsils

• It is one of the mucosa-associated lymphoid tissues (MALT), and protect the body from the entry of exogenous material through mucosal sites.
• Tonsillar (relating to palatine tonsil) B cells can mature to produce all the five major Ig classes
• In addition to humoral immunity elicited by B cells, there is considerable T-cell response in palatine tonsils

Cerebellar tonsil
The cerebellar tonsil (amygdaline nucleus) is a rounded mass, situated in the hemispheres of the cerebellum.

Arnold-Chiari malformation /  tonsillar herniation is a congenital anomaly of the brain in which the cerebellar tonsils are elongated and pushed down through the foramen magnum

Tonsilloliths(tonsil stones)
A tonsillolith is material that accumulates on the tonsil, they can range up to the size of a peppercorn and are white/ cream colour. They have a strong unpleasant odour and are composed of hydrogen sulfide and methyl mercaptan

People with chronic sinusitis and post nasal drip may develop tonsiloliths,

Acute tonsillitis

• In children, the tonsils are common sites of infections that may give rise to acute  tonsillitis.
• The tonsils may appear normal sized or enlarged but are usually erythematous. 

Recurrent tonsillitis

• Recurrent infection has been variably defined as from four to seven episodes of acute tonsillitis in one year, five episodes for two consecutive years or three episodes per year for 3 consecutive years.

Types

• Membranous – which is most common in children
• Follicular – having follicles in the outer layer which appears as yellow dots on the tonsil surface. It is common in young adults. 

Causes:

• Bacterial or viral infection –  beta-hemolytic streptococci
• It also occurs as an allergic reaction to allergens, for example pollens, cold things, food preservatives, drugs, mechanical injury, etc.
• In patients with auto-immune disorders, who suffer from immunodeficiency, tonsillitis may occur due to multiple infections. For example HIV, psoriasis, SLE, etc. 

The source of infection –may be food or water or droplet infection from coughing or mucous secretions of an infected person.

Symptoms

It is associated with sore throat, fever, and difficulty swallowing.

• Excess salivation and dribbling of saliva
• Painful or painless lymph node enlargement below the angle of lower jaw
• Constitutional disturbances like fever with chill and tiredness
• Recurrent or repeated attack of cold and cough.
• Ear ache and bad breath (halitosis)

Complications

• CSOM
• Quinsy
• sinusitis
• septicaemia
• Obstruction causing choking
• Rheumatism and heart strain in case of infection with haemolytic streptococci bacteria.

General treatment

• Rest
• Warm saltwater gargling for soothing effect
• Plenty of liquids to avoid painful swallowing of solid food

Avoid

• Acidic drinks like cold beverages
• Tin packed foods with preservatives
• Spicy and chilly foods
• Smoking
• Alcoholic drinks

Homoeopathic medicines

A/C Stage

BELL -congested’ red, hot face and skin, Strawberry  tongue, Right  side is worse

APIS -Oedema,BSS pains,Uvula  swollen, sac like

ARS-IOD -Scrofulous affectionsTonsils swollen, burning, Persistently irritating,corrosive  discharges, Breath fetid and glandular involvement

CAPS -Tonsillitis, burning and smarting sensation as from cayenne pepper,   not > by heat, Constriction of throat. Intense soreness, Inflamed, dark   red, swollen

CANTH -Inflammation of throat with severe burning and rawness, Great constriction of throat and larynx, with suffocation on any attempt to  swallow water

FER- PHOS – Chronic enlarged hyperaemic tonsils, smooth swelling

• Right sided
• The typical ferr-phos subject is nervous, sensitive, anaemic with the
• false plethora and easy flushing
• Prostration marked
• < Night,4-6pm,touch,jar,motion
• > Cold application

KALI-IOD

• Suited to pale, delicate, subjects with glandular swellings
• Extreme sensitiveness of parts affected
• Nocturnal aggravation
• Discharges are ichorous, corrosive and green

LACHESIS

• Left tonsils affected, tendency to go to right
• Throat purplish
• Sense of constriction, as if something was swollen which must be swallowed
• External throat extremely sensitive to touch
• Liquids more painful
• Pain radiates to ear
• < Hot drinks     <after sleep

LAC  CANINUM

• Begins on left side, changing from side to side every few hours or days
• Sensitive to touch externally
• Constant inclination to swallow, painful almost impossible
• Pain extends to ears
• Sore throat and cough are apt to begin and end with menses
• Probably no remedy in the Materia Medica presents a more  valuable pathogenesis in symptoms of the throat

LYCOPODIUM

• Chronic enlargement of tonsils, which are covered with small ulcers
• Affects right side, right to left
• Children weak, emaciated, with well developed head, but puny, sickly bodies
• < 4-8 pm, cold drinks,  > warm  drinks

MERCURIUS

• More advanced stage When pus has formed, great swelling, whole fauces deep red
• tonsils darker than any other parts,
• ulcers form
• Profuse sweating without relief
• Profuse salivation, breath offensive
• Tongue large flabby with imprint of teeth
• Moist tongue with thirst
• < at night, damp, cold rainy weather

MERCURIUS IODATUS FLAVUS

• Right  sided
• Throat affections with greatly swollen glands
• Tongue  coated thickly yellow at the base
• Constant inclination to swallow
• Better cold drinks

MERCURIUS IODATUS RUBER

• Left sided with  marked glandular swelling
• Parenchymatous tonsillitis
• Will often abort peri-tonsillitis if given frequently

BARYA CARB

• Suppurating tonsils from every cold, stitching and smarting pain, < empty swallowing.
• Can swallow only  liquids.
• Tonsils inflamed with swollen veins.

HEP.SULP

• Sensation as if a plug and of a splinter in throat.
• Quinsy with impending suppuration.

ECHINACEA

• Tonsils purple or black, grey exudation extending to post.nares and air passages.
• Eucalyptus,Tonsils enlarged, ulcerated and throat inflamed

FAGOPYRUM

• Soreness and feeling of excoriation deep down pharynx. Uvula enlarged, tonsils swollen.

FRAGARIA

• Swollen tonsils with strawberry tongue

NITRIC ACID

• Suited to thin persons of rigid fibre, dark   complexions, black hair and eyes
• Catch cold easily
• Sensation of splinter in throat, worse from touch
• Extreme fetidity and corrosiveness of all discharges
• Chilly, loves salt and fat
• Depressed and anxious
• < Evening and night, cold climate
• > Riding in a carriage

KALI MURIATICUM

• Valuable remedy in a/c or c/c tonsillitis with much swelling
• Almost a specific in follicular tonsillitis
• Throat has a gray look, spotted with white

NATRUM MURIATICUM

• Especially for the anemic and cachetic
• Great emaciation, losing flesh while eating well
• Great liability to take cold
• Craving for salt, aversion to bread
• Consolation aggravates
• < Heat of sun,  < sea shore
• > Open air,    >cold bathing

NUXVOMICA

• Is  irritable and oversensitive to external impression
• Coryza dry at night, fluent by day, < warm room, >cold air
• Easily chilled, avoid open air.
• Frequent ineffectual urging for stool
• < Morning,< cold air
• < Damp wet weather 

AGRAPHIS NUTANS

• Enlarged tonsils.
• Throat and ear complaints with tendency to free discharge from mucus membrane.
• Adenoids enlarged, throat deafness.

IODUM

• Persons of a scrofulous diathesis, dark complexioned with enlarged lymphatic glands
• Great emaciation, ravernous appetite
• Acute exacerbation of c/c inflammation
• Hot patient
• < Warm room  > walking in open air

PHOSPHOROUS

• Adapted to tall slender persons of sanguine temperament
• Great susceptibility to external impression
• Thirst for very cold water
• Burning sensation in throat
• Hoarseness and aphonia, worse evening
• Worse lying on left side
• < Evening     < thunder storm  < warm to cold air

PHYTOLACCA

• Pre-eminently a glandular remedy
• Right sided tonsillitis, dark red colour, uvula large dropsical, almost translucent
• Burning as from a coal, of fire or red hot iron, dryness
• Sensation of lump in the throat
• Pain shoots from throat into ears on swallowing
• Quinsy
• < Hot drinks

PSORINUM

• Especially adapted to psoric constitution
• In chronic cases when well selected remedies fails to relieve or permanently improve
• Great  sensitiveness to cold
• Tonsils greatly swollen, difficult painful swallowing
• Profuse offensive saliva
• Tough mucus in throat, must hawk continually
• Eradicates tendency to quinsy
• < Change of weather
• Better by heat

POLYPORUS PINICOLA

• Throat dry, sore, frequent inclination to swallow. Tonsils much congested and enlarged, frequent efforts to swallow, quite painful

PULSATILLA

• Mild, gentle, yielding disposition
• Symptoms ever changing
• Discharges are thick, bland and yellowish green
• Aversion to fatty, warm food and drinks
• Thirstlessness with dry mouth
• Desires open air
• < Warm close room  <evening
• > Open air, cold air and room

SANGUNARIA CANADENSIS

• Right  sided  tonsillitis
• Burning sensation
• Circumscribed red cheeks
• Tongue white, feels scalded
• Quinsy

SEPIA OFFICINALIS

• Left side inflamed, much swelling with little redness
• Sensation of lump in throat
• Waked with sensation  as if had swallowed something which has struck in the throat
• Contraction of throat when swallowing
• Sepia is chilly, indifferent White or gray coating at the base of tongue
• Intolerant to cold and closed places

SILICEA

• Cold, chilly, hugs the fire
• Wants plenty of warm clothing, hates drafts, hands and feel cold,
• Worse in winter
• Scrofulous rachitic children, much sweating about the head
• Ailments, caused by suppressed foot sweat
• Periodical quinsy, pricking as of a pin in tonsil
• Colds settle in throat
• Bad effects of vaccination

SOLANUM-NIGRUM

• Throat sore as if burnt, stiches in right side of throat.
• Raw sensation, painful swallowing, solids or liquids <  on swallowing, at times stitches shooting to drum of right ear.
• Left tonsils swollen. Feeling as if splinter in right tonsil.

SULPHUR

• When carefully selected remedies fail to produce a favourable effect, especially in acute cases
• Chronic  sore throat
• Burning and dryness in throat
• Complaints that are continually relapsing
• Scrofulous, psoric, chronic diseases  that result from suppressed eruption
• Ragged philosopher
• For lean, stoop shouldered persons, standing is the worst position
• Children dislike washing
• <  When  standing
• <  Warmth of bed

TUBERCULINUM

• Tubercular diathesis, tall, slim, flat, narrow chest
• Active and precocious mentally, weak physically
• When symptoms are constantly changing and well selected remedies fails to improve
• Patient takes cold from the slightest exposure
• Emaciation rapid and pronounced
• Enlarged tonsil
• Aversion to meat

THUJA

• Swelling of tonsils and throat
• Accumulation of a large quantity of tenacious mucus in mouth
• Throat feels raw, dry, as from a plug, or as if it were constricted  when swallowing
• Hahnemann’s chief anti sycotic
• Hydrogenoid constitution
• Ill effects of vaccination
• Sweat only on uncovered  parts or all over except head, stops when
• he wakes.   Profuse sour smelling fetid at night
• < Cold damp air
• < Night,3.a.m and 3 p.m

GELSEMIUM

• Painful spot deep in tonsil, hurting out of proportion on swallowing,
• Red, inflamed throat, pain streaking to ear, rapid progress.

AMYGDALA PERSICA

• Has dark injection of the fauces, sharp pains, and difficult swallowing.

GUAIACUM

• One of the most useful remedies at the commencement of an attack,   especially of catarrhal tonsillitis.
• The characteristics are violent burning, headache, throat hot, chill and   aching in back and limbs; abscesses form quickly. In the 1x frequently repeated it will often abort. 

RAPHANUS  

• Heat and burning in throat, at times, chiefly in tonsils, with  lancinations.
• Swelling, redness and pain in tonsils, as if raw. 

STAPHISAGRIA 

• Tonsillitis, on swallowing a stitch runs up from throat into ear.
• Both tonsils inflamed and swollen. 

GUN POWDER : Septic tonsillitis.

SABADILLA

• It is useful when the  disease begins on the left side and extends to the right  [Lach.].
• The pain is worse from empty swallowing and is relieved by warm drinks.
• Sometimes there is a sensation as of a thread or string in the  throat or else,  a sense of constriction 

COLCHICUM AUTUMNALE

• Tonsils inflamed and swollen, here and there spots covered with pus; difficult swallowing;
• Throat dry, with flow of watery saliva; nausea and discomfort 

CUPRUM METALLICUM

• Tonsils, palate and fauces red and inflamed; dull, piercing pain in left tonsils
• Aggr. from external touch 

DROSERA ROTUNDIFOLIA

• Dry, but not shining, mucous membrane;
• Muscles of pharynx swollen;
• Deglutition painful; incessant cough, sometimes ending in vomiting;
• Color of throat of a dark coppery red. 

ELAPS CORALUM

• Tonsils swollen so that no passage is visible, deglutition impossible, throat sensitive to touch 

MANCINELLA

• Great swelling and suppuration of tonsils, with danger of suffocation; whistling breathing;
• Yellowish-white ulcers on tonsils, with violent burning pain; great elongation of uvula; offensive breath. 

NATRIUM PHOSPHORICUM

• Catarrh of tonsils with golden, yellow-tinged exudation, from an acid condition of stomach. 

NATRIUM SULPHURICUM

• Sycosis; tonsils and uvula inflamed and swollen, with ulceration. 

PETROLEUM

• Angina granulosa, with stitches in ears during swallowing and burning in neck; slimy, flat or putrid taste in mouth, with mucous secretions or dry sore throat. 

PLUMBUM METALLICUM

• Tonsils inflamed, covered with small, painful abscesses;
• Angina granulosa, going from left to right; fluids can be swallowed, but solid food comes back into the mouth 

RANUNCULUS SCELERATUS

• Swelling of tonsils, with shooting stitches in them; scraping or burning in throat 

SINAPIS NIGRA

• Sore, hot pains, with sensation of extreme dryness of throat and tongue,
• Tongue thickly coated, fissured in median line; voice nasal; hardly any thirst. 

SANGUNARINUM NITRICUM

• Rough, dry constricted, burning. Right tonsil sore. Swallowing difficult. 

TEPLITZ

• Pain in throat without redness, on swallowing.
• Swelling of uvula and tonsils with difficulty in swallowing.
• Swelling of cervical glands. 

USTILAGO

• Frequent attack of tonsillitis.
• Tonsils are congested and enlarged. The left tonsils is esp. affected.
• It looks large and dusky.
• There is intense pain on swallowing, lancinating pain extents from the tonsils to ear.
• The throat is dry and there is feeling of lump, behind the larynx which make the swallow constantly.