Anita

05 February, 2010

Meningitis

Meningitis is an inflammation of the membranes (meninges) and cerebrospinal fluid surrounding your brain and spinal cord, usually due to the spread of an infection. The swelling associated with meningitis often triggers the "hallmark" symptoms of this condition, including headache, fever and a stiff neck.

Most cases of meningitis are caused by a viral infection, but bacterial and fungal infections also can lead to meningitis. Depending on the cause of the infection, meningitis can resolve on its own in a couple of weeks — or it can be a life-threatening emergency.

If you suspect that you or someone in your family has signs or symptoms of meningitis, seek medical care right away. Early treatment can prevent serious complications.

It's easy to mistake the early signs and symptoms of meningitis for the flu (influenza). Meningitis symptoms may develop over a period of one or two days and typically include:

A high fever
Severe headache
Vomiting or nausea with headache
Confusion, or difficulty concentrating — in the very young, this may appear as inability to maintain eye contact
Seizures
Sleepiness or difficulty waking up
Stiff neck
Sensitivity to light
Lack of interest in drinking and eating
Skin rash in some cases, such as in viral or meningococcal meningitis

Earlier signs and symptoms that may suggest a serious infection, although not necessarily meningitis, include:

Leg pain
Ice-cold hands and feet
Abnormally pale skin tone

Signs in newborns
Newborns and young infants may not have the classic signs and symptoms of headache and stiff neck. Instead, signs and symptoms of meningitis in this age group may include:

Constant crying
Excessive sleepiness or irritability
Poor feeding
A bulge in the soft spot on top of a baby's head (fontanel)
Stiffness in the baby's body and neck

Infants with meningitis may be difficult to comfort, and may even cry harder when picked up.

If you or your child has bacterial meningitis, delaying treatment increases the risk of permanent brain damage. In addition, bacterial meningitis can prove fatal in a matter of days. Seek medical care right away if you or anyone in your family has any signs or symptoms.

Meningitis usually results from a viral infection, but the cause may also be a bacterial infection. Less commonly, a fungal infection may cause meningitis. Because bacterial infections are the most damaging, identifying the source of the infection is an important part of developing a treatment plan.

Bacterial meningitis
Acute bacterial meningitis usually occurs when bacteria enter the bloodstream and migrate to the brain and spinal cord. But it can also occur when bacteria directly invade the meninges, as a result of an ear or sinus infection or a skull fracture.

A number of strains of bacteria can cause acute bacterial meningitis. The most common include:

Streptococcus pneumoniae (pneumococcus). This bacterium is the most common cause of bacterial meningitis in infants and young children in the United States. It can also cause pneumonia and ear and sinus infections. When pneumococcal meningitis is associated with an ear infection, it's not always clear which came first — the meningitis or the ear infection — because they usually occur together.
Neisseria meningitidis (meningococcus). This bacterium is another leading cause of bacterial meningitis. Meningococcal meningitis commonly occurs when bacteria from an upper respiratory infection enter your bloodstream. This infection is highly contagious and may cause local epidemics in college dormitories and boarding schools and on military bases.
Haemophilus influenzae (haemophilus). Before the 1990s, Haemophilus influenzae type b (Hib) bacterium was the leading cause of bacterial meningitis. But new Hib vaccines — available as part of the routine childhood immunization schedule in the United States — have greatly reduced the number of cases of this type of meningitis. When it occurs, it tends to follow an upper respiratory infection, ear infection (otitis media) or sinusitis.
Listeria monocytogenes (listeria). These bacteria can be found almost anywhere — in soil, in dust and in foods that have become contaminated. Contaminated foods have included soft cheeses, hot dogs and luncheon meats. Many wild and domestic animals also carry the bacteria. Fortunately, most healthy people exposed to listeria don't become ill, although pregnant women, newborns and older adults tend to be more susceptible. Listeria can cross the placental barrier, and infections in late pregnancy may cause a baby to be stillborn or die shortly after birth.

Viral meningitis
Viruses cause a greater number of cases of meningitis each year than do bacteria. Viral meningitis is usually mild and often clears on its own within two weeks. A group of common viruses known as enteroviruses are responsible for about 90 percent of viral meningitis in the United States.

The most common signs and symptoms of enteroviral infections are rash, sore throat, joint aches and headache. Many older children and adults with enteroviral meningitis describe the "worst headache I've ever had." These viruses tend to circulate in late summer and early fall. Viruses associated with mumps, herpes infection, West Nile virus or other diseases also can cause viral meningitis.

Chronic meningitis
Ongoing (chronic) forms of meningitis occur when slow-growing organisms invade the membranes and fluid surrounding your brain. Although acute meningitis strikes suddenly, chronic meningitis develops over four weeks or more. Nevertheless, the signs and symptoms of chronic meningitis — headaches, fever, vomiting and mental cloudiness — are similar to those of acute meningitis. This type of meningitis is rare.

Fungal meningitis
Fungal meningitis is relatively uncommon. Cryptococcal meningitis is a fungal form of the disease that affects people with immune deficiencies, such as AIDS. It's life-threatening if not treated with an antifungal medication.

Other meningitis causes
Meningitis can also result from noninfectious causes, such as drug allergies, some types of cancer and inflammatory diseases such as lupus.

Not completing the childhood vaccine schedule increases your risk of meningitis. So do a few other risk factors:

Age. Most cases of viral meningitis occur in children younger than age 5. In the past, bacterial meningitis also usually affected young children. But since the mid-1980s, as a result of the protection offered by current childhood vaccines, the median age at which bacterial meningitis is diagnosed has shifted from 15 months to 25 years.
Living in a community setting. College students living in dormitories, personnel on military bases, and children in boarding schools and child care facilities are at increased risk of meningococcal meningitis, probably because infectious diseases tend to spread quickly wherever large groups of people congregate.
Pregnancy. If you're pregnant, you're at increased of contracting listeriosis — an infection caused by listeria bacteria, which may also cause meningitis. If you have listeriosis, your unborn baby is at risk, too.
Working with animals. People who work with domestic animals, including dairy farmers and ranchers, have a higher risk of contracting listeria, which can lead to meningitis.
Compromised immune system. Factors that may compromise your immune system — including AIDS, diabetes and use of immunosuppressant drugs — also make you more susceptible to meningitis. Removal of your spleen, an important part of your immune system, also may increase your risk.

The complications of meningitis can be severe. The longer you or your child has the disease without treatment, the greater the risk of seizures and of permanent neurological damage, including hearing loss, blindness, loss of speech, learning disabilities, behavior problems and brain damage, even paralysis.

Non-neurological complications may include kidney failure and adrenal gland failure. Your adrenal glands produce a number of important hormones including cortisol, which helps your body deal with stress.

Bacterial infections of your central nervous system progress quickly. Within a matter of days, the disease can lead to shock and death.

Your family doctor or pediatrician can diagnose meningitis based on a medical history, a physical exam and certain diagnostic tests. During the exam, your doctor may check for signs of infection around the head, ears, throat and the skin along the spine. You or your child may undergo the following diagnostic tests:

Throat culture. A throat culture can find and identify the bacteria causing throat pain, neck pain and headache, but can't determine what pathogens may be in your spinal fluid.
Imaging. X-rays and computerized tomography (CT) scans of the chest, skull or sinuses may reveal swelling or inflammation. These tests can also help your doctor look for infection in other areas of the body that may be associated with meningitis.
Spinal tap (lumbar puncture). The definitive diagnosis of meningitis is often made by analyzing a sample of your cerebrospinal fluid (CSF), which is collected during a procedure known as a spinal tap. In people with meningitis, the CSF fluid often shows a low sugar (glucose) level along with an increased white blood cell count and increased protein. CSF analysis may also help your doctor identify the exact bacterium that's causing the illness. Traditionally, it can take up to a week to get these test results. In March 2007, the Food and Drug Administration approved the Xpert EV test, a test that takes only two and one-half hours. This test identifies any genetic material in the CSF from a class of viruses responsible for approximately 90 percent of viral meningitis cases. A positive test tells your doctor you likely have viral meningitis, and a negative test strongly suggests no viral meningitis, making the less common bacterial form of meningitis more likely. This can help those with viral meningitis avoid unnecessary treatment with antibiotics.
Polymerase chain reaction analysis. If your doctor suspects meningitis, he or she may order a DNA-based test known as a polymerase chain reaction (PCR) amplification to check for the presence of certain causes of meningitis.

If you have chronic meningitis caused by cancer or an inflammatory illness, you may need additional tests.

Meningitis typically results from contagious infections. Common bacteria or viruses that can cause meningitis can spread through coughing, sneezing, kissing or sharing eating utensils, a toothbrush or a cigarette. You're also at increased risk if you live or work with someone who has the disease.

These steps can help prevent meningitis:

Wash your hands. Careful hand washing is important to avoiding exposure to infectious agents. Teach your children to wash their hands often, especially before they eat and after using the toilet, spending time in a crowded public place or petting animals. Show them how to wash their hands vigorously, covering both the front and back of each hand with soap and rinsing thoroughly under running water.
Stay healthy. Maintain your immune system by getting enough rest, exercising regularly, and eating a healthy diet with plenty of fresh fruits, vegetables and whole grains.
Cover your mouth. When you need to cough or sneeze, be sure to cover your mouth and nose.
If you're pregnant, take care with food. Reduce your risk of listeriosis if you're pregnant by cooking meat thoroughly and avoiding cheeses made from unpasteurized milk.

Immunizations
Some forms of bacterial meningitis are preventable with the following vaccinations:

Haemophilus influenzae type b (Hib) vaccine. Children in the United States routinely receive this vaccine as part of the recommended schedule of vaccines, starting at about 2 months of age. The vaccine is also recommended for some adults, including those who have sickle cell disease or AIDS and those who don't have a spleen.
Pneumococcal conjugate vaccine (PCV7). This vaccine is also part of the regular immunization schedule for children younger than 2 years in the United States. In addition, it's recommended for children between the ages of 2 and 5 who are at high risk of pneumococcal disease, including children who have chronic heart or lung disease or cancer.
Pneumococcal polysaccharide vaccine (PPV). Older children and adults who need protection from pneumococcal bacteria may receive this vaccine. The Centers for Disease Control and Prevention recommends the PPV vaccine for all adults older than 65 and younger adults and children who have weak immune systems, chronic illnesses such as heart disease, diabetes or sickle cell anemia, and those who don't have a spleen.
Meningococcal conjugate vaccine (MCV4). The Centers for Disease Control and Prevention recommends that a single dose of MCV4 be given to children ages 11 to 12 or to any children ages 11 to 18 who haven't yet been vaccinated. However, this vaccine can be given to younger children who are at high risk of bacterial meningitis or who have been exposed to someone with the disease. It's approved for use in children as young as 2 years old.

Epilepsy

Epilepsy Overview

Epilepsy is a condition in which a person has recurrent seizures. A seizure is defined as an abnormal, disorderly discharging of the brain's nerve cells, resulting in a temporary disturbance of motor, sensory, or mental function.

There are many types of seizures, depending primarily on what part of the brain is involved. The term epilepsy says nothing about the type of seizure or cause of the seizure, only that the seizures happen again and again. A stricter definition of the term requires that the seizures have no known underlying cause. This may also be called primary or idiopathic epilepsy.

Episodes of abnormal electrical activity within the brain result in seizures.
The specific area of the brain affected by the abnormal electrical activity may result in a particular type of seizure.
If all areas of the brain are affected by the abnormal electrical activity, a generalized seizure may result. This means that consciousness is lost or impaired. Often all the person's arms and legs stiffen and then jerk rhythmically.
One seizure type may evolve into another during the course of the seizure. For example, a seizure may start as a partial, or focal, seizure, involving the face or arm. Then the muscular activity spreads to other areas of the body. In this way, the seizure becomes generalized.
Seizures caused by high fevers in children are not considered epilepsy. Also see children's seizures.

Epilepsy Causes

Healthy people may have seizures under certain circumstances. If the seizures have a known cause, the condition is referred to as secondary or symptomatic epilepsy. Some of the more common causes include the following:

Tumor
Chemical imbalance such as low blood sugar or sodium
Head injuries
Certain toxic chemicals or drugs of abuse
Alcohol withdrawal
Stroke including hemorrhage
Birth injuries

Epilepsy Symptoms

Almost any type of behavior that happens repetitively may represent a seizure.

Generalized seizures: All areas of the brain (the cortex) are involved in a generalized seizure. Sometimes these are referred to as grand mal seizures.
- To the observer, the person experiencing such a seizure may cry out or make some sound, stiffen for some seconds, then have rhythmic movements of the arms and legs. Often the rhythmic movements slow before stopping.
- Eyes are generally open.
- The person may not appear to be breathing. The person is often breathing deeply after an episode.
- The return to consciousness is gradual and should occur within a few moments.
- Loss of urine is common.
- Often people will be confused briefly after a generalized seizure.
Partial or focal seizures: Only part of the brain is involved, so only part of the body is affected. Depending on the part of the brain having abnormal electrical activity, symptoms may vary.
- If the part of the brain controlling movement of the hand is involved, for example, then perhaps only the hand may show rhythmic movements or jerking.
- If other areas of the brain are involved, symptoms might include strange sensations or small repetitive movements such as picking at clothes or lip smacking.
- Sometimes the person with a partial seizure appears dazed or confused. This may represent a partial complex seizure. The term complex is used by doctors to describe a person who is between being fully alert and unconscious.
Absence or petit mal seizures: These are most common in childhood.
- Impairment of consciousness is present with the person often staring blankly.
- Repetitive blinking or other small movements may be present.
- Typically, these seizures are brief, lasting only seconds. Some people may have many of these in a day.
- Other seizure types exist particularly in very small children.

Exams and Tests

The first task facing the doctor is to decide if the event was a seizure or some other condition, such as fainting, that may mimic a seizure.

The doctor will take a history about the facts that surrounded the event. Any eyewitness accounts will be very helpful. Family history, social history, and past medical history are important as well.
Bring any medicine containers, including prescription drugs, to the hospital to help the doctor make the diagnosis.
A neurological examination will be performed. This may include some tests not usually performed in other physical examinations, such as strength and reflex testing.
Depending on the history and physical examination, laboratory work may be ordered. This might include blood or urine testing.
Special testing such as MRI, CT scans, or EEG (brain wave patterns) may be performed.

Epilepsy Treatment

Self-Care at Home

Home care with epilepsy varies with the frequency and type of seizures. It is important to take anticonvulsant medication regularly to prevent seizures.

When a seizure occurs, an observer can use common sense to prevent injuries.

Cushion the person's head.
Loosen any tight neckwear.
Turn the person on his or her side.
Do not hold the person down or restrain the person.
Do not place anything in the mouth or try to pry the teeth apart. The person is not in danger of swallowing his or her tongue.
Observe seizure characteristics-length, type of movements, direction of head or eye turning. These characteristics may help the doctor diagnose the type of seizure.

Medications

Depending on the seizure type, different treatments may be prescribed. This will often include anticonvulsant medication that prevents or stops seizures.

The type of anticonvulsant medication selected by your doctor will depend on factors such as seizure type, cost, and other medical conditions.
Anticonvulsant medications may need frequent adjustments, especially after starting medications.
Monitoring of anticonvulsant medications and other laboratory tests may be necessary.

Prevention

If the seizures are related to another medical condition, identification and treatment of that medical condition is the key to prevention. If anticonvulsant medication is prescribed, taking the medication on the recommended schedule and not missing medication is important.

Some people with epilepsy are quite sensitive to alcohol. If this pattern develops, avoid alcohol. Others may have seizures only after ceasing heavy alcohol intake. The key to prevention is avoidance of alcohol.
Sleep deprivation and stress certainly may increase the frequency of seizures in some people with epilepsy.

31 January, 2010

Acute kidney failure

Acute (sudden) kidney failure is the sudden loss of the ability of the kidneys to remove waste and concentrate urine without losing electrolytes.

Causes

There are many possible causes of kidney damage. They include:

Acute tubular necrosis (ATN)
Autoimmune kidney disease, including:
- Acute nephritic syndrome
- Interstitial nephritis
Decreased blood flow due to very low blood pressure, which can result from:
- Burns
- Dehydration
- Hemorrhage
- Injury
- Septic shock
- Serious illness
- Surgery
Disorders that cause clotting within the kidney's blood vessels:
- Hemolytic-uremic syndrome
- Idiopathic thrombocytopenic thrombotic purpura (ITTP)
- Malignant hypertension
- Transfusion reaction
- Scleroderma
Infections that directly injury the kidney such as:
- Acute pyelonephritis
- Septicemia
Pregnancy complications, including:
- Placenta abruptio
- Placenta previa
Urinary tract obstruction

Symptoms

Bloody stools
Breath odor
Brusing easily
Changes in mental statusor mood
Decreased appetite
Decreased sensation, especially in the hands or feet
Fatigue
Flank pain (between the ribs and hips)
Hand tremor
High blood pressure
Metallic taste in mouth
Nausea or vomiting, may last for days
Nosebleeds
Persistent hiccups
Prolonged bleeding
Seizures
Slow, sluggish movements
Swelling - generalized (fluid retention)
Swelling of the ankle, feet, and leg swelling
Urination changes:
- Decrease in amount of urine
- Excessive urination at night
- Urination stops completely

Exams and Tests

Many patients have generalized swelling caused by fluid retention. The doctor may hear a heart murmur, crackles in the lungs, or signs of inflammation of the lining of the heart when listening to the heart and lungs with a stethoscope.

The results of laboratory tests may change suddenly (within a few days to 2 weeks). Such tests may include:

A kidney or abdominal ultrasound is the preferred test for diagnosing kidney failure, but abdominal x-ray, abdominal CT scan, or abdominal MRI can tell if there is a blockage in the urinary tract.

Blood tests may help reveal the underlying cause of kidney failure. Arterial blood gas and blood chemistries may show metabolic acidosis.

Treatment

Once the cause is found, the goal of treatment is to restore kidney function and prevent fluid and waste from building up in the body while the kidneys heal. Usually, you have to stay overnight in the hospital for treatment.

The amount of liquid you eat (such as soup) or drink will be limited to the amount of urine you can produce. You will be told what you may and may not eat to reduce the build-up of toxins normally handled by the kidneys. Your diet may need to be high in carbohydrates and low in protein, salt, and potassium.

You may need antibiotics to treat or prevent infection. Diuretics ("water pills") may be used to help the kidneys lose fluid.

Calcium, glucose/insulin, or potassium will be given through a vein to help avoid dangerous increases in blood potassium levels.

Dialysis may be needed, and can make you feel better. It is not always necessary, but it can save your life if your potassium levels are dangerously high. Dialysis will also be used if your mental status changes, you stop urinating, develop pericarditis, retain too much fluid, or cannot eliminate nitrogen waste products from your body.

Outlook (Prognosis)

Acute kidney failure is potentially life-threatening and may require intensive treatment. However, the kidneys usually start working again within several weeks to months after the underlying cause has been treated.

In some cases, chronic renal failure or end-stage renal disease may develop. Death is most common when kidney failure is caused by surgery, trauma, or severe infection in someone with heart disease, lung disease, or recent stroke. Old age, infection, loss of blood from the intestinal tract, and progression of kidney failure also increase the risk of death.

Possible Complications

Chronic (long-term) kidney failure
Damage to the heart or nervous system
End-stage kidney disease
High blood pressure
Loss of blood in the intestines

Prevention

Treating disorders such as high blood pressure can help prevent acute kidney failure.

Tonsillectomy

Definition

Tonsillectomy is surgery to remove the tonsils. These two fleshy oval-shaped pads are located on either side of the back of the throat. Tonsillectomy is needed when the tonsils become infected frequently (tonsillitis) or an infection doesn't get better with other treatment. In some cases, tonsillectomy is done because enlarged tonsils block normal breathing. This can lead to problems such as sleep apnea. Less often, tonsillectomy is done to treat cancer or a tonsil that won't stop bleeding. Tonsillectomy is one of the more common surgeries in children, but it's done less often in adults.

Why it's done

Tonsillectomy is generally done for one of these reasons:

To prevent recurrent (chronic) tonsil infections
To treat breathing or swallowing problems or other issues caused by enlarged tonsils
In rare cases, to remove cancer or suspected cancer of the tonsil
To treat a bleeding tonsil, which is also rare

Most people choose to have a tonsillectomy after deciding symptoms are bad enough that the pain and potential risks of surgery are worth it. To help weigh the potential benefits and risks of surgery, your doctor will consider a number of factors such as your age, any other health problems you have and any medications you take on a regular basis.

Tonsillectomy for tonsillitis
Tonsils play a minor role in fighting infections, but they can cause more harm than good when they get infected themselves. A tonsillectomy may be needed to treat a serious infection, or if you have infections that keep recurring.

Most cases of tonsillitis are caused by viruses, including the virus that causes mononucleosis (Epstein-Barr virus). In other cases, tonsillitis is caused by a bacterial infection. When tonsillitis is due to the specific type of bacteria known as group A streptococcus, the illness is also referred to as strep throat.

Serious tonsil infections can cause a number of problems in children and adults, including:

Trouble eating and swallowing
An abscess — pocket of infection — in the back of the throat (peritonsillar abscess)
Chronic bad breath
Other health problems, including rheumatic fever and glomerulonephritis — a type of kidney disease.

As well as being painful and inconvenient, for many people tonsillitis also means doctor visits and missed school days or workdays.

Tonsillectomy generally helps cure infections in both adults and children. But, in most cases, younger people appear to benefit more from tonsillectomy than do adults.

Tonsillectomy for enlarged tonsils
Enlarged tonsils can lead to problems such as:

Sleep apnea
Snoring
Trouble swallowing

Usually, a tonsillectomy is considered when other treatments aren't effective. Like any surgery, doctors want to try other treatments first — and make sure surgery is needed and likely to help.

When is a tonsillectomy needed in children?
For tonsillitis, your child's doctor may recommend tonsillectomy if your child has:

A tonsil infection or throat abscess that doesn't get better with other treatment
Seven or more serious throat infections in one year
Five or more serious throat infections every year over a two-year period
Three or more serious throat infections every year over a three-year period

For enlarged tonsils, your child's doctor may recommend a tonsillectomy if your child has enlarged tonsils that:

Block normal breathing, which can lead to sleep apnea and other problems
Make swallowing difficult

When is a tonsillectomy needed in adults?
Your doctor may recommend a tonsillectomy if you have:

Tonsillitis that keeps coming back or tonsillitis that doesn't get better with medication
Oversized tonsils that cause sleep apnea or other related problems
Cancer or suspected cancer of the tonsils

Risks

Tonsillectomy is a major surgery. Like other surgeries, it has certain risks.

Risks during and immediately following the procedure include:

Reactions to anesthesia. Medication to make you sleep during surgery (general anesthesia) can sometimes cause mild or serious reactions.
Tongue soreness or swelling. The tool used to keep your mouth open during a tonsillectomy may make your tongue numb or sore right after the procedure. This is temporary.
Bleeding during surgery. In rare cases, severe bleeding occurs during surgery and requires additional treatment and a longer hospital stay.

Risks during recovery include:

Bleeding during healing. After a tonsillectomy, about one in five adults have bleeding that won't stop. Bleeding occurs less often in children, but can still occur. It usually occurs a week or so after surgery, but may happen sooner or up to two weeks later. This type of bleeding is believed to occur when the scab comes off the tonsil area. It can be caused by eating hard-edged food, such as chips, or by strenuous activity. This requires a trip to the emergency room to check the extent of the bleeding.
Complications with anesthesia if you need surgery to stop bleeding. Follow-up surgery with anesthesia to stop the bleeding can be dangerous because you probably will have food in your stomach. This could place you at risk of inhaling (aspirating) food or liquids.
Infection. Rarely, surgery can lead to an infection that requires further treatment.
Delayed recovery. Some people take longer to heal than do others after a tonsillectomy. Although children usually recover in less than two weeks, it can take a month or longer for some adults. It's difficult to predict exactly how long it will take for you or your child to recover.
Pain. Both children and adults have throat pain after the procedure. However, adults may have more pain than do children, and in adults, pain generally lasts longer. In some cases, adults have throat pain bad enough to make swallowing difficult for several weeks.

How you prepare

Talk to the doctor to make sure you know what to expect and why the surgery needs to be done. Be sure you understand your choices and whether tonsillectomy is the best option. Follow any specific instructions the doctor gives you in the weeks before surgery.

If your child is having a tonsillectomy:

Make arrangements for your child to stay home from school for at least a few days following surgery.
Don't give your child anything to eat or drink after midnight. Check with your doctor regarding other feeding instructions prior to surgery.
Don't give your child medications that contain ibuprofen (Advil, Motrin, others) or naproxen (Naprosyn) for two weeks before surgery, and for two weeks after surgery. These and other nonsteroidal anti-inflammatory medications (NSAIDs) can increase your child's risk of bleeding during and after the procedure.

If you're an adult having a tonsillectomy:

Quit smoking. Quitting will help you avoid breathing problems during your surgery. It will also help you heal more quickly after the procedure. It's best if you can quit at least two weeks before your tonsillectomy.
Don't eat or drink anything after midnight the night before the surgery.
Make arrangements to have someone drive you home from the hospital. You won't be able to drive after anesthesia.
Plan for time off work — you'll likely need a week to 10 days. You may need even longer if your job requires strenuous physical work.
Tell your doctor about all medications you take, including herbal remedies. Don't take aspirin, ibuprofen or any other nonsteroidal anti-inflammatory medication (NSAID) for two weeks before surgery, and for two weeks after surgery. These medications can increase your risk of bleeding during and after the procedure.

What you can expect

Tonsillectomy is usually done on an outpatient basis. That means you, or your child, will be able to go home the day of the surgery.

During the surgery

You, or your child, will be asleep (under general anesthesia) and won't feel any pain.
Using an instrument to hold the mouth open, the doctor will use a special scalpel or burning tool to cut the tonsils from the back of the throat.
Depending on the reason for tonsillectomy, the adenoids also may be removed during surgery. Adenoids are similar to tonsils, but higher up in the throat under the nasal passage. Surgery to remove the adenoids is called adenoidectomy. Surgery, recovery and risks are similar to a tonsillectomy.

During recovery
Recovery may be more painful — and take longer — in adults and teens than in children. Several things can help with recovery after tonsillectomy:

Take medications as directed. If your doctor prescribed antibiotics, make sure you take the entire course exactly as prescribed.
Avoid catching anything contagious. You're more susceptible to infection than usual after surgery. Avoid crowds and exposure to anyone who might be ill.
Stay hydrated. Be sure to drink plenty of water or drink a hydration beverage, such as Gatorade, even though it may be painful to swallow. Dehydration is a common problem after tonsillectomy. It can increase throat pain making it even harder to drink or eat. Sucking on ice cubes or frozen fruit pops, eating ice cream or sherbet, and drinking cold liquids can help ease throat pain. It can also be helpful to use a cool-mist humidifier to moisten the air.
Eat cool, soft and bland foods at first. Examples include ice cream, applesauce, jello, pudding and cold soups. You can eat solid foods when you're ready, but avoid foods that are crispy, brittle or have hard edges, such as chips or pizza — these may cause bleeding. Also avoid acidic or sour foods such as orange juice, which will sting your throat. Gum chewing may be beneficial in helping with pain and healing.
Limit strenuous activity for two weeks after surgery. Ask your doctor what's OK and what's not. Avoid running, contact sports and jarring activities such as tumbling or roughhousing. Less strenuous activities such as walking are OK.
Don't take pain medications that can increase bleeding. You can take acetaminophen (Tylenol, others), but ibuprofen (Advil, Motrin, others), naproxen (Aleve, Naprosyn, others) or aspirin may increase your risk of bleeding. Children and teens should never take aspirin, as it puts them at risk of Reye's syndrome, a rare but serious condition.

When to see the doctor or get emergency help
After surgery, you or your child may need to see the doctor if:

The surgery area starts to bleed. Any bleeding requires a trip to the emergency room to be evaluated. Sometimes the bleeding will require a return to the operating room. Swallowing blood can give you an upset stomach, so try to avoid it as much as possible.
You or your child has a fever of 102 F (38.9 C) or higher.
You or your child has trouble swallowing liquids or has signs or symptoms of dehydration. These can include reduced urination, thirst, dry mouth, fatigue, weakness, headache, dizziness and lightheadedness. Children are likely to be less active than usual and may have few or no tears when crying.

Results

Tonsillectomy can help treat or prevent:

Recurring throat infections and strep throat — and the doctor visits, missed school days or workdays, and the antibiotic use that's required to treat them
Sleep problems such as sleep apnea, or other breathing problems caused by blocked airways
Cancer or suspected cancer of the tonsils

Tonsillitis

Definition

Tonsillitis is when the tonsils — fleshy pads on each side of the back of the throat — become infected with a virus or bacteria. A common childhood ailment, tonsillitis causes the tonsils to become swollen and painful.

Most cases of tonsillitis are caused by a virus and are treated at home with over-the-counter sore throat remedies. Less often, tonsillitis is caused by a bacterial infection and antibiotics are needed. At one time, removing the tonsils (tonsillectomy) was a common treatment for recurrent tonsillitis. Today, surgery is only recommended if tonsillitis doesn't get better with other treatment.

Symptoms

Signs and symptoms of tonsillitis include:

Red, swollen tonsils
White patches on the tonsils
Sore throat
Difficult or painful swallowing
Headache
Fever and chills
Enlarged, tender glands (lymph nodes) in the jaw and neck
Loss of voice (laryngitis)
Abdominal pain in children

Causes

When bacteria and viruses enter your body through your nose or mouth, your tonsils act as a filter — engulfing the offending organisms in white blood cells. This can cause a low-grade infection in your tonsils. Tonsillitis occurs when the infection gets more serious, and the tonsils become painful and inflamed.

Most cases of tonsillitis are caused by viruses, including the virus that causes mononucleosis (the Epstein-Barr virus). In other cases, tonsillitis is caused by a bacterial infection. When tonsillitis is due to a specific type of bacteria (group A streptococci), the illness is also referred to as strep throat. Warning signs that your symptoms may be caused by strep throat include a sudden onset of pain and inflammation, tender lymph nodes in your neck, a high fever and a lack of nasal congestion. If tonsillitis is caused by strep throat or another bacterial infection, you may need treatment with antibiotics. However, most cases of tonsillitis are caused by a virus and not bacteria, and the only treatment is home care.

Risk factors

Being a child. Tonsillitis is especially common in school-age children.
Contact with others. Like the germs that cause colds or the flu, viruses and bacteria that cause tonsillitis tend to get passed on in places such as schools and child care facilities, where people are in close contact.

When to seek medical advice

Although tonsillitis itself usually isn't serious, it can lead to complications if left untreated. Call your doctor if:

Your sore throat lasts more than 48 hours
You have a fever above 103 F (39 C)
You can't swallow because your tonsils are so swollen or painful
Your sore throat is accompanied by abdominal pain, especially if you're vomiting
You have a stiff neck or feel weak

Seek emergency care if you or your child is:

Drooling
Unable to swallow because of pain or swelling

Tests and diagnosis

The doctor will check your tonsils and the back of your throat for signs of infection, such as redness and pus. Tests may include:

Throat swab. With this simple test, the doctor rubs a sterile swab over the back of your throat to get a sample of the secretions. The sample will be checked in the lab for streptococcal bacteria. Test results are available within minutes or up to 24 to 48 hours, depending on the testing method.
Complete blood cell count (CBC). In some cases, a blood test known as a CBC may help identify the cause of your infection. With a CBC, a sample of blood is sent to the laboratory for evaluation of the presence of a high number of white blood cells or abnormal cells that indicate a viral infection.

Complications

When left untreated, swollen tonsils can block normal breathing (airway obstruction), leading to sleep apnea and a number of other health problems.

Untreated tonsillitis can also lead to a collection of pus between a tonsil and the soft tissues around it (abscess). The abscess may cover a large part of the soft area at the back of the roof of the mouth (soft palate). Rarely, the abscess may spread into the bloodstream or into the neck or chest.

Some strains of streptococcal bacteria that cause strep throat leading to tonsillitis can also cause kidney inflammation (nephritis) or rheumatic fever, a serious condition that can affect the heart, joints, nervous system and skin.

Treatments and drugs

Tonsillitis caused by a virus is typically treated with self-care. If tonsillitis is caused by a bacterial infection, your doctor may prescribe antibiotics. Oral penicillin typically needs to be taken for at least 10 days. Other antibiotics may have shorter courses. Although you'll probably feel better in a day or two, it's important to finish the full course of antibiotics. Stopping medication early may cause the infection to come back.

If your child has a positive strep test, he or she needs to complete at least 24 hours of antibiotic treatment before returning to school or child care. If your child has difficulty swallowing, antibiotics may be given by injection. In some cases, treatment with steroid medications may reduce swelling.

Although surgery is no longer the standard treatment for tonsillitis, removing the tonsils (tonsillectomy) may be recommended when other treatments don't work.

Self-care
Most cases of tonsillitis are caused by a viral infection, and antibiotics won't help. The only thing you can do is let the virus run its course — and take steps to relieve pain and inflammation. Recovery may take a week or two.

Drink warm, soothing liquids — such as soup, broth and tea.
Gargle with warm salt water.
Take acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) to help reduce fever and decrease pain. Because of the risk of Reye's syndrome — a potentially life-threatening illness — don't give aspirin to children younger than age 12.

Surgery
Surgical removal of the tonsils (tonsillectomy) is rarely needed for adults. During childhood, surgery may be recommended when a child has had:

Seven or more serious throat infections in one year
Five or more serious throat infections every year over a two-year period
Three or more serious throat infections every year over a three-year period

Tonsillectomy may also be recommended to treat an abscess that doesn't improve with antibiotic treatment, or if swollen tonsils are blocking breathing.

Tonsillectomy is usually done on an outpatient basis. That means your child will be able to go home the day of the surgery. A complete recovery may take up to two weeks.

Prevention

The germs that cause viral and bacterial tonsillitis are contagious. Frequent hand washing is the best way to prevent all kinds of infections, including tonsillitis. Wash your hands often, and encourage your children to do the same.

Other common-sense precautions apply, too. Cough or sneeze into your elbow or a tissue. Don't share drinking glasses or eating utensils. Avoid close contact with anyone who's sick.

Lifestyle and home remedies

A sore throat can make you miserable. These tips can help.

Drink more fluids. Warm liquids — such as soup, broth and tea — are good choices.
Gargle with warm salt water. Mix 1/4 teaspoon of salt in 8 ounces of warm water, gargle, and then spit out the water.
Use honey and lemon. Stir honey and lemon to taste into a glass of hot water. Allow it to cool to room temperature before you sip it. The honey coats and soothes your throat, and the lemon helps reduce mucus. Don't use honey or corn syrup in a drink for children younger than age 1.
Suck on a throat lozenge or hard candy. This stimulates saliva production, which bathes and cleanses your throat.
Humidify the air. Adding moisture to the air can reduce throat irritation and make it easier to sleep. Be sure to change the water in a room humidifier daily and clean the unit at least once every three days to help prevent the growth of harmful molds and bacteria.
Avoid smoke and other air pollutants. Smoke irritates a sore throat.
Rest your voice. Talking may lead to more throat irritation and temporary loss of your voice (laryngitis).

Think about others, too. If you're not feeling well, take a few days off to avoid spreading your germs.