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North Scottsdale Pediatrics
Tonsillitis
What is tonsillitis?
Tonsillitis is characterized by inflammation and infection of the tonsils.
Who gets tonsillitis?
Tonsillitis most commonly affects children and adolescents aged 5-15 years old, but can affect
anyone. The incubation period (the time between picking up the infection and symptoms
starting to appear) is usually two to four days. Tonsillitis can spread from person to person
through hand contact (then touching your mouth with contaminated hands), breathing in the
airborne droplets after someone with tonsillitis has sneezed, or sharing the utensils or
toothbrush of an infected person.
What are the symptoms and signs?
1. Sore throat with difficulty swallowing
2. Red, swollen tonsils with white or yellow pus-filled spots
3. Swollen glands in the neck
4. Fever
5. Scratchy, muffled, loss of voice (called laryngitis)
6. Bad breath
7. Headache
8. Ear and neck pain
9. Tiredness
In young children signs of tonsillitis may include:
1. Stomachache due to the swelling of lymph nodes in the abdomen
2. Drooling due to difficult or painful swallowing
3. Refusal to eat
4. Unusual fussiness
What causes tonsillitis?
Tonsillitis is most often caused by a common cold virus, but other viral and bacterial infections
can also be the cause. The viruses that cause tonsillitis are often the ones that frequently affect
the respiratory system. They include the flu virus, parainfluenza virus (which causes laryngitis
and croup), adenovirus, enterovirus and rhinovirus. In rare cases, tonsillitis can be caused by
the Epstein-Barr virus, which is the virus that causes mono. Bacterial tonsillitis occurs in about
15-30% of cases. It may be caused by a number of different bacteria, but is usually caused by
group A streptococcus bacteria which is the most common. In these cases, the illness may be
called strep throat.
How is tonsillitis diagnosed?
A throat swab can be performed to screen for group A streptococcus infection. If the rapid test
comes back positive, then your child almost certainly has a bacterial infection. If the test comes
back negative, then your child likely has a viral infection. Your doctor will wait, however, for the
more reliable throat culture results within the next 24-48hrs to determine the cause of the
infection.
How is tonsillitis treated?
Appropriate treatment for tonsillitis depends on the cause. A prompt and accurate diagnosis is
important. Whether tonsillitis is caused by a viral or bacterial infection, at-home care strategies
can make your child more comfortable and promote recovery. If a virus is the expected cause of
tonsillitis, these strategies are the only treatment. Your doctor won't prescribe antibiotics. Your
child will likely be better within 7 to 10 days.
At-home care strategies include the following:
1. Encourage rest
2. Provide adequate fluids and comforting foods
3. Prepare a saltwater gargle or offer lozenges to help soothe a sore throat
4. Humidify the air
5. Treat pain and fever
6. Use steroids if your tonsils are swollen and making it hard to breathe
When are antibiotics used?
If tonsillitis is caused by a bacterial infection, your doctor will prescribe a course of antibiotics.
Your child must take the full course of antibiotics as prescribed even if the symptoms go away
completely. Failure to take all of the medication as directed may result in the infection
worsening or spreading to other parts of the body. Not completing the full course of antibiotics
can increase your child’s risk for complications. Your child won’t be contagious after 24hrs of
treatment.
What are the complications?
Inflammation or swelling of the tonsils from frequent or ongoing (chronic) tonsillitis can cause
complications such as:
1. Difficulty breathing
2. Disrupted breathing during sleep (obstructive sleep apnea)
3.
4.
Infection that spreads deep into surrounding tissue (tonsillar cellulitis)
Infection that results in a collection of pus behind a tonsil (tonsillar abscess)
If tonsillitis caused by group A streptococcus isn't treated or if antibiotic treatment is
incomplete, your child has an increased risk of rare disorders such as:
1. Rheumatic fever: an inflammatory disorder affecting the heart, joints and other tissues
2. Post-streptococcal glomerulonephritis: an inflammatory disorder of the kidneys that
results in inadequate removal of waste and excess fluids from blood
When is surgery indicated?
Surgery to remove tonsils, once a common procedure to treat tonsillitis, is usually performed
only when tonsillitis occurs frequently, doesn't respond to other treatments or causes serious
complications.
Frequent tonsillitis is generally defined as:
1. More than six episodes in one year
2. More than four episodes a year over two years
3. More than three episodes a year over three years
A tonsillectomy may also be performed if tonsillitis results in difficult to manage complications,
such as:
1. Obstructed sleep apnea
2. Breathing difficulty
3. A peritonsillar abscess that doesn't improve with antibiotic treatment
Tonsillectomy is usually done as a one-day outpatient surgery. A complete recovery usually
takes 7 to 10 days.
How can tonsillitis be prevented?
The germs that cause viral and bacterial tonsillitis are contagious. Therefore, the best
prevention is to practice good hygiene and avoid sharing of food and drinks.