Tonsillitis

What is tonsillitis?

Tonsillitis is a disorder involving inflammation of the tonsils.

There are two tonsils, situated on either side of the back of the throat and they form part of the body's immune system.

They, like the rest of the immune system, contain special cells to trap and kill bacteria and viruses travelling through the body.

When the main site of infection is within the tonsils: they swell, become red and inflamed and may show a surface coating of white spots.

Tonsillitis is extremely common in children and young people, but it can occur at any age. The characteristics of the disease are pain in the throat and trouble swallowing.

Tonsillitis is usually a self-limiting condition, ie it gets better without treatment, and generally there are no complications.

How do you get tonsillitis?

Whether due to viruses or bacteria, the infection is spread from person to person by airborne droplets, hand contact or kissing.

There are many different individual viruses and bacteria that can potentially cause tonsillitis. For example the Epstein-Barr virus, which is the cause of glandular fever (infectious mononucleosis), is a common cause. It's typically seen in young people, particularly in situations such as university halls of residence when person-to-person spread is made easier by numerous close contacts.

Among the bacteria that cause sore throats, the streptococcus group A is the most common – often known as 'strep throat'. The incubation period between picking up the infection and the disease breaking out is two to four days – sometimes it can be less.

What are the signs and symptoms of tonsillitis?

• Pain in the throat (sometimes severe) that may last more than 48 hours and be associated with difficulty in swallowing. The pain may spread to the ears.
• The throat is reddened, the tonsils are swollen and may be coated or have white spots on them.
• Possibly a high temperature.
• Swollen lymph glands under the jaw and in the neck.
• Headache.
• Loss of voice or changes in the voice.

If the sore throat is due to a viral infection the symptoms are usually milder and often related to the common cold. If due to Coxsackie virus infection, small blisters develop on the tonsils and roof of the mouth. The blisters erupt in a few days and are followed by a scab, which may be very painful.

If the sore throat is due to a streptococcal infection, the tonsils often swell and become coated and the throat is sore. The patient has a temperature, foul-smelling breath and may feel quite ill.

These different appearances are very variable, and it's impossible to tell by looking at someone's throat whether the infection is due to a virus (which cannot be helped by antibiotics) or a bacterial infection (which might be helped by antibiotics).

Good advice

• If signs of a sore throat persist for more than a few days or are severe with marked difficulty in swallowing, high fever or vomiting, then you should consult your GP.
• Warm drinks, soft food and the use of throat lozenges and/or a mouthwash may ease swallowing problems. Your pharmacist can advise on the most appropriate over-the-counter remedies.
• Drink plenty of fluids. Understandably a sore throat can discourage swallowing, but in tonsillitis it's common to lose a lot of body fluid through fever and mouth breathing. Dehydration adds considerably to feeling unwell.
• It's important to ensure you have adequate rest and stay in a warm environment.

How does the doctor make a diagnosis?

The doctor usually makes the diagnosis from the symptoms and signs of the disease. But occasionally a swab of the secretions of the throat and maybe a blood sample are required to identify the cause.

What complications may arise?

Usually a throat infection, such as tonsillitis, causes no trouble and only lasts about a week.

But the following complications can arise.

• A secondary infection may occur in the middle ear or sinuses.
• If the sore throat is due to a streptococcus infection, there may be a rash (scarlet fever).
• An uncommon complication is a throat abscess that occurs usually only on one side. If sufficiently large this can need surgical drainage (Quinsy throat).
• In very rare cases, diseases like rheumatic fever or a particular kidney disease (glomerulonephritis) can occur. This is much less commonly observed now than it was several decades ago.

How is tonsillitis treated?

In the vast majority of people, infection caused by a virus infection need only be treated with paracetamol (eg Calpol, Panadol) to bring the temperature down. Aspirin (eg Disprin) is also useful, but should not be given to children under 16 years of age, unless on the advise of a doctor.

In a small minority of patients, tonsillitis caused by bacteria is treated with penicillin or erythromycin (eg Erythroped) if the person is allergic to penicillin. If antibiotics are prescribed, it's important to complete the full course, or the infection may not be cured.

Antibiotics are advisable for immunocompromised patients, eg those receiving chemotherapy.

Surgery to remove the tonsils (tonsillectomy) may be necessary for those patients suffering from repeated, severe infections (five or more per year) that refuse to respond to treatment and significantly interfere with their school or work schedule. But it's now a relatively uncommon operation compared to previous practice.

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