Tonsillitis

• What is Tonsillitis
• Statistics on Tonsillitis
• Risk Factors for Tonsillitis
• Progression of Tonsillitis
• Symptoms of Tonsillitis
• Clinical Examination of Tonsillitis
• How is Tonsillitis Diagnosed?
• Prognosis of Tonsillitis
• How is Tonsillitis Treated?
• Tonsillitis References

What is Tonsillitis

Tonsillitis involves infection of the pharyngeal tonsils (at the back of the throat). These are symmetrical areas of lymphoid tissue located in the pharynx, on either side of the hard palate.

Statistics on Tonsillitis

Tonsillitis usually occurs in children between 4 and 7 years of age. It is rare in those under 2 or over 40.

Risk Factors for Tonsillitis

Tonsillitis may be caused by viral or bacterial infection.

The viruses causing tonsillitis are the same viruses causing the common cold (rhinovirus, parainfluenza and influenza virus, respiratory syncitial virus, adenovirus) as well as the Epstein-Barr Virus (EBV) which causes glandular fever.

Bacterial tonsillitis is usually due to Group A beta-haemolytic streptococci.

Progression of Tonsillitis

Tonsillitis often occurs along with viral pharyngitis (sore throat). Whether it is referred to as tonsillitis or pharyngitis depends on the area of predominant inflammation. Bacterial tonsillitis is generally a more severe illness. It is usually caused by streptococcal bacteria. Complications of streptococcal tonsillitis include:

• Quinsy – an abscess (area of continued infection and pus) forms in tissue bordering on the tonsil. This causes further pain, fever, and difficulty swallowing.
• Post-streptococcal glomerulonephritis – may occur 2-3 weeks after infection. This causes haematuria (bloody urine), oedema (swelling of arms, feet, around eyes), headache, loin pain, fever, and high blood pressure. Glomerulonephritis may go on to cause serious, progressive kidney damage.
• Rheumatic fever – may cause fever, joint pains and swelling, skin rash and nodules, heart disease and abnormal limb movements. Rheumatic fever may later cause serious, permanent heart damage (rheumatic heart disease).

NOTE – all these are rare complications. Glomerulonephritis and rheumatic fever are especially rare in Australian urban populations. However, they occur relatively often among some Aboriginal communities. The high prevalence of these conditions in the indigineous population has been linked with poor sanitation and overcrowding.

How is Tonsillitis Diagnosed?

Usually none needed.

Prognosis of Tonsillitis

Tonsillitis is a self-limiting disease. Note however, the significant morbidity, and mortality, associated with two complications of streptococcal tonsillitis, especially in Aboriginal patients:

• Glomerulonephritis (causing long-term, progressive renal disease); and
• Acute rheumatic fever (causing rheumatic heart disease).

How is Tonsillitis Treated?

• Viral tonsillitis/sore throat is treated by soothing fluids, including icy poles, aspirin (paracetamol in children), rest with adequate fluid intake, soothing gargles (e.g. soluble asprin).
• Bacterial tonsillitis is treated by all of the above, as well as antibiotics: penicillin or roxithromycin. This treatment has a variable effect on symptoms, and does not protect against glomerulonephritis, but does reduce the likelihood of developing rheumatic fever.
• Specific treatment may be required for the complications of strep throat if they occur.

Tonsillitis References

1. Cotran RS, Kumar V, Collins T, Robbins SL. Robbins Pathologic Basis of Disease (6th edition). Philadelphia: WB Saunders Company; 1999; p763. Book
2. Murtagh J. General Practice (2nd edition). New York: McGraw-Hill; 1998; p683-684. Book
3. Robinson MJ, Roberton DM. Practical Paediatrics (4th edition). London: Churchill Livingstone; 1998; p481, 490, 422-23. Book