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Tonsillitis

Last reviewed: 30 Sep 2024
Last updated: 30 Apr 2024

Summary

Definition

History and exam

Key diagnostic factors

  • pain on swallowing
  • fever (>100.5°F [>38°C])
  • tonsillar exudate
Full details

Other diagnostic factors

  • sudden onset of sore throat
  • headache
  • abdominal pain
  • nausea and vomiting
  • presence of cough or runny nose
  • tonsillar erythema
  • tonsillar enlargement
  • enlarged anterior cervical lymph nodes
Full details

Risk factors

  • age between 5 and 15 years
  • contact with infected people in enclosed spaces (e.g., child care centers, schools, prison)
Full details

Diagnostic tests

1st tests to order

  • throat culture
  • rapid streptococcal antigen test
Full details

Tests 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
Full details

Treatment algorithm

ACUTE

acute tonsillitis not due to group A beta-hemolytic streptococcal infection

acute tonsillitis due to group A beta-hemolytic streptococcal infection

ONGOING

recurrent episodes of tonsillitis

Contributors

Authors

Christos Georgalas, PhD, DLO, FRCS (ORL-HNS)
Christos Georgalas

Professor of Surgery - Head and Neck

University of Nicosia

Cyprus

Disclosures

CG declares that he has no competing interests.

Eleftherios Margaritis, PhD, MSc, MD
Eleftherios Margaritis

Otolaryngologist - Head and Neck Surgeon

Collaborator in Otolaryngology

ENT Department

Hippokration University Hospital

Athens

Greece

Disclosures

EM declares that he has no competing interests.

Peer reviewers

Itzhak Brook, MD, MSc

Professor of Pediatrics and Medicine

Georgetown University

Washington

DC

Disclosures

IB declares that he has no competing interests.

Chris Del Mar, MB BChir, FRACGP MD, MA, FAFPHM

Dean

Faculty of Health Sciences and Medicine

Bond University

Gold Coast

Queensland

Australia

Disclosures

CDM is an author of a number of references cited in this topic.

  • Tonsillitis images
  • Differentials

    • Infectious mononucleosis
    • Epiglottitis
    • Peritonsillar abscess (quinsy)
    More Differentials
  • Guidelines

    • Clinical practice guideline: tonsillectomy in children (update)
    • A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2018 update
    More Guidelines
  • Patient information

    Sore throat

    Tonsillitis

    More Patient information
  • Calculators

    Sore Throat (Pharyngitis) Evaluation and Treatment Criteria (McIsaac)

    More Calculators
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