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Chronic Tonsillitis - Tonsillitis


Overview, Causes, & Risk Factors

Tonsillitis is an inflammation or infection of the tonsils.

What is going on in the body?

The body has two sets, or pairs, of tonsils. The palatine tonsils can be seen at the back of the throat. The lingual tonsils are at the back of the tongue and cannot be seen by looking in the mouth. Tonsillitis usually means the inflammation or infection of the palatine tonsils. But sometimes the infection can involve the lingual tonsils and lymph nodes in the back of the throat.

What are the causes and risks of the infection?

Common causes of acute tonsillitis may include:

  • bacteria, such as streptoccal or hemophilus bacteria
  • viruses such as adenovirus or Epstein-Barr virus, which also causes mononucleosis
  • diphtheria, a serious disease that produces a false membrane in the throat. Diphtheria can be prevented by the DPT vaccine.
  • Subacute tonsillitis is most commonly caused by actinomyces, a normal mouth bacterium that can cause infection.

    In chronic tonsillitis, there is a long-standing infection that is almost always bacterial.


    Symptoms & Signs

    What are the signs and symptoms of the infection?

    There are three forms of tonsillitis:

  • acute, with rapid onset of significant symptoms
  • subacute, with a slow onset of less obvious symptoms
  • chronic, with intermittent symptoms that persist over time
  • Symptoms of acute tonsillitis include:

  • the rapid onset of severe sore throat that worsens over time
  • moderate to high fever
  • difficulty swallowing
  • red, enlarged tonsils that may or may not have pus on the surface or in the pits
  • swollen or tender lymph nodes below the jaw
  • Symptoms of subacute tonsillitis can last from 3 weeks to 3 months, and include:

  • somewhat enlarged tonsils
  • foul-smelling, pasty, infected material that collects inside the pits on the tonsils
  • fluctuating mild to moderate sore throat
  • bad breath
  • foul taste in the mouth
  • mildly swollen, tender lymph nodes
  • Symptoms of chronic tonsillitis include:

  • enlarged, mildly red tonsils that are scarred with large pits
  • slightly enlarged lymph nodes that are not usually tender
  • sore throat that comes and goes

  • Diagnosis & Tests

    How is the infection diagnosed?

    A healthcare provider can diagnose acute tonsillitis based on the person's health history and a physical exam. A throat culture can help identify the organism causing the infection. A complete blood count, or CBC, can also help determine if the infection is caused by a virus or bacteria.

    If mononucleosis is involved, the lymph nodes in the neck, armpit, or groin will be enlarged. An antibody titer may be done to check for antibodies to the Epstein-Barr virus.

    A healthcare provider can diagnose subacute tonsillitis and chronic tonsillitis based on a person's health record and a physical exam.


    Prevention & Expectations

    What can be done to prevent the infection?

    The best way to prevent acute tonsillitis is to avoid people who have strep throat or any of the bacterial or viral infections that can lead to acute tonsillitis.

    A person can get acute tonsillitis by:

  • coming into contact with someone who has strep throat or mononucleosis
  • having strep throat that develops into tonsillitis
  • sharing utensils or toothbrushes with someone carrying strep bacteria or Epstein-Barr virus
  • There is no way to prevent subacute or chronic tonsillitis.

    What are the long-term effects of the infection?

    Usually, no significant long-term effects result from any of the three forms of tonsillitis. However, difficulty swallowing or breathing during sleep can result if the chronic infection causes enlargement of the tonsils. The healthcare provider may recommend a tonsillectomy, or removal of the tonsils, if there are recurrent infections or difficulties with swallowing and breathing.

    What are the risks to others?

    Strep, diphtheria, and Epstein-Barr infections are all contagious.


    Treatment & Monitoring

    What are the treatments for the infection?

    Acute tonsillitis is usually treated with:

  • pain medication
  • oral fluids
  • medications to lower fever
  • For acute tonsillitis caused by strep bacteria, antibiotics will usually cure the infection. Unfortunately, some strep bacteria are becoming resistant to penicillin. This means higher doses of amoxicillin or a different antibiotic need to be used.

    Since antibiotics are not effective against viruses, the only treatment for tonsillitis caused by viral infection is medication to reduce fever and pain. Oral steroids may be given for a short period of time if symptoms are severe.

    Oral steroids can lessen the symptoms of tonsiliitis caused by mononucleosis. Antibiotics can be helpful in preventing infection if material has collected on the surface of the tonsils.

    In subacute tonsillitis caused by actinomyces, penicillin and clindamycin are effective. If these antibiotics do not work, the person can remove the infected material from the tonsil pits with a finger or special irrigating tool. Otherwise, the tonsils should be removed.

    In cases of chronic tonsillitis, antibiotics combined with oral steroids may resolve the infection. If not, the tonsils should be removed.

    Tonsillectomy may be recommended by the healthcare provider if the person has had:

  • 3 to 5 bacterial infections of the tonsils within 3 to 5 years
  • more than 6 episodes of tonsillitis in one year
  • chronic tonsillitis, or infection of the tonsils, that does not respond to antibiotics
  • enlargement of the tonsils that causes sleep apnea, a breathing disorder that occurs during sleep
  • enlargement of the tonsils that causes difficulty swallowing, especially in children
  • What are the side effects of the treatments?

    Side effects depend on the medications used, but may include allergic reactions and upset stomach. Surgery to remove the tonsils can cause bleeding, infection, or allergic reactions to anesthesia.

    What happens after treatment for the infection?

    Most viral episodes of tonsillitis will resolve without further problems. Antibiotics should clear up infections caused by strep or other bacteria. After recovery from tonsillectomy, the person should be free of symptoms.

    How is the infection monitored?

    Any new or worsening symptoms should be reported to the healthcare provider.


    Attribution

    Author:William Stevens, MD
    Date Written:
    Editor:Ballenberg, Sally, BS
    Edit Date:11/29/00
    Reviewer:Eileen McLaughlin, RN, BSN
    Date Reviewed:08/09/01


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