tonsils are generally considered to be the two round asses at the back of
the throat. However, there are other areas where “tonsils”are found.
The adenoids are located in the back of the nose in an area called the
nasopharynx. Because of this location, adenoids are called nasopharyngeal
also exists a mass of tissue at the back of the tongue called the lingual
tonsils. All three tonsils are made of lymphoid tissue similar to the
lymph nodes or glands on the sides of the neck. All lymphoid tissue serve
as a defense against infection, but they may also become the site of
recurrent or chronic infections.
(an infection of the tonsil tissue) is very rare in children under the age
of 1-year-old. The frequency of infections then increases between the ages
of 4 and 8 years. After this time, the rate of infections tends to
cases of tonsillitis, whether a fever is present or not, are caused by
viruses. Because the symptoms of viral and bacterial tonsillitis are often
so similar, it is sometimes difficult to determine the cause based upon
the history and examination alone. Viral tonsillitis is generally
considered a disease, which occurs gradually. Your child may have cold
symptoms, fever, decreased appetite and loss of energy and then develop
the sore throat. Hoarseness, coughing and a runny nose are also common.
The tonsils may have mild redness or have ulcers and yellow plaques
covering them. The lymph nodes in the neck are usually only mildly
enlarged and tender. The entire illness does not usually last more than 5
days. The development of any complications is rare.
tonsillitis (Strep tonsillitis) is caused by a bacteria called Group A
Streptococcus and is the most common bacterial tonsil infection in
children. The streptococcal infection occurs throughout the entire throat
and is not just limited to the tonsil area. Strep throat may continue to
occur in children without tonsils, although the rate is much lower.
tonsillitis tends to occur after the age of 3 years. Children will
complain of headache, stomachache, vomiting and high fevers. These
symptoms tend to occur quickly. The degree of sorethroat varies from
extremely severe to no significant discomfort. The neck lymph nodes become
very large and are usually very tender. Fevers may last up to 4 days with
severely affected children remaining sick for up to 2 weeks. The tonsil
appearance is as variable as in viral tonsillitis. Runny nose, cough, and
hoarseness are rarely present. Complications are common which is why
treatment with antibiotics is so important.
tonsillitis is best treated with penicillin for 10 days. A single
injection of antibiotics into the muscle is also an excellent therapy.
Response to treatment is usually quick with a loss of fever in 24-48
child no longer has a contagious disease within a few hours of taking
Group A Streptococcus bacteria can cause two types of complications,
infectious and non-infectious. The infectious complications are due to the
direct spread of the bacteria while non-infectious complications are due
to the release of harmful substances by the bacteria or by the bacteria
causing changes in the immune system.
of the infectious complications include ear infections, sinus infections,
lymph node infections and abscesses which form around the tonsil (a
peritonsillar abscess), in the back of the throat (a retropharyngeal
abscess) or deeper into the neck tissues (a parapharyngeal abscess).
of the non-infectious complications include Scarlet fever (skin rash due
to harmful substances released), rheumatic fever (damaged heart muscle),
and glomerulonephritis (damaged kidneys).
differentiation between viral tonsillitis and Strep tonsillitis is
important to prevent possible complications. The history may give
important clues but a swab of the back of the throat for a culture is a
critical part of the evaluation.
pediatricians have the Rapid Strep detection test in their offices. This
rapid test may miss up to 20% of true Strep infections. Therefore, if the
rapid test is negative, a standard throat culture is recommended. Some
children have green nasal drainage, tonsillitis and fever. Their cultures
may grow bacteria other than the Group A Streptococcus. Although the
infection is probably a complication of a viral tonsillitis, some of these
children respond well to antibiotics.
is no specific treatment of viral tonsillitis. Pain control with Tylenol
or Motrin, and increased fluid intake are the basic recommendations.
Gargling with warm salt water solutions may also offer some relief of the
antibiotics totally get rid of the bacteria, however in some children the
symptoms totally go away, but the throat cultures stay positive. This is
called a carrier state. Up to 15% of normal healthy children have the
Group A Streptococcus bacteria which lives in the throat and does not
cause disease at all. However, if a child is a carrier of the bacteria and
has a history of rheumatic fever or has a brother or sister with a history
of rheumatic fever, more intensive treatments may be necessary to totally
get rid of the bacteria.
states, which do not require treatment, make the diagnosis of future
tonsillitis episodes more difficult to make. Even if viral tonsillitis is
present, the ever-present Strep bacteria almost demands antibiotic therapy
to prevent the development of possible complications.
(the surgical removal of the tonsils) used to be performed frequently to
prevent the complications of Strep tonsillitis. However, the availability
of antibiotics markedly decreased the need for this surgical procedure.
With more experience in the use of antibiotics, it has been noted that
although Strep tonsillitis could be treated successfully with antibiotics,
some children had frequent, recurrent infection causing repeated sickness
despite adequate medical treatment.
is now utilized in this select group of children to reduce the number and
severity of recurrent episodes of tonsillitis. Several groups of doctors
have set guidelines for what is considered a significant number of
infections. Many insurance
companies have adopted these guidelines. More information about
tonsillectomy may be found in the Surgical
procedures section of this site.
The information provided on
this web site is not intended to take the place of consultation with your
physician. You should always consult a physician whenever you require
diagnosis or treatment.
Copyright © 2008 Atlanta Children's ENT.