Tonsillitis

Select the topic

• What is tonsillitis?
• What are common tonsillitis symptoms?
• What causes tonsillitis?
• What are the risk factors of tonsillitis?
• How can I prevent tonsillitis?
• How is tonsillitis diagnosed?
• How is tonsillitis treated?
• Preparing for your appointment

Tonsillitis

When you experience a sore throat, painful swallowing, swollen tonsils, and enlarged lymph nodes in your neck, these are signs and symptoms of tonsillitis or infection of tonsils, a pair of oval-shaped knobs of tissue at the back of your throat.

Tonsillitis is often due to viral infection. However, bacterial infection can be the cause of tonsillitis as well.

To successfully treat tonsillitis, identifying the actual cause of infection is key. Prompt tonsillectomy was the norm in the past; but nowadays, surgery is undertaken only after multiple episodes of recurrent tonsillitis that is refractory to treatment or attended by severe complications.

Healthy tonsillitis and Tonsillitis stones

Symptoms

Tonsillitis is most common in preschoolers and teenagers, they may experience:

• Sore throat with referred pain to the ear
• Swallowing problem – pain or difficulty in swallowing
• Fever
• Headache
• Bad breath
• Hoarse voice
• Stomachache
• Neck pain or stiff neck
• Swollen, enlarged tonsils
• Yellow or white mucus coating on tonsils
• Swollen lymph nodes in the neck

In children too young to explain their symptoms, parents should notice the following:

• Drooling saliva due to swallowing problem
• Poor appetite
• Unusual fussiness

When to see a doctor

When you have symptoms compatible with tonsillitis, consultation with a medical provider is in order. Consult your doctor when:

• You have a persistent sore throat that does not resolve within 1 or 2 days.
• The sore throat is accompanied by a fever.
• You cannot swallow comfortably.
• Lassitude and unusual fussiness in a child.

Seek immediate medical attention if there are breathing and swallowing difficulties and excessive drooling of saliva.

Causes

Viruses are the most common cause of tonsil infections, whereas, for bacteria, Streptococcus pyogenes (group A streptococcus) is the most frequent agent of strep throat. However, other bacteria or strains of Streptococcus can also cause tonsil infection.

Why do tonsils get infected?

Tonsils are the first line of defense against foreign intruders entering through your mouth. Exposure to pathogens like viruses and bacteria increases the chance of tonsil infection and inflammation. The decline of the immune function of the tonsils starts after puberty making tonsil infection in adults a rarity.

Risk factors

• Age. In general, tonsillitis is most common in young children, and infection by bacteria is largely found in children aged 5 to 15.
• Germ exposure. Children of school age are prone to germ exposures causing sickness including tonsil infection as they are constantly in close contact with their friends.
• Complications. Chronic tonsillitis can lead to complications including:
• Peritonsillar cellulitis or inflammation and infection of the tissue surrounding the tonsils
• Peritonsillar abscess or formation of pus behind a tonsil
• Obstructive sleep apnea or interrupted breathing during sleep
• Streptococcus infection

The occurrence of rare complications below is more likely if you do not finish the course of prescribed antibiotic treatment or tonsillitis due to group A streptococcus or another strain of streptococcal bacteria infection left untreated.

• Poststreptococcal glomerulonephritis (PSGN), a kidney disease
• Scarlet fever, skin rashes caused by streptococcus.
• Rheumatic fever is a severe disease affecting the heart, joints, skin, and nervous system.
• Poststreptococcal reactive arthritis (PSRA) or inflammation of joints

Prevention

Viruses and bacteria which are the cause of tonsillitis are transmissible. However, the disease is preventable if:

• Wash hands often, particularly before meals and after using the restroom
• Refrain from sharing personal utensils or food with others
• Always change the toothbrush after a bout of tonsillitis

To prevent the spreading of infectious agents to others, please

• Remind your child to wash hands after coughing or sneezing
• Cough or sneeze into a piece of tissue paper.
• Stay at home when you are sick

Diagnosis

A physical examination for tonsillitis includes:

• Checking the throat with a lighted instrument as well as the ears and nose for signs of infection
• Check for skin rashes of scarlet fever which is almost always accompanied by a strep throat infection.
• Palpate the neck for swollen lymph nodes
• Check the breathing with a stethoscope
• Check for spleen enlargement of mononucleosis which can cause inflamed tonsils.

Throat swab

In some cases, your doctor will collect secretions from the back of your child’s throat. The secretions will be sent to a lab for identification of streptococcal bacteria.

If the result is positive for streptococcus, this means the cause of tonsillitis is bacteria, whereas viral infection will return a negative result.

Complete blood cell count (CBC)

CBC may be obtained for differential counts of various white blood cell types, which help differentiate viral versus bacterial infection. This test is not routinely ordered but may help with the diagnosis if other tests for strep throat are negative.

Treatment

Home care

Home care helps to speed up the recovery from tonsillitis caused by either viral or bacterial infection.

Home care is the only treatment needed for viral tonsillitis; antibiotics will not be prescribed. The symptoms usually resolve within 7-10 days. At home, you should:

• Make sure your child has plenty of rest and sleep.
• Keep your child well hydrated to maintain a moist throat by offering plenty of water.
• Give soothing warm foods or drinks such as warm soup or warm water with honey or ice cream to relieve the sore throat.
• Let your child gargle saline or saltwater to relieve the sore throat. You can make your own saltwater by mixing 8 ounces (1 cup) of warm water with ½ teaspoon of salt.
• Use a humidifier to moisten the air. Dry air tends to irritate a sore throat.
• Avoid exposure to cigarette smoke and cleaning products as they can cause irritation of the throat.
• Consult your doctor if you need medications to relieve sore throat and fever.

Antibiotics

Antibiotics will be prescribed to treat tonsillitis caused by bacteria. Finishing the full course of prescribed antibiotics is necessary even if your child has fully recovered. Tonsillitis may worsen, or infection may spread to other organs, and complications such as rheumatic fever or acute kidney inflammation may develop if your child fails to complete the course of antibiotics.

Consult your doctor about what you should do if a dose is skipped or forgotten.

Surgery

Tonsillectomy is the treatment for chronic, recurrent tonsillitis, or infection by bacteria not responsive to antibiotics. Tonsillitis is considered frequent if there are:

• Minimum 7 recurrences the year before
• Minimum 5 recurrences per year in the past 2 years
• Minimum 3 recurrences per year in the past 3 years

Surgical removal will be done if there are complications including:

• Obstructive sleep apnea
• Pus discharge caused by bacterial infection not responsive to antibiotics.
• Breathing problem
• Swallowing problem

Preparing for your appointment

Consult a doctor when your child has tonsillitis-related symptoms such as swallowing problems, sore throat, etc. which may require further evaluation by an otolaryngologist.