Summary
Tonsillitis is an infection or inflammation of the tonsils, which are located at the back of the throat. It can be difficult to tell apart from viral pharyngitis, as both conditions cause similar symptoms like a sore throat, difficulty swallowing, and fever. Most cases of tonsillitis resolve on their own within a few days and do not require antibiotics. Pain relief, like over-the-counter medication, is often recommended to ease symptoms. However, if the tonsillitis is caused by a bacterial infection, such as group A streptococcus (which causes strep throat), antibiotics will be needed. This type of infection is responsible for 5% to 15% of sore throats in adults and 15% to 30% in children.
In some cases, if a child experiences frequent or severe bouts of tonsillitis, a doctor may recommend a tonsillectomy (surgical removal of the tonsils) to prevent future problems.
What is Tonsillitis?
Tonsillitis is an infection or swelling of the tonsils, the two oval-shaped tissues located in the back of the throat. It can occur on its own or alongside other throat infections, such as pharyngitis (inflammation of the throat). Tonsillitis is often referred to simply as a “sore throat” because it shares symptoms with many other throat infections. This condition is different from tonsillitis caused by infectious mononucleosis, also known as glandular fever, which is a viral infection.
When to Seek Help
If your child or you experience a severe sore throat, difficulty swallowing, fever, or swollen tonsils, it’s a good idea to see a healthcare provider. If symptoms last longer than a few days or are severe, they may recommend tests to check for bacterial infections and decide whether antibiotics are necessary.
Treatment and Management
- Symptom relief: For most people, tonsillitis improves on its own with rest, plenty of fluids, and over-the-counter pain relievers to reduce fever and throat discomfort.
- Antibiotics: If a bacterial infection like strep throat is causing the tonsillitis, antibiotics will be prescribed.
- Surgery: For children who experience recurrent, severe tonsillitis, a tonsillectomy may be recommended to prevent future infections.
History and Exam
Key diagnostic factor
- Presence of risk factors
- Pain on swallowing
- Fever (>38°C [>100.5°F])
- Tonsillar exudate
Other diagnostic factors
- Sudden onset of sore throat
- Headache
- Abdominal pain
- Nausea and vomiting
Risk factors
- Age between 5 and 15 years
- Contact with infected people in enclosed spaces (e.g., child care centres, schools, prison)
Diagnostic Investigations
1st Investigations to Order
- Throat culture
- Rapid streptococcal antigen test
Investigations to consider
- Serological testing for streptococci
- WBC count and differential
- Heterophile antibodies
- Vaginal and cervical, or penile, and rectal cultures

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