Tonsillitis

Inflammation of the tonsils can be acute or chronic. The uncomplicated acute form usually lasts 4 to 6 days and commonly affects children between ages 5 and 10. Tonsils tend to hypertrophy during childhood and atrophy after puberty.

Causes

When bacteria and viruses enter your body through your nose or mouth, your tonsils act as a filter — engulfing the offending organisms in white blood cells. This may cause a low-grade infection in your tonsils, which stimulates your immune system to form antibodies against future infections. But sometimes the tonsils are overwhelmed by a bacterial or viral infection. The result is tonsillitis.

Various viruses and bacteria can cause tonsillitis, including the virus that causes mononucleosis and the bacterium that causes strep throat (Streptococcus pyogenes).

Signs and Symptoms

The patient with acute tonsillitis may complain of mild to severe sore throat. In a child too young to complain about throat pain, the parents may report that the child has stopped eating. The patient or his parents also may report muscle and joint pain, chills. malaise, headache, and pain that is frequently referred to the ears. Because of excess secretions, the patient may complain of a constant urge to swallow and a constricted feeling in the back of the throat. Such discomfort usually subsides after 72 hours.

Fever may be present, and palpation may reveal swollen, tender lymph nodes in the submandibular area.

Inspection of the throat may discover generalized inflammation of the pharyngeal wall, with swollen tonsils that project from between the pillars of the fauces and exude white or yellow follicles. Purulent drainage becomes apparent when you apply pressure to the tonsillar pillars. The uvula may also be edematous and inflamed.

In chronic tonsillitis, the patient may report recurrent sore throats and attacks of acute tonsillitis. Inspection may expose purulent drainage in the tonsillar crypts.

Diagnostic tests

Throat culture may reveal the infecting organism and indicate appropriate antibiotic therapy. A white blood cell count usually reveals leukocytosis.

Treatment

Management of acute tonsillitis stresses symptom relief and requires rest, adequate fluid intake, aspirin or acetaminophen and, for bacterial infection, antibiotics. For group A beta-hemolytic streptococcus, penicillin is the drug of choice. (Erythromycin or another broad-spectrum antibiotic may be given if the patient is allergic to penicillin.) To prevent complications, antibiotic therapy should continue for 10 days.

Chronic tonsillitis or complications may require tonsillectomy but only after the patient has been free of tonsillar or respiratory tract infections for 3 to 4 weeks.

Prevention

Since 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.