Tonsillitis can be difficult to distinguish from viral pharyngitis as both present with similar clinical symptoms.
Most patients do not seek medical help.
Most cases resolve spontaneously within a few days and do not require antibiotics, although analgesia is recommended for symptom relief. Antibiotics are used to treat group A streptococcal infection that make up between 5% to 15% of cases of pharyngitis in adults and 15% to 30% of cases in children.
There is some evidence that tonsillectomy may be effective in selected children with recurrent severe acute tonsillitis.
Tonsillitis is inflammation of the tonsils; specifically it is an infection of the parenchyma of the palatine tonsils. This definition does not include tonsillitis as part of infectious mononucleosis (also known as glandular fever). Tonsillitis may occur in isolation or as part of a generalized pharyngitis. The clinical distinction between tonsillitis and pharyngitis is unclear in the literature, and the condition is often referred to simply as "acute sore throat".
History and exam
Key diagnostic factors
- pain on swallowing
- fever (>100.5°F [>38°C])
- tonsillar exudate
Other diagnostic factors
- sudden onset of sore throat
- abdominal pain
- nausea and vomiting
- presence of cough or runny nose
- tonsillar erythema
- tonsillar enlargement
- enlarged anterior cervical lymph nodes
- age between 5 and 15 years
- contact with infected people in enclosed spaces (e.g., child care centers, schools, prison)
1st investigations to order
- throat culture
- rapid streptococcal antigen test
Investigations to consider
- serologic testing for streptococci
- WBC count and differential
- heterophile antibodies
- vaginal and cervical, or penile, and rectal cultures
- HIV viral load assay
- lateral cervical view x-ray, exposed for soft tissue
acute tonsillitis not due to group A beta-hemolytic streptococcal infection
acute tonsillitis due to group A beta-hemolytic streptococcal infection
recurrent episodes of tonsillitis
- Infectious mononucleosis
- Peritonsillar abscess (quinsy)
- Clinical practice guideline: tonsillectomy in children (update)
- A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2018 update
TonsillitisMore Patient leaflets
Sore Throat (Pharyngitis) Evaluation and Treatment Criteria (McIsaac)More Calculators
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