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	Tonsillitis;
	Tonsils showing tonsillitis
ICD-10	J03, J35.0
ICD-9	463
DiseasesDB	13165
eMedicine	ent/314
MeSH	D014069

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Revision as of 17:11, 24 February 2010

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

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

Types

There are 3 main types of tonsillitis: acute, subacute and chronic. Acute tonsillitis can either be bacterial or viral in origin. Subacute tonsillitis (which can last between 3 weeks and 3 months) is caused by the bacterium Actinomyces. Chronic tonsillitis, which can last for long periods if not treated, is almost always bacterial.

Symptoms

Tonsillitis is characterized by red, swollen tonsils. White patches may or may not appear on the tonsils. Other signs and symptoms of tonsillitis include a severe sore throat, painful/difficult swallowing, headache, fever and chills, enlarged and tender lymph nodes, pain in the tonsil area, and loss of voice.

Causes

Bacterial tonsillitis may be caused by Group A streptococcal bacteria,^[1] resulting in strep throat.^[2] Viral tonsillitis may be caused by numerous viruses^[3] such as the Epstein-Barr virus^[4] (the cause of infectious mononucleosis)^[5] or the Adenovirus.^[6]

Sometimes, tonsillitis is caused by a superinfection of spirochaeta and treponema, in this case called Vincent's angina or Plaut-Vincent angina.^[7]

Treatment

Treatments of tonsillitis consist of pain management medications^[8] and lozenges.^[9] If the tonsillitis is caused by bacteria,^[10] then antibiotics are prescribed.^[11] Penicillin is the most commonly used antibiotic.^[12]

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.

Ibuprofen or other analgesic can help to decrease the edema and inflammation which will ease the pain and allow the patient to swallow liquids sooner.^[13]

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.^[14]

Also using warm water and salt solution, and gargling may help kill the infection, though it's not a strong treatment.^[15]

Complications

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),^[16]^[17]^[18] 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, produce whitish-yellow deposits known as tonsilloliths. These "tonsil stones" emit a very pungent odour due to the presence of volatile sulphur compounds.

Tonsilloliths which occur in the crypts of the tonsils can only be completely cured by tonsillectomy or by resurfacing the tonsil by laser, but practicing good oral hygiene and use of a water pick may help lessen the symptoms.

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 or glomerulonephritis can occur. These complications are extremely rare in developed nations but remain a significant problem in poorer nations.

References

↑ Putto, Anne. "Febrile Exudative Tonsillitis: Viral or Streptococcal?" Pediatrics 80 (1987): 6-12 - Putto studied 110 children treated for febrile exudates tonsillitis. The patients had at least one symptom like fever, pharyngeal edema, or sore throat. Two tests were performed. One method involved cotton tipped swabs that were used to collected specimens when swabbed over the patients tonsils. Second method involved the latex slide agglutination that used rayon tipped swabs to collected specimens. The results showed that 13 out of the 41 patients with bacterial tonsillitis were caused by Group A streptococci
↑ Putto, Anne. "Febrile Exudative Tonsillitis: Viral or Streptococcal?" Pediatrics 80 (1987): 6-12 - Putto studied 110 children treated for febrile exudates tonsillitis. The patients had to a symptom of fever, pharyngeal edema, or sore throat. Two tests were performed. One method involved cotton tipped swabs that were used to collected specimens when swabbed over the patients tonsils. Second method involved the latex slide agglutination that used rayon tipped swabs to collected specimens. The results had 92 patients that had traced of streptococci in their throat
↑ Putto, Anne. "Febrile Exudative Tonsillitis: Viral or Streptococcal?" Pediatrics 80 (1987): 6-12 - Putto studied 110 children treated for febrile exudates tonsillitis. The patients had to a symptom of fever, pharyngeal edema, or sore throat. Two tests were performed. One method involved cotton tipped swabs that were used to collected specimens when swabbed over the patients tonsils. Second method involved the latex slide agglutination that used rayon tipped swabs to collected specimens. The results had 46 of the 110 patients that had viruses like the Adenovirus that caused 21 of the 46 to get tonsillitis. Epstein-Barr virus caused 10 out of the 46 patient to get tonsillitis and Herpes Simplex virus caused 2 out of the 46
↑ Putto, Anne. "Febrile Exudative Tonsillitis: Viral or Streptococcal?" Pediatrics 80 (1987): 6-12 - Putto studied 110 children treated for febrile exudates tonsillitis. The patients had to a symptom of fever, pharyngeal edema, or sore throat. Two tests were performed. One method involved cotton tipped swabs that were used to collected specimens when swabbed over the patients tonsils. Second method involved the latex slide agglutination that used rayon tipped swabs to collected specimens. The results had 46 of the 110 patients that had viruses like the Adenovirus that caused 21 of the 46 to get tonsillitis. Epstein-Barr virus caused 10 out of the 46 patient to get tonsillitis and Herpes Simplex virus caused 2 out of the 46
↑ Renn, Claudia N. and et al. "Amoxicillin-induced exanthema in young adults with infectious mononucleosis: demonstration of drug-specific lymphocyte reactivity." British Journal of Dermatology 147 (2002): 1166-1170 -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 that pointed to amoxicillin as 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
↑ Putto, Anne. "Febrile Exudative Tonsillitis: Viral or Streptococcal?." Pediatrics 80 (1987): 6-12 - Putto studied 110 children treated for febrile exudates tonsillitis. The patients had to a symptom of fever, pharyngeal edema, or sore throat. Two tests were performed. One method involved cotton tipped swabs that were used to collected specimens when swabbed over the patients tonsils. Second method involved the latex slide agglutination that used rayon tipped swabs to collected specimens. The results had 46 of the 110 patients that had viruses like the Adenovirus that caused 21 of the 46 to get tonsillitis. Epstein-Barr virus caused 10 out of the 46 patient to get tonsillitis and Herpes Simplex virus caused 2 out of the 46
↑ Van Cauwenberge P (1976). "[Significance of the fusospirillum complex (Plaut-Vincent angina)]". 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 agina and 27% of chronic tonsillitis was caused by Spirochaeta
↑ Boureau, F. and et al. "Evaluation of Ibuprofen vs Paracetamol Analgesic Activity Using a Sore Throat Pain Model." Clinical Drug Investigation 17 (1999): 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
↑ Praskash, T. and et al. "Koflet lozenges in the Treatment of Sore Throat." The Antiseptic 98 (2001): 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
↑ Touw-Otten, Fransje WMM. and Kristen Staehr Johansen. "Diagnosis, Antibiotic Treatment and Outcome of Acute Tonsillitis: Report of a WHO Regional Office for Europe Study in 17 European Countries." Family Practice 9 (1992): 255-262 - 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
↑ Touw-Otten, Fransje WMM. and Kristen Staehr Johansen. "Diagnosis, Antibiotic Treatment and Outcome of Acute Tonsillitis: Report of a WHO Regional Office for Europe Study in 17 European Countries." Family Practice 9 (1992): 255-262 - 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
↑ Touw-Otten, Fransje WMM. and Kristen Staehr Johansen. "Diagnosis, Antibiotic Treatment and Outcome of Acute Tonsillitis: Report of a WHO Regional Office for Europe Study in 17 European Countries." Family Practice 9 (1992): 255-262 - 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
↑ Boureau, F. and et al. "Evaluation of Ibuprofen vs Paracetamol Analgesic Activity Using a Sore Throat Pain Model." Clinical Drug Investigation 17 (1999): 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
↑ Paradise, JL. and et al. "Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and non randomized clinical trials." The New England Journal of Medicine 310 (1984): 674-83 - 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 reoccurrence 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
↑ http://www.mayoclinic.com/health/tonsillitis/DS00273/DSECTION=10
↑ "6.3 Referral Criteria for Tonsillectomy". Management of Sore Throat and Indications for Tonsillectomy. Scottish Intercollegiate Guidelines Network. 1999. ISBN 1-899893-66-0. Unknown parameter |month= ignored (help); External link in |publisher= (help) - notes though that these criteria "have been arrived at arbitrarily" from:
Paradise J, Bluestone C, Bachman R, Colborn D, Bernard B, Taylor F, Rogers K, Schwarzbach R, Stool S, Friday G (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 J, Bluestone C, Colborn D, Bernard B, Rockette H, Kurschildren. (2002). Pediatrics. 110 (1 Pt 1): 7–15. PMID 12093941. Missing or empty |title= (help) - 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"
↑ Wolfensberger M, Mund M (2004). "[Evidence based indications for tonsillectomy]". 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"

External links

Template:Respiratory pathology Template:SIB

ar:التهاب اللوزتين cs:Angína da:Halsbetændelse de:Tonsillitis eo:Tonsilito hr:Tonzilitis it:Tonsillite nl:Tonsillitis qu:Amuqlli unquy sv:Halsfluss uk:Ангіна

Template:WikiDoc Sources

[putto-1] Putto, Anne. "Febrile Exudative Tonsillitis: Viral or Streptococcal?" Pediatrics 80 (1987): 6-12 - Putto studied 110 children treated for febrile exudates tonsillitis. The patients had at least one symptom like fever, pharyngeal edema, or sore throat. Two tests were performed. One method involved cotton tipped swabs that were used to collected specimens when swabbed over the patients tonsils. Second method involved the latex slide agglutination that used rayon tipped swabs to collected specimens. The results showed that 13 out of the 41 patients with bacterial tonsillitis were caused by Group A streptococci

[2] Putto, Anne. "Febrile Exudative Tonsillitis: Viral or Streptococcal?" Pediatrics 80 (1987): 6-12 - Putto studied 110 children treated for febrile exudates tonsillitis. The patients had to a symptom of fever, pharyngeal edema, or sore throat. Two tests were performed. One method involved cotton tipped swabs that were used to collected specimens when swabbed over the patients tonsils. Second method involved the latex slide agglutination that used rayon tipped swabs to collected specimens. The results had 92 patients that had traced of streptococci in their throat

[3] Putto, Anne. "Febrile Exudative Tonsillitis: Viral or Streptococcal?" Pediatrics 80 (1987): 6-12 - Putto studied 110 children treated for febrile exudates tonsillitis. The patients had to a symptom of fever, pharyngeal edema, or sore throat. Two tests were performed. One method involved cotton tipped swabs that were used to collected specimens when swabbed over the patients tonsils. Second method involved the latex slide agglutination that used rayon tipped swabs to collected specimens. The results had 46 of the 110 patients that had viruses like the Adenovirus that caused 21 of the 46 to get tonsillitis. Epstein-Barr virus caused 10 out of the 46 patient to get tonsillitis and Herpes Simplex virus caused 2 out of the 46

[4] Putto, Anne. "Febrile Exudative Tonsillitis: Viral or Streptococcal?" Pediatrics 80 (1987): 6-12 - Putto studied 110 children treated for febrile exudates tonsillitis. The patients had to a symptom of fever, pharyngeal edema, or sore throat. Two tests were performed. One method involved cotton tipped swabs that were used to collected specimens when swabbed over the patients tonsils. Second method involved the latex slide agglutination that used rayon tipped swabs to collected specimens. The results had 46 of the 110 patients that had viruses like the Adenovirus that caused 21 of the 46 to get tonsillitis. Epstein-Barr virus caused 10 out of the 46 patient to get tonsillitis and Herpes Simplex virus caused 2 out of the 46

[5] Renn, Claudia N. and et al. "Amoxicillin-induced exanthema in young adults with infectious mononucleosis: demonstration of drug-specific lymphocyte reactivity." British Journal of Dermatology 147 (2002): 1166-1170 -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 that pointed to amoxicillin as 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

[6] Putto, Anne. "Febrile Exudative Tonsillitis: Viral or Streptococcal?." Pediatrics 80 (1987): 6-12 - Putto studied 110 children treated for febrile exudates tonsillitis. The patients had to a symptom of fever, pharyngeal edema, or sore throat. Two tests were performed. One method involved cotton tipped swabs that were used to collected specimens when swabbed over the patients tonsils. Second method involved the latex slide agglutination that used rayon tipped swabs to collected specimens. The results had 46 of the 110 patients that had viruses like the Adenovirus that caused 21 of the 46 to get tonsillitis. Epstein-Barr virus caused 10 out of the 46 patient to get tonsillitis and Herpes Simplex virus caused 2 out of the 46

[7] Van Cauwenberge P (1976). "[Significance of the fusospirillum complex (Plaut-Vincent angina)]". 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 agina and 27% of chronic tonsillitis was caused by Spirochaeta

[8] Boureau, F. and et al. "Evaluation of Ibuprofen vs Paracetamol Analgesic Activity Using a Sore Throat Pain Model." Clinical Drug Investigation 17 (1999): 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

[9] Praskash, T. and et al. "Koflet lozenges in the Treatment of Sore Throat." The Antiseptic 98 (2001): 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

[10] Touw-Otten, Fransje WMM. and Kristen Staehr Johansen. "Diagnosis, Antibiotic Treatment and Outcome of Acute Tonsillitis: Report of a WHO Regional Office for Europe Study in 17 European Countries." Family Practice 9 (1992): 255-262 - 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

[11] Touw-Otten, Fransje WMM. and Kristen Staehr Johansen. "Diagnosis, Antibiotic Treatment and Outcome of Acute Tonsillitis: Report of a WHO Regional Office for Europe Study in 17 European Countries." Family Practice 9 (1992): 255-262 - 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

[12] Touw-Otten, Fransje WMM. and Kristen Staehr Johansen. "Diagnosis, Antibiotic Treatment and Outcome of Acute Tonsillitis: Report of a WHO Regional Office for Europe Study in 17 European Countries." Family Practice 9 (1992): 255-262 - 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

[13] Boureau, F. and et al. "Evaluation of Ibuprofen vs Paracetamol Analgesic Activity Using a Sore Throat Pain Model." Clinical Drug Investigation 17 (1999): 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

[14] Paradise, JL. and et al. "Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and non randomized clinical trials." The New England Journal of Medicine 310 (1984): 674-83 - 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 reoccurrence 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

[15] ttp://www.mayoclinic.com/health/tonsillitis/DS00273/DSECTION=10

[16] "6.3 Referral Criteria for Tonsillectomy". Management of Sore Throat and Indications for Tonsillectomy. Scottish Intercollegiate Guidelines Network. 1999. ISBN 1-899893-66-0. Unknown parameter |month= ignored (help); External link in |publisher= (help) - notes though that these criteria "have been arrived at arbitrarily" from:
Paradise J, Bluestone C, Bachman R, Colborn D, Bernard B, Taylor F, Rogers K, Schwarzbach R, Stool S, Friday G (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.

[17] Paradise J, Bluestone C, Colborn D, Bernard B, Rockette H, Kurschildren. (2002). Pediatrics. 110 (1 Pt 1): 7–15. PMID 12093941. Missing or empty |title= (help) - 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"

[18] Wolfensberger M, Mund M (2004). "[Evidence based indications for tonsillectomy]". 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"

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