Tonsillitis

Topics Details

Tonsils are the two lymph nodes located on each side of the back of your throat. They function as a defense mechanism. They help prevent your body from infection. When the tonsils become infected, the condition is called tonsillitis.

At the back of your throat, two masses of tissue called tonsils act as filters, trapping germs that could otherwise enter your airways and cause infection. They also produce antibodies to fight infection. But sometimes the tonsils themselves become infected. Overwhelmed by bacteria or viruses, they swell and become inflamed, a condition known as tonsillitis.

Tonsillitis is common, especially in children. The condition can occur occasionally or recur frequently.

Causes and Symptoms of Tonsillitis

Bacterial and viral infections can cause tonsillitis. A common cause isStreptococcus (strep) bacteria. Other common causes include:

The main symptoms of tonsillitis are inflammation and swelling of the tonsils, sometimes severe enough to block the airways. Other symptoms include:

Throat pain or tenderness
Redness of the tonsils
A white or yellow coating on the tonsils
Painful blisters or ulcers on the throat
Hoarseness or loss of voice
Headache
Loss of appetite
Ear pain
Difficulty swallowing or breathing through the mouth
Swollen glands in the neck or jaw area
Fever, chills
Bad breath

In children, symptoms may also include:

What is tonsillitis?

Tonsillitis can occur at any age and is a common childhood infection. It is most often diagnosed in children from preschool age through their midteens. Symptoms include a sore throat, swollen tonsils, and fever.

This condition is contagious and can be caused by a variety of common viruses and bacteria, such as streptococcal bacteria, which causes strep throat. Tonsillitis caused by strep throat can lead to serious complications if left untreated.

Tonsillitis is easily diagnosed. Symptoms usually go away within seven to 10 days.

Tonsillitis is inflammation of the tonsils. It’s usually caused by a viral infection or, less commonly, a bacterial infection.

Tonsillitis is a common condition in children, teenagers and young adults.

The symptoms of tonsillitis include:

a sore throat and pain when swallowing
earache
high temperature (fever) over 38C (100.4F)
coughing
headache

Symptoms usually pass within three to four days.

When to see your GP

Tonsillitis isn’t usually a serious condition. You only need to see your GP if symptoms:

last longer than four days and don’t show any signs of improvement
are severe – for example, if you’re unable to eat or drink due to the pain, or you have difficulty breathing

Your GP will examine your throat and ask you some questions about your symptoms. If necessary, a throat swab can be taken to confirm the diagnosis. The results usually take a few days to return.

If your tonsillitis is caused by a bacterial infection, they may prescribeantibiotics. Typical signs of a bacterial infection include white pus-filled spots on the tonsils, no cough and swollen or tender lymph glands.

If you develop severe tonsillitis as a teenager or adult, your GP may recommend a blood test for glandular fever.

The tonsils

The tonsils are two small glands that sit on either side of the throat. In young children, they help to fight germs and act as a barrier against infection.

When the tonsils become infected, they isolate the infection and stop it spreading further into the body.

As a child’s immune system develops and gets stronger, the tonsils become less important and usually shrink. In most people, the body is able to fight infection without the tonsils.

Removal of the tonsils is usually only recommended if they’re causing problems, such as severe or repeated episodes of tonsillitis (see below).

What causes tonsillitis?

Most cases of tonsillitis are caused by a viral infection, such as the viruses that cause the common cold or flu virus (influenza).

Some cases can also be caused by a bacterial infection, typically a strain of bacteria called group A streptococcus bacteria.

These types of infections spread easily, so it’s important to try to avoid passing the infection on to others by:

staying away from public places, such as work, school or nursery, until your GP says it’s safe to return (usually after the symptoms have passed)
coughing and sneezing into a tissue and disposing of the tissue
washing hands before eating, after going to the toilet and, if possible, after coughing and sneezing

Most cases of tonsillitis are caused by a viral infection.

Viruses known to cause tonsillitis include:

rhinoviruses – which cause the common cold
the influenza virus
parainfluenza virus – which causes laryngitis and croup
enteroviruses – which cause hand, foot and mouth disease
adenovirus – which is a common cause of diarrhoea
the rubeola virus – which causes measles

In rare cases, tonsillitis can also be caused by the Epstein-Barr virus, which causes glandular fever.

If this is the case, you’ll probably feel very ill. You’ll have a sore throat and the lymph glands in your throat may be swollen. You may also have a fever and feel very tired.

Bacterial tonsillitis

Bacterial tonsillitis can be caused by a number of different bacteria, but it’s usually due to group A streptococcus bacteria.

In the past, serious bacterial infections, such as diphtheria and rheumatic fever, have been linked with tonsillitis. However, this is now rare, because these conditions are vaccinated against and treatment for them has greatly improved.

How tonsillitis is spread

Tonsillitis itself isn’t contagious, but the infections that cause it are.

Viruses, such as those that cause colds and flu, are spread through coming into close contact with someone who’s infected.

When an infected person coughs or sneezes, the virus is contained in the millions of tiny droplets that come out of their nose and mouth. You can become infected by breathing in the contaminated droplets. This is known as direct contact.

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 bacterial tonsillitis occurs frequently, doesn’t respond to other treatments or causes serious complications.

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 to 48 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

Control

Treatments for Tonsillitis

Treatment for tonsillitis will depend in part on the cause. To determine the cause, your doctor may perform a rapid strep test or throat swab culture. Both tests involve gently swabbing the back of the throat close to the tonsils with a cotton swab. A lab test can detect a bacterial infection. A viral infection will not show on the test, but may be assumed if the test for bacteria is negative. In some cases, the physical findings are convincing enough to diagnose a probable bacterial infection. In these cases, antibiotics may be prescribed without performing a rapid strep test

If tests reveal bacteria, treatment will consist of antibiotics to cure the infection. Antibiotics may be given as a single shot or taken 10 days by mouth. Although symptoms will likely improve within two or three days after starting the antibiotic, it’s important to take all of themedication your doctor prescribes to make sure the bacteria are gone. Some people need to take a second course of antibiotics to cure the infection.

If the tonsillitis is caused by a virus, antibiotics won’t work and your body will fight off the infection on its own. In the meantime, there are things you can do to feel better, regardless of the cause. They include:

Get enough rest
Drink warm or very cold fluids to ease throat pain
Eat smooth foods, such as flavored gelatins, ice cream, or applesauce
Use a cool-mist vaporizer or humidifier in your room
Gargle with warm salt water
Suck on lozenges containing benzocaine or other anesthetics
Take over-the-counter pain relievers such as acetaminophen oribuprofen.

When Tonsillectomy Is Needed

Tonsils are an important part of the immune system throughout life, so it is best to avoid removing them. However, if tonsillitis is recurrent or persistent, or if enlarged tonsils cause upper airway obstruction or difficulty eating, surgical removal of the tonsils, called tonsillectomy, may be necessary. Most tonsillectomies involve using a conventional scalpel to remove the tonsils; however there are many alternatives to this traditional method. Increasingly doctors are using techniques such as lasers, radio waves, ultrasonic energy, or electrocautery to cut, burn, or evaporate away enlarged tonsils.

As with all surgeries, each of these has benefits and drawbacks. When considering the procedure, it’s important to discuss your options with the surgeon to select the most appropriate one for your child.

What to Expect After Surgery

Tonsillectomy is an outpatient procedure performed under general anesthesia and typically lasting between 30 minutes and 45 minutes. It is most commonly performed in children.

Most children go home about four hours after surgery and require a week to 10 days to recover from it. Almost all children will have throat pain, ranging from mild to severe, after surgery. Some may experience pain in the ears, jaw, and neck. Your child’s doctor will prescribe or recommend medication to ease the pain.

During the recovery period, it’s important for your child to get enough rest. It’s also important to make sure your child gets plenty of fluids; however, you should avoid giving your child milk products for the first 24 hours after surgery. Although throat pain may make your child reluctant to eat, the sooner your child eats, the sooner he or she will recover.For several days after surgery, your child may experience a low-grade fever and small specks of blood from the nose or saliva. If the fever is greater than 102 degrees Fahrenheit or if you see bright red blood, call your child’s doctor right away. Prompt medical attention may be necessary.

Treating tonsillitis

There’s no specific treatment for tonsillitis, but you may be able to reduce the symptoms by:

taking paracetamol or ibuprofen to help relieve pain
drinking plenty of fluids
getting plenty of rest

If test results show that your tonsillitis is caused by a bacterial infection, a short course of oral antibiotics may be prescribed.

If oral antibiotics aren’t effective at treating bacterial tonsillitis, intravenous antibiotics (given directly into a vein) may be needed in hospital.

Chronic tonsillitis

In most cases, tonsillitis gets better within a week. However, a small number of children and adults have tonsillitis for longer, or it keeps returning. This is known as chronic tonsillitis and surgical treatment may be needed.

Surgery to remove the tonsils (a tonsillectomy) is usually only recommended if:

you’ve had several severe episodes of tonsillitis over a long period of time
repeated episodes are disrupting normal activities

Complications of tonsillitis

Complications of tonsillitis are rare and usually only occur if it’s caused by a bacterial infection. They’re usually the result of the infection spreading to another part of the body.

Possible complications of tonsillitis include:

a middle ear infection (otitis media) – where fluid between the eardrum and inner ear becomes infected by bacteria
quinsy (peritonsillar abscess) – an abscess (collection of pus) that develops between one of the tonsils and the wall of the throat
obstructive sleep apnoea (OSA) – where the walls of the throat relax during sleep, which causes breathing difficulties and poor sleep

Other complications of tonsillitis are very rare and usually only occur if an underlying bacterial infection is left untreated. They include:

scarlet fever – a condition that causes a distinctive pink-red skin rash
rheumatic fever – this causes widespread inflammation throughout the body, leading to symptoms such as joint pain, rashes and jerky body movements
glomerulonephritis – an infection (swelling) of the filters in the kidneys that can cause vomiting and a loss of appetite

Antibiotics

Antibiotics may not be prescribed, even if tests confirm your tonsillitis is caused by a bacterial infection. The two main reasons for this are:

in most cases, antibiotics won’t speed up the recovery, but they can cause unpleasant side effects, such as stomach pain and feeling sick
the more an antibiotic is used to treat a non-serious infection, the greater the chance it won’t be effective in treating more serious infections; this is known as antibiotic resistance

However, exceptions are usually made if:

symptoms are severe
symptoms show no sign of easing
you or your child has a weakened immune system

In these circumstances, a 10-day course of penicillin is usually recommended. If you or your child is known to be allergic to penicillin, an alternative antibiotic, such as erythromycin, can be used.

Hospital treatment may be required for particularly severe or persistent cases of bacterial tonsillitis that don’t respond to oral antibiotics. In these cases, intravenous antibiotics (given directly into a vein) may be needed.

Antibiotics sometimes cause mild side effects, such as an upset stomach,diarrhoea or a rash.

Surgery

Surgery to remove the tonsils is known as a tonsillectomy.

For children with mild sore throats, watchful waiting is recommended rather than a tonsillectomy.

A tonsillectomy is only considered for a recurrent sore throat if certain criteria are met. You must have:

a sore throat caused by tonsillitis
episodes of sore throat that are disabling and stop you functioning normally
seven or more well-documented, clinically significant, adequately treated sore throats in the preceding year or
five or more such episodes in each of the preceding two years or
three or more such episodes in each of the preceding three years

Tonsillectomies are carried out under general anaesthetic, which means you’ll be asleep during the procedure. Your mouth will be held open to allow the surgeon to see your tonsils and no cuts will be made in your skin.

The operation can be carried out in a number of ways, as described below.

Cold steel surgery – this is the most common method, where a surgical blade is used to cut the tonsils out. Bleeding is controlled by applying pressure or the blood vessels may be sealed using heat generated by diathermy.
Diathermy – a diathermy probe is used to destroy the tissue around the tonsils and to remove the tonsils. At the same time, the heat seals the blood vessels to stop any bleeding.
Coblation (or cold ablation) – this method works in a similar way to diathermy, but uses a lower temperature (60C). It’s considered less painful than diathermy.
Lasers – high-energy laser beams are used to cut away the tonsils and seal the underlying blood vessels shut.
Ultrasound – high-energy ultrasound waves are used in a similar way to lasers.

Each of these techniques is relatively similar in terms of safety, results and recovery, so the type of surgery used will depend on the expertise and training of the surgeon.

You’ll usually be able to leave hospital on the same day as you have surgery, or the day after.

After surgery

After surgery, it’s likely you’ll experience some pain at the site of the operation. This can last for up to a week. Painkillers can help to relieve the pain.

Children who have had a tonsillectomy should be kept off school for two weeks. This is to reduce their risk of picking up an infection from another child that will make them feel more uncomfortable.

Swallowing will probably be difficult after having a tonsillectomy. However, it’s important to eat solid foods, because it will help your throat to heal more quickly. Drink plenty of fluids, but avoid acidic drinks, such as orange juice, because they’ll sting.

Ensuring good oral hygiene by regularly brushing your teeth and using mouthwash can help prevent infection in the mouth.

The pain usually gets worse during the first week after having a tonsillectomy, before gradually improving during the second week.Earache is common with tonsillectomies, but isn’t a cause for concern.

Post-operative bleeding

Bleeding at the site where the tonsils were removed is a fairly common complication of a tonsillectomy. This can occur during the first 24 hours following surgery or up to 10 days afterwards.

It’s estimated that around 1 in 100 children and 1 in 30 adults will experience post-operative bleeding after having a tonsillectomy.

Minor bleeding isn’t usually a cause for concern, because in most cases it resolves by itself. Gargling with cold water can often help stem the bleeding, because the cold helps to contract the blood vessels.

Occasionally, the bleeding can be more severe, causing people to cough up blood. Seek immediate medical advice if this happens. You should be given an emergency contact number before you’re discharged from hospital. Alternatively, you can call NHS 111.

Extensive bleeding may need to be treated with surgery or a blood transfusion.

Preventing infection

It’s not always easy to avoid catching viral infections that are spread by coming into contact with germs.

However, following good hygiene practices can help to prevent infections spreading.

For example:

wash your hands frequently
cough and sneeze into a tissue and dispose of it in the bin
avoid sharing glasses or utensils with people who are ill
Antibiotics are prescribed for tonsillitis caused by strep bacteria. A strep infection will usually go away on its own, but antibiotic treatment is needed because untreated strep throat can cause serious complications. For more information, see the topic Strep Throat.

Remedy

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