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Tonsillitis

Sore throat - tonsillitis

 

Tonsillitis is inflammation (swelling) of the tonsils.

Causes

 

The tonsils are lymph nodes in the back of the mouth and top of the throat. They help to filter out bacteria and other germs to prevent infection in the body.

A bacterial or viral infection can cause tonsillitis. Strep throat is a common cause.

The infection may also be seen in other parts of the throat. One such infection is called pharyngitis.

Tonsillitis is very common in children.

 

Symptoms

 

Common symptoms may be:

  • Difficulty swallowing
  • Ear pain
  • Fever and chills
  • Headache
  • Sore throat, which lasts longer than 48 hours and may be severe
  • Tenderness of the jaw and throat

Other problems or symptoms that may occur are:

  • Problems breathing, if the tonsils are very large
  • Problems eating or drinking

 

Exams and Tests

 

Your health care provider will look in the mouth and throat.

  • The tonsils may be red and may have white spots on them.
  • The lymph nodes in the jaw and neck may be swollen and tender to the touch.

A rapid strep test can be done in most providers' offices. However, this test may be normal, and you can still have strep. Your provider may send the throat swab to a laboratory for a strep culture. Test results can take a few days.

 

Treatment

 

Swollen tonsils that are not painful or do not cause other problems do not need to be treated. Your provider may not give you antibiotics. You may be asked to come back for a checkup later.

If tests show you do have strep, your provider will give you antibiotics. It is important to finish all of your antibiotics as directed, even if you feel better. If you do not take them all, the infection can return.

The following tips may help your throat feel better:

  • Drink cold liquids or suck on fruit-flavored frozen bars.
  • Drink fluids, and mostly warm (not hot), bland fluids.
  • Gargle with warm salt water.
  • Suck on lozenges (containing benzocaine or similar ingredients) to reduce pain (these should not be used in young children because of the choking risk).
  • Take over-the-counter (OTC) medicines, such as acetaminophen (Tylenol) or ibuprofen to reduce pain and fever. DO NOT give a child aspirin. Aspirin has been linked to Reye syndrome.

Some people who have repeated infections may need surgery to remove the tonsils (tonsillectomy).

 

Outlook (Prognosis)

 

Tonsillitis symptoms due to strep will often get better within 2 or 3 days after you start the antibiotics.

Children with strep throat should be kept home from school or day care until they have been on antibiotics for 24 hours. This helps reduce the spread of illness.

 

Possible Complications

 

Complications from strep throat may be severe. They may include:

  • Abscess in the area around the tonsils
  • Kidney disease caused by strep
  • Rheumatic fever and other heart problems

 

When to Contact a Medical Professional

 

Call your provider if there is:

  • Excess drooling in a young child
  • Fever, particularly 101°F (38.3°C) or higher
  • Pus in the back of the throat
  • Red rash that feels rough, and increased redness in the skin folds
  • Severe problems swallowing or breathing
  • Tender or swollen lymph glands in the neck

 

 

References

Meyer A. Pediatric infectious disease. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 197.

Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):1279-1282. PMID: 23091044 www.ncbi.nlm.nih.gov/pubmed/23091044.

van Driel ML, De Sutter AI, Keber N, Habraken H, Christiaens T. Different antibiotic treatments for group A streptococcal pharyngitis. Cochrane Database Syst Rev. 2013;(4):CD004406. PMID: 23633318 www.ncbi.nlm.nih.gov/pubmed/23633318.

Wetmore RF. Tonsils and adenoids. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 383.

 
  • Lymphatic system

    Lymphatic system - illustration

    The lymphatic system filters fluid from around cells. It is an important part of the immune system. When people refer to swollen glands in the neck, they are usually referring to swollen lymph nodes. Common areas where lymph nodes can be easily felt, especially if they are enlarged, are: the groin, armpits (axilla), above the clavicle (supraclavicular), in the neck (cervical), and the back of the head just above hairline (occipital).

    Lymphatic system

    illustration

  • Throat anatomy

    Throat anatomy - illustration

    Structures of the throat include the esophagus, trachea, epiglottis and tonsils.

    Throat anatomy

    illustration

  • Strep throat

    Strep throat - illustration

    Strep throat is the most common bacterial cause of sore throat. Because strep throat can occasionally lead to rheumatic fever, antibiotics are given. Strep throat often includes a fever (greater than 101 degrees Fahrenheit or 38.3 degrees Centrigrade), white draining patches on the throat, and swollen or tender lymph glands in the neck. Children may have headache and stomach pain.

    Strep throat

    illustration

    • Lymphatic system

      Lymphatic system - illustration

      The lymphatic system filters fluid from around cells. It is an important part of the immune system. When people refer to swollen glands in the neck, they are usually referring to swollen lymph nodes. Common areas where lymph nodes can be easily felt, especially if they are enlarged, are: the groin, armpits (axilla), above the clavicle (supraclavicular), in the neck (cervical), and the back of the head just above hairline (occipital).

      Lymphatic system

      illustration

    • Throat anatomy

      Throat anatomy - illustration

      Structures of the throat include the esophagus, trachea, epiglottis and tonsils.

      Throat anatomy

      illustration

    • Strep throat

      Strep throat - illustration

      Strep throat is the most common bacterial cause of sore throat. Because strep throat can occasionally lead to rheumatic fever, antibiotics are given. Strep throat often includes a fever (greater than 101 degrees Fahrenheit or 38.3 degrees Centrigrade), white draining patches on the throat, and swollen or tender lymph glands in the neck. Children may have headache and stomach pain.

      Strep throat

      illustration


     

    Review Date: 12/9/2016

    Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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