Tonsillitis
(Sore Throat · Tonsilitis)
In this condition factsheet:
The Facts on Tonsillitis
Tonsillitis is an infection of the tonsils that causes inflammation. It is most common in children aged 5 to 15. The tonsils are made of lymphatic tissue. Their job is to produce antibodies that fight infection. Ironically, such tissue is quite prone to becoming infected itself. Tonsillitis can be caused by viral or bacterial infections.
Many cases of tonsillitis never reach the doctor's office, but it is estimated that 15% of all visits to family doctors are because of tonsillitis.
Tonsillectomy (tonsil removal) has always been the most common childhood operation, but it is considered a last resort for tonsillitis these days.
Causes of Tonsillitis
There are three common causes of tonsillitis:
Group A streptococcus, which are common bacteria that cause throat infections in about 1 in 5 people, including adults. Many people have no symptoms but they can still transmit the bacteria. Group A streptococcus can also cause strep throat. It's also capable under some circumstances of causing more serious illness, such as rheumatic fever. Bacterial infection accounts for around 30% of tonsillitis cases.
Various respiratory viruses, especially cold and flu viruses, account for most cases of tonsillitis. These infections can be sometimes milder than bacterial infections, but it is often difficult to tell the difference between a viral and bacterial infection.
Infectious mononucleosis, caused by the Epstein-Barr virus, can also produce symptoms of tonsillitis, especially in children.
Symptoms and Complications of Tonsillitis
The main symptom of tonsillitis is sore throat, but since the throat and ears share the same nerves, the pain is often felt in the ears. The pain is usually worse when swallowing. Very young children may not complain of a sore throat but may simply refuse to eat.
Other symptoms can include:
- fever
- general ill feeling
- tender lymph nodes in the neck
- headaches
- vomiting
- stomach ache
- bad breath (halitosis)
- difficulty speaking or muffled voice
All forms of tonsillitis clear up without treatment. It usually takes a few days for bacterial or normal viral tonsillitis to clear, but it can take weeks if mononucleosis is the cause. Because of possible complications associated with bacterial tonsillitis, doctors usually prescribe antibiotics.
One complication of bacterial infection, rheumatic fever, used to be common until doctors started treating bacterial tonsillitis with antibiotics. Your own immune response to Group A streptococcus can cause damage throughout the body, especially to the heart. This can cause permanent damage, resulting in heart disease years later. It's now extremely rare in Canada (only a few cases per year), though it is still a major problem in some countries.
Another possible complication from bacterial tonsillitis is a peritonsillar abscesses (quinsy). This occurs when a clump of bacteria are "walled off" by new tissue growth. The abscess is not in the tonsil itself but on one side of it. Unlike simple tonsillitis, quinsy tends to be felt on only one side of the throat, and people with this condition can often be seen tilting their head to one side to reduce pain. Quinsy is more common in young adults with tonsillitis
