Tonsillitis or sore throat ?

What’s an tonsillitis ?

A sore throat is a frequent cause of consultation which often evokes a diagnosis of « tonsillitis » in people’s minds.
In medicine, the throat is easy to examinate. An tonsillitis is an inflammation which is visible with bare eyes, and strictly limited to the tonsils. In its typical forms, that painful inflammation is a reaction of defense against a viral or bacterial infection which expresses itself through a painful swelling of a couple of ganglions (adenopathy) of the cervical area and fever. Some bad complications (in particular, cardiac and articular) can result as a consequence of a badly taken care of bacterial tonsillitis. These complications have totally disappeared since the arrival of the first antibiotics like penicillin and have justified their very broad use in that indication.
A couple of years ago, it was frequent that a «safety» antibiotic was prescribed systematically. The appearance of the bacterial resistance has called that attitude into question («an antibiotic, that’s not automatic») and there exist, since a short while, rapid diagnostic tests (RDT), which allow to define prescriptions better (but France continues to be the European country which consumes the most antibiotics and where the biggest amount of resistances are observed).

Tonsillitis (En)/Angine blanche (Fr)

In fact, a true tonsillitis is an illness which is easy to diagnose and easy to heal.

What is a sore throat ?

The oropharyngeal area is very richly innervated. It is, in some way, the entrance door to the organism and it all looks as though alarm systems are on the watch there. Under certain circumstances (of tiredness), these alarms can be triggered, thereby inducing a feeling of danger : an «embarrassment», a «swelling» or «clenching sensation», which motivate a visit to the doctor, often in a very characteristic "context of felt emergency". [1]
Yet, at the examination, the throat appears strictly normal in that case and there is neither fever nor adenopathy ! What shall the sick person be told, then ?

False sick or true sick ?

The doctor faces a dilemma in front of an intense sore throat while the tonsils are healthy (with, if necessary, a negative RDT):
- either he/she confirms the «patient’s diagnosis» and prescribes a «symptomatic» treatment (often not paid back in the absence of "sufficient medical service"). It is the « false true-sick ». Time being a good medication, the symptom disappears until the next alarm and the patient gets used to thinking that he/she
« has a fragile throat »,

- or he/she invalidates it ("there is nothing wrong with you") and, if necessary, sends to the psychiatrist. A «small» anxiolytic will besides reveal very efficient (by reducing the intensity of the alarm sign). It is the «true false-sick », the one who suffers without knowing why, and who will change doctors or medicine when the trust relationship will break and he/she will feel like not having been «listened to».

A symptom of tiredness ?

In our experience, intense and worrying « functional » dysphagias (sore throat with difficulty swallowing) are very frequent nocturnal emergencies.
Example : A young man arrives at 3 a.m. in the emergency room of the CHU (teaching hospital) with the grimace of an aching throat which keeps him from sleeping.
How can he be explained that his throat is perfectly healthy ?

In practice, that true « deafs’ dialogue » can only evolve well under the light of « somnicology ». It is not difficult, then, to put forward the responsible elements and the associated signs of a hypo-sleep syndrome:

In fact, it generally appears that the subject goes through some very difficult life events, that he/she is extremely exhausted (in particular, according to relatives) and that (if it is mentioned) his/her sleep has visbly changed, he/she wakes up tired and, since at least a couple of weeks, tries to « rest », goes to bed early and has unusual naps.
We note that he/she presents, as well, numerous other signs of hypo-sleep (headache, back pain, stomach ache, dizzy spells or palpitations and so on...) which are familiar to him/her and no longer give cause to consultations. Indeed, the hypo-sleep symptoms are rarely isolated and it is the most worrying of them which forces the subject to see a doctor.

Organic? Psychosomatic? Or somnosomatic?

A medical attitude which would discard the possibility of a real pain which is neither lesional nor « psychosomatic » would be of no help to that type of sick person.
All in all, the vicious circle of resistance/tiredness can end up in one of the disabling forms of the hypo-sleep syndrome : spasmophilia (or tetany), fibromyalgia, and chronic fatigue syndrome.
These sick people very often show a past history of «tonsillitis» which were difficult to treat or relapsed (sometimes even after the removal of the tonsils, which is absolutely impossible, since an absent organ cannot be infected !).