Tonsils are two masses of tissue located on either side at the back of the throat – in the pharynx region, to be specific. Healthy tonsils are pink in colour and can be seen in the mirror when you open your mouth wide and stick your tongue forward. Tonsils function as part of the immune system, and are packed with white blood cells to filter out microorganisms that enter the body through the nose and mouth.

Tonsillitis (medically referred to as tonsillopharyngitis) refers to inflammation of the tonsils caused by infection – usually viral or bacterial. It mostly affects children up to their mid-teen years, as the immune function of tonsils declines after puberty. Tonsillitis be categorised into three types:

• Acute tonsillitis, which generally lasts for 3-4 days, but could go on for up to two weeks
• Recurrent tonsillitis, which occurs a few times a year
• Chronic tonsillitis, which lasts for a long period of time

Symptoms

More often than not, the inception of tonsillitis may be felt as a sore throat. As such, symptoms may include:

• sore throat
• difficulty swallowing
• inflamed (swollen, red) tonsils
• discolouration (white/yellow) of tonsils and/or white spots on tonsils
• fever
• hoarse/muffled voice
• headache
• stomach ache and/or vomiting
• swollen lymph nodes (glands) in the neck/jaw area and/or below ears
• stiff neck
• bad breath

Complications

In some instances – mostly in the case of bacterial tonsillitis – prolonged or recurrent tonsillitis could lead to complications that include the following:

• peritonsillar abscess (build up of pus around the tonsil/s)
• tonsil stones (formation of small lumps in the tonsils, that could cause bad breath)
• tonsillar cellulitis (spread and penetration of infection into nearby tissues)
• obstructive sleep apnea (disturbed breathing during sleep)
• mid-ear infections

If tonsillitis caused by strep throat (infection by streptococcal bacteria) persists or is left untreated, it could lead to complications such as:

• rheumatic fever (inflammatory conditions that could affect heart, joints, nervous system, skin)
• post-streptococcal reactive arthritis (inflammation of joints)
• post-streptococcal glomerulonephritis (inflammation of kidneys)
• scarlet fever complications (with a prominent rash)

Causes

More often than not (in about 70% of cases), infections caused by common viruses such as adenoviruses and influenza are what lead to the incidence of tonsillitis in children.

However, bacterial infections can also lead to tonsillitis. Group A streptococcal bacteria are the most common source of tonsillitis, Streptococcus pyogenes being the most common of these.

Symptoms can be more severe with bacterial tonsillitis than with viral tonsillitis.

Diagnosis

Generally, a doctor would be able to make a confident diagnosis of tonsillitis by a visual observation of the patient’s throat. They might also feel around the throat/jaw area to determine if there is any inflammation of lymph nodes.

A throat swab might be carried out to determine if tonsillitis has been caused by strep-throat (Streptococcus bacteria).

In addition, a full blood count (FBC) test might be carried out to determine if the cause of tonsillitis is bacterial or viral. In a general sense, an increase in neutrophils suggests a bacterial source of infection, while an increase in lymphocytes suggests a viral infection.

Prevention

Tonsillitis itself is not contagious. However, since tonsillitis is caused by viral or bacterial infections, good hygienic practices could help to prevent the spread of infections that could lead to tonsillitis. Such practices include:

• frequently washing hands with soap, particularly before eating and after using the washroom
• coughing or sneezing into the elbow or into a tissue, and disposing of used tissues carefully
• refraining from going to school while sick
• maintaining a safe distance from others when sick, as well as from others who are sick
• refraining from sharing food and drink, as well as utensils and bottles
• replacing one’s toothbrush after a tonsillitis diagnosis

Treatment

If the source of tonsillitis is found to be a bacterial infection, a doctor would most likely prescribe a dose of antibiotics, which should be taken as advised for the specified time period.

Apart from this – particularly for viral conditions – symptoms should start to subside within a few days. Home remedies that could be followed include:

• getting plenty of rest
• drinking warm or cool fluids to hydrate and soothe the throat
• gargling with warm salt water
• using lozenges to soothe the throat
• using NSAIDs such as acetaminophen, ibuprofen to relieve pain and fever
• refraining from exposure to irritants such as smoke, dust, chemical products, etc.

In the case of recurrent or chronic tonsillitis where the patient’s quality of life is impacted by the condition or complications arise, tonsillectomy (surgical removal of tonsils) may be carried out.

Cover illustration adapted from Vecteezy