Tosillitis

What is tonsillitis?Tonsillitis is an infection or inflammation of the tonsils. The tonsils are balls of lymphatic tissue on either side of the throat, above and behind the tongue, that are part of the immune system.What causes tonsillitis?Most often, tonsillitis is caused by a virus. Less frequently, it is caused by a bacterium, such as the one that also causes strep throat. In rare instances, tonsillitis can also be caused by fungi or parasites.What are the symptoms?The main symptom of tonsillitis is a sore throat, which usually appears red and inflamed along with the tonsils. The tonsils may have spots on them or pus that covers them in patches or entirely. Fever is also common.When sore throat from an infection of the tonsils is associated with coldlike symptoms, such as runny nose, nasal congestion, sneezing, and coughing, a virus is most likely the cause.When the sore throat is accompanied by a sudden and severe fever and swollen lymph nodes, the infection is more likely bacterial. If you have these symptoms, you should see a health professional to be tested for strep throat. Abdominal pain and headache can also indicate a bacterial infection.How is tonsillitis diagnosed?Tonsillitis is diagnosed by a visual examination of the throat. Red and swollen tonsils with spots or sores can indicate tonsillitis.A rapid strep test can be conducted in a doctor's office along with a throat culture to determine whether the tonsillitis is caused by streptococcus bacteria. If you have symptoms characteristic of strep throat (sore throat, fever, and swollen lymph nodes), you should be tested for strep.An accurate history of throat infections is necessary to determine whether the tonsillitis is chronic, which affects the choice of appropriate treatment.A test for mononucleosis may be done if the Epstein-Barr virus (which can cause mononucleosis) is suspected as a cause of the infection.How is it treated?Tonsillitis will usually go away on its own if left untreated.If the infection is viral, treatment focuses on managing symptoms. Gargling with salt water, drinking warm tea, and using other home treatment measures can help relieve discomfort. Nonprescription pain relievers, such as acetaminophen (Tylenol) may also be used by adults and children 6 months and older. Aspirin should not be given to anyone age 20 years or younger because of its link to Reye's syndrome.If tonsillitis is determined to be caused by the strep throat bacterium, your health professional will prescribe antibiotic medication.Surgical removal of the tonsils (tonsillectomy) is generally only recommended as treatment for tonsillitis when a child has serious complications, recurrent infections, or chronic infections that do not respond to treatment and interfere with daily functioning. However, tonsillectomy should only be performed after careful consideration of your child's medical history and overall health by you and your child's doctor. 1CauseTonsillitis is usually caused by a virus. Bacteria can also cause tonsillitis. The most common bacterial cause of tonsillitis is group A beta-hemolytic streptococcus (GABHS), which also causes strep throat.Tonsillitis can also be caused by fungi or parasites, but these causes are rare in people who have healthy immune systems.Although there is no proof that exposure to cigarette smoke can cause tonsillitis, children who live with a smoker have a higher incidence of tonsillectomy, which is a surgical procedure to remove the tonsils. 2How tonsillitis is spreadTonsillitis is spread by close contact with an infected person. Droplets of disease-causing agents (pathogens) pass through the air when an infected person breathes, coughs, or sneezes; you may then become infected after breathing in these droplets. Infection can also occur if pathogens get on the skin or on objects that come in contact with the mouth, nose, eyes, or other mucous membranes. Symptoms usually appear about 2 to 5 days after exposure.A person with tonsillitis caused by strep bacteria is contagious early on and without treatment can remain so for up to 2 weeks. Antibiotics shorten the contagious period, and an infected person is no longer contagious about 24 to 48 hours after beginning antibiotic therapy.SymptomsThe main symptom of tonsillitis is a sore throat. Additional symptoms occur in most cases. Some or all of the following may be present:· Fever· Bad breath· Nasal congestion and runny nose· Swollen lymph nodes· Red, swollen tonsils covered completely or in patches by pus· Difficulty swallowing· Headache· Abdominal pain· Raw, bleeding patches on the tonsils· Visible growth of bacteria on the tonsilsWhen sore throat is accompanied by coldlike symptoms such as nasal congestion, runny nose, sneezing, and coughing, the cause is most likely a virus. Viral infection of the tonsils usually goes away without treatment within 2 weeks.Sore throat with a sudden fever above 101° (38.3°)—milder fever may indicate a viral infection—and swollen lymph nodes may indicate a bacterial infection. Anyone with these symptoms should see a health professional for diagnosis because of the risk of strep throat. Although strep throat will usually go away even without treatment, an untreated strep infection can lead to complications including rheumatic fever, which can permanently damage the heart.What HappensTonsillitis caused by a virus typically lasts 4 to 10 days; a bacterial infection lasts slightly longer. If symptoms include sore throat, fever above 101° (38.3°), and swollen lymph nodes, the infection might be caused by strep bacteria. Strep throat, which must be diagnosed by a health professional, requires antibiotic treatment.In some cases, tonsillitis can become chronic. Surgical removal of the tonsils (tonsillectomy) may be recommended for your child based on his or her medical history and results of physical examinations.Complications of tonsillitisTonsillitis caused by strep bacteria that is not treated with antibiotics may result in complications, such as ear and sinus infections or pockets of infection outside the tonsils (peritonsillar abscess). More serious complications, such as rheumatic fever, may also occur.Recurrent and ongoing (chronic) tonsillitis may obstruct the upper airway and cause problems, such as snoring, nasal congestion, and mouth breathing. Sometimes, chronic tonsillitis can lead to more severe conditions, including obstructive sleep apnea and heart and lung problems.What Increases Your RiskClose contact with an infected person is the main risk factor for tonsillitis. Droplets of disease-causing agents (pathogens) pass through the air when an infected person breathes, coughs, or sneezes; you may then become infected after breathing in these droplets. Infection can also occur if pathogens get on the skin or on objects that come in contact with the mouth, nose, eyes, or other mucous membranes.Nasal obstruction causes you to breath through your mouth, which increases the risk of tonsillitis.Although there is no proof that exposure to cigarette smoke can cause tonsillitis, children who live with a smoker have a higher incidence of tonsillectomy, which is a surgical procedure to remove the tonsils. 2When To Call a DoctorCall your doctor if any of the following occur.· Sore throat, along with any two of these signs of bacterial infection:o Fever of 101° (38.3°) or highero White or yellow coating on the tonsilso Swollen, tender tonsilso Swollen lymph nodes in the necko Abdominal pain and headacheo Severe paino Severe difficulty swallowingo Pain on only one side of the throat· Tonsillitis or sore throat that develops after being exposed to someone who has strep throat.· Five episodes of tonsillitis in a year despite treatment.· Persistent mouth-breathing, snoring, or a very nasal- or muffled-sounding voice.· Signs of dehydration, such as a dry mouth and tongue and urinating less than normal.Watchful WaitingWatchful waiting is a period of time during which you and your health professional observe your or your child's symptoms or condition without using medical treatment. Watchful waiting is appropriate if tonsillitis occurs along with coldlike symptoms such as runny nose, nasal congestion, sneezing, and coughing. Tonsillitis with these symptoms is most often caused by a virus. Viral infection of the tonsils can be treated at home and usually goes away without treatment within 2 weeks. In general, the more like a cold the condition is, the less likely it is that the condition is caused by the strep bacteria.Watchful waiting is not appropriate if tonsillitis occurs with fever of 101° (38.3°) or higher or with swollen lymph nodes in the neck. If these symptoms occur together, see a health professional, as they may indicate strep throat, which should be treated promptly.Who To SeeThe following health professionals can evaluate tonsillitis, perform quick tests or throat cultures, and prescribe antibiotic treatment if needed:· Pediatrician· Family medicine physician· Otolaryngologist (ear, nose, and throat, or ENT, doctor)· Nurse practitioner· Physician assistant· InternistIf surgery to remove the tonsils (tonsillectomy) is indicated, you may be referred to an otolaryngologist (ear, nose, and throat, or ENT, doctor).Exams and TestsDiagnosis of tonsillitis is based on a medical history and a physical examination of the throat. An accurate medical history is necessary in order to determine whether tonsillitis is recurrent, which may affect treatment choices.If your symptoms suggest strep throat, your health professional may want to confirm this diagnosis by doing a throat culture. Strep throat is more likely if 3 or 4 of the following signs or symptoms are present: 3· Fever· White or yellow spots or coating on the throat and/or tonsils (tonsillar exudates)· Swollen or tender lymph nodes on the neck· Absence of coughing or sneezingIf a strep infection is suspected, your health professional may conduct a rapid strep test or a throat culture or both. Both of these tests can be conducted in a doctor's office. You may want to discuss the advantages and disadvantages of each test to determine which test is appropriate.The results of these tests will determine whether antibiotic treatment is necessary. These results combined with an accurate medical history will be considered in deciding whether surgery to remove the tonsils (tonsillectomy) is recommended.If the Epstein-Barr virus, which can cause mononucleosis, is suspected as a cause for the tonsillitis, a test for mononucleosis may be done.Treatment OverviewTonsillitis is most often caused by a virus, which resolves on its own. However, tonsillitis can be caused by strep throat bacteria, which requires treatment with antibiotics. Watch for signs of dehydration, such as a dry mouth and tongue. Also, watch for signs of complications, such as ear pain, from tonsillitis caused by strep bacteria.Tonsillitis caused by a virusTonsillitis caused by a virus will usually go away on its own. Antibiotics are not effective treatment for viral tonsillitis.The virus that causes mononucleosis (mono) can lead to tonsillitis that is as severe as tonsillitis caused by bacteria, and can take several weeks or more before it goes away.Home treatments such as gargling with salt water, drinking warm tea, and taking nonprescription pain medication for children age 6 months and older can help relieve discomfort. Nonprescription pain relievers, such as acetaminophen or ibuprofen, should be given to children instead of aspirin. No one age 20 years or younger should take aspirin because of its link to Reye's syndrome. Acetaminophen should not be given to infants younger than 6 months without first consulting your health professional.Many nonprescription remedies such as antiseptic mouthwashes, decongestants, and antihistamines contain extra ingredients that don't relieve discomfort. These remedies are not recommended for children because they have not been proven to have any benefits in the treatment of acute tonsillitis. 4Tonsillitis caused by bacteriaAntibiotics are prescribed for tonsillitis caused by strep bacteria. Although a strep infection will usually go away on its own, antibiotic treatment is necessary because untreated strep throat can cause serious complications. For more information, see the topic Strep Throat.If antibiotics are prescribed, it is very important to take them exactly as directed by your health professional. Antibiotics should be taken for the entire duration of the prescription, even if the symptoms disappear completely before the prescription is gone. If antibiotics used to treat tonsillitis are not taken as directed, bacteria can become resistant to them (antibiotic resistance). In these cases, antibiotic treatment of future infections may not work.SurgeryAlthough surgical removal of the tonsils (tonsillectomy) is still a common procedure, particularly for children, it is not performed nearly as often as it was in the past. Tonsillectomy may be considered to treat tonsillitis when a child has serious complications, recurrent infections, or chronic infections that do not respond to treatment and interfere with daily functioning. However, the risks and benefits of surgery need to be weighed carefully. Tonsillectomy should only be performed after you and your health professional carefully consider your child's specific medical history and overall health. 1New tonsillectomy techniques are currently being evaluated but are not yet widely available. Ultrasonic dissection, cold ablation, laser tonsillectomy, and diathermy tonsillectomy are all techniques that may be offered as tonsillectomy options in the future. 5PreventionSince a wide variety of viruses and bacteria can cause tonsillitis, the best prevention is to follow basic health and hygiene precautions.· Avoid close contact with others who are sick. If possible, keep your child away from children who are known to have tonsillitis or sore throat.· Frequently remind your child about the importance of proper hand-washing, especially when around people who appear sick. Also tell your child not to share toothbrushes or eating utensils with other children.· Wash and disinfect surfaces and toys.· Teach children to cover their mouths when coughing or sneezing, preferably using a tissue so that germs do not get on their hands. Also show them how to use tissues to wipe their noses.· Carry disposable wipes and a hand sanitizer to clean hands and to wipe off shopping carts or other shared items in public places.· Do not smoke around your child.Home TreatmentThe goal of home treatment of tonsillitis caused by a virus is to manage symptoms as the body fights off the infection. It includes measures to ease the discomfort of sore throat and coldlike symptoms, such as runny nose, nasal congestion, sneezing, and coughing.Gargling with warm salt water [0.25 tsp (1.2 mL) salt to 0.5 cups (118.3 mL) warm water] several times daily, drinking warm tea, and taking nonprescription pain medications (such as acetaminophen) can help relieve sore throat discomfort. Pain relievers should only be used for children older than 6 months. Do not give aspirin to anyone younger than 20 years of age because of its link to Reye's syndrome.Make sure your child gets plenty of rest and regularly drinks fluids such as rehydration drinks, soup, and juice. Using a vaporizer or humidifier in your child's bedroom can also help make him or her more comfortable.Although adults may find throat lozenges helpful in relieving sore throat symptoms, lozenges should not be given to young children because of the risk of choking. Also, many lozenges contain unnecessary ingredients that can be potentially harmful. Antiseptic mouthwashes, decongestants, and antihistamines have not proven effective and may result in harmful side effects. 4 Talk to your health professional before giving your child any of these types of products.A sore throat along with sudden fever and swollen lymph nodes may indicate a bacterial infection. Anyone with these symptoms should see a health professional to be tested for strep throat, which requires treatment with antibiotics. It is important to get plenty of rest and take all the prescribed antibiotics exactly as directed. Keep your child home from school for the first 1 to 2 days of antibiotic treatment because he or she is still contagious during this time and might pass the infection to others.MedicationsTonsillitis is usually caused by a virus and does not require prescription medication. Gargling with salt water and taking nonprescription pain medications (such as acetaminophen) can help manage symptoms as the body fights off the infection. Do not give aspirin to anyone age 20 years or younger because of the risk of Reye's syndrome.An antibiotic, usually penicillin, is used to treat tonsillitis caused by strep bacteria.Although tonsillitis caused by strep bacteria usually will go away on its own, antibiotics are used to prevent the complications, such as rheumatic fever, that can result from untreated strep throat.Medication ChoicesAntibiotics, such as penicillin, are used to treat tonsillitis caused by strep bacteria.What To Think AboutMany nonprescription remedies, including antiseptic mouthwashes, decongestants, and antihistamines, contain extra ingredients that don't relieve discomfort. These remedies are not recommended for children, as these ingredients have not been proven to have any benefits in the treatment of acute tonsillitis. 4If antibiotics are prescribed, it is very important to take them exactly as directed by your health professional until the medication is gone. Even if the symptoms disappear completely before the prescription is gone, all pills should be taken as directed to ensure that the infection is completely destroyed. Bacteria can become resistant to the antibiotics used to treat tonsillitis (antibiotic resistance) if prescriptions aren't taken as directed or if they are prescribed when they aren't necessary.SurgeryTonsillectomy for tonsillitis is generally used for children who have serious complications or recurrent infections that are unresponsive to other treatment, especially when they interfere with daily functioning. However, tonsillectomy should only be performed after you and your health professional carefully consider your child's medical history and overall health. 1Researchers in a recent study concluded that tonsillectomy may be no better than watchful waiting for children with mild symptoms, which was defined as tonsillitis occurring fewer than 3 times per year. 6For some children, however, tonsillectomy can greatly improve their quality of life. Children who are most likely to benefit from tonsillectomy are those who have:· Five or more episodes of tonsillitis in a single year, or a recurrence of at least twice per year for more than 2 years in a row. Tonsillectomy is more likely to be considered as treatment when some of these episodes result in missing school, trouble sleeping, or other problems with normal daily functioning.· Tonsillitis lasting longer than 3 months, despite medication.· Obstructed air passages.· Difficulty swallowing.· Difficulty talking because of nasal obstruction.· Tonsils that bleed heavily.Surgery ChoicesTonsillectomy for strep throat may be performed in cases of recurring tonsillitis that do not respond to antibiotics or if an infection threatens the child's well-being.New tonsillectomy techniques are currently being evaluated but are not yet widely available. Ultrasonic dissection, cold ablation, laser tonsillectomy, and diathermy tonsillectomy are all techniques that may be offered as tonsillectomy options in the future. 5What To Think AboutAlthough tonsillectomy is still the most common surgical procedure performed on children in the United States, it is not done as often as it was in the past. The tonsils are part of the immune system, and studies have shown that the reduction in future infections following tonsillectomy is not in itself significant enough to outweigh the risks posed by the surgery.Upper respiratory infections and tonsillitis usually occur less frequently as a child gets older. 1 Consider whether your child's tonsillitis infections are manageable until you can wait to see if her or she outgrows them.A child who has tonsillectomy will require special care and close monitoring for at least a week after the surgery. Consider your ability to provide this care for your child before deciding on tonsillectomy.