Tonsillitis Patient Information

Anh Q. Truong, MD

Bellevue ENT

1231 116th Avenue NE, Suite 915

Bellevue, WA 98004

Phone: (425) 454 - 3938

What are the tonsils and adenoid?

The palatine tonsils are a pair of lymphoid tissue in the back of throat that can be visualized through the mouth. The adenoid is a mass of lymphoid tissue located deep behind the nose. It can only be visualized with special equipment. The tonsils and adenoid have immune cells covered by mucosa with invaginations that are called crypts.

What are the functions of tonsils?

The tonsils and adenoid are a small part of the lymphatic system which helps fight infections. Other major immune and lymphatic organs include lymph nodes, the thymus, and the spleen. The tonsils and adenoid typically regress as you get older. In most adults, the adenoid and tonsils are typically much smaller.

What is tonsillitis?

Tonsillitis is the inflammation and infection of the tonsils, typically from a viral or bacterial etiology. Patients may typically have a concurrent throat infection (pharyngitis) and an adenoid infection (adenoiditis). Viral causes of tonsillitis may include adenovirus, Epstein-Barr virus (mono), herpes simplex virus, cytomegalovirus, and the measles virus. The most common bacterial tonsillitis is Streptococcus pyogenes (strep throat).

How does tonsillitis typically present?

The common signs and symptoms of tonsillitis may include a sore throat, pain with swallowing, fatigue, fever, foul breath, enlarged tonsils, white exudate and enlarged lymph nodes. With treatment, symptoms typically improve after 3-4 days. However, some patient may experience persistent symptom up to 10-14 days.

How is tonsillitis classified?

Acute tonsillitis typically presents with most of the classic symptoms as discussed above. Recurrent acute tonsillitis is the development of multiple infections in one year. Chronic tonsillitis symptoms are usually less severe but persist despite antibiotic treatment.

How is tonsillitis treated?

A sore throat and tonsillitis from a viral infection typically do not require any treatment other than over the counter pain medication and hydration. Viral tonsillitis such as mono or HSV may benefit from a short course of steroid to reduce the pain and inflammation. When a bacterial tonsillitis is suspected (tonsillar exudates, fever, enlarged lymph node), then antibiotic can be used to treat the infection. Sometimes, it is difficult to differentiate a viral from a bacterial infection. As a result, a throat culture or rapid strep test can help in the diagnosis.

What is a peritonsillar abscess (PTA)?

In rare cases, an episode of tonsillitis can result in the development of a pus pocket deep to the tonsil. It typically occurs on one side and pushes the tonsil and the uvula towards the other side. Along with symptoms of tonsillitis, patients may experience drooling, muffled voice and severe pain, especially with eating and swallowing. It may continue to get worse despite antibiotic treatment.

How is a peritonsillar abscess treated?

A small and early peritonsillar abscess may respond to antibiotic and steroid. A large tonsillar abscess or an abscess that does not respond to antibiotic treatment may require drainage to evacuate the pus. This can be done with the patient awake. Typically, the throat is anesthetized locally with an injection. The pus can then be removed by needle aspiration or by making a small incision.

When is surgery indicated?

Recurrent tonsillitis and chronic tonsillitis can have a significant impact on quality of life with loss of productivity at work and school. In general, the decision to proceed with a tonsillectomy is one that the patient and ENT surgeon makes together.

A tonsillectomy and possible adenoidectomy is typically recommended in patients who have multiple recurrent infections or chronic tonsillitis. In some cases, patients who are streptococcal carrier or patients who develop complications related to tonsillitis such as rheumatic fever may be recommended to have a tonsillectomy. Patients who developed more than one episode of peritonsillar abscess (PTA) are recommended to have a tonsillectomy given the higher likelihood of recurrent PTA.

Other indications for a tonsillectomy include obstructive sleep apnea and tonsillar tumor. Relative indications for a tonsillectomy include trouble swallowing, voice change and chronic tonsil stones (tonsilliths).

Learn more about tonsillectomy and post-operative care after a tonsillectomy.