Tonsilitis Diagnosis

  • Diagnosis

    Tonsillitis is a sudden inflammation of the tonsils that most commonly occurs in early childhood. Tonsillitis occurs when either viruses or bacteria infect the tonsils, two groups of fleshy tissue at the back of the throat. Figure 01 A doctor must identify whether the cause is bacterial or viral in order to determine the best treatment approach. A child who has frequent or persistent episodes of tonsillitis may have chronic tonsillitis. In such cases, the doctor may recommend that the tonsils be removed surgically. However, tonsillectomies are performed less often today than in the past because research has shown that this procedure may not always help lower the risk of tonsillitis.

    Click to enlarge: Normal Tonsils

    Figure 01. Normal Tonsils

    Bacteria or viruses entering through the nose or mouth can cause tonsillitis. Because the tonsils are positioned at the back of the throat, they come into contact with bacteria and viruses that enter through the nose and mouth. Normally the tonsils trap these organisms and produce antibodies to help fight infection. However, the tonsils occasionally become infected, inflamed, and swollen, making them unable to fight off germs trying to enter the body.

    A variety of bacteria or viruses can cause tonsillitis. The bacteria most commonly responsible for tonsillitis is group A beta-hemolytic streptococcus (also known as “strep”). Adenoviruses, parainfluenza viruses, influenza viruses, the Epstein-Barr virus (the virus that causes mononucleosis), enteroviruses (usually found in the intestinal tract), or the herpes simplex virus can all cause viral tonsillitis.

    It is important to learn the cause of tonsillitis because treatment approaches are different. Antibiotics, for example, commonly prescribed for bacterial tonsillitis, are not effective against viral tonsillitis.

    Tonsillitis may be caused by a fungus in patients with HIV infections. Immunocompromised patients such as those infected with HIV are susceptible to infection with the Candida fungus. Candida may infect the tonsils in addition to other parts of the mouth and throat in these patients.

    The most common symptom of tonsillitis is a sore throat Table 01. Other symptoms of either form of tonsillitis may include difficulty swallowing, fever, a hoarse or raspy voice, swollen glands in the neck or jaw, headaches, ear pain, skin rash, vomiting, or abdominal pain.

    As the condition progresses, you may develop a fever (100° F [38°C] or higher). Once a sore throat occurs, you may have difficulty swallowing, and the glands in your neck may become swollen. The tonsils may become reddened and enlarged in some cases, but show only mild redness in others. The tonsils may show specs of pus, or they may be covered with a gray or white coating. There may be tiny red dots or spots near the back of the roof of the mouth.

    Very young children may have abdominal pain or diarrhea, a poor appetite, a runny nose, and other symptoms not centered in the area of the throat. Children may complain of not feeling well, and may also experience vomiting, headache, or abdominal pain before developing throat pain.

    Symptoms of viral tonsillitis usually develop over a period of one or two days. A sore throat may be the first symptom, although it sometimes does not develop until a day or two into the illness. Other symptoms of viral tonsillitis may include voice changes, runny nose, cough, swollen and painful neck glands, and red, inflamed tonsils. An examination may reveal small sores (ulcers), or a white coating covering the tonsils, back of the throat, or roof of the mouth.

    Table 1.  Common Symptoms of Tonsillitis

    Sore throat
    Difficulty swallowing
    Headache
    Tender or swollen neck glands
    Fever and/or chills
    Loss of voice or other voice changes
    White patches in the throat or on the tonsils
    Vomiting

    Tonsillitis occurs most commonly in children. Tonsillitis is extremely common in children under 10 years of age. Young children are more susceptible to tonsillitis than adolescents and adults because their immune responses are less developed. Tonsillitis also becomes less common as children grow because the tonsils shrink with age. Among infants and preschool-aged children, viral tonsillitis is more frequent, while older children and adults are more likely to have bacterial tonsillitis. The tonsils can also become enlarged when an individual is infected with mononucleosis.

    Children exposed to household secondhand smoke face a higher risk of requiring surgery for recurrent tonsillitis than do children from smoke-free households. An estimated 20% of all tonsillectomies performed each year in the U.S. are related to secondhand smoke.

    The doctor will ask questions about your symptoms, and will examine your throat. When examining your throat, the doctor will look for redness, swollen tonsils, and, in some cases, pus or white patches on the tonsils. Tender or swollen glands in the neck and jaw are also a sign of tonsillitis.

    The doctor may take a throat swab to determine the cause of the infection, particularly if the suspected cause is bacterial. A throat swab is a painless procedure in which a sample of fluid is taken from the back of the throat with an elongated cotton swab. The fluid is then rubbed in a petri dish, where the organisms that grow will reveal the cause of the infection. Results will not be available for about 24 hours, but a doctor may prescribe antibiotics before that time if the cause of the infection is fairly certain. Rapid tests are available that can produce results in 15 minutes or less; however, these tests can only determine whether the infection is caused by streptococcus bacteria.

    Taking sanitary precautions in the home, such as using disposable utensils or washing your hands frequently, can reduce the chances that tonsillitis will spread to family members or other close contacts. One of the best ways to prevent tonsillitis is to avoid exposure to anyone who already has the disease. In the home, a child or adult who has tonsillitis or another infection should use separate drinking glasses and eating utensils, which should be washed as soon as possible after use in hot, soapy water. Disposable glasses, plates, and utensils can also be used. Parents, caregivers, or other contacts should wash their hands frequently. In addition, keep infected children out of school or daycare for a period of time recommended by the doctor to prevent them from spreading the disease to classmates.

  • Prevention and Screening

    Taking sanitary precautions in the home, such as using disposable utensils or washing your hands frequently, can reduce the chances that tonsillitis will spread to family members or other close contacts. One of the best ways to prevent tonsillitis is to avoid exposure to anyone who already has the disease. In the home, a child or adult who has tonsillitis or another infection should use separate drinking glasses and eating utensils, which should be washed as soon as possible after use in hot, soapy water. Disposable glasses, plates, and utensils can also be used. Parents, caregivers, or other contacts should wash their hands frequently. In addition, keep infected children out of school or daycare for a period of time recommended by the doctor to prevent them from spreading the disease to classmates.

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