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Tonsillitis

Tonsillitis is inflammation (swelling) of the tonsils.

Causes

The tonsils are lymph nodes in the back of the mouth and top of the throat. They help to filter out bacteria and other germs to prevent infection in the body.

A bacterial or viral infection can cause tonsillitis. Strep throat is a common cause.

Strep throat

The infection may also be seen in other parts of the throat. One such infection is called pharyngitis.

Tonsillitis is very common in children.

Symptoms

Common symptoms may be:

  • Difficulty swallowing
  • Ear pain
  • Fever , chills
  • Headache
  • Sore throat - lasts longer than 48 hours and may be severe
  • Tenderness of the jaw and throat

Other problems or symptoms that may occur are:

  • Problems breathing, if the tonsils are very large
  • Problems eating or drinking

Exams and Tests

Your health care provider will look in the mouth and throat.

  • The tonsils may be red and may have white spots on them.
  • The lymph nodes in the jaw and neck may be swollen and tender to the touch.

A rapid strep test can be done in most doctor's offices. However, this test may be normal, and you can still have strep. Your doctor may send the throat swab to a laboratory for a strep culture . Test results can take a few days.

Treatment

Swollen tonsils that are not painful or do not cause other problems do not need to be treated. Your health care provider may not give you antibiotics. You may be asked to come back for a checkup later.

If tests show you do have strep, your doctor will give you antibiotics. It is important to finish all of your antibiotics as directed by your doctor, even if you feel better. If you do not take them all, the infection can return.

The following tips may help your throat feel better:

  • Drink cold liquids or suck on fruit-flavored frozen bars.
  • Drink fluids, and mostly warm (not hot), bland fluids.
  • Gargle with warm salt water.
  • Suck on lozenges (containing benzocaine or similar ingredients) to reduce pain (these should not be used in young children because of the choking risk).
  • Take over-the-counter medications, such as acetaminophen (Tylenol) or ibuprofen to reduce pain and fever. Do NOT give a child aspirin. Aspirin has been linked to Reye syndrome .

Some people who have repeated infections may need surgery to remove the tonsils (tonsillectomy ).

Outlook (Prognosis)

Tonsillitis symptoms due to strep will often get better within 2 or 3 days after you start the antibiotics.

Children with strep throat should be kept home from school or day care until they have been on antibiotics for 24 hours. This helps reduce the spread of illness.

Possible Complications

Complications from strep throat may be severe. They can include:

When to Contact a Medical Professional

Call your health care provider if there is:

  • Excess drooling in a young child
  • Fever, especially 101°F or higher
  • Pus in the back of the throat
  • Red rash that feels rough, and increased redness in the skin folds
  • Severe difficulty swallowing or breathing
  • Tender or swollen lymph glands in the neck

References

Wetmore RF. Tonsils and adenoids. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics.19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 375.

Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102.

van Driel ML, De Sutter AIM, Keber N, Habraken H, Christiaens T. Different antibiotic treatments for group A streptococcal pharyngitis. Cochrane Database Syst Rev. 2013;4:CD004406. DOI: 10.1002/14651858.CD004406.pub3.

Updated: 12/4/2013

Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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