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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 abscess.
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.
Who gets tonsillitis?
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 present.
What causes tonsillitis?
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.
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What are the symptoms of
tonsillitis?
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The type of tonsillitis determines what
symptoms will occur.
- 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 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 throat, halitosis, tonsillitis,
and persistently tender cervical nodes.
- 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 mouth).
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What happens during the physician
visit?
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 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 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 severity.
Treatment
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 recommended.
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