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Tonsillitides – Causes, Symptoms and Treatment

Tonsillitides are inflammations of the palatine tonsils caused by bacteria or viruses. They typically present with sore throat, difficulty swallowing, and fever.

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Things worth knowing about "Tonsillitides"

Tonsillitides are inflammations of the palatine tonsils caused by bacteria or viruses. They typically present with sore throat, difficulty swallowing, and fever.

What are Tonsillitides?

Tonsillitides (singular: tonsillitis) refer to inflammations of the palatine tonsils. The tonsils are part of the lymphatic tissue in the throat and play an important role in the immune defense system. Tonsillitis can be acute or chronic and affects people of all ages, but is especially common in children and adolescents.

Causes

Tonsillitides are primarily caused by infectious agents. A distinction is made between:

Bacterial tonsillitis: Most commonly caused by Group A Streptococcus (Streptococcus pyogenes). Less frequently, other bacteria such as staphylococci or Haemophilus influenzae are involved.
Viral tonsillitis: Often caused by adenoviruses, the Epstein-Barr virus (responsible for infectious mononucleosis), influenza viruses, or rhinoviruses.
Chronic tonsillitis: Develops through recurrent infections in which bacteria remain permanently within the tonsils.

Symptoms

Typical symptoms of tonsillitides include:

Severe sore throat, worsening upon swallowing
Difficulty swallowing (dysphagia)
Fever, often above 38.5 °C (101.3 °F)
Swollen and reddened tonsils, sometimes with white or yellowish patches
Swollen cervical lymph nodes
Bad breath (halitosis)
General malaise, fatigue, and headache
In children, occasional abdominal pain and nausea

Diagnosis

Tonsillitis is primarily diagnosed through a clinical examination of the throat and lymph nodes. To distinguish between bacterial and viral causes, the following methods are available:

Rapid streptococcal antigen test: A throat swab allows rapid detection of Group A Streptococcus within minutes.
Throat swab with culture: Provides accurate results but takes several days.
Blood count and inflammatory markers: Elevated leukocytes and CRP levels suggest a bacterial infection.
Antibody tests: A specific blood test is performed when infectious mononucleosis is suspected.

The McIsaac score is a clinical scoring system that helps estimate the probability of streptococcal tonsillitis and assess the need for antibiotic treatment.

Treatment

General Measures

For milder cases, particularly those of viral origin, supportive measures are prioritized:

Adequate fluid intake (warm teas, broths)
Rest and physical recuperation
Pain-relieving and fever-reducing medications such as ibuprofen or paracetamol
Lozenges or throat sprays with local anesthetic effects to relieve sore throat

Antibiotic Therapy

When bacterial tonsillitis caused by streptococci is confirmed or highly probable, antibiotic therapy is recommended. The first-line treatment is penicillin V for 7 to 10 days. In the case of penicillin allergy, cephalosporins or macrolides are used. Consistent adherence to the full course is essential to prevent complications such as rheumatic fever or glomerulonephritis.

Surgical Treatment (Tonsillectomy)

For frequently recurring tonsillitis (chronic or recurrent tonsillitis) or in cases of complications such as a peritonsillar abscess, surgical removal of the tonsils (tonsillectomy) may be considered. According to clinical guidelines, this is typically recommended when tonsillitis occurs more than 6 times per year or more than 3 times per year over two consecutive years.

Complications

In rare cases, untreated or inadequately treated tonsillitides can lead to serious complications:

Peritonsillar abscess: A collection of pus beside the tonsil, often associated with severe unilateral pain and trismus (jaw stiffness)
Rheumatic fever: An inflammatory condition that can affect the heart, joints, and nervous system
Post-streptococcal glomerulonephritis: Inflammation of the kidney glomeruli
Otitis media: Middle ear infection resulting from spread of the infection

References

German Society of General Practice and Family Medicine (DEGAM): S2k Guideline on Sore Throat (2020). AWMF Register No. 053-010.
Windfuhr JP et al.: Clinical practice and guidelines for tonsillectomy. HNO, Springer Medizin (2016).
World Health Organization (WHO): Streptococcal pharyngitis and rheumatic fever. WHO Technical Report Series (2004).

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