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Tonsillitis: Symptoms, causes and treatments

At the back of your throat, two masses of tissue called tonsils help the body to fight infection. However, sometimes the tonsils themselves become infected. Overwhelmed by bacteria or viruses, they swell and become inflamed, a condition known as tonsillitis.

Tonsillitis is common, especially in children. The condition can occur occasionally or recur frequently.

Causes and symptoms of tonsillitis

Viral infections are the commonest cause of tonsillitis, but both bacterial and viral infections can cause tonsillitis. A common bacterial cause is Streptococcus (strep) bacteria. Common viral causes include:

  • Adenovirus
  • Rhinovirus
  • Influenza virus
  • Epstein-Barr virus
  • Parainfluenza virus
  • Enterovirus

The main symptom of tonsillitis is a sore throat. Inflammation and swelling of the tonsils often occurs, sometimes severe enough to block the airways. Other symptoms include:

  • Redness of the tonsils
  • White or yellow pus spots on the tonsils
  • Pain when swallowing
  • Headache
  • Loss of appetite
  • Ear pain
  • Difficulty swallowing or breathing through the mouth
  • Swollen glands in the neck or jaw area
  • Fever, chills
  • Bad breath

In children symptoms may also include:

  • Nausea
  • Vomiting
  • Abdominal pain

Treatments for tonsillitis

Treatment for tonsillitis will depend in part on the cause. To determine the cause your doctor may perform a throat swab culture. This test involves gently swabbing the back of the throat close to the tonsils with a cotton swab. A lab test can detect a bacterial infection. A viral infection will not show on the test, but may be assumed if the test for bacteria is negative.

If tests reveal bacteria, treatment may consist of antibiotics to cure the infection. Although symptoms are likely to improve within two or three days after starting the antibiotic, it's important to take all of the medication your doctor prescribes to make sure the bacteria are gone.

If the tonsillitis is caused by a virus, antibiotics won't work and your body will fight off the infection on its own. In the meantime there are things you can do to feel better, regardless of the cause. They include:

  • Get enough rest
  • Drink warm or very cold fluids to ease throat pain
  • Eat smooth foods, such as flavoured jellies, ice cream or apple puree
  • Use a cool-mist vaporiser or humidifier in your room
  • Gargle with warm salt water
  • Suck on lozenges (for example containing benzocaine or other anaesthetics)
  • Take over-the-counter pain relievers such as paracetamol or ibuprofen

When tonsillectomy is needed

If tonsillitis is recurrent or persistent, or if enlarged tonsils cause upper airway obstruction, difficulty eating or affect school attendance, surgical removal of the tonsils, called tonsillectomy, may be necessary. Most tonsillectomies involve using a conventional scalpel to remove the tonsils; however there are many alternatives to this traditional method. Increasingly doctors are using techniques such as lasers, radio waves, ultrasonic energy or electrocautery to cut, burn or evaporate away enlarged tonsils.

As with all operations, each of these has benefits and drawbacks. When considering the procedure it's important to discuss your options with the surgeon to select the most appropriate one for your child.

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WebMD Medical Reference

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