Tonsillitis

Diagnosis

To diagnose tonsillitis, a healthcare professional typically begins with a physical exam. During the exam, they:

• Use a lighted instrument to inspect the throat, ears, and nose
• Check for a scarlatina rash, which may be linked to strep throat
• Gently palpate the neck to assess for swollen glands
• Listen to breathing with a stethoscope
• Check the spleen for enlargement, which can indicate mononucleosis

Throat swab
A healthcare professional may rub a sterile swab over the back of the throat to test for streptococcal bacteria. Rapid in-clinic tests can provide results within minutes, while throat cultures sent to a lab may take hours to days. A positive rapid test usually indicates a bacterial infection. If the test is negative, a viral infection is more likely, but a lab culture may be used for confirmation.

Complete blood count (CBC)
A CBC uses a small blood sample to measure types of blood cells. This can help determine whether an infection is more likely bacterial or viral. CBC is not always required for diagnosing strep throat but may be useful if other tests are inconclusive.

Treatment

Treatment for tonsillitis depends on the cause and severity and can include at-home care, antibiotics, or surgery.

At-home care
For viral tonsillitis, home care is the primary treatment. Symptoms usually improve within 7 to 10 days. Supportive care includes:

• Rest and adequate sleep
• Plenty of fluids to prevent dehydration
• Comforting foods and drinks, such as warm broth, caffeine-free tea, or cold treats like ice pops
• Warm saltwater gargle for children who can gargle (1/2 teaspoon of salt in 8 ounces of warm water)
• Use of a cool-air humidifier or short steam sessions to moisten the air
• Lozenges for children older than 4 to soothe the throat
• Avoiding irritants like cigarette smoke or strong cleaning products
• Pain and fever management with ibuprofen or acetaminophen as recommended by a healthcare professional

Antibiotics
If tonsillitis is caused by bacteria, a healthcare professional will prescribe antibiotics. Penicillin taken orally for 10 days is common for group A streptococcus. Alternative antibiotics may be prescribed for penicillin-allergic children. It is essential to complete the full course to prevent complications such as worsening infection, spread to other parts of the body, rheumatic fever, or kidney inflammation.

Surgery
A tonsillectomy, or surgical removal of the tonsils, may be recommended for:

• Frequent tonsillitis: seven times in the past year, five times per year over two years, or three times per year over three years
• Chronic or antibiotic-resistant bacterial tonsillitis
• Complications such as obstructive sleep apnea, breathing or swallowing difficulties, or persistent abscess

Tonsillectomy is usually an outpatient procedure, with a complete recovery taking 7 to 14 days. Hospital stays may be necessary for very young children, those with other medical conditions, or if complications arise during surgery.