TONSILITIS

What is tonsilitis?
Tonsillitis is caused by infection by a variety of different
micro-organisms. The tonsils may become intensely inflamed, red,
swollen and exude white or yellow pus, which may be tinged with
blood.
Symptoms
The symptoms of tonsillitis include:
Sore throat
Difficulty swallowing
Fever
Headache
Tiredness
Vomiting
Swollen, painful lymph nodes in the neck


Younger children may also complain of tummy ache (probably due to
swelling of lymph glands in the abdomen).
Infectious mononucleosis or glandular fever is caused by
Epstein-Barr virus. In younger children, the symptoms may be
non-specific. In older children, they typically have severe
tonsillitis. They may also have a fever, lethargy, a rash and may be
jaundiced. The infection may last for up to three months.
Causes and risk factors
Tonsillitis is common in children up to the age of about ten, but
may occur at all ages. It is usually caused by a virus, but about
one-third are caused by bacteria (for example, group A
beta-haemolytic streptococci). It is not possible to tell the
difference between viral causes and bacterial causes without doing
tests.
One relatively common complication of tonsillitis is the development
of an abscess in the tissues around the tonsil, known as a
peritonsillar abscess, or quinsy.
Pus collects around the tonsil and may spread over the roof of the
mouth (the palate) and to the neck, chest and lungs. Symptoms
include swelling of the face and neck, problems opening the mouth,
fever, and intensely foul smelling breath.
An abscess may block the airway causing breathing problems, which
can be a life-threatening emergency.
Peritonsillar abscesses are often caused by a type of bacteria
called Group A beta-hemolytic streptococci. Antibiotics must be
given and a small operation is also usually necessary to drain the
pus out of the abscess.
Treatment and recovery
See your GP for advice - they'll diagnose tonsillitis based on a
combination of symptoms and physical examination. Give
pain-relieving syrup and plenty of fluids.
Although only a third of cases are caused by bacteria, antibiotics
are usually given, particularly if the tonsillitis is severe. This
used to be because of concern that a streptococcal infection, such
as rheumatic fever might develop, but this is very rare nowadays.
Some GPs only give antibiotics if a throat swab shows these bacteria
are present. Certain antibiotics can cause a fine widespread rash if
the cause of the tonsillitis is the Epstein-Barr virus. There is no
cure for Epstein-Barr virus; treatment is supportive.
Most children recover in a few days, but some get frequent bouts of
tonsillitis.
Advice and support
If your child gets frequent severe tonsillitis, you may want to talk
to your doctor about tonsillectomy. This operation to remove the
tonsils is done less often nowadays but may still be recommended for
children with recurrent tonsillitis or when the tonsils are so large
they cause obstructive sleep apnoea, with poor performance at school
and growth problems.
This article was last medically reviewed by Dr Orlena Kerek in March 2009