Tonsillitis

Definition

Tonsillitis is inflammation (swelling) of the tonsils.

See also: Strep throat

Alternative Names

Causes, incidence, and risk factors

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 germs to prevent infection in the body.

A bacterial or viral infection can cause tonsillitis. Strep throat is a common cause.

The infection may also be seen in other parts of the throat. See: Pharyngitis

Tonsillitis is very common, especially in children.

Symptoms

• Difficulty swallowing
• Ear pain
• Fever, chills
• Headache
• Sore throat - lasts longer than 48 hours and may be severe
• Tenderness of the jaw and throat

Signs and tests

The health care provider will look in the mouth and throat.

• The tonsils are usually red and may have white spots on them.
• The lymph nodes in the jaw and neck may be swollen and tender to the touch.

A rapid strep test can be done in most doctor's offices. However, this test may be normal, and you can still have strep. Your doctor may send the throat swab to a laboratory for a strep culture. Test results can take a few days.

Treatment

Swollen tonsils that are not painful or do not cause other problems do not need to be treated. Your health care provider may not give you antibiotics. You may be asked to come back for a check up later.

If tests show you do have strep, your doctor will give you antibiotics. It is important to finish all of your antibiotics as directed by your doctor, even if you feel better. If you do not take them all, the infection can return.

The following tips may help your throat feel better:

• Drink cold liquids or suck on popsicles
• Drink fluids, especially warm (not hot), bland fluids
• Gargle with warm salt water
• Suck on lozenges (containing benzocaine or similar ingredients) to reduce pain (these should not be used in young children because of the choking risk)
• Take over-the-counter medications, such as acetaminophen (Tylenol) or ibuprofen to reduce pain and fever. Do NOT give a child aspirin. Aspirin has been linked to Reye syndrome.

Some people who have repeated infections may need surgery to remove the tonsils (tonsillectomy).

Support Groups

Expectations (prognosis)

Tonsillitis symptoms due to strep usually get better about 2 or 3 days after you start the antibiotics. 

Children with strep throat should generally be kept home from school or day care until they have been on antibiotics for 24 hours. This helps reduce the spread of illness.

Complications

• Blocked airway from swollen tonsils
• Dehydration from difficulty swallowing fluids
• Peritonsillar abscess in other parts of the throat behind the tonsils
• Post-streptococcal glomerulonephritis (kidney disease caused by strep)
• Rheumatic fever and other heart problems

Calling your health care provider

Call your health care provider if there is:

• Excess drooling in a young child
• Fever, especially 101°F or higher
• Pus in the back of the throat
• Red rash that feels rough, and increased redness in the skin folds
• Severe difficulty swallowing or breathing
• Tender or swollen lymph glands in the neck

Prevention

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References

Wetmore RF. Tonsils and adenoids.In: Kliegman RM,Behrman RE, Jenson HB, Stanton BF, eds.Nelson Textbook of Pediatrics.19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 375.

Del Mar CB, Glasziou PP, Spinks A. Antibiotics for sore throat. Cochrane Database Syst Rev. 2008:(3):CD000023.

Chan TV. The patient with sore throat. Med Clin North Am. 2010. 94:923-943.