TONSILLITIS - Full extract 

Many people find it hard to visualize exactly what the tonsils look like and where they are situated. The uvula is the much illustrated dangly bit that hangs down from the soft palate towards the back of the tongue. On either side of the uvula is an arch of soft tissue behind which sit the tonsils. They are often quite prominent in small children, sometimes standing out like a pair of strawberries. By adolescence they tend to gradually shrink in size. 

The tonsils contain tissue that forms part of the body's defence system against infection. They have the ability to increase in size and activity to prevent infection going beyond the throat. Tonsillitis, as the name suggests, is an infection of the tonsils. It is usually caused by bacteria called Group A streptococci, hence the American expression Strep throat. It is spread by droplets from coughs and sneezes and is more common in crowded conditions. 

Only some sore throats are due to tonsillitis; most are caused by viral infections. The whole back of the throat, or pharynx, may be quite reddened and the condition is often referred to as viral pharyngitis. The tonsils may be inflamed but not especially so. Antibiotics are of no help at all in this situation; the person is better managed with rest, fluids and paracetamol, if necessary, for pain. 

With true tonsillitis, the main symptoms are a very sore throat, difficulty swallowing and a fever. Vomiting may also be present. Sometimes abdominal pain can occur, especially in children. On examination the tonsils are usually reddened and swollen and the breath can be quite smelly. Sometimes the tonsils are covered with yellow flecks of pus. The tongue may be coated and the person may look quite sick. The glands in the neck are often enlarged and tender to touch. Although the rest of the throat may be a little inflamed, the tonsils are the main area of infection.

Sometimes there is doubt whether the infection is a bacterial tonsillitis or a viral throat infection. A decision is made on clinical grounds whether to treat the person with antibiotics. However, a throat swab can help to determine whether or not a bacterial infection was present. 

The recommended treatment of tonsillitis is a full ten day course of oral antibiotics. Penicillin is still the most effective antibiotic. However, if someone is allergic to penicillin there are several other antibiotics that can be used. If the person is vomiting and unable to keep the medication down, an intramuscular injection may be required. Most cases of tonsillitis settle quickly with a course of antibiotics. Rarely, the tonsils can become so enlarged that breathing difficulties can occur. Even more uncommonly an abscess involving a tonsil can occur. This serious complication is called quinsy. Hospitalization, high dose antibiotics and at times surgery may be required. This complication was seen more commonly in pre-antibiotic days. 

Sometimes a toxin is produced by the strep infection and a generalized red rash will appear. This is called scarlet fever. With treatment of the tonsillitis the condition gradually resolves. Another uncommon complication is a type of glomerulonephritis where inflammation in the kidneys can follow a few weeks after a strep infection. Even less common is a condition called rheumatic fever where permanent damage to heart valves can occur. Although seen more frequently prior to the second World War, isolated cases still occur. 

Glandular fever can look very similar to tonsillitis in the early stages. Both conditions can be characterized by yellow- looking tonsils, a fever and swollen neck glands. If a person is not improving with a course of antibiotics, a blood test for glandular fever should be considered. Because certain antibiotics like amoxycillin and ampicillin cause skin rashes in people with glandular fever, they are usually not recommended in people with tonsillitis. 

Recurrent tonsillitis can be very distressing and may make a person feel chronically unwell. Sometimes repeated or prolonged courses of antibiotics are required. Tonsillectomy, the removal of the tonsils, is performed much less frequently these days; like any other operation, it has its own risk of complications. However, with severe chronic infection tonsillectomy may still be the most effective form of treatment. 

* 

Health Tips:
* Most sore throats are not due to tonsillitis. They are usually viral and will settle without specific treatment.

* The presence of pus on the tonsils may suggest that tonsillitis is present. Tender swollen glands in the neck is another useful sign.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001