Tonsillitis: Wikis


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Classification and external resources

Enlarged, red tonsils and exudative white patches of tonsillitis
ICD-10 J03., J35.0
ICD-9 463
DiseasesDB 13165
eMedicine ent/314
MeSH D014069

Tonsillitis is an infection of the tonsils and will often, but not always, cause a sore throat and fever.



There are 2 main types of tonsillitis:acute and chronic. Acute tonsillitis can either be bacterial or viral in origin. Subacute tonsillitis is caused by the bacterium Actinomyces. Chronic tonsillitis, which can last for long periods if not treated, is mostly caused by bacterial infection.


Symptoms of tonsillitis include a severe sore throat (which may be experienced as referred pain to the ears), painful/difficult swallowing, coughing, headache, myalgia (muscle aches), fever and chills. Tonsillitis is characterized by signs of red, swollen tonsils which may have a purulent exudative coating of white patches (i.e. pus). Swelling of the eyes, face, and neck may occur.
In some cases, symptoms of tonsilitis may be confused with symptoms for EBV infectious mononucleosis, known colloquially as mono(US) or Glandular Fever (elsewhere). Common symptoms of Glandular Fever include fatigue, loss of appetite, an enlarged spleen, enlarged lymph nodes, and a severe sore throat, sometimes accompanied by exudative patches of pus.

It is also important to understand that symptoms will be experienced differently for each person. Cases that are caused by bacteria are often followed by skin rash and a flushed face. Tonsillitis that is caused by a virus will develop symptoms that are flu-like such as runny nose or aches and pains throughout the body. Even though the infection will not cure immediately, tonsillitis symptoms usually improve 2 or 3 days after treatment starts.

Acute tonsillitis is caused by both bacteria and viruses and will be accompanied by symptoms of ear pain when swallowing, bad breath, and drooling along with sore throat and fever. In this case, the surface of the tonsil may be bright red or have a grayish-white coating, while the lymph nodes in the neck may be swollen. [1] The most common form of acute tonsillitis is strep throat, which can be followed by symptoms of skin rash, pneumonia, and ear infection. This particular strand of tonsillitis can lead to damage to the heart valves and kidneys if not treated. Extreme tiredness and malaise are also experienced with this condition with the enlargement of the lymph nodes and adenoids.

Chronic tonsillitis is a persistent infection in the tonsils. Since this infection is repetitive, crypts or pockets can form in the tonsils where bacteria can store. Frequently, small, foul smelling stones are found within these crypts that are made of high quantities of sulfa. These stones cause a symptom of a full throat or a throat that has something caught in the back. A foul breath that is characterized by the smell of rotten eggs (because of the sulfa) is also a symptom of this condition. Other symptoms that can be caused by tonsillitis that are not normally associated with it include snoring and disturbed sleep patterns. These conditions develop as the tonsils enlarge and begin to obstruct other areas of the throat. A person's voice is generally affected by this type of illness and changes in the tone of voice a person normally has. While a person may only become hoarse, it is possible for laryngitis to develop if the throat is used too much while the tonsils are swollen or inflamed. Other uncommon symptoms that can be experienced with tonsillitis include vomiting, constipation, a tongue that feels furry or fuzzy, difficulty opening the mouth, headaches and a feeling of dry or cotton mouth.


Under normal circumstances, as viruses and bacteria enter the body through the nose and mouth, they are filtered in the tonsils. The tonsils work by surrounding them with white blood cells which causes the body to develop a fever that can become extremely high in children. Should the infection becomes serious, the tonsils will inflame and become painful. The infection may also be present in the throat and surrounding areas, causing inflammation of the pharynx. [2] This is the area in the back of the throat that lies between the voice box and the tonsils.

Tonsillitis may be caused by Group A streptococcal bacteria,[3] resulting in strep throat.[3] Viral tonsillitis may be caused by numerous viruses[3] such as the Epstein-Barr virus[3] (the cause of infectious mononucleosis)[4] or adenovirus.[3]

Sometimes, tonsillitis is caused by a infection of spirochaeta and treponema, in this case called Vincent's angina or Plaut-Vincent angina.[5]

Although tonsillitis is associated with infection, it is currently unknown whether the swelling and other symptoms are caused by the infectious agents themselves, or by the host immune response to these agents. Tonsillitis may be a result of aberrant immune responses to the normal bacterial flora of the nasopharynx.

The viruses that cause tonsillitis are often the ones that frequently affect the respiratory system or breathing. Most cases are caused by a virus and will only require treatment of sore throat remedies that can be bought over the counter. Bacteria-caused tonsillitis, however, is treated with prescribed antibiotic medication to reduce the risk for further complications. Tonsillitis most often affects children whose tonsils are responsible for fighting infections. This is also true because as we age, our tonsils become less active. Rare cases have been diagnosed with fungi or parasites being the cause. This generally takes place in persons with weakened immune systems.

There is no research to state that smoking cigarettes causes tonsillitis, however it is widely accepted that smoking weakens the immune system. Also, children and adults who live in a smoke-prone environment may be exposed to factors that could result in a tonsillectomy.


Treatments of tonsillitis consist of pain management medications[6] and lozenges.[7] If the tonsillitis is caused by bacteria, then antibiotics are prescribed, with penicillin being most commonly used.[8] Erythromycin and Clarithromycin are used for patients allergic to penicillin.

In many cases of tonsillitis, the pain caused by the inflamed tonsils warrants the prescription of topical anesthetics for temporary relief. Viscous lidocaine solutions are often prescribed for this purpose, and anaesthetic throat lozonges containing benzocaine, lignocaine, benzydamine and flubiprofen are widely avaliable without prescription.

Ibuprofen or other analgesics such as aspirin or paracetamol can help to decrease the edema and inflammation, which will ease the pain and allow the patient to swallow liquids sooner.[6]

When tonsillitis is caused by a virus, the length of illness depends on which virus is involved. Usually, a complete recovery is made within one week; however, some rare infections may last for up to two weeks.

Chronic cases may indicate tonsillectomy (surgical removal of tonsils) as a choice for treatment[9].

Additionally, gargling with a solution of warm water and salt may reduce pain and swelling.[10] If you are suffering from tonsilloliths (Tonsil stones) try to avoid dairy products like milk, ice cream, yogurt etc..


An abscess may develop lateral to the tonsil during an infection, typically several days after the onset of tonsillitis. This is termed a peritonsillar abscess (or quinsy). Rarely, the infection may spread beyond the tonsil resulting in inflammation and infection of the internal jugular vein giving rise to a spreading septicaemia infection (Lemierre's syndrome).

In chronic/recurrent cases (generally defined as seven episodes of tonsillitis in the preceding year, five episodes in each of the preceding two years or three episodes in each of the preceding three years),[11][12][13] or in acute cases where the palatine tonsils become so swollen that swallowing is impaired, a tonsillectomy can be performed to remove the tonsils. Patients whose tonsils have been removed are certainly still protected from infection by the rest of their immune system.

Bacteria feeding on mucus which accumulates in pits (referred to as "crypts") in the tonsils may produce whitish-yellow deposits known as tonsilloliths. These may emit an odour due to the presence of volatile sulfur compounds.

Hypertrophy of the tonsils can result in snoring, mouth breathing, disturbed sleep, and obstructive sleep apnea, during which the patient stops breathing and experiences a drop in the oxygen content in the bloodstream. A tonsillectomy can be curative.

In very rare cases, diseases like rheumatic fever[14] or glomerulonephritis[15] can occur. These complications are extremely rare in developed nations but remain a significant problem in poorer nations.[16][17]

See also


  1. ^ Tonsillitis and Adenoid Infection MedicineNet. Retrieved on 2010-01-25
  2. ^ Tonsillitis Overview Medline Plus. Retrieved on 2010-01-25
  3. ^ a b c d e Putto A (1987). "Febrile exudative tonsillitis: viral or streptococcal?". Pediatrics 80 (1): 6–12. PMID 3601520. 
  4. ^ Renn CN, Straff W, Dorfmüller A, Al-Masaoudi T, Merk HF, Sachs B (2002). "Amoxicillin-induced exanthema in young adults with infectious mononucleosis: demonstration of drug-specific lymphocyte reactivity". Br. J. Dermatol. 147 (6): 1166–70. doi:10.1046/j.1365-2133.2002.05021.x. PMID 12452866.  -Renn studied 4 patients who where treated amoxicillin for throat infection and lymphadenopathy. Infectious mononucleosis was present in the patient’s blood due to trace of Epstein-Barr antibodies. The three tests performed where the patched test, intracutaneous test, and lymphocyte transformation test. The results of the patched test assas the caused of their rash were 1 out of 4 patients. The intracutaneous showed 2 out of 4 patients with positive results that pointed to amoxicillin. The LTT results showed 3 out of 4 that pointed to amoxicillin
  5. ^ Van Cauwenberge P (1976). "[Significance of the fusospirillum complex (Plaut-Vincent angina)]" (in Dutch; Flemish). Acta Otorhinolaryngol Belg 30 (3): 334–45. PMID 1015288.  - fusospirillum complex (Plaut-Vincent angina) Van Cauwenberge studied the tonsils of 126 patients using direct microscope observation. The results showed that 40% of acute tonsillitis was caused by Vincent's angina and 27% of chronic tonsillitis was caused by Spirochaeta
  6. ^ a b Boureau, F. et al. (1999). "Evaluation of Ibuprofen vs Paracetamol Analgesic Activity Using a Sore Throat Pain Model". Clinical Drug Investigation 17: 1–8.  - Boureau studied 113 patients who saw 19 physicians in France. Patients were give Ibuprofen 400mg or Paracetamol 1000mg randomly. Pain intensity, difficulty swallowing, and global pain relief were use to measure in hourly increments until 6 hours after patients first dose. The results showed that Ibuprofen better than Paracetamol in all three categories
  7. ^ Praskash, T. et al. (2001). "Koflet lozenges in the Treatment of Sore Throat". The Antiseptic 98: 124–127.  - The efficacy of Koflet Lozenges was evaluated by symptomatic relief of pain. The 48 patients were examined by the Physicians and given a scale rating from 0-3. 0 stating no signs and symptoms and 3 being the worse. The results showed patients with pharyngitis 95% of the patient with positive feedbacks. Tonsillitis patients and patients with both symptoms gave 100% positive feedbacks
  8. ^ Touw-Otten FW, Johansen KS (1992). "Diagnosis, antibiotic treatment and outcome of acute tonsillitis: report of a WHO Regional Office for Europe study in 17 European countries". Fam Pract 9 (3): 255–62. doi:10.1093/fampra/9.3.255. PMID 1459378.  - 17 European Countries had a minimum of 10 physicians each that participated in a studied that involved 4094 patients that they had seen from Nov 1989 to May 1990. Sore throat, redness and swelling of tonsils, pus on tonsils, enlarge regional lymph nodes, or fever. Bacterial and serology test were performed to determined antibiotics usage. Antibiotics results had 2334 out of 3646 patient using penicillin. 343 out of the 3646 used amoxicillin and 554 out of 3646 used macrolides
  9. ^ Paradise JL, Bluestone CD, Bachman RZ, et al. (1984). "Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials". N. Engl. J. Med. 310 (11): 674–83. PMID 6700642.  - Paradise studied 187 children with tonsillectomy or tonsillectomy and adenoidectomy. 91 children were randomly put in surgical and non-surgical groups. The other 96 were place by parent’s choice. The results favored the surgical group on recurrence of throat infections during their initial and second year follow-up where the data was collected. While non-surgical groups did better in the long run. 13 out of the 95 surgical group encountered surgical complications after their second year follow up
  10. ^ Tonsillitis: Self-care -
  11. ^ Scottish Intercollegiate Guidelines Network. (January 1999). "6.3 Referral Criteria for Tonsillectomy". Management of Sore Throat and Indications for Tonsillectomy. Scottish Intercollegiate Guidelines Network. ISBN 1-899893-66-0.  - notes though that these criteria "have been arrived at arbitrarily" from:
    Paradise JL, Bluestone CD, Bachman RZ, et al. (1984). "Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials". N. Engl. J. Med. 310 (11): 674–83. PMID 6700642. 
  12. ^ Paradise JL, Bluestone CD, Colborn DK, Bernard BS, Rockette HE, Kurs-Lasky M (2002). "Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children". Pediatrics 110 (1 Pt 1): 7–15. doi:10.1542/peds.110.1.7. PMID 12093941.  - this later study by the same team looked at less severely affected children and concluded "modest benefit conferred by tonsillectomy or adenotonsillectomy in children moderately affected with recurrent throat infection seems not to justify the inherent risks, morbidity, and cost of the operations"
  13. ^ Wolfensberger M, Mund MT (2004). "[Evidence based indications for tonsillectomy]" (in German). Ther Umsch 61 (5): 325–8. PMID 15195718.  - review of literature of the past 25 years concludes "No consensus has yet been reached, however, about the number of annual episodes that justify tonsillectomy"
  14. ^ Del Mar CB, Glasziou PP, Spinks AB (2004). "Antibiotics for sore throat". Cochrane Database Syst Rev (2): CD000023. doi:10.1002/14651858.CD000023.pub2. PMID 15106140.  - Meta-analysis of published research
  15. ^ Zoch-Zwierz W, Wasilewska A, Biernacka A, et al. (2001). "[The course of post-streptococcal glomerulonephritis depending on methods of treatment for the preceding respiratory tract infection]" (in Polish). Wiad. Lek. 54 (1-2): 56–63. PMID 11344703. 
  16. ^ Ohlsson, A. (September 28 2004). "Antibiotics for sore throat to prevent rheumatic fever: Yes or No? How the Cochrane Library can help". CMAJ 171 (7): 721. doi:10.1503/cmaj.1041275. PMID 15451830.  - Canadian Medical Association Journal commentary on Cochrane analysis
  17. ^ "Treatment of sore throat in light of the Cochrane verdict: is the jury still out?". MJA 177 (9): 512–515. 2002.  - Medical Journal of Australia commentary on Cochrane analysis

External links

1911 encyclopedia

Up to date as of January 14, 2010

From LoveToKnow 1911

Medical warning!
This article is from the 1911 Encyclopaedia Britannica. Medical science has made many leaps forward since it has been written. This is not a site for medical advice, when you need information on a medical condition, consult a professional instead.

TONSILLITIS, acute inflammation of the tonsils, or quinsy, due to the invasion of the tonsil, or tonsils, by septic microorganisms which may have gained access through the mouth or by the blood-stream. Sometimes the attack comes on as the result of direct exposure to sewer gas, and it is not at all an uncommon affection of house surgeons, nurses and others who have to spend most of their time in a hospital. The association of quinsy with rheumatism may be the result of the infection of the tonsils by the micro-organisms or the toxins of that disease. Acute tonsillitis is very apt to run on to the formation of abscess. Quinsy may begin with a feeling of chilliness or with an attack of shivering. Then comes on a swelling in the throat with pain, tenderness and difficulty in swallowing. Indeed, if both tonsils are acutely inflamed it may be impossible to swallow even fluid and the breathing may be seriously embarrassed. The temperature may be raised several degrees. There is pain about the ear and about the jaw, and there is a swelling of the glands in the neck. The breath is offensive and the tongue is thickly coated. There may be some yellowish markings on the surface of the tonsil, but these differ from the patches of "false membrane" of diphtheria in that they can be easily brushed off by a swab, but often a true diagnosis can only be made by bacteriological examination. The treatment consists in giving a purgative, and in encouraging the patient to use an inhaler containing hot carbolized water. Hot compresses also may be applied to the neck. As regards medicines, the most trustworthy are salicylic acid, iron and quinine. As soon as abscess threatens, a slender-bladed knife should be thrust from before backward deeply into the swollen mass. And. if, as most likely happens, matter then escapes, the patient's distress speedily ends. Convalescence having set in, a change of air and course of tonic treatment will be advisable.

Chronic tonsillitis is often associated with adenoid vegetations at the back of the throat of tuberculous or delicate children, such children being spoken of as being "liable to sore throat." Chronic enlargement of the tonsils may seriously interfere with a child's general health and vigour and, should the condition not subside under general measures such as a stay at a bracing seaside place and the taking of cod-liver oil and iron, it will be well to treat the tonsils by operation. (E. O.*)

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Up to date as of January 15, 2010

Definition from Wiktionary, a free dictionary

See also tonsillitis



Tonsillitis f. (genitive Tonsillitis, plural Tonsillitiden)

  1. (pathology, scientific terminology) tonsillitis


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