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Encyclopaedia


Tonsillitis

Introduction

Tonsillitis is inflammation of the tonsils. It's usually caused by a viral infection or, less commonly, a bacterial infection. Tonsilliis is a common condition in children, teenagers and young adults.

Symptoms of tonsillitis include:

Symptoms will usually pass within 3-4 days.

When to see your GP

Tonsillitis is not usually a serious condition so you only need to see your GP if symptoms:

  • last longer than four days and show no signs of improvement
  • are severe, such as being unable to eat or drink because of the pain, or you have breathing difficulties

Your GP will examine your throat and ask you some questions about your symptoms. If necessary, a throat swan can be taken to confirm the diagnosis. The results usually take a few days to return.

If your tonsillitis is caused by a bacterial infection, they may prescribe antibiotics. Typical signs of a bacterial infection include white pus-filled spots on the tonsils, no cough and swollen or tender lymph nodes (glands).

If you develop severe tonsilitis as a teenager or adult, your GP may recommend a blood test for glandular fever.

The tonsils

The tonsils are two small glands that sit on either side of the throat. In young children they help fight germs and act as a barrier against infection.

When the tonsils become infected they isolate the infection and stop it spreading further into the body.

As a child's immune system develops and gets stronger, the tonsils become less important and usually shrink. In most people, the body is able to fight infection without the tonsils.

Removal of the tonsils will usually only be recommended if they're causing problems such as severe or repeated episodes of tonsillitis (see below).

What causes tonsillitis?

Most cases of tonsillitis are caused by a viral infection, such as the viruses that can cause the common cold or influenza (flu virus).

Some cases can also be caused by a bacterial infection, typically a strain of bacteria called group A streptococcus bacteria.

These types of infections spread easily so it is important to try to avoid passing the infection on to others by:

  • staying away from public places, such as work, school or nursery, until your GP says it is safe for them to return (this is usually when their symptoms have passed)
  • coughing and sneezing into a tissue and disposing of the tissue
  • washing hands before eating, after going to the toilet and, if possible, after coughing and sneezing

Read more about the causes of tonsillitis.

Treating tonsillitis

There is no specific treatment for tonsillitis, but you may be able to reduce the symptoms by:

  • taking paracetamol or ibuprofen to help relieve pain
  • getting plenty of rest
  • drinking plenty of fluids

If test results show that your tonsillitis is causd by a bacterial infection, a short course of oral antibiotics may be prescribed.

If oral antibiotics are ineffective at treating bacterial tonsillitis, intravenous antibiotics (given directly into a vein) may be needed in hospital.

Chronic tonsillitis

In most cases, tonsillitis gets better within a week. However, a small number of children and adults have tonsillitis for longer or it keeps returning. This is known as chronic tonsillitis and may require treatment with surgery.

Surgery to remove the tonsils (tonsillectomy) is usually only recommended if:

  • you have had several severe episodes of tonsillitis over a long period of time
  • repeated episodes are disruptig normal activities

Read more about treating tonsillitis.

Complications

Complications of tonsillitis are rare and usually only occur if the condition is caused by a bacterial infection. They are usually the result of the infection spreading into another part of the body.

Possible complications of tonsillitis include:

  • a middle ear infection (otitis media) - where fluid between the eardrum and inner ear becomes infected by bacteria
  • quinsy (peritonsillar abscess) - an abscess (collection of pus) that develops between one of the tonsils and the wall of the throat
  • obstructive sleep apnoea (OSA) - where the walls of the throat relax during sleep, which causes breathing difficulties and poor sleep

Other complications of tonsillitis are very rare and usuall only occur if an underlying bacterial infection is left untreated. They include:

  • scarlet fever - a condition that causes a distinctive pink-red skin rash
  • rheumatic fever - this causes widespread inflammation throughout the body, leading to symptoms such as joint pain, rashes and jerky body movements
  • glomerulonephritis - an infection (swelling) of the filters in the kidneys that can cause vomiting and a loss of appetite
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Symptoms

The main symptom of tonsillitis is a sore throat. Your tonsils will be red and swollen and your throat may be very painful, making swallowing difficult. In some cases, the tonsils are coated or have white, pus-filled spots on them.

Other common symptoms of tonsillitis include:

  • high temperature (fever) over 38° (100.4F°)
  • coughing
  • headache
  • earache
  • feeling sick
  • feeling tired
  • swollen, painful lymph nodes (glands) in your neck
  • loss of voice or changes to your voice

The symptoms of tonsillitis usually get better after three to four days.

If you have tonsillitis that's caused by a viral infection, such as the common cold or flu, your symptoms may be milder.

If your tonsillitis is caused by a bacterial infection, such as a streptococcal infection, it's likely that your symptoms will be more severe and you may also have bad breath.

It's difficult to tell just by looking at a person's throat whether they have tonsillitis as a result of a virus or a bacterial infection. Tests are needed to confirm this.

Antibiotics may be recommended if test results show that your tonsillitis is caused by a bacterial infection.

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Causes

Most cases of tonsillitis are caused by a viral infection.

Viruses known to cause tonsillitis include:

In rare cases, tonsillitis can be caused by the Epstein-Barr virus, which is the virus that causes glandular fever. If this is the case, you will probably feel very ill. You'll have a sore throat and the lymph glands in your throat may be swollen. You may also have a fever and feel very tired.

Bacterial tonsillitis

Bacterial tonsillitis may be caused by a number of different bacteria, but it is usually cause by group A streptococcus bacteria.  In the past, serious bacterial infections such as diptheria and rheumatic fever have been associated with tonsillitis, but this is now rare due to vaccination and improved treatment of these diseases.

How tonsillitis is spread

Tonsillitis itself isn't contagious but the infections that cause it are.

Viruses, such as those that cause colds and flu, are spread through coming into close contact with someone who's infected.

When an infected person coughs or sneezes, the virus is contained in the millions of tiny droplets that come out of the nose and mouth. You can then become infected with the virus by breathing in these contaminated droplets. This is known as direct contact.

You can also become infected by touching a surface or object that these droplets have landed on and then touching your face.This is known as indirect contact.

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Treatment

There is no specific treatment for tonsillitis and most cases get better without treatment within a week.

While waiting for the infection to clear up, there are a number of things you can do to help relieve your symptoms (see below).

If your child has tonsillitis make sure that your child has plenty to eat and drink, even if they find it painful to swallow.  Being hungry and dehydrated can make other symptoms, such as headaches and tiredness, worse.

Self-help

Over-the-counter (OTC) painkillers such as paracetamol and ibuprofen can help relieve symptoms such as a sore throat.

When treating children with painkillers it is important to check you have bought the correct type and dosage. Younger children only need small dosages. Your pharmacist will be able to advise you about this.

Children under 16 years of age should not take aspirin.

There are also over-the-counter treatments that can soothe a sore throat, such as lozenges and oral sprays. Some people find that gargling with a mild antiseptic solution can help to relieve a sore throat.

An alternative method is to gargle with warm salty water. Mix half a teaspoon of salt (2.5g) with a quarter of a litre (eight ounces) of water. It is important never to swallow the water so this method may not be suitable for younger children.

Antibiotics

Even if tests confirm that your child’s tonsillitis is due to a bacterial infection they still may not be prescribed antibiotics. There are two main reasons for this:

  • in most cases of tonsillitis the use of antibiotics will not speed up the recovery time but can still cause unpleasant side effects such as stomach pain and feeling sick
  • the more an antibiotic is used to treat a non-serious infection, the greater the chance that it will not be effective in treating a more serious infection (this is known as antibiotic resistance)

Exceptions are made if:

  • symptoms are severe
  • symptoms show no sign of easing
  • you or your child has a weakened immune system

In these circumstances a 10-day course of penicillin is usually recommended. If you, or your child has a known allergy to penicillin then alternative antibiotics, such as erythromycin, can be used.

Hospital treatment may be required for particularly severe or persistent cases of bacterial tonsillitis that don't respond to oral antibiotics. In these cases, intravenous antibiotics that are given directly into a vein may be needed.

Antibiotics sometimes cause mild side effects, such as an upset stomach, diarrhoea or a rash.

Surgery

Surgery to remove the tonsils is known as a tonsillectomy.

For children with mild sore throats, watchful waiting is recommended rather than a tonsillectomy.

A tonsillectomy is only considered for a recurrent sore throat if certain criteria are met. You must have:

  • a sore throat caused by tonsillitis
  • episodes of sore throat that are disabling and stop you functioning normally
  • seven or more well-documented, clinically significant, adequately treated sore throats in the preceding year or
  • five or more such epsidoes in each of the preceding two years or
  • three or more such episodes in each of the preceding three years

A tonsillectomy is done under a general anaesthetic, which means that you will be asleep during the procedure. Your mouth will be held open so that the surgeon can see the tonsils, and no cuts will be made in the skin.

The operation can be carried out in a number of ways:

  • Cold steel surgery. This is the most common method, which uses a surgical blade to cut the tonsils out. Bleeding is controlled by applying pressure or the blood vessels may be sealed using heat generated by diathermy.
  • Diathermy. An instrument called a diathermy probe is used to destroy tissue surrounding the tonsils and to remove the tonsils. At the same time, the heat seals the blood vessels to stop any bleeding.
  • Coblation (or cold ablation). This method works in a similar way to diathermy but uses a lower temperature (60°C). It is considered less painful than diathermy.
  • Lasers. High energy laser beams are used to cut away the tonsils and then seal the underlying blood vessels shut.
  • Ultrasound. High energy ultrasound waves are used in a similar way to lasers.

Each of these techniques is relatively similar in terms of safety, results and recovery so the type of surgery that is used will depend on the expertise and training of the surgeon.

You will usually be able to leave hospital the same day or the day after surgery is performed.

After surgery

After surgery it is likely that you will experience some pain at the site of the operation. This can last for up to a week. Painkillers can help relieve the pain.

Children who have had a tonsillectomy should be kept off school for two weeks. This is to reduce the chance of them picking up an infection from another child that will make them feel more uncomfortable.

They will probably find swallowing difficult after a tonsillectomy, but it is important to eat solid foods as this will help the throat heal more quickly. They should drink plenty of fluids but avoid acidic drinks, such as orange juice, as they will sting.

Ensuring good oral hygiene by regularly brushing your teeth and using mouthwash can help prevent infection in the mouth.

The pain usually gets worse during the first week after the operation and gradually improves during the second week. Earache is common with tonsillectomies and no cause for concern.

Post-operative bleeding

A relatively common complication of tonsillectomy is bleeding at the site where the tonsils were removed. This can occur in the first 24 hours after surgery or up to 10 days after surgery.

It is estimated that around 1 in 100 children and 1 in 30 adults will experience post-operative bleeding after having a tonsillectomy.

Minor bleeding is not usually a cause for concern as, in most cases, it resolves by itself. Gargling cold water can often help stem the bleeding as the cold water can contract the blood vessels.

Occasionally the bleeding can be more severe, causing people to cough up blood.

In this case you should seek immediate medical advice. You should be given a contact number in case of emergency before you’re discharged from hospital. If you're not given an emergency number call NHS Direct Wales on 0845 46 47.

Extensive bleeding may need treatment with surgery or a blood transfusion.

Preventing infection

It's not always easy to avoid catching viral infections that are spread by coming into contact with germs.

However, following good hygiene practices can help prevent infections spreading.

For example:

  • wash your hands frequently
  • cough and sneeze into a tissue and dispose of it in the bin
  • avoid sharing glasses or utensils with people who are ill

 

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 02/03/2016 09:20:46

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