Tonsillitis

Last reviewed: 26 Apr 2022
Last updated: 12 Oct 2021

Summary

Definition

History and exam

Key diagnostic factors

  • pain on swallowing
  • fever (>100.5°F [>38°C])
  • tonsillar exudate
More key diagnostic factors

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
Other diagnostic factors

Risk factors

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

Diagnostic investigations

1st investigations to order

  • throat culture
  • rapid streptococcal antigen test
More 1st investigations to order

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
More investigations to consider

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 leaflets

    Sore throat

    Tonsillitis

    More Patient leaflets
  • Calculators

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

    More Calculators
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