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Tonsillitis is a common condition that affects children and young adults and it may present as acute tonsillitis or recurrent acute infections or as a chronic condition, all with different presentations and treatment options. Tonsillitis is usually a self-limiting condition but there can be severe complications  such as rheumatic fever or acute glomerulonephritis on rare occasions.

Clinical Features

Acute Tonsillitis is an infection of the tonsils which is manifested by fever, a sore throat, difficulty swallowing and general malaise. When we examine the throat we often note the tonsils to be enlarged, red and with exudate or pus covering the surface with tender lymph glands in the neck.

Recurrent Acute tonsillitis is when a child has
• 7 attacks per year for one year
• 6 attacks per year for 2 years or
• 5 attacks per year for 3 years

and this may well be an indication for tonsillectomy.

Chronic Tonsillitis is more difficult to define but the main feature is chronic sore throat difficulty swallowing and a sore throat persisting for over 4 weeks. There may also be bad breath, coughing up of “blue vein cheese” type material from the crypts or crevices in the tonsils and tender glands in the neck. Often if we compress the tonsil this cryptic debris which is undigested food and bacteria will come out on to our depressor.

This condition may also be associated with snoring and obstructive sleep disorder and the consideration for tonsillectomy will take that into account as well. Occasionally throat swabs are performed and occasionally blood tests for glandular fever (EBV). Most tonsillitis is viral (80-90%) and only 10-20% are bacterial requiring antibiotics to reduce the severity of the symptoms and prevent rheumatic fever. Management is usually Penicillin type medication and if the symptoms become more significant, such as those mentioned for recurrent acute tonsillitis, then tonsillectomy may be indicated. In chronic tonsillitis there may be social and other reasons particularly with respect to halitosis (bad Breath) why the tonsils may be removed.

Uncommonly the child may develop one-sided tonsillar swelling with severe pain and difficulty opening the mouth and this may represent peri- tonsilar abscess or quinsy. For information regarding tonsillectomy please see the appropriate section.

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