Q. How can parents tell the difference between a simple sore throat and strep throat?
A. Without a throat culture, there is no sure way to tell if a patient with a sore throat has a simple viral illness or strep throat. In other words, just looking at the throat will not give us the answer.
In general, the patient with strep throat may experience any of the following symptoms:
• sudden onset of throat pain
• white patchy areas in the throat
• pain when swallowing
• tender or enlarged glands (lymph nodes) in the neck
• red and enlarged tonsils
• headache
• lower stomach pain
• fever
• general discomfort, uneasiness, or ill feeling
• loss of appetite and nausea
• rash
Strep is more common in children, ages 5 to 15, and it is very rare in children less than 3 years of age. The disease is common in winter and spring, with the majority of cases recorded from January to May.
In contrast, patients with viral upper respiratory illnesses (simple sore throat) tend to show less severe throat pain, more gradual onset, as well as more nasal and gastrointestinal symptoms.
Q. Does strep throat require treatment or will it go away on its own?
A. In most cases, strep throat is a short-lived, self-limited process. For a small number of patients however, untreated strep can cause major, even life threatening, complications. The major reason patients with strep see their physician is to get relief from their throat pain. Prompt treatment with antibiotics has shown in several studies to shorten the duration of strep related symptoms. Treatment also dramatically decreases the risk of spreading Strep to those in close contact, i.e. in family members, and students.
The major reason to treat strep is to prevent acute rheumatic fever (ARF). ARF is a delayed consequence of Strep, capable of producing severe heart and other tissue damage. Amoxicillin and several other antibiotics are uniformly effective in the prevention of ARF. This bacteria, unlike many others we treat today, has not shown resistance to older antibiotics. Other strep complications include peritonsillar abscess, a serious infection with pus collecting around the tonsil. This is a surgical emergency requiring drainage.
Q. How can I avoid contracting strep?
A. Strep throat is usually spread person-to-person. If an untreated individual with the infection has close contact with another person, there is a 35 percent chance the other person will contract the disease. However, after 24 hours of antibiotic therapy the patient is minimally contagious. The best way to avoid strep is to stay away from a newly-diagnosed person. After a day of adequate treatment and improvement in symptoms, students are usually safe to return to school.
Q. When should tonsils be removed?
Tonsils are removed for a variety of indications. When patients suffer recurrent bouts of tonsillitis causing lifestyle limitation, i.e.., several days of missed work or school, a tonsillectomy is considered. There is no specific number for any given patient. In general, two to three infections per year for consecutive years or five to six infections in a single year will warrant serious consideration. Other factors that influence the decision include a history of rheumatic fever, severe infections, or complications such as abscess.
The other primary indication for tonsillectomy would be partial obstruction of the upper airway. Enlarged tonsils and adenoids will often narrow the breathing passages of the nose and throat, especially in children. The patients will experience snoring, breathless pauses called apneas, and disrupted sleep quality. These patients will often be fatigued during the day, impairing their performance at work or in school. This is the most common reason for tonsillectomy and adenoidectomy in children. Several studies have shown that children performing poorly in school because of impaired sleep quality benefit from removal of the enlarged tonsils and adenoid. The warning sign for these children is habitual snoring.
Q. Is there a way to remove tonsils without pain?
A. No. There is some discomfort after a tonsillectomy regardless of the techniques used. Good pain medicine and a soft diet will lessen the postoperative pain. The most common method for removal uses a thermal instrument called "cautery" which seals the blood vessels during dissection. This technique reduces the risk of bleeding after surgery to 1 to 2 percent.
The tonsil beds are tender during the healing process for the first week. Recently there has been interest in partial removal of tonsils to decrease the pain with surgical recovery. Many of us in the field of Otolaryngology are concerned this may lead to the need for repeat procedures if the remaining tonsil tissue becomes infected in the future.
- As an Otorhinolaryngologist, Dr. Rogerson manages medical and surgical problems related to the ear, nose, throat, and neck. He is also trained in reconstructive plastic surgery. Dr. Rogerson is board-certified in Otorhinolaryngology and serves as a clinical professor at the University of Wisconsin. He is a member of the American College of Surgeons and a fellow of the American Academy of Otolaryngology, Head and Neck Surgery.
A. Without a throat culture, there is no sure way to tell if a patient with a sore throat has a simple viral illness or strep throat. In other words, just looking at the throat will not give us the answer.
In general, the patient with strep throat may experience any of the following symptoms:
• sudden onset of throat pain
• white patchy areas in the throat
• pain when swallowing
• tender or enlarged glands (lymph nodes) in the neck
• red and enlarged tonsils
• headache
• lower stomach pain
• fever
• general discomfort, uneasiness, or ill feeling
• loss of appetite and nausea
• rash
Strep is more common in children, ages 5 to 15, and it is very rare in children less than 3 years of age. The disease is common in winter and spring, with the majority of cases recorded from January to May.
In contrast, patients with viral upper respiratory illnesses (simple sore throat) tend to show less severe throat pain, more gradual onset, as well as more nasal and gastrointestinal symptoms.
Q. Does strep throat require treatment or will it go away on its own?
A. In most cases, strep throat is a short-lived, self-limited process. For a small number of patients however, untreated strep can cause major, even life threatening, complications. The major reason patients with strep see their physician is to get relief from their throat pain. Prompt treatment with antibiotics has shown in several studies to shorten the duration of strep related symptoms. Treatment also dramatically decreases the risk of spreading Strep to those in close contact, i.e. in family members, and students.
The major reason to treat strep is to prevent acute rheumatic fever (ARF). ARF is a delayed consequence of Strep, capable of producing severe heart and other tissue damage. Amoxicillin and several other antibiotics are uniformly effective in the prevention of ARF. This bacteria, unlike many others we treat today, has not shown resistance to older antibiotics. Other strep complications include peritonsillar abscess, a serious infection with pus collecting around the tonsil. This is a surgical emergency requiring drainage.
Q. How can I avoid contracting strep?
A. Strep throat is usually spread person-to-person. If an untreated individual with the infection has close contact with another person, there is a 35 percent chance the other person will contract the disease. However, after 24 hours of antibiotic therapy the patient is minimally contagious. The best way to avoid strep is to stay away from a newly-diagnosed person. After a day of adequate treatment and improvement in symptoms, students are usually safe to return to school.
Q. When should tonsils be removed?
Tonsils are removed for a variety of indications. When patients suffer recurrent bouts of tonsillitis causing lifestyle limitation, i.e.., several days of missed work or school, a tonsillectomy is considered. There is no specific number for any given patient. In general, two to three infections per year for consecutive years or five to six infections in a single year will warrant serious consideration. Other factors that influence the decision include a history of rheumatic fever, severe infections, or complications such as abscess.
The other primary indication for tonsillectomy would be partial obstruction of the upper airway. Enlarged tonsils and adenoids will often narrow the breathing passages of the nose and throat, especially in children. The patients will experience snoring, breathless pauses called apneas, and disrupted sleep quality. These patients will often be fatigued during the day, impairing their performance at work or in school. This is the most common reason for tonsillectomy and adenoidectomy in children. Several studies have shown that children performing poorly in school because of impaired sleep quality benefit from removal of the enlarged tonsils and adenoid. The warning sign for these children is habitual snoring.
Q. Is there a way to remove tonsils without pain?
A. No. There is some discomfort after a tonsillectomy regardless of the techniques used. Good pain medicine and a soft diet will lessen the postoperative pain. The most common method for removal uses a thermal instrument called "cautery" which seals the blood vessels during dissection. This technique reduces the risk of bleeding after surgery to 1 to 2 percent.
The tonsil beds are tender during the healing process for the first week. Recently there has been interest in partial removal of tonsils to decrease the pain with surgical recovery. Many of us in the field of Otolaryngology are concerned this may lead to the need for repeat procedures if the remaining tonsil tissue becomes infected in the future.
- As an Otorhinolaryngologist, Dr. Rogerson manages medical and surgical problems related to the ear, nose, throat, and neck. He is also trained in reconstructive plastic surgery. Dr. Rogerson is board-certified in Otorhinolaryngology and serves as a clinical professor at the University of Wisconsin. He is a member of the American College of Surgeons and a fellow of the American Academy of Otolaryngology, Head and Neck Surgery.
