Tonsillitis

Definition

Tonsillitis is inflammation of the tonsils, two oval-shaped pads of tissue at the back of the throat — one tonsil on each side. Signs and symptoms of tonsillitis include swollen tonsils, sore throat, difficulty swallowing and tender lymph nodes on the sides of the neck.

Most cases of tonsillitis are caused by infection with a common virus, but bacterial infections also may cause tonsillitis.

Because appropriate treatment for tonsillitis depends on the cause, it's important to get a prompt and accurate diagnosis. Surgery to remove tonsils, once a common procedure to treat tonsillitis, is usually performed only when tonsillitis occurs frequently, doesn't respond to other treatments or causes serious complications.

Symptoms

Tonsillitis most commonly affects children between preschool ages and the mid-teenage 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, particularly in younger children
• 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

When to see a doctor

It's important to get an accurate diagnosis if your child has symptoms that may indicate tonsillitis.

Call your doctor if your child is experiencing:

• A sore throat that doesn't go away within 24 hours
• Painful or difficult swallowing
• Extreme weakness, fatigue or fussiness

Get immediate care if your child has any of these symptoms:

• Difficulty breathing
• Extreme difficulty swallowing
• Drooling

Causes

Tonsillitis is most often caused by common viruses, but bacterial infections can also be the cause.

The most common bacterium causing tonsillitis is Streptococcus pyogenes (group A streptococcus), the bacterium that causes strep throat. Other strains of strep and other bacteria also may cause 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 is most common from the preschool years to the mid-teenage years.
• 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:

• Difficulty breathing
• 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 (tonsillar 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, an inflammatory disorder that affects the heart, joints and other tissues
• Post-streptococcal glomerulonephritis, an inflammatory disorder of the kidneys that results in inadequate removal of waste and excess fluids from blood

Tests and 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 may also 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

With this simple test, the doctor rubs a sterile swab over the back of your child's throat to get a sample of secretions. The sample will be checked in a lab for streptococcal bacteria.

Many clinics are equipped with a lab that can get a test result within a few minutes. However, a second more reliable test is usually sent out to a lab that can return results within 24 to 48 hours.

If the rapid in-clinic test comes back positive, then your child almost certainly has a bacterial infection. If the test comes back negative, then your child likely has a viral infection. Your doctor will wait, however, for the more reliable out-of-clinic lab test to determine the cause of the infection.

Complete blood cell count (CBC)

Your doctor may order a CBC with a small sample of your child's blood. The result of this test, which can often be completed in a clinic, produces a count of the different types of blood cells. The profile of what's elevated, what's normal or what's below normal can indicate whether an infection is more likely caused by a bacterial or viral agent. A CBC is not often needed to diagnose strep throat. However, if the strep throat lab test is negative, the CBC may be needed to help determine the cause of tonsillitis.

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 or utensils
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.