Chronic infections of the tonsils or throat

Causes
Symptoms
Diagnosis
Treatment options

Tonsillitis, strep throat, sore throat…these terms are often used together, but how are they related?

A persistent sore throat is generally a symptom of something else—usually a virus or bacteria infecting part of the upper respiratory tract (mouth, nose and throat). Having a sore throat doesn't necessarily mean that you or your child has strep throat or infected tonsils. And having a sore throat or being diagnosed with strep throat doesn't necessarily mean that your tonsils are infected, too. It can be very confusing!

Tonsils act as part of the body's immune system to filter germs, bacteria and viruses when they enter the body through the nose and mouth. Sometimes the tonsils themselves can become infected or inflamed, a condition known as tonsillitis. Chronic or recurring tonsillitis is a common reason for children and adults to have their tonsils removed, a procedure known as a tonsillectomy.

When tonsillitis is present, tonsil infection and swollen tonsils are the most common symptoms, along with the surrounding throat area often being infected at the same time (pharyngitis). "Strep throat" is the common name for a particular type of bacterial infection in the throat caused by the streptococcus pyogenes bacteria. Chronic or recurring strep throat infections are another reason the tonsils are sometimes removed, though this happens less frequently today than it did 20 years ago.

In some patients, chronic tonsil infections and enlarged tonsils can lead to a condition called chronic cryptic tonsillitis. The tonsils contain many small pockets and infoldings called crypts, which can trap small food particles and other debris. This can produce small, white stone-like particles called tonsilliths, composed of bacteria and dead cells, which are foul-smelling, can prolong the infection, and may cause a mild, intermittent sore throat.

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Causes

Tonsil and throat infections may be caused by either a virus or bacteria, and can be spread from one person to the other through coughing, sneezing and nasal fluids. In preschool children and infants, the common cold virus or flu virus often causes chronic tonsillitis. In adults and adolescents, it is more likely to be caused by bacteria—the streptococcus, staphylocci, pneumococci, or hemophilus bacteria. In rare cases, the bacteria responsible for scarlet fever, diphtheria and mononucleosis can cause tonsillitis.

"Strep throat" is a particular type of bacterial infection in the throat caused by the streptococcus pyogenes bacteria. Tonsillitis, or inflamed tonsils, may or may not accompany a strep throat infection.

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Symptoms of tonsil and throat infections

Typical symptoms of tonsil and throat infections include:
  • Sore throat, mild to severe
  • Yellow or white coating on the tonsils
  • Swelling of the tonsils or throat
  • Redness of the tonsils or throat
  • Fever
  • Painful/difficult swallowing
  • Swollen lymph glands in the neck
  • Bad breath (halitosis)
It is important to seek medical attention for a persistent sore throat, even if it is not accompanied by a fever. Untreated tonsil or throat infections can lead to problems with the heart and kidneys, such as rheumatic fever. If tonsillitis is untreated, a condition called peritonsillar abscess can develop, in which swelling from the abscess can become large enough to obstruct the airway. The infection can also spread into the neck and chest and become fatal.

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Diagnosis

Different kinds of bacteria and viruses can cause throat infections or tonsillitis, so your doctor usually will want to test for the strep bacteria to make sure the appropriate treatment is given. Untreated strep throat can, in rare cases, result in rheumatic fever, a disease that damages the joints and heart.

To determine what is causing your tonsil or throat infection, the doctor will take a small sample of fluid from the back of your throat with a gentle swab. A quick test can indicate if strep bacteria are present, or if the infection is due to a virus.

If the test for strep throat is negative, your doctor may want to confirm this result by performing a 24-hour culture. In this test, your doctor will place a small sample of fluid from the back of your throat on a culture dish and leave it for 24 hours. If you have strep throat, the strep bacteria will usually grow on the culture dish within 24 hours.

Treatment options

Tonsil and throat infections are treated with symptom-relieving measures to make you feel better, and where appropriate, medications to combat the infection. Salt-water gargles, increased fluid intake, anti-inflammatory medications, and rest can help lessen the severity of your symptoms.

Antibiotics—antibacterial agents—are used for tonsillitis treatment, or throat infections caused by bacteria, but they have no effect if used to treat infections caused by a virus, and can even be harmful.

Occasionally, the tonsils and/or adenoids may become so inflamed and swollen that they interfere with swallowing. In this case, hospitalization and intravenous fluids may be required.

Chronic cryptic tonsillitis is sometimes treated with antibiotics, but this is usually only helpful temporarily. Some mechanical methods, such as picks and swabs, may be used also, but the only permanent cure is a tonsillectomy. Not everyone with chronic cryptic tonsillitis has symptoms severe enough to warrant surgery.

If you or your child has chronic, recurring tonsil or throat infections despite medical treatment, a tonsillectomy may be advisable. General guidelines are:

  • Five or more episodes in one year
  • Three or more episodes per year for two years
  • Infections that do not respond to treatment
Since an infection can spread from the tonsils to the adenoids or vice versa, they are often removed together in the same operation, particularly in children. Your doctor can determine the cause of your symptoms and the most appropriate treatment method.

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Why are they removed?

Tonsils only
Adenoids only
Tonsils and adenoids together Important Safety Information

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Version 2.1.0 This webpage was first published on September 07, 2005, and was last updated on August 31, 2007.
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