Tonsils are lumps of tissue at the back of the throat. There are two of them, one on each side.

Along
with the adenoids, tonsils are part of the lymphatic system. The lymphatic system clears away
infection and keeps body fluids in balance. Tonsils and adenoids work by trapping the germs coming
in through the mouth and nose.

Tonsillitis is an inflammation (swelling) of the tonsils. Sometimes along with tonsillitis, the adenoids
are also swollen.

Tonsillitis is inflammation of the tonsils, two oval-shaped pads of tissue at the back of the throat —
one tonsil on each side.

Most cases of tonsillitis are caused by infection with a common virus, but bacterial infections also may
cause tonsillitis.

Risk factors

Risk factors for tonsillitis include:

 Young age. Tonsillitis most often occurs in children, but rarely in those younger than
age 2. Tonsillitis caused by bacteria is most common in children ages 5 to 15, while
viral tonsillitis is more common in younger children.

 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.

Causes
Tonsils are the first line of defense against potential diseases and infections. For
this reason, they can easily develop an infection.

Tonsillitis is typically viral. Less commonly, bacteria can cause the infection.

Viral or bacterial tonsillitis can be contagious and spread from person to person.
However, if tonsillitis is due to a secondary illness, such as sinusitis or hay fever,
it is unlikely to spread.

Viral causes

A viral infection is the most common cause of tonsillitis. The most common types
of virus that infect the tonsils include:
  adenovirus, which is a possible cause of the common cold and sore throat

 rhinovirus, which is the most common cause of the common cold

 influenza, or flu

 respiratory syncytial virus, which often leads to acute respiratory tract

infections.

 two subtypes of coronavirus, one of which causes SARS

Less commonly, the following can cause viral tonsillitis:

 Epstein-Barr virus (EBV)

 herpes simplex virus (HSV)

 cytomegalovirus (CMV)

Bacterial causes

The most common type of bacteria to infect the tonsils is Streptococcus

pyogenes. However, less often, other species can cause tonsillitis, including:

 Staphylococcus aureus

 Mycoplasma pneumonia

 Chlamydia pneumonia

 Bordetella pertussis

 Fusobacterium

 Neisseria gonorrhoeae

Types
Different types of tonsillitis may occur. Doctors define them by their symptoms
and recovery period.
These include:

 Acute tonsillitis: Symptoms usually last around 3–4 days but may last up
to 2 weeks.

 Recurrent tonsillitis: A person has several different instances of acute

tonsillitis in a year.

 Chronic tonsillitis: Individuals will have an ongoing sore throat and foul-
smelling breath.

Acute tonsillitis
Tonsillitis is incredibly common in children. In fact, almost every child will probably
get tonsillitis at least once.

If symptoms last around 10 days or less, it’s considered acute tonsillitis. If symptoms
last longer, or if tonsillitis comes back multiple times during the year, it may be
chronic or recurrent tonsillitis.

Acute tonsillitis will likely improve with home treatments, but in some cases may
require other treatments, like antibiotics.

Chronic tonsillitis
Chronic tonsillitis symptoms continue longer than acute. You may experience long-
lasting:

 sore throat

 bad breath (halitosis)

 tender lymph nodes in the neck

Chronic tonsillitis may also cause tonsil stones, where materials like dead cells,
saliva, and food build up in the crevices of your tonsils. Eventually, the debris can
harden into small stones. These may come loose on their own, or they may need to
be removed by a doctor.

Your doctor may recommend a tonsillectomy to surgically remove your tonsils if you
have chronic tonsillitis.

Recurrent tonsillitis
As with chronic tonsillitis, a standard treatment for recurrent tonsillitis is a
tonsillectomy. Recurrent tonsillitis is often defined as:

 a sore throat or tonsillitis at least 5 to 7 times in 1 year

 occurrences at least 5 times in each of the previous 2 years

 occurrences a least 3 times in each of the previous 3 years

Symptoms

The most common symptoms of tonsillitis include:

 a sore throat and pain when swallowing

 red and swollen tonsils with pus-filled spots

 fever

 headache

 difficulty swallowing

 pain in the ears and neck

 tiredness

 difficulty sleeping

 coughing

 chills

 swollen lymph glands

Less common symptoms may include:

 fatigue

 stomach pain and vomiting

 nausea

 furry tongue

 changes in the sound of the voice

 bad breath

 difficulty opening the mouth

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
Diagnosis
Tonsillitis Diagnosis
Your doctor will do a physical exam. They’ll look at your tonsils to
see if they’re red or swollen or have pus on them. They’ll also
check for a fever. They may look in your ears and nose for signs
of infection and feel the sides of your neck for swelling and pain.
You might need tests to find the cause of your tonsillitis. They
include:

 A throat swab. Your doctor will test saliva and cells from
your throat for strep bacteria. They’ll run a cotton swab
along the back of your throat. This might be uncomfortable
but won’t hurt. Results are usually ready in 10 or 15
minutes. Sometimes, your doctor will also want a lab test
that takes a couple of days. If these tests are negative, a
virus caused your tonsillitis.
 A blood test. Your doctor may call this a complete blood
cell count (CBC). It looks for high and low numbers of blood
cells to show whether a virus or bacteria caused your
tonsillitis.

To diagnose tonsillitis, a doctor will start with a general examination and will
check for swelling around the tonsils, often with white spots.

Doctors may also inspect the exterior of the throat for signs of enlarged lymph
glands and a rash that sometimes occurs.

The doctor might take a swab of the infected area for closer inspection. Using this
technique, they can determine whether the cause of the infection is viral or
bacterial.

They may also carry out a complete blood cell count. This test involves taking a
tiny amount of blood to investigate levels of certain types of blood cells. This
bloodwork can help a doctor supplement the information they have obtained from
the swab.

In some cases, if the swab is inconclusive, a complete blood cell count can help
the doctor determine the best treatment.

Treatment
If a person cannot treat tonsillitis at home, a range of treatment options is
available.

Medications

People can use over-the-counter (OTC) pain relieving medications to numb the
symptoms of tonsillitis.

If a bacterial infection is causing tonsillitis, a doctor will usually

prescribe antibiotics. However, they will not do so for a person with viral tonsillitis.
Antibiotics are not effective against viruses.

Penicillin is the most common antibiotic. When on a course of antibiotics, a

person must follow the full course and continue taking them, even if the
symptoms have resolved. Stopping a course of antibiotics part of the way through
might allow the infection to spread.

Rarely, if left untreated, certain types of bacteria may lead toTrusted

Source rheumatic fever or kidney inflammation.

Removal

Previously, doctors regularly recommended surgery to treat tonsillitis. Today, a

doctor will not recommend a tonsillectomy unless the condition is chronic and
recurring.
Although the tonsils become less active after puberty, they are still a functional
organ. For this reason, a surgeon will not remove them unless necessary.

A doctor might request a tonsillectomy if the tonsils are causing secondary

issues, such as:

 sleep apnea, which involves problems breathing at night

 difficulties with breathing or swallowing

 an abscess that is difficult to treat

 tonsillar cellulitis, in which the infection spreads to other areas and leads to
a buildup of pus behind the tonsils

If a tonsillectomy is necessary, doctors can choose from a variety of

methodsTrusted Source. Medical practitioners have successfully used lasers,
radio waves, ultrasonic energy, cold temperatures, or a heated needle to remove
the tonsils.

Surgery has increasingly become the last port of call. The negative implications
of surgery may outweigh the positives of tonsil removal.

While tonsillitis can be distressing and uncomfortable when it occurs, it will pass
without any serious long term implications for most people.

Complications

Inflammation or swelling of the tonsils from frequent or ongoing (chronic) tonsillitis can cause
complications such as:

 Difficulty breathing

 Disrupted breathing during sleep (obstructive sleep apnea)

 Infection that spreads deep into surrounding tissue (tonsillar cellulitis)

 Infection that results in a collection of pus behind a tonsil (peritonsillar abscess)

Strep infection

If tonsillitis caused by group A streptococcus or another strain of streptococcal bacteria isn't

treated, or if antibiotic treatment is incomplete, your child has an increased risk of rare
disorders such as:

 Rheumatic fever, an inflammatory disorder that affects the heart, joints and other tissues

 Poststreptococcal glomerulonephritis, an inflammatory disorder of the kidneys that results in

inadequate removal of waste and excess fluids from blood

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 his or her hands thoroughly and frequently, especially after using the toilet and
before eating

 Avoid sharing food, drinking glasses, water bottles or utensils

 Replace his or her toothbrush after being diagnosed with tonsillitis

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

 Keep your child at home when he or she is ill

 Ask your doctor when it's all right for your child to return to school

 Teach your child to cough or sneeze into a tissue or, when necessary, into his or her
elbow

 Teach your child to wash his or her hands after sneezing or coughing