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Encyclopaedia


Tonsillitis

Introduction

Tonsillitis is inflammation of the tonsils, usually due to a viral infection or, less commonly, a bacterial infection. It is a common type of infection in children, although it can sometimes affect adults.

Symptoms of tonsillitis include:

Symptoms will usually pass within 3-4 days.

 

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).

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.

There are four main signs that tonsillitis is caused by a bacterial infection rather than a viral infection. They are:

  • a high temperature
  • white pus-filled spots on the tonsils
  • no cough
  • swollen and tender lymph nodes (glands)

Further testing may be recommended if you have at least two of the above signs. If you have three, it's highly likely that you have bacterial tonsillitis and antibiotics may be prescribed (see below).

Treating tonsillitis

There is no specific treatment for tonsillitis, but there are several things that can help alleviate symptoms, such as:

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

If tests show that a bacterial infection is the cause of tonsillitis, a short course of antibiotics may also be prescribed.

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

Most cases of tonsillitis get better within a week. A small number of children have tonsillitis for a long time or it keeps coming back. This is known as chronic tonsillitis and may require treatment with surgery.

However, surgery to remove the tonsils (tonsillectomy) is usually only recommended in cases where there have been several severe episodes of tonsillitis over a long period of time, or if repeated episodes disrupt normal activities.

Read more about treating tonsillitis.

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,  and keeping your child away from 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 throwing it in a bin
  • washing hands before eating, after going to the toilet and, if possible, after coughing and sneezing

Read more about the causes of tonsillitis.

Who is affected

Tonsillitis can affect both children and adults, but it's much more common in children. Most children have at least one episode of tonsillitis.

Viral infections that cause tonsillitis are easily spread through close contact with someone who is infected. Anyone who spends time in schools or nurseries is at increased risk of developing an infection that could lead to tonsillitis.

In teenagers and young adults, tonsillitis often follows glandular fever.

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, such as the middle ear (otitis media).

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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 include:

  • high temperature (fever) over 38° (100.4F°)
  • coughing
  • headache
  • tiredness
  • pain in the ears or neck
  • swollen lymph nodes (glands) in your neck
  • loss of voice or changes to the normal tone of the 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. Your tonsils will be swollen, your throat will be very sore and you may have a fever. 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 very rare due to vaccination and improved treatment of these diseases.

How you catch tonsillitis

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 when an infected person sneezes or coughs. You can then become infected with the virus by breathing in these droplets from the air. 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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Diagnosis

See your GP if you think that you, or your child has tonsillitis. Your GP will examine your or your child's throat and ask them (or you) questions about your symptoms.

There are four main signs that determine whether tonsillitis is due to a bacterial infection rather than a viral infection.

These are:

  • a high temperature
  • white pus-filled spots on your child’s tonsils
  • no cough
  • swollen and tender lymph nodes (glands)

If your child has two of the above, your GP may recommend further testing. If your child has three or more of the above then it is highly likely that your child has bacterial tonsillitis and antibiotics may sometimes be prescribed.

Laboratory testing

If a more detailed diagnosis is required, a swab sample can be sent to a laboratory for analysis. The results can take a few days to return.

Laboratory tests are mainly used for patients in high-risk groups (such as those with weakened immune systems) or if previous treatment has failed.

Blood test

If you develop tonsillitis as an adult and you also have additional symptoms such as swollen nodes and a very painful throat your GP may recommend you have a blood test to see whether you have glandular fever. Read more about the diagnosis of glandular fever

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Treatment

There is no specific treatment for tonsillitis.

Whether your child's tonsillitis is caused by a virus or by bacteria, it is likely that their immune system will clear the infection within a few days. In the meantime, there are a number of things that you can do to help.

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.

If your child has recurring bouts of tonsillitis, surgery may be considered.

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 as younger children only need small dosages. Your pharmacist will be able to advise you.

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:

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

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

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

Surgery

Surgery for tonsillitis is now usually only recommended if:

  • your child has five or more episodes of sore throat due to tonsillitis in one year
  • the episodes of tonsillitis are disabling and are disrupting normal activities, such as school work

Surgery involves removing the tonsils. This is done in an operation known as a tonsillectomy.

A tonsillectomy is done under a general anaesthetic, which means that your child will be asleep during the procedure. Your child's mouth will be held open so that the surgeon can see their tonsils, and no cuts will be made in their 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, occasionally, the blood vessels are 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.

Your child 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 your child will experience some pain at the site of the surgery. 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.

It is important to make sure they keep their teeth clean as this helps 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.

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.

However, in some cases the bleeding can be extensive, causing people to vomit up or 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.

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Complications

Complications resulting from tonsillitis are uncommon, but some of the problems that can occur are outlined below.

Middle ear infection (also known as otitis media) is when the fluid in the middle ear, between the ear drum and inner ear becomes infected by bacteria. In most cases, the infection clears by itself.

Quinsy is an abscess (a collection of pus) that develops between one of the tonsils and the wall of the throat. It's a rare complication of tonsillitis that often affects teenagers and young adults.

If you develop quinsy, your symptoms will become rapidly worse. Symptoms include:

  • a worsening sore throat, usually on one side
  • a high temperature of 38C (100.4F) or above
  • difficulty opening the mouth
  • pain and difficulty swallowing, which may lead to drooling saliva
  • difficulty speaking or changes to the voice
  • bad breath
  • earache on the affected side
  • headache and feeling generally unwell
  • swelling around the face and neck

Only 1 in 1,000 children with tonsillitis will go on to develop quinsy.Quinsy is usually treated using a combination of antibiotics and surgery to drain the pus from the abscess.

sleep apnoea -Persistent or recurring tonsillitis (chronic tonsillitis) may cause breathing difficulties during sleep. This is known as obstructive sleep apnoea.

OSA that's due to chronic tonsillitis tends to affect children more than adults. Your child will not usually wake up during sleep, but their deep sleep will be disturbed. This can make them feel very tired during the day. Children affected by sleep apnoea will often snore or gasp loudly as they sleep. If your child develops sleep apnoea due to tonsillitis, it would usually be recommended that their tonsils are surgically removed (tonsillectomy).

Other complications

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

  • scarlet fever – a condition that causes a distinctive pink-red skin rash
  • Glomerulonephritis - an infection (swelling) of the filters in the kidneys that can cause vomiting and loss of appetite
  • Rheumatic fever is a rare condition that causes widespread inflammation throughout the body, leading to symptoms such as joint pain, skin rashes and jerky body movements.
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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 10/11/2014 14:07:44

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