Tonsillitis

At the back of your throat, two masses of tissue called tonsils act as filters, trapping germs that could otherwise enter your airways and cause infection. They also produce antibodies to fight infection. But 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
Bacterial and viral infections can cause tonsillitis. A common cause is Streptococcus(strep) bacteria. Other common causes include:

  • adenoviruses
  • influenza virus
  • Epstein-Barr virus
  • parainfluenza viruses
  • enteroviruses
  • herpes simplex virus

The main symptoms of tonsillitis are inflammation and swelling of the tonsils, sometimes severe enough to block the airways. Other symptoms include:

  • Throat pain or tenderness
  • Redness of the tonsils
  • A white or yellow coating on the tonsils
  • Painful blisters or ulcers on the throat
  • Hoarseness or loss of voice
  • 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 rapid strep test or throat swab culture. Both tests involve 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 will consist of antibiotics to cure the infection. Antibiotics may be given as a single shot or taken 10 days by mouth. Although symptoms will likely 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. Some people need to take a second course of antibiotics to cure the infection.

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 flavored gelatins, ice cream, or applesauce
  • Use a cool-mist vaporizer or humidifier in your room
  • Gargle with warm salt water
  • Suck on lozenges containing benzocaine or other anesthetics
  • Take over-the-counter pain relievers such as acetaminophen or ibuprofen.

When Tonsillectomy Is Needed
If tonsillitis is recurrent or persistent, or if enlarged tonsils cause upper airway obstruction or difficulty eating, 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 surgeries, 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.

Tonsillectomy
A tonsillectomy is the surgical removal of the tonsils. The adenoidsmay or may not be removed at the same time. Adenoidectomy is not discussed in this topic. For more information, see the topic Ear Infections.

A general anesthetic is always used to sedate a child having a tonsillectomy. Adults may require only a local anesthetic to numb the throat.

What To Expect After Surgery
The surgery may be done as outpatient surgery or, sometimes, during an overnight hospital stay.

A very sore throat usually follows a tonsillectomy and may last for several days. This may affect the sound and volume of the person’s voice and his or her ability to eat and drink. The person may also have bad-smelling breath for a few days after surgery. There is a very small risk of bleeding after surgery.

A child having a tonsillectomy may feel “out of sorts” for a period of a week to 10 days. But if the child is feeling well enough, there is no need to restrict his or her activity or to keep the child at home after the first few days.

Why It Is Done
A tonsillectomy may be done in the following cases:

  • A person has ongoing or recurring episodes of tonsillitis.
  • A person has recurring episodes of strep throat in a single year despite antibiotic treatment.
  • Abscesses of the tonsils do not respond to drainage. Or an abscess is present in addition to other indications for a tonsillectomy.
  • A persistent foul odor or taste in the mouth is caused by tonsillitis and does not respond to antibiotic treatment.
  • A biopsy is needed to evaluate a suspected tumor of the tonsil.
  • Especially in children, the tonsils are so large they affect nighttime breathing, called sleep apnea.

Large tonsils are not a reason to have a tonsillectomy unless they are causing one of the above problems or they are blocking the upper airway, which may causesleep apnea or problems with eating.

How Well It Works
Children whose tonsils are removed for recurrent throat infections may have fewer and less severe strep throat infections for at least 2 years. But over time many children who do not have surgery also have fewer throat infections.1

Adults who have their tonsils removed after repeated strep throat infections don’t get as many new infections as adults who do not have the surgery. And adults who had the surgery also don’t get sore throats as often.

Risks
Normal or expected risks of tonsillectomy include some bleeding after surgery. This is common, especially when the healed scab over the cut area falls off.

Less common or rare risks include:

  • More serious bleeding.
  • Anesthetic complications.
  • Death after surgery (very rare).