What is Tonsillitis?
Tonsillitis refers to acute inflammation of the tonsils.
The tonsils (mostly referring to the palatine tonsils) are two small lymphoid organs that lie on either side of the back of the throat that one can see when the mouth is opened.
The inflammation in tonsillitis can also include the adenoids (pharyngeal tonsils) and the lingual tonsils.
The adenoids are situated behind the nose and quite high up the throat. Adenoids unlike tonsils require special instruments to be viewed. Lingual tonsils are also situated at the back of the throat.
Tonsillitis occurs primarily in children and sometimes in adults. It can be classified as acute, recurrent and chronic tonsillitis.
Both the tonsils and adenoids act as the body’s first line of defense (by producing antibodies) to protect the throat against disease germs that enter via the nose and mouth. Incidentally, this also makes these lymph nodes particularly vulnerable to infection and inflammation.
- Acute Tonsillitis or acute sore throat is caused either by a virus or bacteria.
- Recurring Tonsillitis: Occurs when there are up to seven culture-proven episodes of tonsillitis or throat infections in one year, five in two consecutive years or three each in three consecutive years. In such cases, the cessation of the antibiotic leads to another bout of the bacterial infection within a few weeks, thus causing it to recur again.
- Chronic Tonsillitis:Occurs when recurring tonsillitis infections cause chronic sore throat, bad breath and persistent tender cervical nodes.
- Peritonsillar Abscess (PTA) or Quinsy: Peritonsillar Abscess is a bacterial infection that develops lateral to the tonsillar region when an acute tonsillitis infection has been left untreated. An abscess or a swollen area with pus forms in this peritonsillar region. The pathogens are typically Staphylococci, Streptococci, Haemophilus and Fusobacterium necrophorum. No virus is involved. Severe throat pain, fever, drooling, foul breath, difficulty opening the mouth, and altered voice quality are the symptoms.
- Tonsil or Tonsillar Hyperplasia or Tonsillar Hypertrophy: Abnormal enlargement of the palatal tonsils with cardinal symptoms including snoring, difficulty in swallowing and (rarely) difficulty in speaking.
The most common cause of tonsillitis is either a bacterial or a viral infection.
- It can spread from person to person by coughing and sneezing.
- Adults who have some form of immunodeficiency (for e.g. HIV-infected patients) are also susceptible to tonsillitis.
- Taking antibiotics which destroys the normal flora of organisms in the mouth and uncontrolled diabetes are other causes of tonsillitis.
- Viruses that cause most of the acute tonsillitis are the adenovirus, rhinovirus, influenza, coronavirus, and respiratory syncytial virus. Less common viruses are the herpes simplex virus, Epstein-Barr virus (EBV), cytomegalovirus, and HIV.
- Most bacterial tonsillitis (strep throat) is caused by Group A β-hemolytic streptococcus (GABHS).
Age - Children above the age of 2 are more likely to get tonsillitis. Bacterial tonsillitis is more common in children between 5 and 15 years of age. Tonsillitis is rare in adults.
Exposure - Daycare and school going children are more exposed to tonsillitis due to close contact with other children and exposure to viral and bacterial infections.
Common symptoms of an acute tonsillitis are:
- Sore throat - Pain in the throat
- Tender, red, swollen tonsils or lymph glands in the neck or jaw with white spots or pus
- Difficulty in swallowing and hence difficulty in ingesting
- High to moderate rise in body temperature / fever >38.3°C measured rectally
- In case of sepsis on the tonsils, there may be fever with chills.
- Blisters or painful ulcerated areas on the throat
- Lethargy and malaise (discomfort)
Infected tonsils and adenoids block the normal breathing of a person and the drainage of the sinuses. This obstructed air passage can cause:
- Sleep disorders like apnea
- Snoring in children
- Pain in the ear and neck
- Bad breath
Recurring Tonsillitis leads to inflammed or swollen tonsils. In the long run it could cause -
- Obstructive sleep apnea (disrupted breathing)
- Tonsillar cellulitis or infection of the surrounding tissues
- Peritonsillar abscess
- Difficulty in breathing
Tonsillitis caused by group A streptococcus or another strain of streptococcal bacteria when left untreated poses risk of rare disorders such as:
Rheumatic fever, an inflammatory disorder that affects the heart, joints, skin and brain. It affects children between the age of 5 and 15 and usually develops 2 weeks after untreated or partially treated strep throat or scarlet fever.
Post-streptococcal glomerulonephritis, develops 1 or 2 weeks after an untreated throat infection. It causes inflammation of the tiny blood vessels of the glomeruli or the filtering units of the kidneys. This results in impaired filtration and inadequate removal of waste and excess fluids from blood.
Diagnosis is made on the basis of clinical symptoms.
Initial diagnosis is done by a physical inspection of the mouth,throat, ears and nose using a lighted instrument.
In case of infection, the tonsils will be enlarged, usually red with white spots on them. Some cases of strep throat might reveal a rash. Gentle examination of the neck and jaw will reveal swollen, tender glands.
A throat swab or a culture of the tonsils is taken to identify bacterial infection. In particular, the diagnosis of GABHS tonsillitis is confirmed by obtaining cultures from both tonsillar surfaces and the posterior pharyngeal wall.
A Complete Blood Cell count (CBC) can also be taken to check whether the infection is caused by a bacteria or a virus.
- Wang H, Fu Y, Feng Y, Guan J, Yin S. Tonsillectomy versus Tonsillotomy for Sleep-Disordered Breathing in Children: A Meta Analysis. Gao C-Q, ed. PLoS ONE. 2015;10(3)
- Stelter K. Tonsillitis and sore throat in children. GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery. 2014;13
- Omrani M, Barati B, Omidifar N, Okhovvat AR, Hashemi SAG. Coblation versus traditional tonsillectomy: A double blind randomized controlled trial. Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences. 2012;17(1):45-50.
- About Tonsillitis - (http://www.mayoclinic.org/diseases-conditions/tonsillitis/basics/definition/con-20023538)
- Tonsillitis-Introduction - (http://www.entnet.org/content/tonsillitis)
- What is Tonsillitis? - (https://en.wikipedia.org/wiki/Tonsillitis)
Latest Publications and Research on TonsillitisPotential of the Novel PTA Score to Identify Patients with Peritonsillar Inflammation Profiting from Medical Treatment. - Published by PubMed
[Clinical and genetic analysis of 11 cases with periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome]. - Published by PubMed
LEUKOENCEPHALOPATHY WITH EVANESCENT WHITE MATTER: A CASE REPORT. - Published by PubMed
Self-medication with antibiotics in Saudi Arabia. - Published by PubMed
[The bacterial flora and drug sensitivity of chronic tonsillitis in different age groups]. - Published by PubMed