Tonsillitis

In Denver and Lone Tree, Colorado

What is Tonsillitis?

Tonsillitis refers to inflammation of the pharyngeal tonsils (glands at the back of the throatvisible through the mouth)The inflammation may involve other areas of the back of the throatincluding the adenoids and the lingual tonsils (tonsil tissue at the back of the tongue)There are several variations of tonsillitis: acuterecurrentand chronic tonsillitisand peritonsillar abscess.

Viral or bacterial infections and immunologic factors lead to tonsillitis and its complicationsNearly all children in the United States experience at least one episode of tonsillitisDue to improvements in medical and surgical treatmentscomplications associated with tonsillitisincluding mortalityare rare.

Who gets tonsillitis?

Tonsillitis most often occurs in childrenbut rarely in those younger than two years oldTonsillitis caused by bacteria (streptococcus species) typically occurs in children aged 5 to 15 yearswhile viral tonsillitis is more common in younger childrenA peritonsillar abscess is usually found in young adults but can occur occasionally in childrenThe patient’s history often helps identify the type of tonsillitis present (acuterecurrentor chronic).

Tonsillitis causes

The herpes simplex virusSeptococcus pyogenes (GABHS)epstein-barr virus (EBV)cytomegalovirusadenovirusand the measles virus cause most cases of acute pharyngitis and acute tonsillitis.

Bacteria cause 15-30 percent of pharyngotonsillitis casesGABHS is the cause for most bacterial tonsillitis(“strep throat”).

Tonsillitis Symptoms

The type of tonsillitis determines what symptoms will occur.

Acute tonsillitis: Patients have a feversore throatfoul breathdysphagia (difficulty swallowing)odynophagia (painful swallowing)and tender cervical lymph nodesAirway obstruction due to swollen tonsils may cause mouth breathingsnoringnocturnal breathing pausesor sleep apneaLethargy and malaise are commonThese symptoms usually resolve in three to four daysbut may last up to two weeks despite therapy.

Recurrent tonsillitis: This diagnosis is made when an individual has multiple episodes of acute tonsillitis in a year.

Chronic tonsillitis: Individuals often have chronic sore throathalitosistonsillitisand persistently tender cervical nodes.

Peritonsillar abscess: Individuals often have severe throat painfeverdroolingfoul breathtrismus (difficulty opening the mouth)and muffled voice qualitysuch as the “hot potato” voice (as if talking with a hot potato in his or her mouth).

What happens during your visit with one of our ENT physicians?

Your child will undergo a general earnoseand 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 (“strep throat”) associated with the presence of palatal petechiae (tiny hemorrhagic spotsof pinpoint to pinhead sizeon the soft palate)Neck nodes may be enlargedA fine red rash over the body suggests scarlet feverGABHS pharyngitis usually occurs in children 5-15 years old.

Open-mouth breathing and muffled voice resulting from obstructive tonsillar enlargementThe 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 tonsillitis).

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 tonsillitisparticularly when cervicalaxillaryand/or groin nodes are tenderSevere lethargymalaiseand 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 existsa stiff jawdifficulty opening the mouthand pain referred to the ear may be present in varying severity.

Tonsillitis Treatment

Tonsillitis is usually treated with a regimen of antibioticsFluid replacement and pain control are importantHospitalization may be required in severe casesparticularly when there is airway obstructionWhen the condition is chronic or recurrenta surgical procedure to remove the tonsils is often recommendedPeritonsillar abscess may need more urgent treatment to drain the abscess.