The tonsils are lymph nodes in the back of the mouth and top of the throat. They normally help to filter out bacteria and other microorganisms to prevent infection in the body.
They may become so overwhelmed by bacterial or viral infection that they swell and become inflamed, causing tonsillitis. The infection may also be present in the throat and surrounding areas, causing inflammation of the pharynx. The pharynx is in the back of the throat, between the tonsils and the voicebox (larynx).
Tonsillitis most often occurs in children; however, the condition rarely occurs in children younger than two years. Tonsillitis caused by Streptococcus species typically occurs in children aged five to 15 years, while viral tonsillitis is more common in younger children. A peritonsillar abscess is usually found in young adults but can occur occasionally in children. The patient's history often helps identify the type of tonsillitis (i.e., acute, recurrent, chronic) that is present.
Types of tonsillitis:
Acute Tonsillitis: Acute tonsillitis is an infection of the tonsils caused by one of several possible types of bacteria or viruses. Acute tonsillitis is characterized by either the sudden or gradual onset of a sore throat which is usually associated with fever. The patient may stop swallowing saliva, start to drool, complain of ear pain with swallowing, and have bad breath. The surface of the tonsil may be bright red or have a grayish-white coating (exudate). The lymph nodes in the neck may be swollen. Fever can be present.
Strep throat (tonsillitis) is a specific type of infection caused by the streptococcus bacteria. Strep tonsillitis can cause secondary damage to the heart valves (rheumatic fever) and kidneys (glomerulonephritis). It can also lead to a skin rash (scarlet fever), sinusitis, pneumonia, and ear infections.
Chronic Tonsillitis: Chronic tonsillitis is a persistent infection of the tonsils. Repeated infections may cause the formation of small pockets (crypts) in the tonsils which harbor bacteria. Frequently, small, foul smelling stones are found within these crypts. These stones (tonsilloliths) may contain high quantities of sulfa. When crushed, they give off the characteristic rotten egg smell which causes bad breath. They may also give a patient the sense of something being caught in the back of the throat.
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.
Signs and symptoms of tonsillitis include:
Causes and Risk factors:
Bacteria or viruses entering through the nose or mouth can cause tonsillitis. Because the tonsils are positioned at the back of the throat, they come into contact with bacteria and viruses that enter through the nose and mouth. Normally the tonsils trap these organisms and produce antibodies to help fight infection. However, the tonsils occasionally become infected, inflamed, and swollen, making them unable to fight off germs trying to enter the body.
A variety of bacteria or viruses can cause tonsillitis. The bacteria most commonly responsible for tonsillitis is group A beta-hemolytic streptococcus (also known as “strep”). Adenoviruses, parainfluenza viruses, influenza viruses, the Epstein-Barr virus (the virus that causes mononucleosis), enteroviruses (usually found in the intestinal tract), or the herpes simplex virus can all cause viral tonsillitis.
It is important to learn the cause of tonsillitis because treatment approaches are different. Antibiotics, for example, commonly prescribed for bacterial tonsillitis, are not effective against viral tonsillitis.
Tonsillitis may be caused by a fungus in patients with HIV infections. Immunocompromised patients such as those infected with HIV are susceptible to infection with the Candida fungus. Candida may infect the tonsils in addition to other parts of the mouth and throat in these patients.
Close contact with an infected person is the main risk factor for tonsillitis. Droplets of disease-causing agents (pathogens) pass through the air when an infected person breathes, coughs, or sneezes; you may then become infected after breathing in these droplets. Infection can also occur if pathogens get on the skin or on objects that come in contact with the mouth, nose, eyes, or other mucous membranes.
Nasal obstruction causes you to breathe through your mouth, which increases the risk of tonsillitis.
Although there is no proof that exposure to cigarette smoke can cause tonsillitis, children who live with a smoker have a higher incidence of tonsillectomy, which is a surgical procedure to remove the tonsils.
Diagnosis of tonsillitis is based on a medical history and a physical examination of the throat. An accurate medical history is necessary in order to determine whether tonsillitis is recurrent, which may affect treatment choices.
If your symptoms suggest strep throat, your health professional may want to confirm this diagnosis by doing a throat culture. Strep throat is more likely if 3 or 4 of the following signs or symptoms are present:
- Red, swollen tonsils.
- White patches on the tonsils.
- Sore throat.
- Difficult or painful swallowing.
- Fever and chills.
- Enlarged, tender glands (lymph nodes) in the jaw and neck.
- Loss of voice (laryngitis).
- Abdominal pain in children.
The results of these tests will determine whether antibiotic treatment is necessary. These results combined with an accurate medical history will be considered in deciding whether surgery to remove the tonsils (tonsillectomy) is recommended.
If the Epstein-Barr virus, which can cause mononucleosis, is suspected as a cause for the tonsillitis, a test for mononucleosis may be done.
- White or yellow spots or coating on the throat and/or tonsils (tonsillar exudates).
- Swollen or tender lymph nodes on the neck.
- Absence of coughing or sneezing.
- If a strep infection is suspected, your health professional may conduct a rapid strep test or a throat culture or both. Both of these tests can be conducted in a doctor's office. You may want to discuss the advantages and disadvantages of each test to determine which test is appropriate.
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.
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.
Lifestyle and home remedies include:
Medicine and medications:
- 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).
Tonsillitis is usually caused by a virus and does not require prescription medicine. Gargling with salt water and taking over-the-counter pain medicines such as acetaminophen (Tylenol) can help manage symptoms as the body fights off the infection. Do not give aspirin to anyone age 20 years or younger because of the risk of Reye's syndrome.
An antibiotic, usually penicillin, is used to treat tonsillitis caused by strep bacteria.
Although tonsillitis caused by strep bacteria usually will go away on its own, antibiotics are used to prevent the complications, such as rheumatic fever, that can result from untreated strep throat.
Many over-the-counter remedies, including antiseptic mouthwashes, decongestants, and antihistamines, contain extra ingredients that don't relieve discomfort. These remedies are not recommended for children, as these ingredients have not been proven to have any benefits in the treatment of acute tonsillitis.
If antibiotics are prescribed, it is very important to take them exactly as directed by your health professional until the medicine is gone. Even if the symptoms disappear completely before the prescription is gone, all pills should be taken as directed to ensure that the infection is completely destroyed. Bacteria can become resistant to the antibiotics used to treat tonsillitis (antibiotic resistance) if prescriptions aren't taken as directed or if they are prescribed when they aren't necessary.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.