Tonsillitis refers to inflammation of the pharyngeal tonsils (glands at the back of the throat, visible through the mouth). The inflammation may involve other areas of the back of the throat, including the adenoids and the lingual tonsils (tonsil tissue at the back of the tongue). There are several variations of swollen tonsils and tonsillitis: acute, recurrent, and chronic tonsillitis, and peritonsillar abscess.
Viral or bacterial infections and immunologic factors lead to tonsillitis and its complications. Nearly all children in the United States experience at least one episode of tonsillitis. Due to improvements in medical and surgical treatments, complications associated with tonsillitis, including mortality, are rare.
Who gets tonsillitis?
Tonsillitis most often occurs in children, but rarely in those younger than two years old. Tonsillitis caused by bacteria (streptococcus species) Streptococcus species typically occurs in children aged 5 to 15 years, while viral tonsillitis is more common in younger children. A peritonsillar abscess is usually found in young adults but can occur occasionally in children. The patient’s history often helps identify the type of tonsillitis present (i.e., acute, recurrent, chronic).
What causes tonsillitis?
The herpes simplex virus, Streptococcus pyogenes (GABHS), Epstein-Barr virus (EBV), cytomegalovirus, adenovirus, and the measles virus cause most cases of acute pharyngitis and acute tonsillitis. Bacteria cause 15-30 percent of pharyngotonsillitis cases; GABHS is the cause for most bacterial tonsillitis. (i.e., “strep throat”).
What are the symptoms of tonsillitis?
The type of tonsillitis determines what symptoms of swollen tonsils will occur.
- Acute tonsillitis: Patients have a fever, sore throat, foul breath, dysphagia (difficulty swallowing), odynophagia (painful swallowing), and tender cervical lymph nodes. Airway obstruction due to swollen tonsils may cause mouth breathing, snoring, nocturnal breathing pauses, or sleep apnea. Lethargy and malaise are common. These symptoms usually resolve in three to four days, but may last up to two weeks despite therapy.
- Recurrent tonsillitis: This diagnosis is made when an individual has multiple episodes of acute tonsillitis in a year.
- Chronic tonsillitis: Individuals often have chronic sore throat, halitosis, tonsillitis, and persistently tender cervical nodes.
- Peritonsillar abscess: Individuals often have swollen tonsils, severe throat pain, fever, drooling, foul breath, trismus (difficulty opening the mouth), and muffled voice quality, such as the “hot potato” voice (as if talking with a hot potato in his or her mouth).
What happens during the physician visit?
Your child will undergo a general ear, nose, and throat examination as well as a review of the patient’s medical history. A physical examination of a young patient with tonsillitis may find:
- Fever and enlarged inflamed tonsils covered by pus.
- Group A beta-hemolytic Streptococcus pyogenes (GABHS) can cause tonsillitis (“strep throat”) associated with the presence of palatal petechiae (tiny hemorrhagic spots, of pinpoint to pinhead size, on the soft palate). Neck nodes may be enlarged. A fine red rash over the body suggests scarlet fever. GABHS pharyngitis usually occurs in children 5-15 years old.
- Open-mouth breathing and muffled voice resulting from obstructive tonsillar enlargement. The voice change with acute tonsillitis usually is not as severe as that associated with peritonsillar abscess.
- Tender cervical lymph nodes and neck stiffness (often found in acute tonsillitis).
- Signs of dehydration (found by examination of skin and mucosa).
- The possibility of infectious mononucleosis due to EBV in an adolescent or younger child with acute tonsillitis, particularly when cervical, axillary, and/or groin nodes are tender. Severe lethargy, malaise, and low-grade fever accompany acute tonsillitis.
- A grey membrane covering tonsils that are inflamed from an EBV infection. (This membrane can be removed without bleeding.) Palatal petechiae (pinpoint spots on the soft palate) may also be seen with an EBV infection.
- Red swollen tonsils that may have small ulcers on their surfaces in individuals with herpes simplex virus (HSV) tonsillitis.
- Unilateral bulging above and to the side of one of the tonsils when peritonsillar abscess exists. A stiff jaw, difficulty opening the mouth, and pain referred to the ear may be present in varying severity.
Treatment
Tonsillitis is usually treated with a regimen of antibiotics. Fluid replacement and pain control are important. Hospitalization may be required in severe cases, particularly when there is airway obstruction. When the condition is chronic or recurrent, a surgical procedure to remove the tonsils is often recommended. Peritonsillar abscess may need more urgent treatment to drain the abscess.
Frequently Asked Questions
Tonsillitis is caused by viral or bacterial infections, with common culprits including herpes simplex virus, Streptococcus pyogenes (Group A beta-hemolytic Streptococcus), Epstein-Barr virus, cytomegalovirus, adenovirus, and the measles virus. Bacterial tonsillitis, especially from Streptococcus pyogenes, accounts for 15-30% of cases and is often referred to as strep throat.
Tonsillitis most commonly affects children, particularly those aged 5 to 15 years for bacterial (strep) tonsillitis. Viral tonsillitis is more frequent in younger children, while peritonsillar abscesses usually occur in young adults but can occasionally affect children. It is rare in children younger than two years old.
Acute tonsillitis symptoms include fever, sore throat, foul breath, difficulty and pain when swallowing, tender cervical lymph nodes, mouth breathing, snoring, sleep apnea, lethargy, and malaise. These symptoms usually resolve within three to four days but can last up to two weeks even with therapy.
Diagnosis involves a thorough ear, nose, and throat exam and a review of medical history. Physicians look for signs such as fever, enlarged inflamed tonsils with pus, palatal petechiae, enlarged neck nodes, open-mouth breathing, muffled voice, and possible indications of infectious mononucleosis or peritonsillar abscess based on specific clinical features.
Tonsillitis is primarily treated with antibiotics to address bacterial infections, along with fluid replacement and pain control. Hospitalization may be necessary if airway obstruction occurs. Chronic or recurrent cases often require surgical removal of the tonsils, while peritonsillar abscesses may require urgent drainage.
A peritonsillar abscess is a complication of tonsillitis characterized by a unilateral bulging near one tonsil, severe throat pain, fever, drooling, foul breath, difficulty opening the mouth (trismus), and a muffled 'hot potato' voice. It may require urgent medical intervention to drain the abscess.
Recurrent tonsillitis is diagnosed when a person experiences multiple episodes of acute tonsillitis within a year. Chronic tonsillitis involves persistent symptoms such as a chronic sore throat, bad breath (halitosis), and tender cervical lymph nodes despite ongoing symptoms over an extended period.
