What is tonsillitis?
Tonsillitis is redness, swelling and pain of the tonsils. The tonsils are collections of lymph tissue that can be seen at the back of throat throat. There is one tonsil on either side of throat. Tonsils vary in size from person to person and are usually at their largest during the years that we transition from a child to an adult. Their function is to act as one of the first lines of defence against infections that are inhaled in through the mouth before the air then enters the lungs. As such, when an infection is encountered, the tonsils engorge with blood and nutrients to help fight the infection. This causes the stereotypical swelling and redness of the tonsils seen in tonsillitis.
What does it feel like?
Tonsillitis typically causes a very sore throat. As it is often a part of an infection other infective features are commonly evident including a temperature and joint aches and pains. As tonsillitis is painful there is usually a reluctance to want to eat or drink which can result in tiredness and dehydration.
Other widespread infections can also cause a sore throat that is similar to tonsillitis. Examples include; the common cold, influenza, hand foot and mouth disease, measles and glandular fever.
How did I get it?
Tonsillitis is often caused by an infection such as a virus but is also frequently bacterial in origin. Less frequently, the cause is a fungal infection.
Some medicines may also act to lower the effectiveness of the immune system which predisposes to getting infections.
It is important to note that there are many conditions which can cause a sore throat but are not infections. As such, a sore throat in the absence of infective features should trigger a review by one of our medical team.
How long will it last?
That depends upon the cause.
A sore throat caused by a virus such as a cold may lasts somewhere in the region of 7-14 days.
A streptococcal infection should begin to respond to antibiotics within 3 days.
Do I need any treatment?
As tonsillitis is usually painful, pain killers are often needed to help cope. Paracetamol and ibuprofen may be helpful and are available over the counter without a prescription. We will also advise you to drink plenty of water to stay hydrated as an infection and temperature can lead to dehydration. We may suggest the addition of Diorolyte to your drinks to help provide relief from the symptoms of dehydration. This is also available over the counter without a prescription.
Many patients also find eating ice cream, yoghurt or jelly soothing.
When one of our team feel that the infection may be bacterial in origin, antibiotics are indicated.
We use the FeverPAIN and CENTOR criteria to help us decide if you are likely to be suffering from an infection by an organises called streptococcus. We may also take a swab of your throat to help us make the diagnosis, although this is often not necessary.
The FeverPAIN criteria are: score 1 point for each (maximum score of 5)
- Fever over 38°C
- “Pus” at the back of the throat
- Rapid onset of 3 days or less
- Severely inflamed tonsils
- No cough or runny nose
A score of 0 or 1 is associated with a 13% to 18% likelihood of streptococcus infection.
A score of 2 or 3 is associated with a 34% to 40% likelihood of streptococcus infection.
A score of 4 or 5 is associated with a 62% to 65% likelihood of streptococcus infection.
The CENTOR criteria are : score 1 point for each (maximum score of 4)
- Fever over 38°C
- “Pus” on the tonsils
- Tender and swollen lymph nodes in the neck
- Absence of cough
A score of 0, 1 or 2 is thought to be associated with a 3 to 17% likelihood of streptococcus infection.
A score of 3 or 4 is thought to be associated with a 32 to 56% likelihood of streptococcus infection.
Surgery to remove the tonsils is no longer routinely offered on the NHS.