Definition

Tonsillitis is an infection that causes inflammation of the tonsils, which are two masses of tissue located at the back of the throat. These tissues act as filters, trapping harmful organisms or germs to prevent them from spreading and causing more extensive infections. However, the tonsils can become infected by viruses or bacteria, leading to swelling and painful symptoms. Most cases of tonsillitis are caused by bacterial infections.

Tonsillitis can occur at any age but is more commonly found in children. The disease is categorized into acute, chronic, and recurrent tonsillitis.

• Acute tonsillitis: Inflammation of the tonsils with symptoms typically lasting three to four days but can last up to two weeks.
• Chronic tonsillitis: Inflammation of the tonsils due to infection lasting more than two weeks.
• Recurrent tonsillitis: Tonsil infections with symptoms that recur several times within a year, resolving and then reappearing.

Causes

Tonsillitis is generally caused by bacterial or viral infections. Streptococcus is the most common bacterium causing tonsillitis, which can also lead to inflammation of the throat walls. Other bacteria that can cause tonsillitis include Mycoplasma pneumoniae, Corynebacterium diphtheriae, and Chlamydia pneumoniae.

Most acute tonsillitis cases are caused by viral infections, including adenovirus, influenza virus, parainfluenza virus, enterovirus, herpes simplex virus, and Epstein-Barr virus.

Risk factor

Children are at higher risk for tonsillitis, though it is rare in children under two years old. Children often spend much time with peers, making them more susceptible to germs causing tonsillitis.

Adults who spend significant time with children are also at risk. Tonsillitis caused by Streptococcus bacteria is common in children aged 5-15, while viral tonsillitis is more frequent in younger children.

Symptoms

Common symptoms of tonsillitis include:

• Fever
• Swollen and red tonsils
• White or yellow coating on the tonsils
• Sore throat
• Difficulty or pain when swallowing
• Enlarged lymph nodes, especially in the neck area
• Hoarse voice
• Difficulty breathing
• Neck pain or stiffness
• Headache

In young children who cannot express their symptoms, tonsillitis can be assessed by observing behaviors such as pain while swallowing, reduced appetite, fussiness, and fever.

Diagnosis

Diagnosis of tonsillitis is typically made by a doctor asking about symptoms and performing a physical examination. The doctor will check for swelling, the presence of a coating on the tonsils, and signs of inflammation in the throat and tonsil area. The doctor may also feel for swollen lymph nodes in the neck.

A lung examination may be conducted to assess lung infections and their relation to the tonsil infection. Throat swab tests may be done to collect samples from the throat for laboratory analysis to identify the specific microorganisms causing the inflammation.

A complete blood count (CBC) test might be performed to check for elevated blood cells indicating bacterial or viral infections. However, a CBC is not necessary if the throat swab results are negative.

Management

Treatment for tonsillitis varies depending on the causative organism. For viral infections, antibiotics are not prescribed. Instead, the doctor will advise adequate rest and a proper diet. Viral tonsillitis typically resolves within ten days.

For bacterial infections, antibiotics are prescribed and should be taken as directed to avoid resistance. In addition to antibiotics, symptom relief medications such as fever reducers and pain relievers are recommended. The doctor will also suggest rest, adequate fluid intake, nutritious food, gargling with saltwater, and avoiding irritants like smoking.

If medications are ineffective and severe symptoms, such as swallowing or breathing difficulties, may occur, surgical removal of the tonsils (tonsillectomy) may be considered.

Complications

Untreated tonsillitis can lead to various complications, including changes in mental status, trismus, high fever, and severe swelling that can cause swallowing or breathing issues. It can also cause ear infections, pus accumulation around the tonsils, and spread to surrounding tissues.

Bacterial tonsillitis caused by Streptococcus can lead to serious complications like rheumatic fever, scarlet fever, sinusitis, and kidney infections (glomerulonephritis).

Prevention

Preventing tonsillitis involves maintaining hygiene, washing hands before eating, not sharing eating or drinking utensils, and being cautious around people with sore throats or tonsillitis.

When to see a doctor?

Contact a doctor if tonsillitis or tonsil inflammation symptoms appear, such as fever, persistent sore throat for 24-48 hours, pain and difficulty swallowing, and fatigue. In children, signs include excessive drooling and irritability.

Immediate medical attention is necessary for symptoms like high fever, severe throat pain, difficulty swallowing, drooling in children, or any signs of breathing problems.