Overview
Tonsillitis is inflammation of the tonsils, two oval-shaped pads of tissue at the back of the throat — one tonsil on each side.Swollen tonsils, a sore throat, trouble swallowing, and tender lymph nodes on the sides of the neck are all indicators of tonsillitis.
Although bacterial infections can also cause tonsillitis, common viral infections account for the majority of instances.
It’s critical to receive a timely and precise diagnosis because the proper therapy for tonsillitis depends on the underlying reason. Once a routine therapy for tonsillitis, surgery to remove the tonsils is now typically only done when the infection is severe, recurrent, or causes other serious consequences.
Symptoms
Tonsillitis most commonly affects children between preschool ages and the midteenage years. Common signs and symptoms of tonsillitis include:
- Red, swollen tonsils
- White or yellow coating or patches on the tonsils
- Sore throat
- Difficult or painful swallowing
- Fever
- Enlarged, tender glands (lymph nodes) in the neck
- A scratchy, muffled or throaty voice
- Bad breath
- Stomachache
- Neck pain or stiff neck
- Headache
In young children who are unable to describe how they feel, signs of tonsillitis may include:
- Drooling due to difficult or painful swallowing
- Refusal to eat
- Unusual fussiness
Causes
Common viruses are most frequently to blame for tonsillitis, but bacterial infections can also be to blame.
Streptococcus pyogenes (group A streptococcus), the bacterium that causes strep throat, is the most frequent cause of tonsillitis. Numerous additional bacteria, including strep types, have been linked to tonsillitis.
Why do tonsils get infected?
The tonsils are the immune system’s first line of defense against bacteria and viruses that enter your mouth. This function may make the tonsils particularly vulnerable to infection and inflammation. However, the tonsil’s immune system function declines after puberty — a factor that may account for the rare cases of tonsillitis in adults.
Risk factors
Risk factors for tonsillitis include:
- Young age. Tonsillitis most often affects children, and tonsillitis caused by bacteria is most common in children ages 5 to 15.
- Frequent exposure to germs. School-age children are in close contact with their peers and frequently exposed to viruses or bacteria that can cause tonsillitis.
Complications
Inflammation or swelling of the tonsils from frequent or ongoing (chronic) tonsillitis can cause complications such as:
- Disrupted breathing during sleep (obstructive sleep apnea)
- Infection that spreads deep into surrounding tissue (tonsillar cellulitis)
- Infection that results in a collection of pus behind a tonsil (peritonsillar abscess)
Strep infection
If tonsillitis caused by group A streptococcus or another strain of streptococcal bacteria isn’t treated or if antibiotic treatment is incomplete, your child has an increased risk of rare disorders such as:
- Rheumatic fever, a serious inflammatory condition that can affect the heart, joints, nervous system and skin
- Complications of scarlet fever, a streptococcal infection characterized by a prominent rash
- Inflammation of the kidney (poststreptococcal glomerulonephritis)
- Poststreptococcal reactive arthritis, a condition that causes inflammation of the joints
Prevention
The germs that cause viral and bacterial tonsillitis are contagious. Therefore, the best prevention is to practice good hygiene. Teach your child to:
- Wash his or her hands thoroughly and frequently, especially after using the toilet and before eating
- Avoid sharing food, drinking glasses, water bottles or utensils
- Replace his or her toothbrush after being diagnosed with tonsillitis
To help your child prevent the spread of a bacterial or viral infection to others:
- Keep your child at home when he or she is ill
- Ask your doctor when it’s all right for your child to return to school
- Teach your child to cough or sneeze into a tissue or, when necessary, into his or her elbow
- Teach your child to wash his or her hands after sneezing or coughing
Diagnosis
Your child’s doctor will start with a physical exam that will include:
- Using a lighted instrument to look at your child’s throat and likely his or her ears and nose, which also may be sites of infection
- Checking for a rash known as scarlatina, which is associated with some cases of strep throat
- Gently feeling (palpating) your child’s neck to check for swollen glands (lymph nodes)
- Listening to his or her breathing with a stethoscope
- Checking for enlargement of the spleen (for consideration of mononucleosis, which also inflames the tonsils)
Throat swab
A sterile swab is used in this quick test to collect a sample of secretions from the back of your child’s throat. Streptococcal bacteria will be examined in a lab or at the clinic.
Many clinics have a lab that can produce a test result in a matter of minutes. However, a second more trustworthy test is typically submitted to a lab that may frequently deliver results in a few hours or days.
Complete blood cell count (CBC)
Your doctor might ask for a tiny blood sample from your child and order a CBC. This test, which is frequently performed in a clinic, yields a count of the various blood cell types. The profile of what is high, normal, or below normal can help determine whether a virus or bacteria is more likely to be to blame for an infection. The diagnosis of strep throat doesn’t frequently require a CBC. However, the CBC may be required to assist identify the source of tonsillitis if the strep throat lab test is negative.
Treatment
At-home care
Whether a bacterial or viral infection is the cause of your child’s tonsillitis, at-home care techniques can help them feel more at ease and heal more quickly.
These methods are the only ones that can be used to treat tonsillitis if a virus is the expected cause. Antibiotics won’t be recommended by your doctor. Your youngster should feel better in seven to ten days.
At-home care strategies to use during the recovery time include the following:
- Encourage rest. Encourage your child to get plenty of sleep.
- Provide adequate fluids. Give your child plenty of water to keep his or her throat moist and prevent dehydration.
- Provide comforting foods and beverage. Warm liquids — broth, caffeine-free tea or warm water with honey — and cold treats like ice pops can soothe a sore throat.
- Prepare a saltwater gargle. If your child can gargle, a saltwater gargle of 1/2 teaspoon (2.5 milliliters) of table salt to 8 ounces (237 milliliters) of warm water can help soothe a sore throat. Have your child gargle the solution and then spit it out.
- Humidify the air. Use a cool-air humidifier to eliminate dry air that may further irritate a sore throat, or sit with your child for several minutes in a steamy bathroom.
- Offer lozenges. Children older than age 4 can suck on lozenges to relieve a sore throat.
- Avoid irritants. Keep your home free from cigarette smoke and cleaning products that can irritate the throat.
- Treat pain and fever. Talk to your doctor about using ibuprofen (Advil, Children’s Motrin, others) or acetaminophen (Tylenol, others) to minimize throat pain and control a fever. Low fevers without pain do not require treatment.Unless aspirin is prescribed by a doctor to treat a particular disease, children and teenagers should not take aspirin. Aspirin use by children to treat symptoms of cold or flu-like illnesses has been linked to Reye’s syndrome, a rare but potentially life-threatening condition.
Antibiotics
Your doctor will recommend a course of antibiotics if a bacterial infection is the cause of your tonsillitis. The most common antibiotic administered for tonsillitis brought on by group A streptococcus is penicillin, taken orally for 10 days. Your doctor will recommend an alternative antibiotic if your child is allergic to penicillin.
Even if the symptoms totally go, your kid must complete the entire course of antibiotics as directed. If you don’t take all of the prescribed treatment, the infection could get worse or spread to other areas of your body. Particularly, not finishing the entire antibiotic course can raise your child’s risk of developing rheumatic fever and experiencing severe kidney irritation.
Surgery
Surgery to remove tonsils (tonsillectomy) may be used to treat frequently recurring tonsillitis, chronic tonsillitis or bacterial tonsillitis that doesn’t respond to antibiotic treatment. Frequent tonsillitis is generally defined as:
- At least seven episodes in the preceding year
- At least five episodes a year in the past two years
- At least three episodes a year in the past three years
A tonsillectomy may also be performed if tonsillitis results in difficult-to-manage complications, such as:
- Obstructive sleep apnea
- Breathing difficulty
- Swallowing difficulty, especially meats and other chunky foods
- An abscess that doesn’t improve with antibiotic treatment
A tonsillectomy is usually done as an outpatient procedure, unless your child is very young, has a complex medical condition or if complications arise during surgery. That means your child should be able to go home the day of the surgery. A complete recovery usually takes seven to 14 days.