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Tonsillitis; Sore throat; Tonsils; Viral infection; Bacterial infection; Tonsillectomy; Diagnosis; Treatment; Fever; Swelling

Tonsillitis is a common condition that affects the tonsils, two small glands located at the back of the throat. These glands are part of the body’s immune system and play a role in fighting infections [1, 2]. When the tonsils themselves become infected, they can become inflamed and swollen, leading to a variety of symptoms that affect the throat, swallowing, and overall comfort [3]. Tonsillitis can occur in both children and adults, though it is most frequently seen in children. While the condition is often self-limiting, it can also lead to complications if left untreated [4]. This article explores the causes, symptoms, diagnosis, and treatment options for tonsillitis, emphasizing the importance of early intervention and appropriate management.

Causes of tonsillitis

Tonsillitis is typically caused by either viral or bacterial infections, both of which can lead to inflammation of the tonsils [5]. Understanding the different causes is crucial for determining the appropriate treatment.

Viral infections

The majority of tonsillitis cases are caused by viral infections, such as the following:

• This virus can lead to sore throat and swollen tonsils.
• Flu can cause severe inflammation of the tonsils, often accompanied by fever and body aches.
• The virus responsible for mononucleosis, commonly known as “mono,” can lead to swollen tonsils, sore throat, and fever.
• These viruses are associated with respiratory infections, including tonsillitis.
• Though rare, this virus can cause tonsil infections, particularly in individuals with weakened immune systems.

Bacterial infections

Bacterial infections are less common but can cause more severe symptoms. This bacterium, which causes strep throat, is a frequent cause of bacterial tonsillitis. Strep throat is often accompanied by a sudden onset of a sore throat, fever, and swollen tonsils, sometimes with white or yellow patches [6].

In addition to infections, other factors can lead to tonsillitis, including:

Allergies can cause throat irritation and inflammation, although they are not a direct cause of tonsillitis.

Exposure to smoke, pollution, or other irritants can contribute to inflammation of the tonsils.

In some cases, chronic or recurrent tonsillitis can be caused by an ongoing issue with the tonsils, leading to persistent symptoms.

Symptoms of tonsillitis

The symptoms of tonsillitis can vary depending on whether the cause is viral or bacterial.  One of the most common symptoms of tonsillitis, often severe, makes swallowing painful. The tonsils may appear red, inflamed, and may have white or yellow patches if infected with bacteria. A fever often accompanies tonsillitis, especially in bacterial infections like strep throat [7]. Swelling and pain can make it challenging to swallow food and liquids.

The lymph nodes in the neck may become tender and swollen in response to infection. The infection can cause foul-smelling breath. A headache may also occur in association with the infection. The pain may radiate to the ears due to the close proximity of the tonsils to the ear structures [8]. In the case of viral infections, symptoms such as runny nose, cough, and fatigue may also be present. With bacterial infections, especially strep throat, the symptoms tend to be more sudden and severe.

Diagnosis of tonsillitis

A diagnosis of tonsillitis begins with a thorough physical examination by a healthcare provider. The physician will examine the tonsils for signs of swelling, redness, and the presence of pus or white spots [9]. Additionally, the doctor will evaluate other symptoms, such as fever and swollen lymph nodes.

To determine whether the tonsillitis is caused by a bacterial infection, the doctor may perform a throat culture. This involves swabbing the back of the throat and testing the sample for the presence of Group A Streptococcus. If strep throat is detected, antibiotics will be prescribed.

In some cases, a rapid antigen test may be conducted to quickly identify Group A Streptococcus. This test produces results in a few minutes, which is helpful for guiding treatment decisions.

In cases of viral tonsillitis or more severe symptoms, a blood test may be conducted to identify the underlying virus, such as Epstein-Barr virus or influenza.

Treatment options for tonsillitis

Treatment for tonsillitis depends on the underlying cause of the infection (viral or bacterial) and the severity of symptoms.

Since viral infections cannot be treated with antibiotics, treatment for viral tonsillitis typically focuses on relieving symptoms:

Over-the-counter medications, such as ibuprofen or acetaminophen, can help reduce pain and fever.

Drinking plenty of fluids is important to stay hydrated and soothe the throat.

Resting helps the body recover and boosts the immune system’s ability to fight off the virus.

Gargling with warm salt water can help alleviate throat pain.

Lozenges can provide temporary relief from throat discomfort.

Bacterial tonsillitis

When bacterial tonsillitis, such as strep throat, is diagnosed, antibiotics are prescribed to clear the infection. It is essential to complete the full course of antibiotics, even if symptoms improve, to prevent complications like rheumatic fever or kidney inflammation [10]. Additional treatments for bacterial tonsillitis may include:

Like viral tonsillitis, pain relievers are used to reduce discomfort.

Applying a compress to the throat can provide relief from pain.

In cases of chronic or recurrent tonsillitis, a tonsillectomy (surgical removal of the tonsils) may be recommended. This procedure is typically considered when tonsillitis causes frequent infections, significant complications, or obstructs breathing and swallowing.

While it is not always possible to prevent tonsillitis, certain measures can reduce the risk of infection:

Regular hand washing and avoiding close contact with infected individuals can help prevent the spread of bacteria and viruses.

Reducing exposure to smoke, pollution, and allergens can help protect the tonsils from irritation.

A healthy diet, adequate sleep, and regular exercise can support immune function.

Conclusion

Tonsillitis is a common condition that can cause significant discomfort and disruption in daily life. While viral infections are the leading cause of tonsillitis, bacterial infections such as strep throat can lead to more severe symptoms and require antibiotic treatment. Early diagnosis and appropriate treatment are key to managing tonsillitis effectively and preventing complications. In cases of recurrent or chronic tonsillitis, surgical intervention may be necessary to improve quality of life and overall health.

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