Tonsillitis

Definition

Tonsillitis is an infection and swelling of the tonsils, which are oval-shaped masses of lymph gland tissue located on both sides of the back of the throat.

Description

The tonsils normally help to prevent infections . They act like filters to trap bacteria and viruses entering the body through the mouth and sinuses. The tonsils also stimulate the immune system to produce antibodies which fight off infections. Anyone can have tonsillitis; however, it is most common in children between the ages of five and 10 years.

Causes & symptoms

Tonsillitis is caused by viruses or bacteria that cause the tonsils to swell and become inflamed. A mild or severe sore throat is one of the first symptoms of tonsillitis. Symptoms can also include fever, chills , lethargy, muscle aches, earache, pain or discomfort when swallowing, and swollen glands in the neck. Young children may be fussy and stop eating. When a doctor or nurse looks into the mouth with a otoscope, the tonsils may appear swollen and red. Sometimes they will have white or yellow spots and a thin mucous coating. Symptoms usually last four to six days.

Diagnosis

The diagnosis of tonsillitis is made from the visible symptoms and a physical examination of the patient. The doctor will examine the eyes, ears, nose, and throat, looking at the tonsils for signs of swelling, redness, or a discharge. A careful examination of the throat is necessary to rule out diphtheria and other conditions that may cause a sore throat. Since most sore throats in children are caused by viruses rather than bacteria, the doctor may take a throat culture or rapid diagnostic test in order to test for the presence of streptococcal bacteria. A throat culture is performed by wiping a cotton swab across the tonsils and back of the throat and sending the swab to a laboratory for culturing. Streptococcus pyogenes, the bacterium that causes strep throat , is the most common disease agent responsible for tonsillitis. Depending on what type of test is used for strep, the doctor may be able to determine within a few minutes if S. pyogenes is present. The quick tests for strep are not as reliable as a laboratory culture, which can take 24-48 hours. If the results of a quick test are positive, however, the doctor can prescribe antibiotics right away. If the quick test results are negative, the doctor can do a throat culture to verify the results and wait for the laboratory report before prescribing antibiotics. A blood test may also be done to rule out a more serious infection or condition, and to check the white blood cell count to see if the body is responding to the infection. In some cases, the doctor may order blood tests for mononucleosis , since about a third of patients with mononucleosis develop infections in the tonsils.

Treatment

Treatment of tonsillitis usually involves keeping the patient comfortable while the illness runs its course. This

supportive care includes bed rest, drinking extra fluids, gargling with warm salt water, and taking pain relievers to reduce fever. Frozen juice bars and cold fruit drinks can bring some temporary relief of sore throat pain and drinking warm tea or broth can be soothing.

Strengthening the immune system is important whether tonsillitis is caused by bacteria or viruses. Naturopaths often recommend dietary supplements of vitamin C, bioflavonoids , and beta-carotenes—found naturally in fruits and vegetables—to ease inflammation and fight infection. A variety of herbal remedies also may be helpful in treating tonsillitis. Calendula (Calendula officinalis ) and cleavers (Galium aparine ) target the lymphatic system, while echinacea (Echinacea spp. ) and astragalus (Astragalus embranaceus ) stimulate the immune system. Goldenseal (Hydrastis canadensis ), myrrh (Commiphora molmol ), and bitter orange (Citrus aurantium ) act as antibacterials. Lomatium dissectum and Ligusticum porteri have an antiviral action.

Some of the homeopathic medicines that may be used to treat symptoms of tonsillitis include Belladonna, Phytolacca, Mercurius, Lycopodium, Lachesis, Hepar sulphuris, Arsenicum, or Rhus toxicodendron. As with any condition, the treatment and dosage should be appropriate for the particular symptoms and age of the patient. Other demulcent herbs include teas made with slippery elm bark, wild cherry , and licorice .

Allopathic treatment

If the throat culture shows that S. pyogenes is present, penicillin or other antibiotics will be prescribed. An injection of benzathine or procaine penicillin may be most effective in treating the infection, but it is also painful. If an oral antibiotic is prescribed, it must be taken for the full course of treatment, which is usually 10-14 days.

Expected results

Tonsillitis is usually resolved within a few days with rest and supportive care. Treating the symptoms of sore throat and fever will make the patient more comfortable. If fever persists for more than 48 hours, however, or is higher than 102°F (39°C), the patient should be seen by a doctor. If antibiotics are prescribed to treat an infection, they should be taken as directed for the complete course of treatment, even if the patient starts to feel better in a few days. Prolonged symptoms may indicate that the patient has other upper respiratory infections, most commonly in the ears or sinuses. An abscess behind the tonsil (a peritonsillar abscess) may also occur. In rare cases, a persistent sore throat may point to more serious conditions such as rheumatic fever or pneumonia .

KEY TERMS

Streptococcus pyogenes

—A common bacterium that causes strep throat and can also cause tonsillitis.

Prevention

The bacteria and viruses that cause tonsillitis are easily spread from person to person. It is not unusual for an entire family or several students in the same classroom to come down with similar symptoms, especially if S. pyogenes is the cause. The risk of transmission can be lowered by avoiding exposure to anyone who already has tonsillitis or a sore throat. Drinking glasses and eating utensils should not be shared and should be washed in hot, soapy water before reuse. Old toothbrushes should be replaced to prevent reinfection. People who are caring for someone with tonsillitis should wash their hands frequently, to prevent spreading the infection to others.

Resources

BOOKS

Berkow, Robert. "Tonsillitis." In The Merck Manual of Diagnosis and Therapy. Rahway, NJ: Merck Research Laboratories, 1992.

Eckman, Margaret, and Nancy Priff. "Ear, Nose, and Throat Disorders: Tonsillitis." In Diseases. Springhouse, PA: Springhouse Corporation, 1997.

Inlander, Charles B., ed., et al. "Tonsillitis." The Consumer's Medical Desk Reference. New York: A Stonesong Press Book, 1995.

Norris, June. "Tonsillitis." In Professional Guide to Diseases. Springhouse, PA: Springhouse Corporation, 1995.

Shaw, Michael. "Tonsillitis." In Everything You Need to Know about Diseases. Springhouse, PA: Springhouse Corporation, 1996.

Kathleen D. Wright

Tonsillitis

Definition

Tonsillitis is an infection and swelling of the tonsils, which are oval-shaped masses of lymph gland tissue located on both sides of the back of the throat.

Description

The tonsils normally help to prevent infections. They act like filters to trap bacteria and viruses entering the body through the mouth and sinuses. The tonsils also stimulate the immune system to produce antibodies that help fight infections. Anyone of any age can have tonsillitis; however, it is most common in children between the ages of five and 15 years.

Transmission

Tonsillitis is transmitted from one person to another in the same way that many common diseases are, such as by coughing and sneezing. It can also spread when a child touches his or her nose and then other children's toys or by children eating or drinking with the same utensils. Children with bacterial tonsillitis are usually no longer contagious 24 hours after beginning a course of antibiotics .

Demographics

Tonsillitis is very common among children. Nearly all children will have some form of tonsillitis at least once.

Causes and symptoms

Tonsillitis is caused by viruses or bacteria that make the tonsils swell and become inflamed. Most cases of tonsillitis are caused by viruses, which cannot be treated with antibiotics. A mild or severe sore throat is one of the first symptoms of tonsillitis. Symptoms can also include fever , chills, tiredness, muscle aches, earache, pain or discomfort when swallowing, and swollen glands in the neck. Very young children may be fussy and stop eating. When a doctor or nurse looks into the mouth with a flashlight, the tonsils may appear swollen and red. Sometimes, the tonsils will have white or yellow spots or flecks. Symptoms usually last four to six days.

When to call the doctor

If the child is displaying the symptoms of tonsillitis and has had a sore throat for more than 48 hours, especially when accompanied by a fever, a doctor should be called. The doctor can determine if the child has tonsillitis, if it is bacterial or viral, and treat the problem accordingly. If the child cannot breathe or cannot swallow emergency medical attention should be sought.

Diagnosis

The diagnosis of tonsillitis is made from the visible symptoms and a physical examination of the patient. The doctor examines the eyes, ears, nose, and throat, looking at the tonsils for signs of swelling, redness, or discharge. A careful examination of the throat is necessary to rule out diphtheria and other conditions that may cause a sore throat. Since most sore throats in children are caused by viruses rather than bacteria, the doctor may take a throat culture in order to test for the presence of streptococcal bacteria. A throat culture is performed by wiping a cotton swab across the tonsils and back of the throat and sending the swab to a laboratory for culturing. Streptococcus pyogenes, the bacterium that causes "strep" throat, is the most common bacterial agent responsible for tonsillitis. Depending on what type of test is used for strep, the doctor may be able to determine within a few minutes if S. pyogenes is present. The quick tests for strep are not as reliable as a laboratory culture, which can take 24 to 48 hours. If the results of a quick test are positive, however, the doctor can prescribe antibiotics right away. If the quick test results are negative, the doctor can do a throat culture to verify the results and wait for the laboratory report before prescribing antibiotics. A blood test may also be done to rule out a more serious infection or condition and to check the white blood cell count to see if the body is responding to the infection. In some cases, the doctor may order blood tests for mononucleosis, since about one third of patients with mononucleosis develop streptococcal infections of the tonsils.

Treatment

Treatment of tonsillitis usually involves keeping the patient comfortable while the illness runs its course. This supportive care includes bed rest, drinking extra fluids, gargling with warm salt water, and taking pain relievers. Children under the age of 12 should not be given aspirin as a pain reliever because of the threat of Reye's syndrome . Frozen juice bars and cold fruit drinks can bring some temporary relief of sore throat pain. Drinking warm tea or broth can also be soothing. If the throat culture shows that S. pyogenes is present, penicillin or other antibiotics will be prescribed. An injection of benzathine or procaine penicillin may be most effective in treating the infection, but it is also painful. If an oral antibiotic is prescribed, it must be taken for the full course of treatment, usually 10 to 14 days, even if the symptoms are no longer present. If the child has several episodes of severe tonsillitis, the doctor may recommend a tonsillectomy, which is the surgical removal of the tonsils.

Alternative treatment

Strengthening the immune system is important whether tonsillitis is caused by bacteria or viruses. Naturopaths often recommend dietary supplements of vitamin C, bioflavonoids, and beta-carotenes, found naturally in fruits and vegetables, to ease inflammation and fight infection. A variety of herbal remedies also may be helpful in treating tonsillitis. Calendula (Calendula officinalis ) and cleavers (Galium aparine ) target the lymphatic system, while echinacea (Echinacea spp. ) and astragalus (Astragalus membranaceus )stimulate the immune system. Goldenseal (Hydrastis canadensis ), myrrh (Commiphora molmol ), and bitter orange act as antibacterials. Lomatium dissectum and ligusticum porteri have an antiviral action. Some of the homeopathic medicines that may be used to treat symptoms of tonsillitis include:

• arsenicum
• belladonna
• hepar sulphuris
• lachesis
• lycopodium
• mercurius
• phytolacca
• rhus toxicodendron

As with any condition, the treatment and dosage should be appropriate for the particular symptoms and age of the patient.

Prognosis

Tonsillitis usually resolves within a few days with rest and supportive care. Treating the symptoms of sore throat and fever will make the child more comfortable. If fever persists for more than 48 hours, however, or is higher than 102°F (38.9°C) the child should be seen by a doctor. If antibiotics are prescribed to treat an infection, they should be taken as directed for the complete course of treatment, even if the child starts to feel better in a few days. Prolonged symptoms may indicate that the child has other upper respiratory infections, most commonly in the ears or sinuses. An abscess behind the tonsil (a peritonsillar abscess) may also occur. In rare cases, a persistent sore throat may point to more serious conditions, such as rheumatic fever or pneumonia .

Prevention

The bacteria and viruses that cause tonsillitis are easily spread from person to person. It is not unusual for an entire family or several students in the same classroom to come down with similar symptoms, especially if S. pyogenes is the cause. The risk of transmission can be lowered by avoiding exposure to anyone who already has tonsillitis or a sore throat. Drinking glasses and eating utensils should not be shared and should be washed in hot, soapy water before reuse. Old toothbrushes should be replaced to prevent reinfection. People who are caring for someone with tonsillitis should wash their hands frequently to prevent spreading the infection to others.

Parental concerns

Tonsillitis usually has no long term effects if it is detected and treated promptly. If it is not treated it can lead to other medical conditions such as rheumatic fever, kidney inflammation, or abscesses that could block a child's breathing passage.

KEY TERMS

Streptococcus pyogenes —A common bacterium that causes strep throat and can also cause tonsillitis.

Tonsillectomy —A surgical procedure to remove the tonsils. A tonsillectomy is performed if the patient has recurrent sore throats or throat infections, or if the tonsils have become so swollen that the patient has trouble breathing or swallowing.

Tonsils —Common name for the palatine tonsils, which are lymph masses in the back of the mouth, on either side of the tongue. Tonsils act like filters to trap bacteria and viruses.

Resources

BOOKS

Silverstien, Alvin, Virginia Silverstein, and Laura S. Nunn. Sore Throats and Tonsillitis. Danbury, CT: Franklin Watts, 2000.

"Tonsillitis." In Professional Guide to Diseases, 7th ed. Springhouse, PA: Springhouse Corporation, 2001.

PERIODICALS

"Sore Throat." Journal of the American Medical Association 291, no. 13 (April 7, 2004): 1664.

Tish Davidson, A.M.

Tonsillitis

Definition

Tonsillitis is an infection and swelling of the tonsils, which are oval-shaped masses of lymph gland tissue located on both sides of the back of the throat.

Description

The tonsils normally help to prevent infections. They act like filters to trap bacteria and viruses entering the body through the mouth and sinuses. The tonsils also stimulate the immune system to produce antibodies to help fight off infections. Anyone of any age can have tonsillitis; however, it is most common in children between the ages of five and 10 years.

Causes and symptoms

Tonsillitis is caused by viruses or bacteria that cause the tonsils to swell and become inflamed. A mild or severe sore throat is one of the first symptoms of tonsillitis. Symptoms can also include fever, chills, tiredness, muscle aches, earache, pain or discomfort when swallowing, and swollen glands in the neck. Very young children may be fussy and stop eating. When a doctor or nurse looks into the mouth with a flashlight, the tonsils may appear swollen and red. Sometimes, the tonsils will have white or yellow spots or flecks or a thin coating. Symptoms usually last four to six days.

Diagnosis

The diagnosis of tonsillitis is made from the visible symptoms and a physical examination of the patient. The doctor will examine the eyes, ears, nose, and throat, looking at the tonsils for signs of swelling, redness, or a discharge. A careful examination of the throat is necessary to rule out diphtheria and other conditions that may cause a sore throat. Since most sore throats in children are caused by viruses rather than bacteria, the doctor may take a throat culture in order to test for the presence of streptococcal bacteria. A throat culture is performed by wiping a cotton swab across the tonsils and back of the throat, and sending the swab to a laboratory for culturing. Streptococcus pyogenes, the bacterium that causes strep throat, is the most common disease agent responsible for tonsillitis. Depending on what type of test is used for strep, the doctor may be able to determine within a few minutes if S. pyogenes is present. The quick tests for strep are not as reliable as a laboratory culture, which can take 24-48 hours. If the results of a quick test are positive, however, the doctor can prescribe antibiotics right away. If the quick test results are negative, the doctor can do a throat culture to verify the results and wait for the laboratory report before prescribing antibiotics. A blood test may also be done to rule out a more serious infection or condition, and to check the white blood cell count to see if the body is responding to the infection. In some cases, the doctor may order blood tests for mononucleosis, since about a third of patients with mononucleosis develop streptococcal infections of the tonsils.

Treatment

Treatment of tonsillitis usually involves keeping the patient comfortable while the illness runs its course. This supportive care includes bed rest, drinking extra fluids, gargling with warm salt water, and taking pain relievers—usually NSAIDs—to reduce fever. Frozen juice bars and cold fruit drinks can bring some temporary relief of sore throat pain; drinking warm tea or broth can be soothing. If the throat culture shows that S. pyogenes is present, penicillin or other antibiotics will be prescribed. An injection of benzathine or procaine penicillin may be most effective in treating the infection, but it is also painful. If an oral antibiotic is prescribed, it must be taken for the full course of treatment, usually 10-14 days. If the patient has several episodes of severe tonsillitis, the doctor may recommend a tonsillectomy, which is the surgical removal of the tonsils.

Alternative treatment

Strengthening the immune system is important whether tonsillitis is caused by bacteria or viruses. Naturopaths often recommend dietary supplements of vitamin C, bioflavonoids, and beta-carotenes—found naturally in fruits and vegetables—to ease inflammation and fight infection. A variety of herbal remedies also may be helpful in treating tonsillitis. Calendula (Calendula officinalis ) and cleavers (Galium aparine ) target the lymphatic system, while echinacea (Echinacea spp.) and astragalus (Astragalus membranaceus ) stimulate the immune system. Goldenseal (Hydrastis canadensis ), myrrh (Commiphora molmol ), and bitter orange act as antibacterials. Lomatium dissectum and Ligusticum porteri have an antiviral action. Some of the homeopathic medicines that may be used to treat symptoms of tonsillitis include Belladonna, Phytolacca, Mercurius, Lycopodium, Lachesis, Hepar sulphuris, Arsenicum, or Rhus toxicodendron. As with any condition, the treatment and dosage should be appropriate for the particular symptoms and age of the patient.

Prognosis

Tonsillitis usually resolves within a few days with rest and supportive care. Treating the symptoms of sore throat and fever will make the patient more comfortable. If fever persists for more than 48 hours, however, or is higher than 102°F, the patient should be seen by a doctor. If antibiotics are prescribed to treat an infection, they should be taken as directed for the complete course of treatment, even if the patient starts to feel better in a few days. Prolonged symptoms may indicate that the patient has other upper respiratory infections, most commonly in the ears or sinuses. An abscess behind the tonsil (a peritonsillar abscess) may also occur. In rare cases, a persistent sore throat may point to more serious conditions, such as rheumatic fever or pneumonia.

Prevention

The bacteria and viruses that cause tonsillitis are easily spread from person to person. It is not unusual for an entire family or several students in the same classroom to come down with similar symptoms, especially if S. pyogenes is the cause. The risk of transmission can be lowered by avoiding exposure to anyone who already has tonsillitis or a sore throat. Drinking glasses and eating utensils should not be shared and should be washed in hot, soapy water before reuse. Old toothbrushes should be replaced to prevent reinfection. People who are caring for someone with tonsillitis should wash their hands frequently, to prevent spreading the infection to others.

Resources

OTHER

"Tonsillitis." Kids Health Page. 〈http://KidsHealth.org/parent/common/tonsillitis.html〉.

KEY TERMS

Streptococcus pyogenes— A common bacterium that causes strep throat and can also cause tonsillitis.

Tonsillectomy— A surgical procedure to remove the tonsils if the patient has recurrent sore throats or throat infections, or if the tonsils have become so swollen that the patient has trouble breathing or swallowing.

Tonsils— Oval-shaped masses of glandular tissue located on both sides at the back of the throat. Tonsils act like filters to trap bacteria and viruses.

TONSILLITIS

DEFINITION

Tonsillitis (pronounced tahn-suh-LIE-tiss) is an infection and swelling of the tonsils. The tonsils are lymph nodes, or oval-shaped masses of lymph gland tissue, located on both sides of the throat that are part of the body immune system.

DESCRIPTION

The tonsils normally help prevent infections in two ways. They act like filters to trap bacteria, viruses, and other materials that enter the body through the mouth and sinuses. They also produce antibodies to help fight off infections. An antibody is a chemical produced by blood cells to fight off specific kinds of foreign bodies, such as bacteria and viruses.

While a person can get tonsillitis at any age, the infection occurs most commonly among children between the ages of five and ten years.

Tonsillitis: Words to Know

Antibiotic:

A substance derived from bacteria or other organisms that fights the growth of other bacteria or organisms.

Lymph nodes:

Small round or oval bodies within the immune system. Lymph nodes provide materials that fight disease and help remove bacteria and other foreign material from the body.

Tonsillectomy:

A surgical procedure to remove the tonsils.

Tonsils:

Oval-shaped masses of lymph gland tissue located on both sides of the back of the throat.

CAUSES

Tonsillitis is caused by viruses or bacteria that infect the tonsils. They cause the tonsils to become inflamed and swollen. One of the first symptoms of tonsillitis is a severe sore throat (see sore throat entry). Other symptoms include fever, chills, tiredness, muscle aches, earache, swollen glands in the neck, and pain or discomfort when swallowing. Very young children with tonsillitis may become fussy and stop eating.

SYMPTOMS

Tonsillitis may cause the tonsils, which are visible at the back of the throat, to look red and enlarged. The tonsils may also have visible white or yellow spots or a thin coating. The symptoms of tonsillitis usually last four to six days.

DIAGNOSIS

Tonsillitis can be diagnosed from visible symptoms and a physical examination. A doctor will examine the patient's eyes, ears, nose, and throat and look for signs of swelling, redness, or discharge.

The doctor may also take a throat culture. To do a throat culture, the doctor wipes a cotton swab across the tonsils and back of the throat. The swab is then tested for the presence of bacteria and viruses that cause tonsillitis.

Some tests can be performed quickly. A doctor may suspect the presence of certain disease-causing bacteria almost immediately. He or she can then prescribe antibiotics to treat the infection. An antibiotic is a substance derived from bacteria or other organisms that fights the growth of other bacteria or organisms.

But a longer waiting period is needed for more reliable tests. The cotton swab may need to be incubated for twenty-four to forty-eight hours. During incubation the swab is kept in a warm, moist environment. Bacteria and viruses grow well in this environment. A researcher can then study the material on the swab under a microscope and determine which bacteria and/or viruses are present. With this information, the doctor can make a sound diagnosis of the patient's condition.

A doctor may decide to conduct exclusionary tests also. An exclusionary test is one performed to find out if some condition other than tonsillitis is present. For example, the patient's sore throat might be caused by diphtheria. Blood tests will often rule out infections other than those that cause tonsillitis. If no other infections are present, the doctor may decide that the patient's problem really is tonsillitis.

TREATMENT

Treatment for tonsillitis depends on the agent that caused the infection. If the infection is bacterial, antibiotics can help cure the disease. If the infection is viral, there are no drugs that will cure the disease.

Most doctors will recommend treatments designed to keep a patient comfortable while the disease runs its course. These treatments include bed rest, drinking extra fluids, gargling with warm salt water, and taking pain relievers to reduce fever. Eating frozen juice bars or drinking either cold fruit drinks or warm tea or broth can also bring some relief of sore throat pain.

In many cases, doctors decide to treat tonsillitis with surgery. This treatment may be recommended for children who have severe cases of tonsillitis more than once. In a tonsillectomy, the tonsils are surgically removed.

Alternative Treatment

Alternative practitioners recommend a variety of natural products for the treatment of tonsillitis. These products include dietary supplements, such as vitamin C and beta-carotenes, and certain herbal remedies. The herbs that are suggested include calendula, cleavers, echinacea, astragalus, goldenseal, myrrh, bitter orange, Lomatium dissectum, and Ligusticum porteri. Some of these

herbs are thought to strengthen the immune system. Others are believed to kill bacteria or viruses.

Some homeopathic remedies suggested for tonsillitis include Belladonna, Phytolacca, Mercurius, Lycopodium, Lachesis, Hepar sulphuris, Arsenicum, and Rhus toxicodendron.

PROGNOSIS

Tonsillitis usually gets better on its own within a few days. Treating the symptoms of sore throat and fever will make the patient more comfortable. In cases where the fever lasts for more than forty-eight hours or reaches a temperature of more than 102°F (38°C) the patient should be seen by a doctor.

Any medication that has been prescribed should be taken until all of it has been taken. Patients sometimes stop taking their medications when they feel better, but though the symptoms may have cleared up, the infection may not have been cured. The infection may spread to other parts of the upper respiratory (breathing) system. The ears and sinuses are especially subject to such infection. In rare cases, much more serious conditions, such as rheumatic fever (see rheumatic fever entry) or pneumonia (see pneumonia entry) may develop.

PREVENTION

The bacteria and viruses that cause tonsillitis are easily transmitted from person to person. The infection often spreads quickly among members of a family or students in a classroom. Avoiding contact with anyone who has the symptoms of tonsillitis can reduce the risk of infection.

Drinking glasses and eating utensils should never be shared. A person who has had tonsillitis should throw out his or her toothbrush to avoid reinfection. People who are caring for a person with tonsillitis should take special precautions and wash their hands often to prevent spreading the infection to other people.

FOR MORE INFORMATION

Books

Inlander, Charles B., and the staff of the People's Medical Society, eds. "Tonsilitis." In The Consumer's Medical Desk Reference. New York: Stonesong Press, 1995.

Shaw, Michael, ed. "Tonsilitis." In Everything You Need to Know about Diseases. Springhouse, PA: Springhouse Corporation, 1996.

Web sites

"Childhood Infections: Tonsillitis." KidsHealth. [Online] http://kidshealth.org/parent/common/tonsillitis.html (accessed on November 5, 1999).

Tonsillitis

Tonsils

Symptoms

Treatment

Precautions

Tonsillitis is an inflammation or infection of the tonsils, caused by either bacteria or viruses. Tonsils, which function to prevent infections in the body, are oval-shaped masses of lymph gland tissue located on both sides of the back of the throat. They act like filters to trap bacteria and viruses entering the body through the mouth and sinuses. When tonsillitis occurs, the tonsils usually become swollen and very painful, making swallowing difficult. Sometimes the tonsils have spots of exudates (usually leukocytes) or pus on the surface. The surface of the tonsils is covered by recesses or crypts (cryptae tonsillares ) that may branch and extend deep into the tonsil. The crypts often hold a variety of bacteria, some of which can cause tonsillitis. Anyone of any age can have tonsillitis; however, it is most common in children between the ages of 5 and 10.

Tonsils

the tonsils are conglomerations of lymphoid nodules, covered by a mucous membrane. They help to provide immune responses by, for example, providing lymphocytes and antibodies. There are three types of onsils. They form an irregular, circular band (Waldeyer’s ring) around the throat, at the very back of the mouth. Tonsils are strategically located, guarding the opening to the digestive and respiratory tracts. The pharyngeal tonsils (adenoids) are embedded in the posterior wall of the pharynx. The lingual tonsils are located at the base of the tongue, and the palatine tonsils are the oval shaped masses situated on both sides of the throat.

It is usually the prominent, palatine tonsils that become infected or inflamed, and these are the tonsils that are removed surgically (tonsillectomy) when medically indicated, to treat chronic tonsillitis or repeated episodes of acute tonsillitis. Occasionally the pharyngeal tonsils or adenoids are also removed surgically (adenotonsillectomy) if they cause ear infections, or block the eustachian tubes or nasal passages. Adenoviruses (upper respiratory infection or common cold) are the most common cause of viral tonsillitis. The Epstein-Barr virus (infectious mononucleosis) can also cause tonsillitis. The most common bacteria to cause tonsillitis are any of the group A streptococcus bacteria (Streptococcus pyogenes ). Bacterial tonsillitis is treated with antibiotics. However, antibiotics are ineffective with viral tonsillitis. Symptoms can be relieved with aspirin (or other anti-inflammatories), gargling with saltwater, and rest.

Symptoms

a mild or severe sore throat is one of the first symptoms of tonsillitis. Symptoms can also include fever, chills, tiredness, muscle aches, earache, pain or discomfort when swallowing, and swollen glands in the neck. Very young children may be fussy and stop eating. When a doctor or nurse looks into the mouth with a flashlight, the tonsils may appear swollen and red. Sometimes, the tonsils will have white or yellow spots or flecks or a thin coating. The doctor will also examine the eyes, ears, nose, and throat, looking at the tonsils for signs of swelling, redness, or a discharge. A careful examination of the throat is necessary to rule out diphtheria and other conditions that may cause a sore throat. Since most sore throats in children are caused by viruses rather than bacteria, the doctor may take a throat culture in order to test for the presence of streptococcal bacteria, verify the results, and wait for the laboratory report before prescribing antibiotics. A blood test may also be done to rule out a more serious infection or condition and to check the white blood cell count to see if the body is responding to the infection. In some cases, the doctor may order blood tests for mononucleosis, since about a third of patients with mononucleosis develop streptococcal infections of the tonsils.

Treatment

treatment of tonsillitis also involves keeping the patient comfortable while the illness runs its course. This supportive care includes bed rest, drinking extra fluids, gargling with warm salt water, and taking pain relievers—usually NSAIDs (non-steroidal anti-inflammatory drugs)—to reduce fever. Frozen juice bars and cold fruit drinks can bring some temporary relief of sore throat pain; drinking warm tea or broth can be soothing. If the patient has several episodes of severe tonsillitis or does not respond to antibiotics, the doctor may recommend a tonsillectomy, which is the surgical removal of the tonsils.

Strengthening the immune system is important whether tonsillitis is caused by bacteria or viruses. Naturopaths often recommend dietary supplements of vitamin C, bioflavonoids, and beta-carotenes—found

naturally in fruits and vegetables—to ease inflammation and fight infection. A variety of herbal remedies also may be helpful in treating tonsillitis. As with any condition, the treatment and dosage should be appropriate for the particular symptoms and age of the patient.

Tonsillitis usually resolves within a few days with rest and supportive care. Treating the symptoms of sore throat and fever will make the patient more comfortable. If fever persists for more than 48 hours, however, or is higher than 102°F (38.9°C), the patient should be seen by a doctor. If antibiotics are prescribed to treat an infection, they should be taken as directed for the complete course of treatment, even if the patient starts to feel better in a few days. Prolonged symptoms may indicate that the patient has other upper respiratory infections, most commonly in the ears or sinuses. An abscess behind the tonsil (a peritonsillar abscess) may also occur, along with abscesses in other parts of the throat. In rare cases, a persistent sore throat may point to serious conditions such as rheumatic fever or pneumonia. Other possible complications include bacterial and viral pharyngitis, dehydration, kidney failure, and post-streptococcal glomerulonephritis (a disorder of the kidneys).

Precautions

the bacteria and viruses that cause tonsillitis are easily spread from person to person. It is common for an entire family or several students in the same classroom to come down with similar symptoms, especially if S. pyogenes is the cause. The risk of transmission can be lowered by avoiding exposure to anyone who already has tonsillitis or a sore throat. Drinking glasses and eating utensils should not be shared and should be washed in hot, soapy water before reuse. Old toothbrushes should be replaced to prevent reinfection. People who are caring for someone with tonsillitis should wash their hands frequently, to prevent spreading the infection to others and themselves.