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Disease: Tonsillitis Tonsillitis
Category: Infectious diseases
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Disease Definition:

Tonsillitis (a common childhood disease) is a viral or bacterial infection of the tonsils, causing them to swell and become painful.

Viral infections are more common and treated with over the counter medications of sore throat.

Antibiotics are needed when bacterial infections occur, which are less common. Previously, surgical removal (tonsillectomy) was the common treatment for tonsillitis recurrences; but nowadays, it is the last resort when other treatments completely fail to achieve any improvement.

Work Group:

Prepared by: Scientific Section

Symptoms, Causes


Patients with tonsillitis may experience the following symptoms:


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


Tonsils act as filters when bacteria or viruses penetrate the body through the mouth or the nose, by attacking them with white blood cells, resulting in a mild infection of the tonsils. As the infection gets more serious, tonsils become more inflamed and the case is called tonsillitis.

Tonsillitis is more common with viral infections including the virus that causes mononucleosis (the Epstein-Barr virus), while the rest of the cases are due to bacterial infections. The disease is called strep throat when a specific type of bacteria is causing the infection (group A streptococci), which is characterized by sudden high fever, lack of nasal congestion, tender neck lymph nodes, inflammation and pain, in which case the use of antibiotics is necessary.

Tonsillitis is a common disease in school aged children and can be contagious in schools and child care facilities.



If tonsillitis is not treated properly, the swollen tonsils can obstruct airways, resulting in sleep apnea among other problems.

Not receiving proper treatment may also cause pus accumulation between a tonsil and the soft tissues around it (abscess) that covers a large part of the soft area at the back of the roof of the mouth (soft palate) and though rare, it can spread in the chest or neck or into the bloodstream.

Rheumatic fever or kidney inflammation (nephritis) may also occur with some strains of streptococcal bacteria that cause strep throat.


Viral infections that result in tonsillitis can be treated with self care, but antibiotics are prescribed in the case of bacterial infections, such as penicillin, administered orally for a minimum period of 10 days or less in the case of other antibiotics. Patients should be warn about completing the course of antibiotics even if their condition improves within a few days, since early stopping of the antibiotic course may lead to the recurrence of the infection.

In the case of children, parents should make sure that their child receives antibiotic treatment at least for 24 hours before returning them to school or child care. In the case of difficulty swallowing, antibiotics are administered by injection, and in some other cases swelling is reduced by steroid medications. Surgical removal (tonsillectomy) of tonsils is only recommended if all other treatment methods fail to improve the condition.

In the case of viral infections, since antibiotics are not useful, it is carried out by letting the body fight the virus, while taking steps to minimize inflammation and pain. The process of recovery may take up to two weeks. Some of these steps are:


  • Drinking warm, soothing liquids such as soup, broth and tea.
  • Gargling with warm salt water
  • Taking acetaminophen or ibuprofen to help reduce fever and decrease pain. Because of the risk of Reye's syndrome (a potentially fatal illness), aspirin must not be given to children below the age of 12.

The need of surgically removing the tonsils (tonsillectomy) is rare for adults, while it is recommended for children who have had:


  • Seven or more serious throat infections in one year
  • Five or more serious throat infections annually for two successive years
  • Three or more serious throat infections annually for three successive years

Surgery might also be recommended to treat an abscess that did not respond to antibiotic treatment or in the case of airway blockage by swollen tonsils. While the child can go home the same day of surgery, recovery takes up to two weeks.


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Consultants Corner

Yaser Habrawi , F.R.C.S.Ed

Yaser Habrawi , F.R.C.S.Ed Consultant Ophthalmologist

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