Causes

It may be caused by Group A streptococcal bacteria, when it is sometimes confused with strep throat. Most tonsilitis however is viral in origin, such as the Epstein-Barr virus (the cause of glandular fever) or the Coxsackie virus.

Treatment

Treatment consists of plenty of painkillers and fluids; if caused by bacteria then antibiotics are also prescribed. Usually penicillin, or erythromycin if the patient is allergic to penicillin. Amoxicillin should not be used because if mononucleosis is mistaken as tonsillitis and amoxicillin is given, a rash might develop.

Complications

An abscess may develop lateral to the tonsil during an infection, typically several days after the onset of tonsillitis. This is termed a peritonsillar abscess (or quinsy). Very rarely a secondary infection may grow in the abscess which can give rise to a spreading septicaemia infection (Lemierre's syndrome).

In chronic cases (generally defined as 6 or more episodes a year ^[1]), or in acute cases where the palatine tonsils become so swollen that swallowing is impaired, a tonsillectomy can be performed to remove the tonsils. Patients whose tonsils have been removed are still protected from infection by the rest of their immune system.

When bacteria that collects on the tonsils consume mucus that has pooled in pits (referred to as "crypts") in the tonsils, a whitish-yellow deposit known as a tonsillolith is produced. These "tonsil stones" emit a very pungent odor due to the presence of volatile sulphur compounds.

Tonsilloliths (or tonsil stones) which occur in the crypts of the tonsils can only be cured by tonsillectomy or by sealing the crypts by laser. It is still possible to get tonsiloliths after removal of the tonsils unless a complete tonsillectomy is performed.

Hypertrophy of the tonsils can result in snoring, mouth breathing, disturbed sleep, and obstructive sleep apnea, during which the patient stops breathing and experiences a drop in the oxygen content in the bloodstream. A tonsillectomy can be curative.