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Tonsillitis
By Mayo Clinic staffMayo Clinic Health Manager
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Definition
Tonsillitis is when the tonsils — fleshy pads on each side of the back of the throat — become infected with a virus or bacteria. A common childhood ailment, tonsillitis causes the tonsils to become swollen and painful.
Most cases of tonsillitis are caused by a virus and are treated at home with over-the-counter sore throat remedies. Less often, tonsillitis is caused by a bacterial infection and antibiotics are needed. At one time, removing the tonsils (tonsillectomy) was a common treatment for recurrent tonsillitis. Today, surgery is only recommended if tonsillitis doesn't get better with other treatment.
Symptoms
Signs and symptoms of tonsillitis include:
- Red, swollen tonsils
- White patches on the tonsils
- Sore throat
- Difficult or painful swallowing
- Headache
- Fever and chills
- Enlarged, tender glands (lymph nodes) in the jaw and neck
- Loss of voice (laryngitis)
- Abdominal pain in children
Causes
When bacteria and viruses enter your body through your nose or mouth, your tonsils act as a filter — engulfing the offending organisms in white blood cells. This can cause a low-grade infection in your tonsils. Tonsillitis occurs when the infection gets more serious, and the tonsils become painful and inflamed.
Most cases of tonsillitis are caused by viruses, including the virus that causes mononucleosis (the Epstein-Barr virus). In other cases, tonsillitis is caused by a bacterial infection. When tonsillitis is due to a specific type of bacteria (group A streptococci), the illness is also referred to as strep throat. Warning signs that your symptoms may be caused by strep throat include a sudden onset of pain and inflammation, tender lymph nodes in your neck, a high fever and a lack of nasal congestion. If tonsillitis is caused by strep throat or another bacterial infection, you may need treatment with antibiotics. However, most cases of tonsillitis are caused by a virus and not bacteria, and the only treatment is home care.
Risk factors
- Being a child. Tonsillitis is especially common in school-age children.
- Contact with others. Like the germs that cause colds or the flu, viruses and bacteria that cause tonsillitis tend to get passed on in places such as schools and child care facilities, where people are in close contact.
When to seek medical advice
Although tonsillitis itself usually isn't serious, it can lead to complications if left untreated. Call your doctor if:
- Your sore throat lasts more than 48 hours
- You have a fever above 103 F (39 C)
- You can't swallow because your tonsils are so swollen or painful
- Your sore throat is accompanied by abdominal pain, especially if you're vomiting
- You have a stiff neck or feel weak
Seek emergency care if you or your child is:
- Drooling
- Unable to swallow because of pain or swelling
Tests and diagnosis
The doctor will check your tonsils and the back of your throat for signs of infection, such as redness and pus. Tests may include:
- Throat swab. With this simple test, the doctor rubs a sterile swab over the back of your throat to get a sample of the secretions. The sample will be checked in the lab for streptococcal bacteria. Test results are available within minutes or up to 24 to 48 hours, depending on the testing method.
- Complete blood cell count (CBC). In some cases, a blood test known as a CBC may help identify the cause of your infection. With a CBC, a sample of blood is sent to the laboratory for evaluation of the presence of a high number of white blood cells or abnormal cells that indicate a viral infection.
Complications
When left untreated, swollen tonsils can block normal breathing (airway obstruction), leading to sleep apnea and a number of other health problems.
Untreated tonsillitis can also lead to a collection of pus between a tonsil and the soft tissues around it (abscess). The abscess may cover a large part of the soft area at the back of the roof of the mouth (soft palate). Rarely, the abscess may spread into the bloodstream or into the neck or chest.
Some strains of streptococcal bacteria that cause strep throat leading to tonsillitis can also cause kidney inflammation (nephritis) or rheumatic fever, a serious condition that can affect the heart, joints, nervous system and skin.
Treatments and drugs
Tonsillitis caused by a virus is typically treated with self-care. If tonsillitis is caused by a bacterial infection, your doctor may prescribe antibiotics. Oral penicillin typically needs to be taken for at least 10 days. Other antibiotics may have shorter courses. Although you'll probably feel better in a day or two, it's important to finish the full course of antibiotics. Stopping medication early may cause the infection to come back.
If your child has a positive strep test, he or she needs to complete at least 24 hours of antibiotic treatment before returning to school or child care. If your child has difficulty swallowing, antibiotics may be given by injection. In some cases, treatment with steroid medications may reduce swelling.
Although surgery is no longer the standard treatment for tonsillitis, removing the tonsils (tonsillectomy) may be recommended when other treatments don't work.
Self-care
Most cases of tonsillitis are caused by a viral infection, and antibiotics won't help. The only thing you can do is let the virus run its course — and take steps to relieve pain and inflammation. Recovery may take a week or two.
- Drink warm, soothing liquids — such as soup, broth and tea.
- Gargle with warm salt water.
- Take acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) to help reduce fever and decrease pain. Because of the risk of Reye's syndrome — a potentially life-threatening illness — don't give aspirin to children younger than age 12.
Surgery
Surgical removal of the tonsils (tonsillectomy) is rarely needed for adults. During childhood, surgery may be recommended when a child has had:
- Seven or more serious throat infections in one year
- Five or more serious throat infections every year over a two-year period
- Three or more serious throat infections every year over a three-year period
Tonsillectomy may also be recommended to treat an abscess that doesn't improve with antibiotic treatment, or if swollen tonsils are blocking breathing.
Tonsillectomy is usually done on an outpatient basis. That means your child will be able to go home the day of the surgery. A complete recovery may take up to two weeks.
Prevention
The germs that cause viral and bacterial tonsillitis are contagious. Frequent hand washing is the best way to prevent all kinds of infections, including tonsillitis. Wash your hands often, and encourage your children to do the same.
Other common-sense precautions apply, too. Cough or sneeze into your elbow or a tissue. Don't share drinking glasses or eating utensils. Avoid close contact with anyone who's sick.
Lifestyle and home remedies
A sore throat can make you miserable. These tips can help.
- Drink more fluids. Warm liquids — such as soup, broth and tea — are good choices.
- Gargle with warm salt water. Mix 1/4 teaspoon of salt in 8 ounces of warm water, gargle, and then spit out the water.
- Use honey and lemon. Stir honey and lemon to taste into a glass of hot water. Allow it to cool to room temperature before you sip it. The honey coats and soothes your throat, and the lemon helps reduce mucus. Don't use honey or corn syrup in a drink for children younger than age 1.
- Suck on a throat lozenge or hard candy. This stimulates saliva production, which bathes and cleanses your throat.
- Humidify the air. Adding moisture to the air can reduce throat irritation and make it easier to sleep. Be sure to change the water in a room humidifier daily and clean the unit at least once every three days to help prevent the growth of harmful molds and bacteria.
- Avoid smoke and other air pollutants. Smoke irritates a sore throat.
- Rest your voice. Talking may lead to more throat irritation and temporary loss of your voice (laryngitis).
Think about others, too. If you're not feeling well, take a few days off to avoid spreading your germs.
