Tonsillitis

Definition
By Mayo Clinic Staff

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

Symptoms
By Mayo Clinic Staff

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 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
Causes
By Mayo Clinic Staff

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 strep and other bacteria also may cause tonsillitis.

Why do tonsils get infected?

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

Risk factors
By Mayo Clinic Staff

Risk factors for tonsillitis include:

Young age. Tonsillitis is most common from the preschool years to the
mid-teenage years.
Frequent exposure to germs. School-age children are in close contact
with their peers and frequently exposed to viruses or bacteria that can
cause tonsillitis.

Tests and diagnosis

By Mayo Clinic Staff

Your child's doctor will start with a physical exam that will include:
 Using a lighted instrument to look at your child's throat and likely his or
her ears and nose, which may also be sites of infection
Checking for a rash known as scarlatina, which is associated with some
cases of strep throat
Gently feeling (palpating) your child's neck to check for swollen glands
(lymph nodes)
Listening to his or her breathing with a stethoscope
Checking for enlargement of the spleen (for consideration of
mononucleosis which also inflames the tonsils)
Throat swab
With this simple test, the doctor rubs a sterile swab over the back of your
child's throat to get a sample of secretions. The sample will be checked in a
lab for streptococcal bacteria.

Many clinics are equipped with a lab that can get a test result within a few
minutes. However, a second more reliable test is usually sent out to a lab
that can return results within 24 to 48 hours.

If the rapid in-clinic test comes back positive, then your child almost
certainly has a bacterial infection. If the test comes back negative, then
your child likely has a viral infection. Your doctor will wait, however, for the
more reliable out-of-clinic lab test to determine the cause of the infection.

Complete blood cell count (CBC)

Your doctor may order a CBC with a small sample of your child's blood.
The result of this test, which can often be completed in a clinic, produces a
count of the different types of blood cells. The profile of what's elevated,
what's normal or what's below normal can indicate whether an infection is
more likely caused by a bacterial or viral agent. A CBC is not often needed
to diagnose strep throat. However, if the strep throat lab test is negative,
the CBC may be needed to help determine the cause of tonsillitis.
Treatments and drugs
By Mayo Clinic Staff

At-home care
Whether tonsillitis is caused by a viral or bacterial infection, at-home care
strategies can make your child more comfortable and promote better
recovery.

If a virus is the expected cause of tonsillitis, these strategies are the only
treatment. Your doctor won't prescribe antibiotics. Your child will likely be
better within seven to 10 days.

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

Encourage rest. Encourage your child to get plenty of sleep and to rest
his or her voice.
Provide adequate fluids. Give your child plenty of water to keep the
throat moist and prevent dehydration.
Provide comforting foods and beverage. Warm liquids broth,
caffeine-free tea or warm water with honey and cold treats like ice
pops can soothe a sore throat.
Prepare a saltwater gargle. If your child can gargle, a saltwater gargle
of 1 teaspoon (5 milliliters) of table salt to 8 ounces (237 milliliters) of
warm water can help soothe a sore throat. Have your child gargle 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 with your child for several minutes in a
steamy bathroom.
Offer lozenges. Children older than age 4 can suck on lozenges to
relieve a sore throat.
 Avoid irritants. Keep your home free from cigarette smoke and
cleaning products that can irritate the throat.
Treat pain and fever. Talk to your doctor about using ibuprofen (Advil,
Motrin, others) or acetaminophen (Tylenol, others) to minimize throat
pain and control a fever. Use caution when giving aspirin to children or
teenagers. Though aspirin is approved for use in children older than
age 2, children and teenagers recovering from chickenpox or flu-like
symptoms should never take aspirin. This is because aspirin has been
linked to Reye's syndrome, a rare but potentially life-threatening
condition, in such children.
Antibiotics
If tonsillitis is caused by a bacterial infection, your 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 alternative antibiotic.

Your child must take the full course of antibiotics as prescribed even if the
symptoms go away completely. Failure to take all of the medication as
directed may result in the infection worsening or spreading to other parts of
the body. Not completing the full course of antibiotics can, in particular,
increase your child's risk of rheumatic fever and serious kidney
inflammation.

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

Surgery
Surgery to remove tonsils (tonsillectomy) may be used to treat frequently
recurring tonsillitis, chronic tonsillitis or bacterial tonsillitis that doesn't
respond to antibiotic treatment. Frequent tonsillitis is generally defined as:
 More than seven episodes in one year
More than five episodes a year in each of the preceding two years
More than three episodes a year in each of the preceding three years
A tonsillectomy may also be performed if tonsillitis results in difficult-to-
manage complications, such as:

Obstructive sleep apnea

Breathing difficulty
Swallowing difficulty, especially meats and other chunky foods
An abscess that doesn't improve with antibiotic treatment
Tonsillectomy is usually done as a one-day surgery, unless your child is
very young. That means your child should be able to go home the day of
the surgery. A complete recovery usually takes seven to 14 days.

Prevention
By Mayo Clinic Staff

The germs that cause viral and bacterial tonsillitis are contagious.
Therefore, the best prevention is to practice good hygiene. Teach your
child to:

Wash his or her hands thoroughly and frequently, especially after using
the toilet and before eating
Avoid sharing food, drinking glasses or utensils
Laryngitis
Definition
By Mayo Clinic Staff

Laryngitis is an inflammation of your voice box (larynx) from overuse,

irritation or infection.

Inside the larynx are your vocal cords two folds of mucous membrane
covering muscle and cartilage. Normally, your vocal cords open and close
smoothly, forming sounds through their movement and vibration.

But in laryngitis, your vocal cords become inflamed or irritated. This

swelling causes distortion of the sounds produced by air passing over
them. As a result, your voice sounds hoarse. In some cases of laryngitis,
your voice can become almost undetectable.

Laryngitis may be short-lived (acute) or long lasting (chronic). Most cases

of laryngitis are triggered by temporary viral infection or vocal strain and
aren't serious. Persistent hoarseness can sometimes signal a more serious
underlying medical condition.

Symptoms
By Mayo Clinic Staff

In most cases laryngitis symptoms last less than a couple of weeks and are
caused by something minor, such as a virus. Less often, laryngitis
symptoms are caused by something more serious or long lasting. Laryngitis
signs and symptoms can include:

Hoarseness
Weak voice or voice loss
Tickling sensation and rawness of your throat
 Sore throat
Dry throat
Dry cough
When to see a doctor
You can manage most acute cases of laryngitis with self-care steps, such
as resting your voice and drinking plenty of fluids. Strenuous use of your
voice during an episode of acute laryngitis can damage your vocal cords.

Make an appointment with a doctor if hoarseness lasts more than two

weeks.

Seek immediate medical attention if your child:

Makes noisy, high-pitched breathing sounds when inhaling
Drools more than usual
Has trouble swallowing
Has difficulty breathing
Has a fever higher than 103 F (39.4 C)
These signs and symptoms may indicate croup inflammation of the
larynx and the airway just beneath it. Although croup can usually be treated
at home, severe symptoms require medical attention. These symptoms
also can indicate epiglottitis, an inflammation of the tissue that covers the
windpipe (trachea), which can be life-threatening for children and adults.
Causes
By Mayo Clinic Staff

Acute laryngitis
Most cases of laryngitis are temporary and improve after the underlying
cause gets better. Causes of acute laryngitis include:

Viral infections similar to those that cause a cold

Vocal strain, caused by yelling or overusing your voice
Bacterial infections, such as diphtheria, although this is rare
Chronic laryngitis
Laryngitis that lasts longer than three weeks is known as chronic laryngitis.
This type of laryngitis is generally caused by exposure to irritants over time.
Chronic laryngitis can cause vocal cord strain and injuries or growths on
the vocal cord (polyps or nodules). These injuries can be caused by:

Inhaled irritants, such as chemical fumes, allergens or smoke

Acid reflux, also called gastroesophageal reflux disease (GERD)
Chronic sinusitis
Excessive alcohol use
Habitual overuse of your voice (such as with singers or cheerleaders)
Smoking
Less common causes of chronic laryngitis include:

Bacterial or fungal infections

Infections with certain parasites
Other causes of chronic hoarseness include:

Cancer
 Vocal cord paralysis, which can result from injury, stroke, a lung tumor
or other health conditions
Bowing of the vocal cords in old age

Risk factors
By Mayo Clinic Staff

Risk factors for laryngitis include:

Having a respiratory infection, such as a cold, bronchitis or sinusitis

Exposure to irritating substances, such as cigarette smoke,
excessive alcohol, stomach acid or workplace chemicals
Overusing your voice, by speaking too much, speaking too loudly,
shouting or singing

Complications
By Mayo Clinic Staff

In some cases of laryngitis caused by infection, the infection may spread to

other parts of the respiratory tract.

Tests and diagnosis

By Mayo Clinic Staff

The most common sign of laryngitis is hoarseness. Changes in your voice

can vary with the degree of infection or irritation, ranging from mild
hoarseness to almost total loss of your voice. If you have chronic
hoarseness, your doctor may want to listen to your voice and to examine
your vocal cords, and he or she may refer you to an ear, nose and throat
specialist.
These techniques sometimes are used to help diagnose laryngitis:

Laryngoscopy. Your doctor can visually examine your vocal cords in a

procedure called laryngoscopy, by using a light and a tiny mirror to look
into the back of your throat. Or your doctor may use fiber-optic
laryngoscopy. This involves inserting a thin, flexible tube (endoscope)
with a tiny camera and light through your nose or mouth and into the
back of your throat. Then your doctor can watch the motion of your
vocal cords as you speak.
Biopsy. If your doctor sees a suspicious area, he or she may do a
biopsy taking a sample of tissue for examination under a
microscope.

Treatments and drugs

By Mayo Clinic Staff

Acute laryngitis caused by a virus often gets better on its own within a week
or so. Self-care measures also can help improve symptoms.

Chronic laryngitis treatments are aimed at treating the underlying causes,

such as heartburn, smoking or excessive use of alcohol.

Medications used in some cases include:

Antibiotics. In almost all cases of laryngitis, an antibiotic won't do any

good because the cause is usually viral. But if you have a bacterial
infection, your doctor may recommend an antibiotic.
Corticosteroids. Sometimes, corticosteroids can help reduce vocal
cord inflammation. However, this treatment is used only when there's an
urgent need to treat laryngitis for example, when you need to use
your voice to sing or give a speech or oral presentation, or in some
cases when a toddler has laryngitis associated with croup.
Prevention
By Mayo Clinic Staff

To prevent dryness or irritation to your vocal cords:

Don't smoke, and avoid secondhand smoke. Smoke dries your

throat and irritates your vocal cords.
Limit alcohol and caffeine. These cause you to lose total body water.
Drink plenty of water. Fluids help keep the mucus in your throat thin
and easy to clear.
Avoid clearing your throat. This does more harm than good, because
it causes an abnormal vibration of your vocal cords and can increase
swelling. Clearing your throat also causes your throat to secrete more
mucus and feel more irritated, making you want to clear your throat
again.
Avoid upper respiratory infections. Wash your hands often, and
avoid contact with people who have upper respiratory infections such as
colds.

Sore throat
Definition
By Mayo Clinic Staff

A sore throat is pain, scratchiness or irritation of the throat that often

worsens when you swallow.
 A sore throat is the primary symptom of pharyngitis inflammation of the
throat (pharynx). But the terms "sore throat" and "pharyngitis" are often
used interchangeably.

The most common cause of a sore throat is a viral infection, such as a cold
or the flu. A sore throat caused by a virus resolves on its own with at-home
care. Strep throat (streptococcal infection), a less common type of sore
throat caused by bacteria, requires additional treatment with antibiotic
drugs to prevent complications.

Other less common causes of sore throat may require more complex
treatment.

Symptoms
By Mayo Clinic Staff

Multimedia

Throat anatomy

Symptoms of a sore throat may vary depending on the cause. Signs and
symptoms may include:

Pain or a scratchy sensation in the throat

Pain that worsens with swallowing or talking
Difficulty swallowing
Dry throat
 Sore, swollen glands in your neck or jaw
Swollen, red tonsils
White patches or pus on your tonsils
Hoarse or muffled voice
Common infections causing a sore throat may result in other signs and
symptoms, as well. They may include:

Fever
Chills
Cough
Runny nose
Sneezing
Body aches
Headache
Nausea or vomiting
When to see a doctor
Take your child to a doctor if your child's sore throat doesn't go away
with the first drink in the morning, recommends the American Academy of
Pediatrics.

Get immediate care if your child has severe signs such as:

Difficulty breathing
Difficulty swallowing
Unusual drooling, which may indicate an inability to swallow
If you're an adult, see your doctor if you have a sore throat and any of
the following associated problems occur, according to the American
Academy of Otolaryngology:
 A sore throat that is severe or lasts longer than a week
Difficulty swallowing
Difficulty breathing
Difficulty opening your mouth
Joint pain
Earache
Rash
Fever higher than 101 F (38.3 C)
Blood in saliva or phlegm
Frequently recurring sore throats
A lump in your neck
Hoarseness lasting more than two weeks

Causes
By Mayo Clinic Staff

Most sore throats are caused by viruses that cause the common cold and
flu (influenza). Less often, sore throats are due to bacterial infections.

Viral infections
Viral illnesses that cause a sore throat include:

Common cold
Flu (influenza)
Mononucleosis (mono)
Measles
Chickenpox
Croup a common childhood illness characterized by a harsh, barking
cough
Bacterial infections
Bacterial infections that can cause a sore throat include:

Strep throat, which is caused by a bacterium known as Streptococcus

pyogenes, or group A streptococcus
Whooping cough, a highly contagious respiratory tract infection
Diphtheria, a serious respiratory illness that's rare in industrialized
nations, but is more common in developing countries
Other causes
Other causes of sore throat include:

Allergies. Allergies to pet dander, molds, dust and pollen can cause a
sore throat. The problem may be complicated by postnasal drip, which
can irritate and inflame the throat.
Dryness. Dry indoor air, especially in winter when buildings are heated,
can make your throat feel rough and scratchy, particularly in the
morning when you first wake up. Breathing through your mouth often
because of chronic nasal congestion also can cause a dry, sore
throat.
Irritants. Outdoor air pollution can cause ongoing throat irritation.
Indoor pollution tobacco smoke or chemicals also can cause
chronic sore throat. Chewing tobacco, drinking alcohol and eating spicy
foods also can irritate your throat.
Muscle strain. You can strain muscles in your throat just as you can
strain them in your arms or legs. Yelling at a sporting event, trying to
talk to someone in a noisy environment or talking for long periods
without rest can result in a sore throat and hoarseness.
Gastroesophageal reflux disease (GERD). GERD is a digestive
system disorder in which stomach acids or other contents of the
stomach back up in the food pipe (esophagus). Other signs or
 symptoms may include heartburn, hoarseness, regurgitation of stomach
contents and the sensation of a lump in your throat.
HIV infection. A sore throat and other flu-like symptoms sometimes
appear early after someone is infected with HIV. Also, a person who is
HIV-positive may have a chronic or recurring sore throat due to a
secondary infection. Common problems include a fungal infection called
oral thrush and cytomegalovirus infection, a common viral infection that
can be serious in people with compromised immune systems.
Tumors. Cancerous tumors of the throat, tongue or voice box (larynx)
can cause a sore throat. Other signs or symptoms may include
hoarseness, difficulty swallowing, noisy breathing, a lump in the neck,
and blood in saliva or phlegm.
Rarely, an infected area of tissue (abscess) in the throat causes a sore
throat. Another rare cause of a sore throat is a condition that occurs when
the small cartilage "lid" that covers the windpipe swells, blocking airflow
(epiglottitis). Both causes can block the airway, creating a medical
emergency.

Risk factors
By Mayo Clinic Staff

Although anyone can get a sore throat, some factors make you more
susceptible. These factors include:

Being a child or teenager. Children and teens are most likely to

develop sore throats. Children are also more likely to have strep throat,
the most common bacterial infection associated with a sore throat.
Being exposed to tobacco smoke. Smoking and secondhand smoke
can irritate the throat. The use of tobacco products also increases the
risk of cancers of the mouth, throat and voice box.
 Having allergies. If you have seasonal allergies or ongoing allergic
reactions to dust, molds or pet dander, you're more likely to develop a
sore throat than are people who don't have allergies.
Being exposed to chemical irritants. Particulate matter in the air from
the burning of fossil fuels, as well as common household chemicals,
can cause throat irritation.
Having chronic or frequent sinus infections. Chronic or frequent
sinus infections increase the risk of sore throat because drainage from
the nose can irritate the throat or spread infection.
Living or working in close quarters. Viral and bacterial infections
spread easily anywhere people gather child care centers,
classrooms, offices, prisons and military installations.
Having decreased immunity. You're more susceptible to infections in
general if your resistance is low. Common causes of lowered immunity
include HIV, diabetes, treatment with steroids or chemotherapy drugs,
stress, fatigue, and poor diet.

Tests and diagnosis

By Mayo Clinic Staff

Your doctor will start with a physical exam that is generally the same for
children and adults. The exam will include:

Using a lighted instrument to look at your throat, and likely your ears
and nasal passages
Gently feeling (palpating) your neck to check for swollen glands (lymph
nodes)
Listening to your breathing with a stethoscope
Throat swab
With this simple test, the doctor rubs a sterile swab over the back of your
throat to get a sample of secretions. The sample will be checked in a lab for
streptococcal bacteria, the cause of strep throat. Many clinics are equipped
with a lab that can get a test result within a few minutes. However, a
second more reliable test is usually sent out to a lab that can return results
within 24 to 48 hours.

If the rapid, in-clinic test comes back positive, then you almost certainly
have a bacterial infection. If the test comes back negative, then you likely
have a viral infection. Your doctor will wait, however, for the more reliable,
out-of-clinic lab test to determine the cause of the infection.

Other tests

Complete blood count (CBC). Your doctor may order a CBC with a
small sample of your blood. The result of this test, which can often be
completed in a clinic, produces a count of the different types of blood
cells. The profile of what's elevated, what's normal or what's below
normal can indicate whether an infection is more likely caused by a
bacterial or viral agent.
Allergy tests. If your doctor suspects your sore throat is related to an
allergy, you may be referred to an allergist for additional tests.
You may be referred to an ENT doctor or other specialist if you have
chronic or frequent sore throat or if there are any signs or symptoms that
suggest a serious condition other than a common viral or bacterial
infection.

Treatments and drugs

By Mayo Clinic Staff

A sore throat caused by viral infection the most common cause

usually lasts five to seven days and doesn't require medical treatment.
Treating bacterial infections
If your sore throat is caused by a bacterial infection, your doctor will
prescribe a course of antibiotics. Penicillin taken by mouth for 10 days is
the most common antibiotic treatment prescribed for infections such as
strep throat. If you're allergic to penicillin, your doctor will prescribe an
alternative antibiotic.

You must take the full course of antibiotics as prescribed even if the
symptoms go away completely. Failure to take all of the medication as
directed may result in the infection worsening or spreading to other parts of
the body. Not completing the full course of antibiotics to treat strep throat
can, in particular, increase a child's risk of rheumatic fever and serious
kidney inflammation.

Talk to your doctor or pharmacist about what to do if you forget to take a

dose.

Other treatments
If a sore throat is a symptom of a condition other than a viral or bacterial
infection, other treatments will likely be considered depending on the
diagnosis