Overview
Tonsillitis is inflammation of the tonsils, which are two oval-shaped pads of tissue located at the back of the throat. It can be caused by viral or bacterial infections and is commonly associated with symptoms such as swollen tonsils, sore throat, difficulty swallowing, and tender lymph nodes in the neck. Tonsillitis is most common in children, particularly those between preschool ages and the midteenage years. The risk factors for tonsillitis include frequent exposure to germs and close contact with peers. While the condition usually resolves on its own, antibiotic treatment may be necessary for bacterial tonsillitis, and surgical removal of the tonsils (tonsillectomy) may be considered in cases of frequent infections, complications, or severe symptoms.
Understanding the disease
Symptoms
The symptoms of tonsillitis include swollen tonsils, a sore throat, difficulty swallowing, and tender lymph nodes in the neck. Other common symptoms include a white or yellow coating on the tonsils, fever, headache, stomachache, and a scratchy or muffled voice. Children who are unable to describe their symptoms may exhibit signs such as drooling, refusal to eat, or unusual fussiness. If a child has a sore throat with fever, a sore throat that doesn't go away within 24-48 hours, painful or difficult swallowing, or extreme weakness, fatigue, or fussiness, it's important to see a doctor. If an adult has a sore throat and associated problems such as difficulty swallowing, difficulty breathing, or blood in the saliva or phlegm, they should also seek medical attention.
Risk Factors
Risk factors for tonsillitis include frequent exposure to germs, such as in school-age children, as well as having a weakened immune system. Certain bacterial infections, like group A streptococcus, can also cause tonsillitis. While tonsillitis is more common in children, it can also occur in adults, particularly if their immune system has declined after puberty.
Development
Tonsillitis can develop due to viral or bacterial infections. Viral infections are the most common cause of tonsillitis, particularly in children. Bacterial infections, such as Streptococcus pyogenes (group A streptococcus), can also cause tonsillitis. The bacteria enter the tonsils through the mouth and throat, causing inflammation and swelling. Frequent exposure to germs, such as in school-age children who are in close contact with their peers, can increase the risk of contracting tonsillitis.
Assessment and Diagnosis
Triage
You should see a doctor if your child has symptoms that may indicate tonsillitis and experiences any of the following:
- A sore throat with fever
- A sore throat that doesn't go away within 24 to 48 hours
- Painful or difficult swallowing
- Extreme weakness, fatigue, or fussiness If your child exhibits any of these severe signs and symptoms, seek immediate care:
- Difficulty breathing
- Extreme difficulty swallowing
- Excessive drooling For adults, consult your doctor if you have a sore throat and any of the following associated problems:
- A sore throat that is severe or lasts longer than a week
- Difficulty swallowing
- Difficulty breathing
- Joint pain
- Earache
- Rash
- Fever higher than 101 F (38.3 C)
- Blood in your saliva or phlegm
Diagnosis
To diagnose tonsillitis, a doctor will typically start with a physical exam that includes examining the throat, ears, and nose using a lighted instrument. They may also check for swollen glands in the neck, listen to breathing with a stethoscope, and check for enlargement of the spleen. A throat swab is performed to obtain a sample of secretions, which is then checked for streptococcal bacteria. A complete blood cell count (CBC) may also be ordered to help determine the cause of the infection. If the rapid in-clinic test comes back positive, it is likely a bacterial infection, while a negative test suggests a viral infection.
Management and Treatment
Complications
Potential complications of tonsillitis include:
- Disrupted breathing during sleep (obstructive sleep apnea) due to inflammation or swelling of the tonsils.
- Infection that spreads deep into surrounding tissue (tonsillar cellulitis).
- Infection that results in a collection of pus behind a tonsil (peritonsillar abscess).
- Rheumatic fever, a serious inflammatory condition that can affect the heart, joints, nervous system, and skin if tonsillitis caused by group A streptococcus or another strain of streptococcal bacteria isn't treated or if antibiotic treatment is incomplete. It's essential to seek immediate care if your child experiences difficulty breathing, extreme difficulty swallowing, excessive drooling, or any other concerning symptoms.
Prevention
While there are no definitive ways to prevent tonsillitis, you can take some precautions to reduce your risk:
- Practice good hygiene: Regularly wash your hands and encourage your children to do the same. Teach them to cover their mouth and nose when coughing or sneezing to minimize the spread of germs.
- Maintain a healthy lifestyle: Ensure your child receives a balanced diet and gets sufficient rest. A healthy immune system is better equipped to fight off infections.
- Avoid close contact: Encourage your child to avoid close contact with people who are sick, especially during the cold and flu season.
- Vaccinations: Ensure your child receives all recommended vaccinations, including the HPV vaccine, to reduce their risk of infections that may lead to tonsillitis.
- Antibiotics: If your child has been prescribed antibiotics for a bacterial infection, ensure they complete the full course of treatment as directed by the doctor, even if they start feeling better before the medication is finished. This helps prevent the spread of bacteria and reduces the likelihood of recurrent infections.
- Regular dental check-ups: Regular dental care can help detect signs of tonsillitis and other oral cancers. While these steps may not completely prevent tonsillitis, they can help reduce the likelihood of contracting the infection and its complications.
Home Remedies
It is recommended to consult a healthcare professional for appropriate treatment options.
Treatment
Treatment for tonsillitis depends on the cause, which can be either a viral or bacterial infection. Here are some general treatment options:
- Viral Tonsillitis: Viral tonsillitis is typically self-limiting, meaning it will resolve on its own within 7 to 10 days. The main goal of treatment is to manage symptoms while the body fights off the infection. This may involve:
- Over-the-counter pain relievers like acetaminophen (paracetamol) or ibuprofen to help reduce fever and alleviate throat pain
- Cold or warm compresses to help soothe the throat
- Sucking on lozenges or hard candy to alleviate throat discomfort
- Plenty of rest and staying hydrated
- Bacterial Tonsillitis: If the tonsillitis is caused by bacteria, such as group A streptococcus, antibiotics will be prescribed to help combat the infection. The doctor may prescribe:
- Penicillin or amoxicillin, which are commonly used to treat streptococcal infections
- Other antibiotics if penicillin or amoxicillin are not suitable or effective
- Chronic Tonsillitis: If tonsillitis occurs frequently or doesn't respond to other treatments, surgery to remove the tonsils (tonsillectomy) may be considered. This is typically performed as a last resort, especially since tonsillectomy carries its own risks and complications. Remember, if you or your child experiences severe symptoms, difficulty breathing, extreme difficulty swallowing, excessive drooling, or signs of dehydration, seek immediate medical attention.