Tonsillitis

• 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 fever and 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.

Review Date: 11/2/2009

Reviewed By: 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.