Tonsillitis

Description

Tonsillitis is the inflammation of the tonsils, two oval-shaped pads of tissue at the back of the throat-one tonsil on each side. The 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 is important to get a prompt and accurate diagnosis. The surgery to remove the tonsils, once a common procedure for the treatment of tonsillitis, usually done only when tonsillitis occurs frequently, do not respond to other treatments or causes serious complications.

Symptoms

Tonsillitis most commonly affects children between preschool and the ages of the midteenage years. The signs and symptoms of tonsillitis include:

  • Red, swollen tonsils
  • White or yellow coating or patches on the tonsils
  • Sore throat
  • Difficulty or pain when swallowing
  • Fever
  • Enlarged, tender glands (lymph nodes) in the neck
  • A scratchy, muffled or throaty voice
  • Bad breath
  • The pain of stomach
  • Neck pain or stiffness in the neck
  • Headache

In young children who are not able to describe how they feel, signs of tonsillitis may include:

  • Drooling due to difficult or painful swallowing
  • Refusal to eat
  • Irritability, unusual

When to see a doctor

It is important to obtain an accurate diagnosis if your child has symptoms that may indicate strep throat.

Call your doctor if your child is experiencing:

  • A sore throat with fever
  • A sore throat that does not go away within 24 to 48 hours
  • Pain or difficulty swallowing
  • Extreme weakness, fatigue, or irritability

Get immediate medical attention if your child has any of these symptoms:

  • Difficulty breathing
  • The extreme difficulty swallowing
  • Excessive 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 streptococci and other bacteria also may cause tonsillitis.

Why the tonsils are infected?

The tonsils are the immune system's first line of defense against bacteria and viruses that enter your mouth. This function can make the tonsils particularly vulnerable to infection and inflammation. However, the amygdala is the function of the immune system decreases after puberty — a factor that may account for the rare cases of tonsillitis in adults.

Risk factors

Risk factors for tonsillitis include:

  • The young age. Tonsillitis most often affects children, and tonsillitis caused by bacteria is most common in children between the ages of 5 to 15.
  • Frequent exposure to germs. School-age children are in close contact with their peers and often exposed to the virus or bacteria that can cause tonsillitis.

Complications

The inflammation or swelling of the tonsils from frequent or long-lasting (chronic) for strep throat can cause complications, such as:

  • Interrupted breathing during sleep (obstructive sleep apnea)
  • The infection that extends deep into the surrounding tissue (tonsillar cellulitis)
  • The infection that results in an accumulation of pus behind an infection of the tonsils (peritonsillar abscess)

Strep infection

If the tonsillitis is caused by group a streptococcus or another strain of strep bacteria not treated or if the antibiotic treatment is incomplete, your child has a higher risk of rare diseases, such as:

  • Rheumatic fever, a serious inflammatory disease that can affect the heart, joints, the nervous system and the skin
  • Complications of scarlet fever, a strep infection is characterized by a major eruption
  • 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 your hands thoroughly and frequently, especially after using the bathroom and before eating
  • Avoid sharing food, drinking glasses, water bottles, and cooking utensils
  • Replace your toothbrush after being diagnosed with tonsillitis

To help your child to avoid the spread of a viral or bacterial infection to others:

  • Keep your child home when he or she is sick
  • Ask your doctor when it is okay for their child to return to school
  • Teach your child to cough or sneeze into a disposable tissue or, when necessary, into their elbow
  • Teach your child to wash their hands after sneezing or coughing

Tonsillitis

Diagnosis

Your child's doctor will start with a physical exam that includes:

  • The use of a lighted instrument to look at your child's throat and it is likely that his or her ears and nose, which may also be the sites of infection
  • The checking of a rash known as scarlatina, which is associated with some cases of strep throat
  • Gently feel (palpate) your child's neck to check for swollen glands (lymph nodes)
  • Listening to your breathing with a stethoscope
  • The checking of the enlargement of the spleen (for the consideration of mononucleosis, which is also inflamed tonsils)

Throat swab

With this simple test, the doctor rubbed with a sterile swab in the back of your child's throat to get a sample of secretions. The shows will be marked in the clinic or laboratory to the streptococcal bacteria.

Many clinics are fully equipped with a lab that you can get a test result within a couple of minutes. However, a second more reliable test is usually sent to a laboratory that can often return results within a few hours or a couple of days.

If the fast in the clinic of the test is positive, then the child will almost certainly have a bacterial infection. If the test is negative, then your child is likely to have a viral infection. Your doctor will have to wait, however, for the more reliable outside of the clinical laboratory test to determine the cause of the infection.

Complete blood count (CBC)

Your doctor may order a complete blood count (CBC) with a small sample of the blood of his child. The result of this test, which can often be completed in a clinical setting, it produces a count of the different types of blood cells. The profile of what is high, what is normal or what that is below normal can indicate whether an infection is more likely to be caused by a bacterial infection or viral agent. A CBC is often not necessary to diagnose streptococcal pharyngitis. However, if the strep throat infection lab test is negative, the CBC may be necessary to help determine the cause of tonsillitis.

Treatment

Home care

If the tonsillitis is caused by a bacterial or viral infection, in home care strategies can make your child more comfortable and promote a better recovery.

If a virus is the expected cause of tonsillitis, these strategies are the only treatment. The doctor will not prescribe antibiotics. It is likely that your son will be better within seven to 10 days.

At-home care strategies to utilize during the time of recovery include the following:

  • Encourage others. Encourage your child to sleep.
  • Provide the right amount of liquid. Give your child a lot of water to keep your throat moist and prevent dehydration.
  • Provide comforting food and drinks. Warm liquids — broth, caffeine, tea, or warm water with honey and cold treats like ice pops can soothe a sore throat.
  • Prepare a gargle salt water. If your child can gargling salt water gargle-1/2 teaspoon (2.5 ml) of table salt to 8 ounces (237 milliliters) of warm water can help soothe a sore throat. Have your child gargle with 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 down with your child for a few minutes in a steam bath.
  • Supply of pills for cough. Children older than 4 years of age, suck on lozenges to soothe your sore throat.
  • Avoid irritants. Keep your home free from cigarette smoke and cleaning products that can irritate the throat.
  • Treat pain and fever.Talk with your doctor about the use of ibuprofen (Advil, Children's Motrin, others) or acetaminophen (Tylenol, others) to minimize throat pain and control a fever. Low fever without pain do not require treatment. Unless aspirin is prescribed by a physician to treat a particular disease, children and teenagers should not take aspirin. The use of aspirin by children to treat the symptoms of the cold or of the flu-like disease has been associated with Reye's syndrome, a rare but potentially life-threatening.

Treat pain and fever. Talk with your doctor about the use of ibuprofen (Advil, Children's Motrin, others) or acetaminophen (Tylenol, others) to minimize throat pain and control a fever. Low fever without pain do not require treatment.

Unless aspirin is prescribed by a physician to treat a particular disease, children and teenagers should not take aspirin. The use of aspirin by children to treat the symptoms of the cold or of the flu-like disease has been associated with Reye's syndrome, a rare but potentially life-threatening.

Antibiotics

If the tonsillitis is caused by a bacterial infection, the doctor will prescribe a course of antibiotics. Penicillin taken by mouth for 10 days is the most common antibiotic treatment prescribed for tonsillitis caused by group a streptococcus. If your child is allergic to penicillin, your doctor will prescribe an antibiotic alternative.

Your child must take the full course of antibiotics prescribed, even if symptoms disappear completely. The failure to take the medication as directed can result in the infection from getting worse or spreading to other parts of the body. Not completing the full course of antibiotics, in particular, to increase your child's risk of rheumatic fever and severe inflammation of the kidneys.

Talk with your doctor or pharmacist about what to do if you forget to give your child a dose.

Surgery

The surgery to remove the tonsils (tonsillectomy) may be used to treat tonsillitis, recurrent, chronic tonsillitis or tonsillitis bacterial that does not respond to antibiotic treatment. Frequent tonsillitis is generally defined as:

  • At least seven episodes in the previous year
  • At least five episodes per year over the last two years
  • At least three episodes per year in the last three years

A tonsillectomy may also be performed if the tonsillitis results are difficult to manage complications, such as:

  • Obstructive sleep apnea
  • The difficulty of breathing
  • Difficulty swallowing, especially meats, and other bulk food
  • An abscess that does not 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 surgery. A full recovery typically takes seven to 14 days.

Preparing for your appointment

If your child is experiencing a sore throat, difficulty swallowing, or other symptoms that may indicate strep throat, is likely to begin with a visit to your family doctor or your child's pediatrician. You may be referred to a specialist in ear, nose and throat disorders.

Your doctor may ask you a series of questions about your child's condition. Be prepared to answer the following questions:

  • When did the symptoms begin?
  • If your child has a fever, what was its temperature?
  • He or she has difficulty swallowing or pain when swallowing?
  • Is there something to improve symptoms, such as over-the-counter pain relievers or hot liquids?
  • Your child has been diagnosed with tonsillitis or strep throat before? If so, when?
  • Do the symptoms seem to affect your sleep?
  • Your child has been exposed to someone known to have strep throat?

The questions that you can ask your doctor include the following:

  • How much time does it take to get the results of the test?
  • What is the best course of treatment?
  • Should I be concerned with how often my son is receiving the tonsillitis?
  • When my child return to school or resume other activities?
Symptoms and treatment of Tonsillitis