Tonsils and Tonsil Infections(Tonsillitis)

The tonsils, two little bumps found in the back of the throat, are small at birth and during infancy. Between the ages of five and ten years of age they start to get bigger on their own. Eventually after the age of twelve they start to shrink on their own. In the meantime, they can get infected and enlarge enough to cause problems. Some children’s tonsils get so big that they are unable to breathe properly, especially at night. In addition, enlarged tonsils can also prevent a child from eating or swallowing well. Most tonsil-related problems occur in children over the age of two years. 

What is tonsillitis?

Tonsillitis is an infection of the tonsils caused either by viruses or by bacteria. The usual bacteria causing tonsil infections is Streptococcus also known as Strep throat. The symptoms of a tonsil infection include

  • Sore throat;
  • Difficulty swallowing;
  • Drooling;
  • Not being able to fully open his or her mouth;
  • Pain in the lymph nodes in the neck;
  • Neck pain.

Sometimes there can be associated nonspecific symptoms of a throat or tonsil infection in young children including fever, headache, and even abdominal pain.

Tonsillitis treatment

Most throat or tonsil infections are caused by viruses and do not need any treatment. Usually with viral infections of the tonsils, there are other associated symptoms of a cold such as a runny nose and cough. Strep throat, on the other hand, usually causes a very sharp pain, in the throat without any other symptoms.

By examining the throat, a healthcare provider cannot tell whether it is a viral infection or a Strep throat. It is important to know the cause, because unlike viral infections, the streptococcal throat infections can cause complications such as local spread to the back of the throat and longer term kidney and heart problems. Antibiotics given promptly will prevent most of these complications. To test for the presence of Streptococcus, a swab is taken from the back of the throat. If the test shows it is a Streptococcal infection, then antibiotics, usually taken by mouth, are prescribed. It usually takes about twenty-four to forty-eight hours for the fever to fall and the child to start feeling better. In the meantime, make sure the child is drinking well and enough. Also during this time, acetaminophen can be given for fever. If your child worsens or the fever persists despite forty-eight hours of antibiotics contact your healthcare provider.

Note that very rarely the infection spreads into the throat to cause an abscess full of pus. This complication requires hospitalization for surgery to drain the pus as well as antibiotics given intravenously.

Removing tonsils

In most children, the tonsils will not cause any significant problems and therefore do not need to be surgically removed. However, in some situations they need to be removed surgically under general anesthesia. This operation is known as a tonsillectomy. Currently the indications for removing tonsils are:

  • Recurrent (Strep) infections; more than six in a year.
  • Enlarged tonsils block breathing and/or preventing eating.
  • Abscess around the tonsils.

Note that children and adults can still get throat infections(pharyngitis) even if they have had their tonsils removed in the past.