Tonsillitis is an inflammation of the tonsils most commonly caused by viral or bacterial infection. Symptoms of tonsillitis include sore throat and fever. While viral tonsillitis must resolve on its own, tonsillitis caused by bacteria is treatable with antibiotics, which usually resolves symptoms in two to three days.
What is the purpose of the tonsils and adenoids?
The tonsils and adenoids are thought to assist the body in its defense against incoming bacteria and viruses by helping the body form antibodies. However, this function may only be important during the first year of life. There is no evidence to support a significant role of the tonsils and adenoids in immunity. Medical studies have shown that children who have their tonsils and adenoids removed suffer no loss whatsoever in their future immunity to disease or ability to ward off infections.
The signs and symptoms of tonsillitis include:
- White or yellow spots of pus on the tonsils.
- Sore throat – some children complain of pain in their tummy, rather than a sore throat.
- Swollen lymph glands under each side of the jaw.
- Pain when swallowing.
- Bad breath.
Streptococcus and glandular fever
When tonsillitis is caused by bacteria (about 15 per cent of all infections), the most common type of bacteria that causes tonsillitis are streptococci. It is not easy to tell when tonsillitis is caused by bacteria; your doctor may do a throat swab (gently rubbing sterile cotton wool on a stick over the tonsil) and send it for testing.
Glandular fever is one of the viral illnesses which can cause tonsillitis, but there are many other viruses that may also be responsible. Antibiotics do not make a difference if the tonsillitis is caused by a viral infection.
Complications of tonsillitis
Tonsillitis can lead to a number of complications, including:
- Chronic tonsillitis– infection of the tonsils which does not clear up; the person may go on feeling unwell and tired.
- Secondary infections – the infection can spread to the nose, sinuses or ears.
- Glue ear (otitis media) in children – the adenoids are part of the same group of lymph nodes as tonsils. When the adenoids swell up (usually when the tonsils are also large), they can block the thin tube which goes from the back of the throat to the middle ear. This is the tube that you push air along when you ‘pop’ your ear. If this tube (eustacian tube) stays blocked most of the time, sticky fluid forms in the middle ear which interferes with hearing (a glue ear).
- Quinsy – if the infection spreads into the tissue around the tonsils an abscess in the throat can form, also known as a peri-tonsillar abscess. This causes severe pain and can interfere with swallowing and even breathing. Antibiotics may help, but sometimes an operation is needed to drain the abscess.
How is tonsillitis and adenoid infection treated?
Bacterial infections of the tonsils and adenoids are treated with various antibiotics. Tonsillitis caused by the streptococcus bacteria can lead to serious complications, and must be treated. Often the diagnosis of strep throat is confirmed by a throat culture or rapid-strep tests in the doctors office. Once treatment begins, it is important to take the full course of antibiotics as prescribed because premature discontinuance of therapy can lead to adverse consequences and regrowth of the bacteria. Surgical removal is considered in situations resistant to medical therapy or in frequently recurrent infections.
Viral causes of tonsillitis are often treated with only supportive care (hydration and control of fever). Antibiotics are not effective for viral infection of the tonsils.
A peritonsillar abscess should be drained either by removal of fluid with a needle and syringe (needle aspiration), cutting open with a scalpel (incision), or tonsillectomy. Chronic stones in the tonsil can be removed with a clean finger or with a blunt probe. Massive enlargement of the tonsils and adenoids causing airway obstruction may be treated with a long course of antibiotics, or even a brief course of steroids (cortisone-related medications, such as prednisone and prednisolone).
How is Tonsillitis diagnosed?
Tonsillitis can be diagnosed by performing a rapid strep test, also called a throat culture. To perform the throat culture, the doctor will use a long cotton swab to swipe off some of the stuff on the surface of the back of your throat. The doctor will then test the “stuff” on the cotton swab. This test will determine whether you have tonsillitis and whether it is caused by a bacteria or a virus.
Palliative treatments to reduce the discomfort from tonsillitis symptoms include;
- pain relief, anti-inflammatory, fever reducing medications (acetaminophen, ibuprofen, aspirin)
- sore throat relief (salt water gargle, lozenges, warm liquids)
If the tonsillitis is caused by bacteria, then antibiotics are prescribed, with penicillin being most commonly used. Erythromycin and Clarithromycin are used for patients allergic to penicillin. When tonsillitis is caused by a virus, the length of illness depends on which virus is involved. Usually, a complete recovery is made within one week; however, some rare infections may last for up to two weeks. Chronic cases may be treated with tonsillectomy (surgical removal of tonsils) as a choice for treatment