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Tonsillitis

NHS Direct Online Health Encyclopaedia

Introduction

Tonsillitis is an inflammation of the tonsils, which are small glands located at the back of your throat. The function of these glands is not entirely clear but research indicates that they help to fight infections.

Both viruses and bacteria may cause tonsillitis. In general, young children tend to get viral tonsillitis, and older children and adults get bacterial infections.

Tonsillitis can spread from person to person through throat or nasal fluids - this includes saliva, hand contact or airborne droplets. The incubation period (the period between picking up the infection and symptoms starting to appear) is usually between two and four days.

Symptoms

Common symptoms of tonsillitis include:

  • Swollen, red tonsils,
  • Sore throat or pain on swallowing,
  • Fever (which can be very high in young children) or chills,
  • Spots of pus come from cracks (crypts) in the surface of the tonsils,
  • Material from the crypts forms a whitish membrane or skin over the surface of the tonsils, and
  • Lymph nodes (glands) in the neck are swollen and tender to the touch.
  • Other symptoms may include headache, feeling generally unwell (malaise), constipation, earache, furry tongue and foul-smelling breath, or difficulty opening mouth or thickened speech.

Tonsillitis often develops alongside a throat infection (pharyngitis).

Causes

 Tonsillitis is commonly caused by a viral infection. These viruses are often the ones that frequently affect the respiratory (breathing) system, and include the flu (influenza) virus and parainfluenza (the virus that causes laryngitis and croup). The Epstein-Barr virus, which is the cause of glandular fever, may also be a cause.

Bacterial tonsillitis may be caused by a number of different bacteria, but the most common are streptococcus group A bacteria.

In the past, serious bacterial infections such as diptheria and scarlet fever would cause tonsillitis, but this is now rare due to improved immunisation and treatment.

Diagnosis

Diagnosis is based on the symptoms presented (such as complaints of soreness), the appearance of the throat and tonsils, and the presence of swollen glands in the neck.

The doctor checks other symptoms presented by the patient, to work out whether the tonsillitis is viral or bacterial. For example, if the sore throat is caused by the flu virus, then other flu symptoms such as a runny nosey and aching body may be present. If it is bacterial tonsillitis, then there may be other signs of the bacterial infection such as a skin rash (sometimes called a scarlet fever rash) or a flushed face.

Sometimes a throat swab (a small sample of mucus) may be taken for laboratory analysis but the results can take up to two days to return. These tests are mainly used for patients in high-risk groups or if previous treatment has failed.

Treatment

 Most sore throats are caused by viruses, and do not respond to antibiotics. They will usually go away on their own, but paracetamol or ibuprofen can be taken to ease some of the symptoms. Gargles using aspirin or salt water may also be helpful.

Tonsillitis caused by streptococcal bacteria responds well to antibiotic treatment, clearing the infection more quickly than without treatment.

Severe or complicated tonsillitis that keeps on coming back may justify the removal of the tonsils, an operation known as tonsillectomy. Tonsillectomy is always done under a general anaesthetic. It done less often than it used to be: there are risks associated with surgery (excessive bleeding, effects of anaethesia); diptheria and other conditions that cause tonsillitis are less common; and recent research suggests that the tonsils may help in fighting infections.

Complications

Complications of tonsillitis are uncommon, but may include abscess behind the tonsil (quinsy or peritonsillar abscess), inflammation of the middle ear (otitis media), rheumatic fever, kidney inflammation (glomerulonephritis) and, very rarely, blood poisoning (septicaemia).

Swellings from tonsillitis can be so severe they block the airways and prevent a person from breathing. Chronic tonsillitis can cause obstructive sleep apnoea, preventing full oxygen supplies getting to the brain and leading to disturbed sleeping patterns.

Prevention

 

The best way to avoid tonsillitis is to avoid close contact with people who have the viral or bacterial infections that lead to the development of the condition. This includes avoiding sharing toothbrushes and eating or drinking utensils, and keeping a high level of hygiene (for example, frequent hand-washing).

References

Glossary

Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Brain
The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.
Oxygen
Oxygen is an odourless, colourless gas that makes up about 20% of the air we breathe.
Kidney
Kidneys are a pair of bean-shaped organs located at the back of the abdomen, which remove waste and extra fluid from the blood and pass them out of th
Lymph node
Lymph nodes are small oval tissues that remove unwanted bacteria and particles from the body. Part of the immune system.
Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some others are good for you.
Chronic
Chronic usually means a condition that continues for a long time or keeps coming back.
Abscess
An abscess is a lump containing pus, which is made by the body during infection.
Anaesthetic
Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.
High temperature
A high temperature, also known as a fever, is when someone's body temperature goes above the normal 37°C (98.6°F).
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Ache
An ache is a constant dull pain in a part of the body.
Constipation
Constipation is when you pass stools less often than usual, or when you are having difficulty going to the toilet because your stools are hard and small.
Antibiotic
Antibiotic s are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. For example amoxicillin, streptomycin and erythromycin.

 

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Crown copyright material is reproduced with the permission of the controller of HMSO and the Queens Printer for Scotland.

 

 

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