The tonsils normally help to prevent infections. They act like filters to trap bacteria and viruses entering the body through the mouth and sinuses.
The tonsils also stimulate the immune system to produce antibodies which fight off infections. Anyone can have tonsillitis; however, it is most common in children between the ages of five and 10 years.
Causes and symptoms
Tonsillitis is caused by viruses or bacteria that cause the tonsils to swell and become inflamed. A mild or severe sore throat is one of the first symptoms of tonsillitis. Symptoms can also include fever, chills, lethargy, muscle aches, earache, pain or discomfort when swallowing, and swollen glands in the neck.
Young children may be fussy and stop eating. When a doctor or nurse looks into the mouth with a otoscope, the tonsils may appear swollen and red. Sometimes they will have white or yellow spots and a thin mucous coating. Symptoms usually last four to six days.
The diagnosis of tonsillitis is made from the visible symptoms and a physical examination of the patient. The doctor will examine the eyes, ears, nose, and throat, looking at the tonsils for signs of swelling, redness, or a discharge. A careful examination of the throat is necessary to rule out diphtheria and other conditions that may cause a sore throat.
Since most sore throats in children are caused by viruses rather than bacteria, the doctor may take a throat culture or rapid diagnostic test in order to test for the presence of streptococcal bacteria. A throat culture is performed by wiping a cotton swab across the tonsils and back of the throat and sending the swab to a laboratory for culturing.
Streptococcus pyogenes, the bacterium that causes strep throat, is the most common disease agent responsible for tonsillitis. Depending on what type of test is used for strep, the doctor may be able to determine within a few minutes if S. pyogenes is present. The quick tests for strep are not as reliable as a laboratory culture, which can take 24-48 hours.
If the results of a quick test are positive, however, the doctor can prescribe antibiotics right away. If the quick test results are negative, the doctor can do a throat culture to verify the results and wait for the laboratory report before prescribing antibiotics.
A blood test may also be done to rule out a more serious infection or condition, and to check the white blood cell count to see if the body is responding to the infection. In some cases, the doctor may order blood tests for mononucleosis, since about a third of patients with mononucleosis develop infections in the tonsils.
Treatment of tonsillitis usually involves keeping the patient comfortable while the illness runs its course. This supportive care includes bed rest, drinking extra fluids, gargling with warm salt water, and taking pain relievers to reduce fever. Frozen juice bars and cold fruit drinks can bring some temporary relief of sore throat pain and drinking warm tea or broth can be soothing.
Strengthening the immune system is important whether tonsillitis is caused by bacteria or viruses. Naturopaths often recommend dietary supplements of vitamin C, bioflavonoids, and beta-carotenes—found naturally in fruits and vegetables—to ease inflammation and fight infection. A variety of herbal remedies also may be helpful in treating tonsillitis.
Calendula (Calendula officinalis) and cleavers (Galium aparine) target the lymphatic system, while echinacea (Echinacea spp.) and astragalus (Astragalus embranaceus) stimulate the immune system. Goldenseal (Hydrastis canadensis), myrrh (Commiphora molmol), and bitter orange (Citrus aurantium) act as antibacterials. Lomatium dissectum and Ligusticum porteri have an antiviral action.
Some of the homeopathic medicines that may be used to treat symptoms of tonsillitis include Belladonna, Phytolacca, Mercurius, Lycopodium, Lachesis, Hepar sulphuris, Arsenicum, or Rhus toxicodendron. As with any condition, the treatment and dosage should be appropriate for the particular symptoms and age of the patient. Other demulcent herbs include teas made with slippery elm bark, wild cherry, and licorice.
If the throat culture shows that S. pyogenes is present, penicillin or other antibiotics will be prescribed. An injection of benzathine or procaine penicillin may be most effective in treating the infection, but it is also painful. If an oral antibiotic is prescribed, it must be taken for the full course of treatment, which is usually 10-14 days.
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If fever persists for more than 48 hours, however, or is higher than 102°F (39°C), the patient should be seen by a doctor. If antibiotics are prescribed to treat an infection, they should be taken as directed for the complete course of treatment, even if the patient starts to feel better in a few days.
Prolonged symptoms may indicate that the patient has other upper respiratory infections, most commonly in the ears or sinuses. An abscess behind the tonsil (a peritonsillar abscess) may also occur. In rare cases, a persistent sore throat may point to more serious conditions such as rheumatic fever or pneumonia.
The bacteria and viruses that cause tonsillitis are easily spread from person to person. It is not unusual for an entire family or several students in the same classroom to come down with similar symptoms, especially if S. pyogenes is the cause. The risk of transmission can be lowered by avoiding exposure to anyone who already has tonsillitis or a sore throat.
Drinking glasses and eating utensils should not be shared and should be washed in hot, soapy water before reuse. Old toothbrushes should be replaced to prevent reinfection. People who are caring for someone with tonsillitis should wash their hands frequently, to prevent spreading the infection to others.