Tonsilitis

Tonsillitis is an infection of the tonsils and will often, but not necessarily, cause a sore throat and fever.

Types

There are 3 main types of tonsillitis: acute, subacute and chronic. Acute tonsillitis can either be bacterial or viral in origin. Subacute tonsillitis is caused by the bacterium Actinomyces. Chronic tonsillitis, which can last for long periods if not treated, is mostly caused by bacterial infection.

Symptoms

Symptoms of tonsillitis include a severe sore throat (which may be experienced as referred pain to the ears), painful/difficult swallowing, crouch coughing, headache, fever and chills. Tonsillitis is characterized by signs of red, swollen tonsils which may have a purulent exudative coating of white patches (i.e. pus). There may be enlarged and tender neck cervical lymph nodes.

Causes

Tonsillitis may be caused by Group A streptococcal bacteria, resulting in strep throat. Viral tonsillitis may be caused by numerous viruses such as the Epstein-Barr virus (the cause of infectious mononucleosis) or adenovirus.

Sometimes, tonsillitis is caused by a superinfection of spirochaeta and treponema, in this case called Vincent's angina or Plaut-Vincent angina.

Although tonsillitis is associated with infection, it is currently unknown whether the swelling and other symptoms are caused by the infectious agents themselves, or by the host immune response to these agents. Tonsillitis may be a result of aberrant immune responses to the normal bacterial flora of the nasopharynx.

Treatment

Treatments of tonsillitis consist of pain management medications and lozenges. If the tonsillitis is caused by bacteria, then antibiotics are prescribed, with penicillin being most commonly used. Erythromycin is used for patients allergic to penicillin.

In many cases of tonsillitis, the pain caused by the inflamed tonsils warrants the prescription of topical anesthetics for temporary relief. Viscous lidocaine solutions are often prescribed for this purpose.

Ibuprofen or other analgesics can help to decrease the edema and inflammation, which will ease the pain and allow the patient to swallow liquids sooner.

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 indicate tonsillectomy (surgical removal of tonsils) as a choice for treatment.

Additionally, gargling with a solution of warm water and salt may reduce pain and swelling.

Complications

An abscess may develop lateral to the tonsil during an infection, typically several days after the onset of tonsillitis. This is termed a peritonsillar abscess (or quinsy). Rarely, the infection may spread beyond the tonsil resulting in inflammation and infection of the internal jugular vein giving rise to a spreading septicaemia infection (Lemierre's syndrome).

In chronic/recurrent cases (generally defined as seven episodes of tonsillitis in the preceding year, five episodes in each of the preceding two years or three episodes in each of the preceding three years), or in acute cases where the palatine tonsils become so swollen that swallowing is impaired, a tonsillectomy can be performed to remove the tonsils. Patients whose tonsils have been removed are certainly still protected from infection by the rest of their immune system.

Bacteria feeding on mucus which accumulates in pits (referred to as "crypts") in the tonsils may produce whitish-yellow deposits known as tonsilloliths. These may emit an odour due to the presence of volatile sulfur compounds.

Hypertrophy of the tonsils can result in snoring, mouth breathing, disturbed sleep, and obstructive sleep apnea, during which the patient stops breathing and experiences a drop in the oxygen content in the bloodstream. A tonsillectomy can be curative.

In very rare cases, diseases like rheumatic fever or glomerulonephritis can occur. These complications are extremely rare in developed nations but remain a significant problem in poorer nations.

What is Tonsillitis?

Tonsillitis (ton-sil-lie-tiss) is an inflammation of the tonsils caused by an infection. In tonsillitis, the tonsils are enlarged, red, and often coated (either partly or entirely) by a substance that is yellow, gray, or white. Tonsillitis usually occurs as part of a pharyngitis (throat infection). Tonsillitis usually begins with sudden sore throat and painful swallowing.

Sometimes, tonsillitis reoccurs, and may cause difficulty breathing. If this occurs, your doctor may recommend taking them out. This procedure of removing tonsils from the throat is called a tonsillectomy.

What are Tonsils?

The tonsils are fleshy clusters of tissue that lie in bands on both sides of the back of the throat, above and behind the tongue. The tonsils' major function is to catch incoming germs before the germs cause infections in the throat, mouth, or sinuses. Tonsils contain infection-fighting cells and antibodies that stop the spread of the germs further into the body.

If the tonsils are taken out, the individual will not suffer from more infections than they did when they had their tonsils. There are other tissues in the body that will produce antibodies to fight infection.

What are the symptoms of Tonsillitis?

Each person with tonsillitis may not experience all of the symptoms. Some of the major symptoms of tonsillitis are:

a very sore throat fever redder-than-normal tonsils chills a yellow or white coating on the tonsils a funny-sounding voice swollen glands in the neck bad breath

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.

Is Tonsillitis Contagious?

Yes. Tonsillitis usually spreads from person to person by contact with the throat or nasal fluids of someone who is already infected.

How Is Tonsillitis Treated?

Treatment for tonsillitis depends on whether it was caused by a virus or bacteria. If the tonsillitis was caused by strep bacteria (streptococci), the doctor will prescribe antibiotics. If the tonsillitis was caused by a virus, your body will fight off the infection on its own. However, medication can be prescribed to alleviate the symptoms.

How long does Tonsillitis Last?

If tonsillitis is caused by bacteria, with antibiotic treatment, the illness is usually cured within 1 week. However, it may take several weeks for the tonsils and swollen glands to return to normal size.

When tonsillitis is caused by viruses, the length of illness depends on which virus is involved. Usually, people are almost completely recovered within 1 week.

Tonsilitis: Introduction

Tonsilitis is a common infection or inflammation of the tonsils in the back of the throat. Tonsilitis can lead to serious insidious complications such as sleep apnea. Snoring can also be a sign of tonsilitis or other tonsil disorders. See also adenoiditis and the adenoids, which are related to the tonsils.

Symptoms of Tonsilitis

The list of signs and symptoms mentioned in various sources for Tonsilitis includes the 16 symptoms listed below:

Severe sore throat Pain on swallowing Symptoms in young children:

o Refusing to eat

o Pulling at the ears

o Vomiting

Malaise Loss of appetite Fever Earache Red tonsils Swollen tonsils

Whitened tonsils Enlarged neck lymph glands Enlarged jaw lymph glands Epidemic outbreaks of tonsillitis

Complications list for Tonsilitis:

The list of complications that have been mentioned in various sources for Tonsilitis includes:

Tonsil abscess (type of Abscess) Recurrent tonsilitis Permanent tonsil enlargement Permanent adenoid enlargement Rheumatic fever - usually prevented by antibiotic treatments of tonsilitis Kidney complications (see Kidney symptoms) Sleep apnea Obstructive sleep apnea

Complications and sequelae of Tonsilitis from the Diseases Database include:

Throat sore Cervical lymphadenopathy Short stature Quinsy Trismus Retropharyngeal abscess Haemoptysis

TopAbout complications:

Complications of Tonsilitis are secondary conditions, symptoms, or other disorders that are caused by Tonsilitis. In many cases the distinction between symptoms of Tonsilitis and complications of Tonsilitis is unclear or arbitrary.

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Alternative diagnoses list for Tonsilitis:

For a diagnosis of Tonsilitis, the following list of conditions have been mentioned in sources as possible alternative diagnoses to consider during the diagnostic process for Tonsilitis:

Viral Adenovirus Herpes simplex virus Group A streptococci Infectious mononucleosis Gonorrhea Mycoplasma Chlamydia pneumoniae Influenza Diptheria Necrotizing gingivostomatitis Arcanobacterium haemolyticum Peritonsillar abscess Oral candidiasis Epiglottis Acute HIV infection Drymouth Nasopharyngeal carcinoma Glossopharyngeal neuralgia Meningococcemia Toxic shock syndrome Drug eruption Viral exanthem

Diseases for which Tonsilitis may be an alternative diagnosis

The other diseases for which Tonsilitis is listed as a possible alternative diagnosis in their lists include:

Adenoid disorders Adenoiditis Tonsil cancer

List of causes of Tonsilitis

Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Tonsilitis) that could possibly cause Tonsilitis includes:

Bacterial tonsilitis Streptococcus Viral tonsilitis Common cold Streptococcus Group A Adenoviridae Infections - tonsillitis Pneumococcus Diphtheria Rosai-Dorfman disease - tonsillitis Infectious mononucleosis Tularemia - tonsillitis HIV/AIDS - tonsillitis Asrar-Facharzt-Haque syndrome - tonsillitis Lemierre syndrome Adenovirus infection in immunocompromised patients - tonsillitis Pericoronitis Adenovirus

Causes of Tonsilitis (Diseases Database):

The follow list shows some of the possible medical causes of Tonsilitis that are listed by the Diseases Database:

Streptococcus Group A Infectious mononucleosis Adenovirus Lemierre syndrome Common cold Pericoronitis Diphtheria Pneumococcus

Subacute Tonsillitis - Tonsillitis

Overview, Causes, & Risk Factors

Tonsillitis is an inflammation or infection of the tonsils.

What is going on in the body?

The body has two sets, or pairs, of tonsils. The palatine tonsils can be seen at the back of the throat. The lingual tonsils are at the back of the tongue and cannot be seen by looking in the mouth. Tonsillitis usually means the inflammation or infection of the palatine tonsils. But sometimes the infection can involve the lingual tonsils and lymph nodes in the back of the throat.

What are the causes and risks of the infection?

Common causes of acute tonsillitis may include:

bacteria, such as streptoccal or hemophilus bacteria

viruses such as adenovirus or Epstein-Barr virus, which also causes mononucleosis

diphtheria, a serious disease that produces a false membrane in the throat. Diphtheria can be prevented by the DPT vaccine.

Subacute tonsillitis is most commonly caused by actinomyces, a normal mouth bacterium that can cause infection.

In chronic tonsillitis, there is a long-standing infection that is almost always bacterial.

Symptoms & Signs

What are the signs and symptoms of the infection?

There are three forms of tonsillitis:

acute, with rapid onset of significant symptoms

subacute, with a slow onset of less obvious symptoms

chronic, with intermittent symptoms that persist over time

Symptoms of acute tonsillitis include:

the rapid onset of severe sore throat that worsens over time

moderate to high fever

difficulty swallowing

red, enlarged tonsils that may or may not have pus on the surface or in the pits

swollen or tender lymph nodes below the jaw

Symptoms of subacute tonsillitis can last from 3 weeks to 3 months, and include:

somewhat enlarged tonsils

foul-smelling, pasty, infected material that collects inside the pits on the tonsils

fluctuating mild to moderate sore throat

bad breath

foul taste in the mouth

mildly swollen, tender lymph nodes

Symptoms of chronic tonsillitis include:

enlarged, mildly red tonsils that are scarred with large pits

slightly enlarged lymph nodes that are not usually tender

sore throat that comes and goes

Diagnosis & Tests

How is the infection diagnosed?

A healthcare provider can diagnose acute tonsillitis based on the person's health history and a physical exam. A throat culture can help identify the organism causing the infection. A complete blood count, or CBC, can also help determine if the infection is caused by a virus or bacteria.

If mononucleosis is involved, the lymph nodes in the neck, armpit, or groin will be enlarged. An antibody titer may be done to check for antibodies to the Epstein-Barr virus.

A healthcare provider can diagnose subacute tonsillitis and chronic tonsillitis based on a person's health record and a physical exam.

Prevention & Expectations

What can be done to prevent the infection?

The best way to prevent acute tonsillitis is to avoid people who have strep throat or any of the bacterial or viral infections that can lead to acute tonsillitis.

A person can get acute tonsillitis by:

coming into contact with someone who has strep throat or mononucleosis

having strep throat that develops into tonsillitis

sharing utensils or toothbrushes with someone carrying strep bacteria or Epstein-Barr virus

There is no way to prevent subacute or chronic tonsillitis.

What are the long-term effects of the infection?

Usually, no significant long-term effects result from any of the three forms of tonsillitis. However, difficulty swallowing or breathing during sleep can result if the chronic infection causes enlargement of the tonsils. The healthcare provider may recommend a tonsillectomy, or removal of the tonsils, if there are recurrent infections or difficulties with swallowing and breathing.

What are the risks to others?

Strep, diphtheria, and Epstein-Barr infections are all contagious.

Treatment & Monitoring

What are the treatments for the infection?

Acute tonsillitis is usually treated with:

pain medication

oral fluids

medications to lower fever

For acute tonsillitis caused by strep bacteria, antibiotics will usually cure the infection. Unfortunately, some strep bacteria are becoming resistant to penicillin. This means higher doses of amoxicillin or a different antibiotic need to be used.

Since antibiotics are not effective against viruses, the only treatment for tonsillitis caused by viral infection is medication to reduce fever and pain. Oral steroids may be given for a short period of time if symptoms are severe.

Oral steroids can lessen the symptoms of tonsiliitis caused by mononucleosis. Antibiotics can be helpful in preventing infection if material has collected on the surface of the tonsils.

In subacute tonsillitis caused by actinomyces, penicillin and clindamycin are effective. If these antibiotics do not work, the person can remove the infected material from the tonsil pits with a finger or special irrigating tool. Otherwise, the tonsils should be removed.

In cases of chronic tonsillitis, antibiotics combined with oral steroids may resolve the infection. If not, the tonsils should be removed.

Tonsillectomy may be recommended by the healthcare provider if the person has had:

3 to 5 bacterial infections of the tonsils within 3 to 5 years

more than 6 episodes of tonsillitis in one year

chronic tonsillitis, or infection of the tonsils, that does not respond to antibiotics

enlargement of the tonsils that causes sleep apnea, a breathing disorder that occurs during sleep

enlargement of the tonsils that causes difficulty swallowing, especially in children

What are the side effects of the treatments?

Side effects depend on the medications used, but may include allergic reactions and upset stomach. Surgery to remove the tonsils can cause bleeding, infection, or allergic reactions to anesthesia.

What happens after treatment for the infection?

Most viral episodes of tonsillitis will resolve without further problems. Antibiotics should clear up infections caused by strep or other bacteria. After recovery from tonsillectomy, the person should be free of symptoms.

How is the infection monitored?

Any new or worsening symptoms should be reported to the healthcare provider.

Treatment Overview

Tonsillitis is most often caused by a virus, which resolves on its own. However, tonsillitis can be caused by strep throat bacteria, which requires treatment with antibiotics. Watch for signs of dehydration, such as a dry mouth and tongue. Also, watch for signs of complications, such as ear pain, from tonsillitis caused by strep bacteria.

Tonsillitis caused by a virus

Tonsillitis caused by a virus will usually go away on its own. Antibiotics are not effective treatment for viral tonsillitis.

The virus that causes mononucleosis (mono) can lead to tonsillitis that is as severe as tonsillitis caused by bacteria, and can take several weeks or more before it goes away.

Home treatments such as gargling with salt water, drinking warm tea, and taking nonprescription pain medicine for children age 6 months and older may help relieve discomfort. Nonprescription pain relievers, such as acetaminophen (Tylenol) or ibuprofen (Advil), should be given to children instead of aspirin. No one age 20 years or younger should take aspirin because of its link to Reye's syndrome. Acetaminophen should not be given to infants younger than 6 months without first consulting your health professional.

Many nonprescription remedies such as antiseptic mouthwashes, decongestants, and antihistamines contain extra ingredients that don't relieve discomfort. These remedies are not recommended for children because they have not been proved to have any benefits in the treatment of acute tonsillitis.4

Tonsillitis caused by bacteria

Antibiotics are prescribed for tonsillitis caused by strep bacteria. Although a strep infection will usually go away on its own, antibiotic treatment is necessary because untreated strep throat can cause serious complications. For more information, see the topic Strep Throat.

If antibiotics are prescribed, it is very important to take them exactly as directed by your health professional. Antibiotics should be taken for the entire duration of the prescription, even if the symptoms disappear completely before the prescription is gone. If antibiotics used to treat tonsillitis are not taken as directed, bacteria can become resistant to them (antibiotic resistance). In these cases, antibiotic treatment of future infections may not work.

Surgery

Although surgical removal of the tonsils (tonsillectomy) is still a common procedure, particularly for children, it is not performed nearly as often as it was in the past. Tonsillectomy may be considered to treat tonsillitis when a child has serious complications, recurrent infections, or chronic infections that do not respond to treatment and interfere with daily functioning. However, the risks and benefits of surgery need to be weighed carefully. Tonsillectomy should only be performed after you and your doctor carefully consider your or your child's overall health.1 For more information, see:

Should my child have a tonsillectomy?

New tonsillectomy techniques are currently being evaluated but are not yet widely used. Ultrasonic dissection, cold ablation, laser tonsillectomy, and diathermy tonsillectomy are all techniques that may be offered as tonsillectomy options in the future.5

What Happens

Tonsillitis caused by a virus typically lasts 4 to 10 days; a bacterial infection lasts slightly longer. If symptoms include sore throat, fever above 101F, and swollen lymph nodes, the infection might be caused by strep bacteria. Strep throat, which must be diagnosed by a health professional, requires antibiotic treatment.

In some cases, tonsillitis can become chronic. Surgical removal of the tonsils (tonsillectomy) may be recommended for you or your child based on past health and results of physical exams.

Complications of tonsillitis

Tonsillitis caused by strep bacteria that is not treated with antibiotics may result in 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 with sleep apnea and enlarged tonsils do not have a history of tonsillitis.

Topic Overview

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 4 to 10 days.

What causes tonsillitis?

Most often, tonsillitis is caused by a virus. Less often, it is caused by the same bacteria that cause strep throat. In rare cases, a fungus or a parasite can cause it.

Tonsillitis is spread through the air in droplets when an infected person breathes, coughs, or sneezes. You may then become infected after breathing in these droplets or getting them on your skin or on objects that come in contact with your mouth, nose, or eyes.

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. Fever is also common.

If you feel like you have a cold, with symptoms such as runny and stuffy nose, sneezing, and coughing, a virus is most likely the cause.

If you have a sore throat plus a sudden and severe fever and swollen lymph nodes , but you do not have symptoms of a cold, the infection is more likely caused by bacteria. This means you need to see a doctor and probably need a strep test.

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 it treated?

Tonsillitis caused by a virus will usually go away on its own. Treatment focuses on helping you feel better. You may be able to ease throat pain by gargling with salt water, drinking warm tea, and using other home treatments. Over-the-counter pain medicines, such as acetaminophen (Tylenol, for example), may also be used by adults and children age 6 months and older. But do not give aspirin to anyone age 20 or younger. It is linked to a serious disease called Reye's syndrome.

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 only advise surgery to remove tonsils (tonsillectomy) 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 if surgery is the right choice after a careful review of your or your child's overall health.1

What Increases Your Risk

Close contact with an infected person is the main risk factor for tonsillitis. 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 pathogens get on the skin or on objects that come in contact with the mouth, nose, eyes, or other mucous membranes.

Nasal obstruction causes you to breathe through your mouth, which increases the risk of tonsillitis.

Although there is no proof that exposure to cigarette smoke can cause tonsillitis, children who live with a smoker have a higher incidence of tonsillectomy, which is a surgical procedure to remove the tonsils.2

Exams and Tests

Diagnosis of tonsillitis is based on a medical history and a physical examination of the throat. An accurate medical history is necessary in order to determine whether tonsillitis is recurrent, which may affect treatment choices.

If your symptoms suggest strep throat, your health professional may want to confirm this diagnosis by doing a throat culture. Strep throat is more likely if 3 or 4 of the following signs or symptoms are present:3

Fever White or yellow spots or coating on the throat and/or tonsils (tonsillar exudates)

Swollen or tender lymph nodes on the neck

Absence of coughing or sneezing

If a strep infection is suspected, your health professional may conduct a rapid strep test or a throat culture or both. Both of these tests can be conducted in a doctor's office. You may want to discuss the advantages and disadvantages of each test to determine which test is appropriate.

The results of these tests will determine whether antibiotic treatment is necessary. These results combined with an accurate medical history will be considered in deciding whether surgery to remove the tonsils (tonsillectomy) is recommended.

If the Epstein-Barr virus, which can cause mononucleosis, is suspected as a cause for the tonsillitis, a test for mononucleosis may be done.

Prevention

Since a wide variety of viruses and bacteria can cause tonsillitis, the best prevention is to follow basic health and hygiene precautions. The following steps are especially helpful for children:

Avoid close contact with others who are sick . If possible, keep your child away from children who are known to have tonsillitis or sore throat.

Frequently remind your child about the importance of proper hand-washing, especially when around people who appear sick. Also tell your child not to share toothbrushes or eating utensils with other children.

Wash and disinfect surfaces and toys .

Teach children to cover their mouths when coughing or sneezing, preferably using a tissue so that germs do not get on their hands. Also show them how to use tissues to wipe their noses.

Carry disposable wipes and a hand sanitizer to clean hands and to wipe off shopping carts or other shared items in public places.

Do not smoke around your child.

Medications

Tonsillitis is usually caused by a virus and does not require prescription medicine. Gargling with salt water and taking over-the-counter pain medicines such as acetaminophen (Tylenol) can help manage symptoms as the body fights off the infection. Do not give aspirin to anyone age 20 years or younger because of the risk of Reye's syndrome.

An antibiotic, usually penicillin, is used to treat tonsillitis caused by strep bacteria.

Although tonsillitis caused by strep bacteria usually will go away on its own, antibiotics are used to prevent the complications, such as rheumatic fever, that can result from untreated strep throat.

Medication Choices

Antibiotics, such as penicillin, are used to treat tonsillitis caused by strep bacteria.

What To Think About

Many over-the-counter remedies, including antiseptic mouthwashes, decongestants, and antihistamines, contain extra ingredients that don't relieve discomfort. These remedies are not recommended for children, as these ingredients have not been proven to have any benefits in the treatment of acute tonsillitis.4 Check with the doctor before giving these medicines to your child. Experts say not to give decongestants to children younger than 2.

If antibiotics are prescribed, it is very important to take them exactly as directed by your health professional until the medicine is gone. Even if the symptoms disappear completely before the

prescription is gone, all pills should be taken as directed to ensure that the infection is completely destroyed. Bacteria can become resistant to the antibiotics used to treat tonsillitis (antibiotic resistance) if prescriptions aren't taken as directed or if they are prescribed when they aren't necessary.

Surgery

Tonsillectomy for tonsillitis is generally used for children who have serious complications or recurrent infections that are unresponsive to other treatment, especially when they interfere with daily functioning. However, tonsillectomy should only be performed after you and your health professional carefully consider your child's medical history and overall health.1

Researchers in a recent study concluded that tonsillectomy may be no better than watchful waiting for children with mild symptoms, which was defined as tonsillitis occurring fewer than 3 times per year.6

For some children, however, tonsillectomy can greatly improve their quality of life. Children who are most likely to benefit from tonsillectomy are those who have:

Five or more episodes of tonsillitis in a single year, or a recurrence of at least twice per year for more than 2 years in a row. Tonsillectomy is more likely to be considered as treatment when some of these episodes result in missing school, trouble sleeping, or other problems with normal daily functioning.

Tonsillitis lasting longer than 3 months, despite medicine.

Obstructed air passages.

Difficulty swallowing.

Difficulty talking because of nasal obstruction.

Tonsils that bleed heavily.

Surgery Choices

Tonsillectomy for strep throat may be performed in cases of recurring tonsillitis that do not respond to antibiotics or if an infection threatens the child's well-being. For more information, see:

Should my child have a tonsillectomy?

New tonsillectomy techniques are currently being evaluated but are not yet widely used. Ultrasonic dissection, cold ablation, laser tonsillectomy, and diathermy tonsillectomy are all techniques that may be offered as tonsillectomy options in the future.5

What To Think About

Although tonsillectomy is still the most common major surgical procedure performed on children in the United States, it is not done as often as it was in the past. The tonsils are part of the immune system, and studies have shown that the reduction in future infections following tonsillectomy is not in itself significant enough to outweigh the risks posed by the surgery.1

Upper respiratory infections and tonsillitis usually occur less frequently as a child gets older.1 Consider whether your child's tonsillitis infections are manageable until you can wait to see if he or she outgrows them.

A child who has tonsillectomy will require special care and close monitoring for at least a week after the surgery. Consider your ability to provide this care for your child before deciding on tonsillectomy.

Home Treatment

The goal of home treatment of tonsillitis caused by a virus is to manage symptoms as the body fights off the infection. It includes measures to ease the discomfort of sore throat and coldlike symptoms, such as runny nose, nasal congestion, sneezing, and coughing.

Things that may help you or your child feel better include:

Gargling with warm salt water [0.25tsp salt to 0.5cups warm water] several times a day. Drinking warm or cool liquids (whichever feels better). These include tea, soup, juice, and

rehydration drinks.

Eating frozen desserts such as Popsicles.

Taking nonprescription pain medicines (such as acetaminophen) that can help relieve sore throat pain. Pain relievers should only be used for children older than 6 months. Do not give aspirin to anyone younger than 20 years of age because of its link to Reye's syndrome.

Getting plenty of rest.

Using a vaporizer or humidifier in the bedroom.

Using throat lozenges to help relieve sore throat symptoms. But lozenges should not be given to young children because of the risk of choking. Also, many lozenges contain unnecessary ingredients that can be potentially harmful.

Antiseptic mouthwashes, decongestants, and antihistamines have not been proved effective and may result in harmful side effects.4 Check with the doctor before giving these medicines to your child. Experts say not to give decongestants to children younger than 2.

A sore throat along with sudden fever and swollen lymph nodes, and without symptoms of an upper respiratory tract infection, may indicate a bacterial infection. Anyone with these symptoms

should see a health professional to be tested for strep throat, which requires treatment with antibiotics. It is important to get plenty of rest and take all the prescribed antibiotics exactly as directed. Keep your child home from school for the first 1 to 2 days of antibiotic treatment because he or she is still contagious during this time and might pass the infection to others.

Cause

Tonsillitis is usually caused by a virus. Bacteria can also cause tonsillitis. The most common bacterial cause of tonsillitis is group A beta-hemolytic streptococcus (GABHS), which also causes strep throat.

Tonsillitis can also be caused by fungi or parasites, but these causes are rare in people who have healthy immune systems.

Although there is no proof that exposure to cigarette smoke can cause tonsillitis, children who live with a smoker have a higher incidence of tonsillectomy, which is a surgical procedure to remove the tonsils.2

How tonsillitis is spread

Tonsillitis 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 pathogens get on the skin or on objects that come in contact with your mouth, nose, eyes, or other mucous membranes. Symptoms usually appear about 2 to 5 days after exposure.

A person with tonsillitis caused by strep bacteria is contagious early on and without treatment can remain so for up to 2 weeks. Antibiotics shorten the contagious period, and an infected person is no longer contagious about 24 to 48 hours after beginning antibiotic therapy.

Symptoms

The main symptom of tonsillitis is a sore throat. Additional 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 pain

Raw, bleeding patches on the tonsils

When sore throat is accompanied by coldlike symptoms such as nasal congestion, runny nose, sneezing, and coughing, the cause is most likely a virus. Viral infection of the tonsils usually goes away without treatment within 2 weeks.

Sore throat with a sudden fever above 101F-milder fever may indicate a viral infection-and swollen lymph nodes, and without symptoms of an upper respiratory tract infection, may indicate a bacterial infection. Anyone with these symptoms should see a health professional 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 including rheumatic fever, which can permanently damage the heart.

Reye syndrome is a very rare but serious disease that most often occurs in children 6 to 12 years old. The exact cause is not known, but it is associated with children who have recently had chickenpox (varicella) or flu (influenza) and taken aspirin.

The disease primarily targets the brain and liver and can cause drowsiness, confusion, seizures, coma, and in severe cases, death. The symptoms usually develop 3 to 7 days after the viral illness starts. Reye syndrome is not contagious.

All children with Reye syndrome are treated in a hospital intensive care unit, and most recover in a few weeks. But some children develop permanent brain damage. Early treatment increases the chance for full recovery.

Aspirin or aspirin products should not be given to anyone younger than 20, unless they are specifically prescribed by a doctor. Aspirin is also called acetyl salicylate, acetylsalicylic acid, salicylic acid, salicylate, or subsalicylate. Aspirin products are found in over-the-counter medicines such as Pepto-Bismol, Kaopectate, and Alka Seltzer.

Mononucleosis (also called "mono") is an illness, caused by infection with the Epstein-Barr virus, that most often affects young adults. Symptoms of mononucleosis include high fever, sore throat, swollen lymph nodes (glands), and fatigue.

Symptoms tend to be mild in young children and worse in teens and adults. The illness also causes the spleen (an organ in the abdomen) to swell, so a person who has mono needs to avoid activities that could injure the abdomen.

Mono is usually a mild illness that goes away without treatment after several weeks. During this time, symptoms may come and go and may change with time. It is normal for the lymph nodes to remain enlarged for up to a month. Fatigue that makes normal activities difficult or impossible may linger for 2 to 3 months. There is no specific treatment except rest, plenty of fluids, and nonprescription pain relievers, such as acetaminophen (Tylenol) and ibuprofen (Motrin, Advil), for body aches. Aspirin should not be given to anyone younger than age 20 because its use has been linked to Reye's syndrome, a serious illness.

Swollen glands (lymph nodes)

Lymph nodes are small, bean-shaped glands in the body. They are part of the lymphatic system, which carries lymph fluid, nutrients, and waste material between the body tissues and the bloodstream. The lymphatic system is part of the immune system-the body's defense system against disease.

Lymph nodes are found singly or in groups. They may be as small as the head of a pin or as large as an olive. Groups of lymph nodes can be felt in the neck, groin, and underarms. Many lymph nodes in the body cannot be felt.

When a part of the body is infected, the nearby lymph nodes can become swollen. For example, if a person has a throat infection, the lymph nodes in the neck may swell and become tender.

ComplicationsBy Mayo Clinic staff

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.