Tonsillitis

Tonsillitis is when the tonsils, fleshy pads on each side of the back of the throat, become infected with a virus or bacteria. A common childhood ailment, tonsillitis causes the tonsils to become swollen and painful.

Most cases of tonsillitis are caused by a virus and are treated at home with over-the-counter sore throat remedies. Less often, tonsillitis is caused by a bacterial infection and antibiotics are needed. At one time, removing the tonsils (tonsillectomy) was a common treatment for recurrent tonsillitis. Today, surgery is only recommended if tonsillitis doesn't get better with other treatment.

Signs and symptoms of tonsillitis include:

• Red, swollen tonsils
• White patches on the tonsils
• Sore throat
• Difficult or painful swallowing
• Headache
• Fever and chills
• Enlarged, tender glands (lymph nodes) in the jaw and neck
• Loss of voice (laryngitis)
• Abdominal pain in children

When bacteria and viruses enter your body through your nose or mouth, your tonsils act as a filter, engulfing the offending organisms in white blood cells. This can cause a low-grade infection in your tonsils. Tonsillitis occurs when the infection gets more serious, and the tonsils become painful and inflamed.

Most cases of tonsillitis are caused by viruses, including the virus that causes mononucleosis (the Epstein-Barr virus). In other cases, tonsillitis is caused by a bacterial infection. When tonsillitis is due to a specific type of bacteria (group A streptococci), the illness is also referred to as strep throat. Warning signs that your symptoms may be caused by strep throat include a sudden onset of pain and inflammation, tender lymph nodes in your neck, a high fever and a lack of nasal congestion. If tonsillitis is caused by strep throat or another bacterial infection, you may need treatment with antibiotics. However, most cases of tonsillitis are caused by a virus and not bacteria, and the only treatment is home care.

Although tonsillitis itself usually isn't serious, it can lead to complications if left untreated. Call your doctor if:

• Your sore throat lasts more than 48 hours
• You have a fever above 103' F (39 C)
• You can't swallow because your tonsils are so swollen or painful
• Your sore throat is accompanied by abdominal pain, especially if you're vomiting
• You have a stiff neck or feel weak

Seek emergency care if you or your child is:

• Drooling
• Unable to swallow because of pain or swelling

The doctor will check your tonsils and the back of your throat for signs of infection, such as redness and pus. Tests may include:

• Throat swab. With this simple test, the doctor rubs a sterile swab over the back of your throat to get a sample of the secretions. The sample will be checked in the lab for streptococcal bacteria. Test results are available within minutes or up to 24 to 48 hours, depending on the testing method.
• Complete blood cell count (CBC). In some cases, a blood test known as a CBC may help identify the cause of your infection. With a CBC, a sample of blood is sent to the laboratory for evaluation of the presence of a high number of white blood cells or abnormal cells that indicate a viral infection.

Tonsillitis caused by a virus is typically treated with self-care. If tonsillitis is caused by a bacterial infection, your doctor may prescribe antibiotics. Oral penicillin typically needs to be taken for at least 10 days. Other antibiotics may have shorter courses. Although you'll probably feel better in a day or two, it's important to finish the full course of antibiotics. Stopping medication early may cause the infection to come back.

If your child has a positive strep test, he or she needs to complete at least 24 hours of antibiotic treatment before returning to school or child care. If your child has difficulty swallowing, antibiotics may be given by injection. In some cases, treatment with steroid medications may reduce swelling.

Although surgery is no longer the standard treatment for tonsillitis, removing the tonsils (tonsillectomy) may be recommended when other treatments don't work.

Self-care
Most cases of tonsillitis are caused by a viral infection, and antibiotics won't help. The only thing you can do is let the virus run its course, and take steps to relieve pain and inflammation. Recovery may take a week or two.

• Drink warm, soothing liquids, such as soup, broth and tea.
• Gargle with warm salt water.
• Take acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) to help reduce fever and decrease pain. Because of the risk of Reye's syndrome, a potentially life-threatening illness, don't give aspirin to children younger than age 12.

Surgery
Surgical removal of the tonsils (tonsillectomy) is rarely needed for adults. During childhood, surgery may be recommended when a child has had:

• Seven or more serious throat infections in one year
• Five or more serious throat infections every year over a two-year period
• Three or more serious throat infections every year over a three-year period

Tonsillectomy may also be recommended to treat an abscess that doesn't improve with antibiotic treatment, or if swollen tonsils are blocking breathing.

Tonsillectomy is usually done on an outpatient basis. That means your child will be able to go home the day of the surgery.

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.