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Health Knowledge and Encyclopedia
At your local Pearn's Pharmacy we can offer advice on most general health matters. You can also use our Health Encyclopaedia to provide you with the tools and links you need to pinpoint symptoms and get a full explanation of a suspected condition.
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Tonsillitis is inflammation of the tonsils, usually due to a viral infection or, less commonly, a bacterial infection. It is a common type of infection in children.
Symptoms of tonsillitis include:
Symptoms will usually pass within 3-4 days.
When to see your GP
Tonsillitis is not usually a serious condition so you only need to see your GP if your child:
There is no specific treatment for tonsillitis, but there are several things that can help alleviate symptoms, such as:
If tests show that a bacterial infection is the cause of tonsillitis, a short course of antibiotics may also be prescribed, although this is often not necessary.
Most cases of tonsillitis get better within a week. A small number of children have tonsillitis for a long time or it keeps coming back. This is known as chronic tonsillitis and may require treatment with surgery.
However, surgery to remove the tonsils (tonsillectomy) is now usually only recommended if your child has five or more debilitating episodes of tonsillitis in a single year.
Read more about treating tonsillitis.
What are tonsils?
The tonsils are two small glands found at the back of the throat behind the tongue. It is thought that they act as a barrier against infection in children whose immune system (the body’s defence against infection) is still developing.
The theory is that by becoming infected the tonsils isolate any infection and prevent it from spreading further into the body.
It is thought that the tonsils then lose this ability as the rest of the immune system fully develops. This may explain why tonsillitis is so common in children but relatively rare in adults.
What causes tonsillitis?
Most cases of tonsillitis are caused by a viral infection, such as the viruses that can cause the common cold or influenza (flu virus).
Some cases can also be caused by a bacterial infection, typically a strain of bacteria called group A streptococcus bacteria.
These types of infections spread easily so it is important to try to avoid passing the infection on to others by:
Read more about the causes of tonsillitis.
Who is affected
Tonsillitis is very common in children aged 5-15 years old. Almost all children will have at least one episode of tonsillitis as they grow up.
Approximately 50,000 tonsillectomies are carried out in England and Wales every year.
Tonsillitis occasionally occurs in young adults. This is usually the result of a type of infection known as glandular fever.
Complications of tonsillitis are rare and usually only occur if the condition is caused by a bacterial infection.
They are usually the result of the infection spreading into another part of the body, such as the middle ear (otitis media).^^ Back to top
The main symptom of tonsillitis is a sore throat. Other common symptoms include:
Less common symptoms of tonsillitis may include:
Younger children may also complain of a tummy ache, which can be caused by the swelling of the lymph nodes in the abdomen.^^ Back to top
It is estimated that around 8 out of 10 cases of tonsillitis are caused by a viral infection.
Viruses known to cause tonsillitis include:
In rare cases, tonsillitis can be caused by the Epstein-Barr virus, which is the virus that causes glandular fever. If this is the case, you will probably feel very ill. You may have swollen lymph nodes (glands) throughout your body and an enlarged spleen.
Bacterial tonsillitis may be caused by a number of different bacteria, but it is usually cause by group A streptococcus bacteria. In the past, serious bacterial infections such as diptheria and rheumatic fever have been associated with tonsillitis, but this is now very rare due to vaccination and improved treatment of these diseases.
How you catch tonsillitis
Tonsillitis is spread in the same ways as colds and flu. It's contained in the millions of tiny droplets that come out of the nose and mouth when an infected person sneezes or coughs. You can then become infected with the virus by breathing in these droplets from the air.
You can also become infected by handling a surface or object that these droplets have landed on and then touching your face.^^ Back to top
See your GP if you think that your child has tonsillitis. Your GP will examine their throat and ask them (or you) questions about your symptoms.
There are four main signs that determine whether tonsillitis is due to a bacterial infection rather than a viral infection.
If your child has two of the above, your GP may recommend further testing. If your child has three or more of the above then it is highly likely that your child has bacterial tonsillitis and antibiotics may sometimes be prescribed.
If a more detailed diagnosis is required, a swab sample can be sent to a laboratory for analysis. The results can take a few days to return.
Laboratory tests are mainly used for patients in high-risk groups (such as those with weakened immune systems) or if previous treatment has failed.
If you develop tonsillitis as an adult and you also have additional symptoms such as swollen nodes and a very painful throat your GP may recommend you have a blood test to see whether you have glandular fever. Read more about the diagnosis of glandular fever.^^ Back to top
There is no specific treatment for tonsillitis.
Whether your child's tonsillitis is caused by a virus or by bacteria, it is likely that their immune system will clear the infection within a few days. In the meantime, there are a number of things that you can do to help.
Make sure that your child has plenty to eat and drink, even if they find it painful to swallow. Being hungry and dehydrated can make other symptoms, such as headaches and tiredness worse.
If your child has recurring bouts of tonsillitis, surgery may be considered.
When treating children with painkillers it is important to check you have bought the correct type and dosage as younger children only need small dosages. Your pharmacist will be able to advise you.
Children under 16 years of age should not take aspirin.
There are also over-the-counter treatments that can soothe a sore throat, such as lozenges and oral sprays.
Some people find that gargling with a mild antiseptic solution can help to relieve a sore throat.
An alternative method is to gargle with warm salty water. Mix half a teaspoon of salt (2.5g) with a quarter of a litre (eight ounces) of water. It is important never to swallow the water so this method may not be suitable for younger children.
Even if tests confirm that your child’s tonsillitis is due to a bacterial infection they still may not be prescribed antibiotics. There are two main reasons for this:
Exceptions are made if:
In these circumstances a 10-day course of penicillin is usually recommended. If your child has a known allergy to penicillin then alternative antibiotics, such as erythromycin, can be used.
Antibiotics sometimes cause mild side effects, such as an upset stomach, diarrhoea or a rash.
Surgery for tonsillitis is now usually only recommended if:
Surgery involves removing the tonsils. This is done in an operation known as a tonsillectomy.
A tonsillectomy is done under a general anaesthetic, which means that your child will be asleep during the procedure. Your child's mouth will be held open so that the surgeon can see their tonsils, and no cuts will be made in their skin.
The operation can be carried out in a number of ways:
Each of these techniques is relatively similar in terms of safety, results and recovery so the type of surgery that is used will depend on the expertise and training of the surgeon.
Your child will usually be able to leave hospital the same day or the day after surgery is performed.
After surgery it is likely that your child will experience some pain at the site of the surgery. This can last for up to a week. Painkillers can help relieve the pain.
Children who have had a tonsillectomy should be kept off school for two weeks. This is to reduce the chance of them picking up an infection from another child that will make them feel more uncomfortable.
They will probably find swallowing difficult after a tonsillectomy, but it is important to eat solid foods as this will help the throat heal more quickly. They should drink plenty of fluids but avoid acidic drinks, such as orange juice, as they will sting.
It is important to make sure they keep their teeth clean as this helps prevent infection in the mouth.
The pain usually gets worse during the first week after the operation and gradually improves during the second week. Earache is common with tonsillectomies and no cause for concern.
A relatively common complication of tonsillectomy is bleeding at the site where the tonsils were removed. This can occur in the first 24 hours after surgery or up to 10 days after surgery.
It is estimated that around 1 in 100 children and 1 in 30 adults will experience post-operative bleeding.
Minor bleeding is not usually a cause for concern as, in most cases, it resolves by itself. Gargling cold water can often help stem the bleeding as the cold water can contract the blood vessels.
However, in some cases the bleeding can be extensive, causing people to vomit up or cough up blood.
In this case you should seek immediate medical advice. You should be given a contact number in case of emergency before you’re discharged from hospital. If you're not given an emergency number call NHS Direct Wales on 0845 46 47.
Extensive bleeding may need treatment with surgery or a blood transfusion.^^ Back to top
Complications resulting from tonsillitis are uncommon, but some of the problems that can occur are outlined below.
Other complications of tonsillitis are now very rare and usually only occur if an underlying bacterial infection is left untreated. They include:
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