What is tonsillitis? Tonsillitis refers to
inflammation of the pharyngeal tonsils. The inflammation may involve other areas
of the back of the throat including the adenoids and the lingual tonsils (areas
of tonsil tissue at the back of the tongue). There are several variations of
tonsillitis: acute, recurrent, and chronic tonsillitis and peritonsillar
Viral or bacterial infections and immunologic factors lead to
tonsillitis and its complications. Nearly all children in the United States
experience at least one episode of tonsillitis. Because of improvements in
medical and surgical treatments, complications associated with tonsillitis,
including mortality, are rare.
Tonsillitis most often occurs in children;
however, the condition rarely occurs in children younger than two years.
Tonsillitis caused by Streptococcus species typically occurs in children aged
five to 15 years, while viral tonsillitis is more common in younger children. A
peritonsillar abscess is usually found in young adults but can occur
occasionally in children. The patient's history often helps identify the type of
tonsillitis (i.e., acute, recurrent, chronic) that is
The herpes simplex virus, Streptococcus pyogenes
(GABHS) and Epstein-Barr virus (EBV), cytomegalovirus, adenovirus, and the
measles virus cause most cases of acute pharyngitis and acute tonsillitis.
Bacteria cause 15-30 percent of pharyngotonsillitis cases; GABHS is the cause
for most bacterial tonsillitis.
| What are the symptoms of
The type of tonsillitis determines what symptoms will
- Acute tonsillitis: Patients have a fever, sore throat, foul
breath, dysphagia (difficulty swallowing), odynophagia (painful
swallowing), and tender cervical lymph nodes. Airway obstruction due to
swollen tonsils may cause mouth breathing, snoring, nocturnal breathing
pauses, or sleep apnea. Lethargy and malaise are common. These symptoms
usually resolve in three to four days but may last up to two weeks
- Recurrent tonsillitis: This diagnosis is made when an
individual has multiple episodes of acute tonsillitis in a
- Chronic tonsillitis: Individuals often have chronic sore
throat, halitosis, tonsillitis, and persistently tender cervical
- Peritonsillar abscess: Individuals often have severe throat
pain, fever, drooling, foul breath, trismus (difficulty opening the
mouth), and muffled voice quality, such as the “hot potato” voice (as if
talking with a hot potato in his or her
What happens during the physician
Your child will undergo a general ear, nose, and throat examination as well as a review of the patient's medical history.
A physical examination
of a young patient with tonsillitis may find:
- Fever and enlarged inflamed tonsils covered by pus.
- Group A beta-hemolytic Streptococcus pyogenes (GABHS) can cause
tonsillitis associated with the presence of palatal petechiae (minute
hemorrhagic spots, of pinpoint to pinhead size, on the soft palate). Neck
nodes may be enlarged. A fine red rash over the body suggests scarlet fever.
GABHS pharyngitis usually occurs in children aged 5-15 years.
- Open-mouth breathing and muffled voice resulting from obstructive
tonsillar enlargement. The voice change with acute tonsillitis usually is not
as severe as that associated with peritonsillar abscess.
- Tender cervical lymph nodes and neck stiffness (often found in acute
- Signs of dehydration (found by examination of skin and mucosa).
- The possibility of infectious mononucleosis due to EBV in an adolescent or
younger child with acute tonsillitis, particularly when cervical, axillary,
and/or groin nodes are tender. Severe lethargy, malaise and low-grade fever
accompany acute tonsillitis.
- A grey membrane covering tonsils that are inflamed from an EBV infection.
(This membrane can be removed without bleeding.) Palatal petechiae (pinpoint
spots on the soft palate) may also be seen with an EBV infection.
- Red swollen tonsils that may have small ulcers on their surfaces in
individuals with herpes simplex virus (HSV) tonsillitis.
- Unilateral bulging above and to the side of one of the tonsils when
peritonsillar abscess exists. A stiff jaw may be present in varying
Tonsillitis is usually treated with a regimen of antibiotics. Fluid
replacement and pain control are important. Hospitalization may be required in
severe cases, particularly when there is airway obstruction. When the condition
is chronic or recurrent, a surgical procedure to remove the tonsils is often
© 2004 AAO-HNS/AAO-HNSF
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