Tonsillitis

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What are tonsils? 

The tonsils are two pads of immune tissue located at the back of the throat. They are part of the body’s immune system and help recognize germs that enter through the mouth and nose. 

What is tonsillitis? 

Tonsillitis is inflammation of the tonsils, most often caused by an infection. The tonsils may become red, swollen, and painful. 

What causes tonsillitis? 

Viruses cause most cases of tonsillitis. Group A Streptococcus (strep) is a common bacterial cause. Other viruses, including Epstein-Barr virus (the virus that causes infectious mononucleosis, or “mono”), can also cause tonsillitis. These infections can spread from person to person through respiratory droplets and close contact. 

What are the symptoms of tonsillitis? 

Symptoms vary from child to child and may include: 

• Sore throat
• Red or swollen tonsils, sometimes with white or yellow patches 
• Pain or difficulty with swallowing 
• Fever 
• Swollen or tender lymph nodes in the neck 
• Bad breath 
• Headache
• Decreased appetite 
• Tiredness 

Some children with enlarged or inflamed tonsils may also snore. Symptoms of tonsillitis can overlap with other illnesses, so your child’s healthcare provider can help determine the cause. 

What is a peritonsillar abscess? 

Rarely, an infection can form a pocket of pus next to a tonsil. This is called a peritonsillar abscess. Symptoms may include: 

• Severe throat pain, often worse on one side 
• A muffled or changed voice 
• Drooling or difficulty swallowing 
• Difficulty opening the mouth 

A child with these symptoms should be evaluated promptly. A peritonsillar abscess may require antibiotics and drainage. 

How is tonsillitis diagnosed? 

Your child’s healthcare provider will ask about their symptoms and medical history and examine the mouth, throat, and neck. If strep throat is suspected, the provider may swab the throat for a rapid strep test and, in some cases, a throat culture or other confirmatory test. 

How is tonsillitis treated? 

Treatment depends on the cause and severity of the illness. Viral tonsillitis usually improves with supportive care such as fluids, rest, and medicines for pain or fever when appropriate. Antibiotics do not treat viral infections. 

If testing shows that tonsillitis is caused by strep bacteria, your child’s healthcare provider may prescribe antibiotics. It is important to give antibiotics exactly as directed. 

When is tonsil surgery considered? 

Most children who have occasional tonsillitis do not need surgery. Tonsillectomy (surgery to remove the tonsils) may be considered when throat infections are frequent, severe, or significantly affect a child’s health, school attendance, or quality of life. Your child’s doctor may consider the number and severity of infections and how well they have been documented when discussing whether surgery may be helpful. 

Tonsillectomy may also be recommended for some children whose enlarged tonsils contribute to sleep-disordered breathing or obstructive sleep apnea. This is a separate reason for tonsil surgery and does not require recurrent tonsillitis. 

When should I seek medical care? 

Contact your child’s healthcare provider if your child has a severe or persistent sore throat, fever, difficulty swallowing, or symptoms that are getting worse instead of better. 

Seek urgent medical attention if your child has trouble breathing, cannot swallow liquids, shows signs of dehydration, has significant drooling, develops severe one-sided throat pain or swelling, or has difficulty opening the mouth. 

What can I do to help prevent the spread of infection? 

There is no single way to prevent all cases of tonsillitis, but these steps can reduce the spread of infections that cause sore throat and tonsillitis: 

• Wash hands often with soap and water. 
• Avoid sharing cups, utensils, toothbrushes, and other personal items. 
• Cover coughs and sneezes. 
• Avoid close contact with people who are sick when possible.