Tonsillitis

What is tonsillitis?
Tonsillitis is an infection or inflammation of the tonsils. The tonsils are balls of lymphatic tissue on both sides of the throat, above and behind the tongue. They are part of the immune system, which helps the body fight infection.

Tonsillitis often goes away on its own after four to 10 days. In some cases, tonsillitis can become chronic. Surgical removal of the tonsils (tonsillectomy), a procedure usually performed by an ear, nose and throat doctor, may be recommended for you or your child based on past health and the results of physical exams.

What causes tonsillitis?
Tonsillitis is usually caused by a virus and is spread by close contact with an infected person. Droplets of disease-causing agents (pathogens) pass through the air when an infected person breathes, coughs or sneezes. You may then become infected after breathing in these droplets. Infection can also occur if the virus comes in contact with your mouth, nose, eyes or other mucous membranes through touch (for example, shaking hands with someone who is infected, and then rubbing your eye). Symptoms usually appear about two to five days after exposure.

Tonsillitis can also be caused by bacteria, usually the same bacteria that cause strep throat (streptococcus group A). A person with tonsillitis caused by strep bacteria is contagious early on and without treatment can remain so for up to two weeks. Antibiotics shorten the contagious period, and an infected person is no longer contagious about 24 to 48 hours after beginning antibiotic therapy.

What are the symptoms?
The main symptom of tonsillitis is a sore throat. The throat and tonsils usually look red and swollen. The tonsils may have spots on them or pus that covers them completely or in patches. More symptoms occur in most cases. Some or all of the following may be present:

  • Fever
  • Bad breath
  • Nasal congestion and runny nose
  • Swollen lymph nodes
  • Red, swollen tonsils covered completely or in patches by pus
  • Difficulty swallowing
  • Headache
  • Abdominal (belly) pain
  • Raw, bleeding patches on the tonsils

If you feel as if you have a cold, with symptoms such as runny and stuffy nose, sneezing and coughing, a virus is most likely the cause. Viral infection of the tonsils usually goes away without treatment within two weeks.

Sore throat with a sudden fever above 101°F (38.3°C), swollen lymph nodes and no symptoms of an upper respiratory tract infection may point to a bacterial infection. (Milder fever may point to a viral infection.) Anyone with these symptoms should see a doctor for diagnosis because of the risk of strep throat. Although strep throat will usually go away even without treatment, an untreated strep infection can lead to complications, such as ear and sinus infections or pockets of infection outside the tonsils (peritonsillar abscess). More serious complications, such as rheumatic fever, may also occur.

Recurrent and ongoing (chronic) tonsillitis may obstruct the upper airway and cause problems, such as snoring, nasal congestion and mouth breathing. Sometimes chronic tonsillitis can lead to more severe conditions, including obstructive sleep apnea and heart and lung problems. But most children who have sleep apnea and enlarged tonsils do not have a history of tonsillitis.

When should you call a doctor?
Call your doctor if the following occur.
- Sore throat, along with any two of these signs of bacterial infection:

  • Fever of 101°F (38.3°C) or higher
  • White or yellow coating on the tonsils
  • Swollen, tender tonsils
  • Swollen lymph nodes in the neck
  • Abdominal (belly) pain and headache
  • Severe pain
  • Severe difficulty swallowing
  • Pain on only one side of the throat
  • Tonsillitis or sore throat that starts after being exposed to someone who has strep throat
  • Five episodes of tonsillitis in a year despite treatment
  • Persistent mouth breathing, snoring, or a very nasal- or muffled-sounding voice
  • Signs of dehydration, such as a dry mouth and tongue and urinating less than normal

Do you need a primary care physician? Visit our Providence Medical Group website to find a doctor near you.

How is tonsillitis diagnosed?
Your doctor will look at your throat to see if you have red and swollen tonsils with spots or sores. These signs can mean you have tonsillitis.

Your doctor may do a rapid strep test along with a throat culture. These will show whether the tonsillitis is caused by streptococcus bacteria.

Your doctor may also ask about past throat infections. If you get tonsillitis often, it may affect the choice of treatment.

You may have a test for mononucleosis if your doctor thinks that you have mono.

How is tonsillitis treated?
Tonsillitis caused by a virus will usually go away on its own, so treatment focuses on helping you feel better (watchful waiting). You may be able to ease throat pain if you gargle with salt water, drink warm tea, take over-the-counter pain medicine and use other home treatments. Do not give aspirin to anyone age 20 or younger. It is linked to a serious disease called Reye syndrome.

Watchful waiting is a period of time during which you and your doctor observe your or your child's symptoms or condition without using medical treatment. Watchful waiting is appropriate if tonsillitis occurs along with cold symptoms such as runny nose, nasal congestion, sneezing and coughing.

Watchful waiting is not appropriate if tonsillitis occurs:

  • With a fever of 101°F (38.3°C), or
  • With swollen lymph nodes in the neck, and
  • Without symptoms of an upper respiratory tract infection

If these symptoms occur together, see a doctor. You may have strep throat, which should be treated promptly. If your tonsillitis is caused by strep, you need treatment with antibiotics. Antibiotics can help prevent rare but serious problems caused by strep and can control the spread of infection.

As a rule, doctors advise surgery to remove tonsils only when there are serious problems with the tonsils. These include infections that happen again and again, or long-lasting infections that do not get better after treatment and get in the way of daily activities. You and your doctor can decide whether surgery is the right choice after a careful review of your or your child's overall health.

Learn more
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