Tonsillitis

Answer 1

Definition

Tonsillitis is inflammation (swelling) of the tonsils.

See also:

• Sore throat
• Strep throat

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 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). See: Pharyngitis

Tonsillitis is extremely common, particularly 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
• Voice changes, loss of voice

Signs and tests

The health care provider will look in the mouth and throat for swollen tonsils. The tonsils are usually reddened and may have white spots on them. The lymph nodes in the jaw and neck may be swollen and tender to the touch.

Tests that may be done include:

• Rapid strep test
• Throat swab culture

Treatment

If the cause of the tonsillitis is bacteria such as strep, antibiotics are given to cure the infection. The antibiotics may be given once as a shot, or taken for 10 days by mouth.

If antibiotic pills are used, they must be taken for the entire amount of time prescribed by the doctor. DO NOT stop taking them just because the discomfort stops, or the infection may not be cured.

Rest to allow the body to heal. Fluids, especially warm (not hot), bland fluids or very cold fluids may soothe the throat. Gargle with warm salt water or suck on lozenges (containing benzocaine or similar ingredients) to reduce pain.

Over-the-counter medications, such as acetaminophen (Tylenol) or ibuprofen may be used 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).

Expectations (prognosis)

Tonsillitis symptoms usually improve 2 or 3 days after treatment starts. The infection usually is cured after treatment is completed, but some people may need more than one course of antibiotics.

Complications of untreated strep tonsillitis may be severe. Children with tonsillitis related to strep throat or pharyngitis 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
• Kidney failure
• Peritonsillar abscess or abscess in other parts of the throat
• Pharyngitis - bacterial
• Post-streptococcal glomerulonephritis
• Rheumatic feverand related cardiovascular disorders

Calling your health care provider

Call your health care provider if:

• A sore throat lasts longer than 48 hours
• New symptoms develop
• Symptoms get worse
• You have other symptoms with the sore throat

References

Wetmore RF. Tonsils and adenoids. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics.18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 380.

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

Answer 2

Definition

Tonsillitis is inflammation (swelling) of the tonsils.

See also: Strep throat

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).

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.

ComplicationsComplications from strep throat may be severe. They can include:

• 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 feverand 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

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.

Reviewed By

Review Date: 11/07/2011

Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 3

If your child often has a sore throat, trouble swallowing, and ear pain, she may have a problem with her tonsils.

So, what causes tonsillitis?

The tonsils are small, dimpled, Golf ball-like nodes on either side of the back of your child's throat. They normally help to filter out bacteria and other germs to prevent infection in the body. If the tonsils become so overwhelmed with bacteria from strep throat or a viral infection, they can swell and become inflamed, causing tonsillitis.

Your child's doctor will look in your child's mouth and throat for swollen tonsils. The tonsils will probably be red and may have white spots on them. The lymph nodes in your child's jaw and neck may be swollen and tender to the touch. The doctor may test your child's blood for infection.

If bacteria are the cause, your child will probably need to take antibiotics, either in a shot or in pill form. If your child needs to take antibiotic pills, make sure she takes all of the medicine. To comfort your child, give her cold liquids and popsicles. Gargling with salt water can help. She can also take over-the-counter medicine like acetaminophen or ibuprofen for her pain and fever.

Tonsillitis usually improves two or three days after treatment starts. The infection usually goes away too, but some people may need to take antibiotics for longer. If your child has a great many repeated infections, surgery may be recommended to remove her tonsils, but this is no longer a common reason to have the tonsils out.

Reviewed By

Review Date: 10/25/2011

Alan Greene, MD, Author and Practicing Pediatrician; also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.