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*Recurrent tonsillitis will usually not resolve itself and will require [[antimicrobrial]] therapy or [[tonsillectomy]] where indicated.<ref name="pmid19561812">{{cite journal |vauthors=Stuck BA, Götte K, Windfuhr JP, Genzwürker H, Schroten H, Tenenbaum T |title=Tonsillectomy in children |journal=Dtsch Arztebl Int |volume=105 |issue=49 |pages=852–60; quiz 860–1 |year=2008 |pmid=19561812 |pmc=2689639 |doi=10.3238/arztebl.2008.0852 |url=}}</ref>
*Recurrent tonsillitis will usually not resolve itself and will require [[antimicrobrial]] therapy or [[tonsillectomy]] where indicated.<ref name="pmid19561812">{{cite journal |vauthors=Stuck BA, Götte K, Windfuhr JP, Genzwürker H, Schroten H, Tenenbaum T |title=Tonsillectomy in children |journal=Dtsch Arztebl Int |volume=105 |issue=49 |pages=852–60; quiz 860–1 |year=2008 |pmid=19561812 |pmc=2689639 |doi=10.3238/arztebl.2008.0852 |url=}}</ref>
**Left untreated, recurrent tonsillitis may persist and recur over periods of time and can lead to infectious complications.
**Left untreated, recurrent tonsillitis may persist and recur over periods of time and can lead to infectious complications.
* In certain cases, 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),<ref>{{cite book | title=Management of Sore Throat and Indications for Tonsillectomy | url=http://www.sign.ac.uk/guidelines/fulltext/34/index.html | chapter=6.3 Referral Criteria for Tonsillectomy | chapterurl=http://www.sign.ac.uk/guidelines/fulltext/34/section6.html | publisher=[http://www.sign.ac.uk Scottish Intercollegiate Guidelines Network] | id=ISBN 1-899893-66-0 | year=1999 | month=January}} - notes though that these criteria "have been arrived at arbitrarily" from:<br>{{cite journal |author=Paradise JL, Bluestone CD, Bachman RZ, ''et al'' |title=Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials |journal=N. Engl. J. Med. |volume=310 |issue=11 |pages=674–83 |year=1984 |pmid=6700642 |doi=}}</ref><ref name="pmid12093941">{{cite journal |author=Paradise JL, Bluestone CD, Colborn DK, Bernard BS, Rockette HE, Kurs-Lasky M |title=Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children |journal=Pediatrics |volume=110 |issue=1 Pt 1 |pages=7–15 |year=2002 |pmid=12093941 |doi=10.1542/peds.110.1.7}} - 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"</ref><ref name="pmid15195718">{{cite journal |author=Wolfensberger M, Mund MT |title=[Evidence based indications for tonsillectomy] |language=German |journal=Ther Umsch |volume=61 |issue=5 |pages=325–8 |year=2004 |pmid=15195718 |doi=}} - 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"</ref> 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.
* Towards the end of the infection, bacteria feeding on [[mucus]] may accumulate in the pits (referred to as "crypts") of the tonsils may produce whitish-yellow deposits known as [[tonsillolith]]s. These may emit an odor due to the presence of [[Volatility (chemistry)|volatile]] [[sulfur]] compounds.
==Complications==
==Complications==
The complications can be listed as:
Complications of tonsillitis are caused by persistence and/or spread of the responsible pathogen - usually [[bacterial - and include the following:<ref name="urlTonsillitis - NHS Choices">{{cite web |url=http://www.nhs.uk/conditions/Tonsillitis/Pages/Introduction.aspx |title=Tonsillitis - NHS Choices |format= |work= |accessdate=}}</ref>
* Blocked [[airway]] from swollen tonsils
*[[Otitis media]]
 
*[[Peritonsillar abscess]]
* [[Dehydration]] from [[difficulty swallowing]] fluids
*[[Sleep apnea]]
 
*[[Scarlet fever]]
* [[Peritonsillar abscess]] in other parts of the throat behind the tonsils
*[[Rheumatic fever]]
 
*[[Glomerulonephritis]]
* Post-streptococcal [[glomerulonephritis]]  
*[[Tonsilloliths]]<ref name="pmid18037821">{{cite journal |vauthors=Rio AC, Franchi-Teixeira AR, Nicola EM |title=Relationship between the presence of tonsilloliths and halitosis in patients with chronic caseous tonsillitis |journal=Br Dent J |volume=204 |issue=2 |pages=E4 |year=2008 |pmid=18037821 |doi=10.1038/bdj.2007.1106 |url=}}</ref>
 
* [[Rheumatic fever]] and other heart problems
 
==Prognosis==
==Prognosis==
Tonsillitis symptoms due to strep usually get better about 2 or 3 days after you start the antibiotics. Children with strep throat should generally be kept home from school or day care until they have been on antibiotics for 24 hours. This helps reduce the spread of illness.
Tonsillitis symptoms due to strep usually get better about 2 or 3 days after you start the antibiotics. Children with strep throat should generally be kept home from school or day care until they have been on antibiotics for 24 hours. This helps reduce the spread of illness.
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[[Category:Disease]]
[[Category:Inflammations]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Primary care]]
[[Category:Primary care]]
[[Category:Needs overview]]
[[Category:Needs content]]


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Revision as of 19:16, 24 October 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Natural History

  • Acute tonsillitis will usually present with erythema and edema of the tonsils rapidly upon infiltration of the pathogen.[1]
    • Symptoms, including fever and sore throat, will usually manifest within 24 hours of infection.
  • Acute tonsillitis is usually self-limited and will be resolved within 3-4 days.
  • Recurrent tonsillitis will usually not resolve itself and will require antimicrobrial therapy or tonsillectomy where indicated.[2]
    • Left untreated, recurrent tonsillitis may persist and recur over periods of time and can lead to infectious complications.

Complications

Complications of tonsillitis are caused by persistence and/or spread of the responsible pathogen - usually [[bacterial - and include the following:[1]

Prognosis

Tonsillitis symptoms due to strep usually get better about 2 or 3 days after you start the antibiotics. Children with strep throat should generally be kept home from school or day care until they have been on antibiotics for 24 hours. This helps reduce the spread of illness.

References

  1. ↑ 1.0 1.1 "Tonsillitis - NHS Choices".
  2. ↑ Stuck BA, Götte K, Windfuhr JP, Genzwürker H, Schroten H, Tenenbaum T (2008). "Tonsillectomy in children". Dtsch Arztebl Int. 105 (49): 852–60, quiz 860–1. doi:10.3238/arztebl.2008.0852. PMC 2689639. PMID 19561812.
  3. ↑ Rio AC, Franchi-Teixeira AR, Nicola EM (2008). "Relationship between the presence of tonsilloliths and halitosis in patients with chronic caseous tonsillitis". Br Dent J. 204 (2): E4. doi:10.1038/bdj.2007.1106. PMID 18037821.

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