Tonsillitis is one of the common conditions that can be widely seen in all age groups. However, it is particularly prevalent among teenagers. 

Introduction

Tonsillitis is an infection of the tonsils at the sides of your throat. It's a common childhood illness, but teenagers and adults can get it too.¹ Tonsils are lymphoid tissues that play an important role in the body's immune mechanism. As tonsils are located at the beginning of the throat, they become primary organs to fight infections that enter the body through the mouth and nose. When the tonsils become infected, they swell, leading to pain and discomfort. 

Tonsillitis can occur in people of all ages, but it is most common in children and teenagers. Teenagers are more susceptible because they are frequently exposed to germs, especially in school settings. 

Causes of tonsillitis

Tonsillitis is generally the result of an infection, which may be viral or bacterial

Bacterial infections 

Bacterial infections are typically due to group A beta-hemolytic Streptococcus (GABHS)²

Other bacteria include: 

• Staphylococcus aureus
• Streptococcus pneumoniae
• Haemophilus influenza
• Corynebacterium diphtheriae
• HIV
• Syphilis
• Gonorrhea
• Chlamydia

Viral infections

Viral etiologies are the most common.²

Viruses include: 

• Rhinovirus
• Respiratory syncytial virus
• Adenovirus
• Coronavirus.
• Epstein-Barr (causing mononucleosis)
• cytomegalovirus
• hepatitis A
• Rubella
• HIV

Transmission methods

Tonsillitis spreads easily through close contact. 

• When someone infected coughs, sneezes, or talks, they release droplets containing the bacteria or virus into the air. If these droplets come into contact with another person, especially in crowded places like schools, there is a high risk of transmission
• Sharing utensils or drinks with someone who has tonsillitis can also spread the infection

Symptoms of tonsillitis

Symptoms in children and adults can include:

• sore throat
• problems swallowing
• high temperature
• coughing
• headache
• feeling sick
• earache
• feeling tired

Sometimes the symptoms can be more severe and include:

• swollen, painful glands in your neck (feels like a lump on the side of your neck)
• pus-filled spots or white patches on your tonsils
• bad breath¹

Sore throat

A persistent sore throat is the hallmark symptom of tonsillitis. The pain may worsen when swallowing and can make eating and drinking difficult.

Swollen tonsils

The tonsils often become red and swollen, sometimes with white or yellow patches of pus on their surface. This swelling can cause discomfort, especially when swallowing.

Difficulty swallowing

Due to the inflammation, swallowing may become painful or difficult. Teenagers with tonsillitis may avoid eating or drinking because of this pain.

Fever

Many teenagers with tonsillitis experience a fever, which is the body’s way of fighting off infection.

Fatigue

Because the body is fighting an infection, teenagers may feel more tired than usual.

Bad breath

The infection can lead to a foul smell in the mouth due to the buildup of bacteria in the tonsils.

The duration of tonsillitis symptoms varies depending on the cause. Viral tonsillitis usually resolves on its own within 7-10 days, while bacterial tonsillitis may persist longer without treatment.

Why is tonsillitis common in teenagers?

There are several reasons why tonsillitis is particularly common in teenagers:

Immune system changes: During adolescence, the immune system undergoes changes as the body transitions from childhood to adulthood. While the immune system is still developing, teenagers are more susceptible to infections, including tonsillitis.

Higher exposure to germs in school settings: Schools are breeding grounds for germs because of close contact between students. Teenagers are frequently exposed to various viruses and bacteria, increasing their risk of contracting infections like tonsillitis.

Lifestyle factors: Teenagers often have busy schedules that may affect their health. Lack of sleep, high-stress levels, and poor diet can weaken the immune system, making them more prone to infections. Stress from schoolwork, exams, or extracurricular activities can contribute to their vulnerability to illnesses like tonsillitis.

Diagnosis of tonsillitis

Diagnosing tonsillitis typically involves a physical examination and, in some cases, tests to confirm whether the infection is viral or bacterial. The main diagnostic methods include:

Physical examination

A doctor will examine the throat for signs of inflammation, such as redness, swelling, and white or yellow patches on the tonsils. The doctor may also check the neck for swollen lymph nodes, which can be a sign of infection.

Throat swab and rapid strep test

To determine if the tonsillitis is caused by a bacterial infection (such as strep throat), the doctor may take a throat swab. This sample is tested to detect the presence of bacteria. A rapid strep test can provide results within minutes, but a more thorough culture may take a day or two.

Throat swabs are neither specific nor sensitive to micro bacteria, causing sore throat symptoms. However, current guidelines suggest they are still useful in some cases; and the clinical diagnosis of symptomatic patients needs confirmation by throat culture and the microbiological evidence of bacteria in the throat swab which proves the existence of bacteria in the swab site.³

Differentiating from other throat conditions

Tonsillitis shares symptoms with other throat conditions, such as strep throat and pharyngitis. A throat swab helps distinguish between these conditions and ensures that the correct treatment is given.

Treatment options

The treatment for tonsillitis depends on whether it is caused by a virus or bacteria. There are several approaches to managing the condition:

Home remedies

For mild cases of tonsillitis, especially those caused by a virus, home remedies can help relieve symptoms. 

These include:

• Drinking plenty of fluids to stay hydrated and to soothe the throat
• Gargling with warm salt water to reduce throat discomfort
• Getting plenty of rest to support the body’s immune system
• Using throat lozenges or sprays to ease pain

Medical treatments

If the tonsillitis is caused by bacteria, antibiotics may be prescribed. Antibiotics, such as penicillin or amoxicillin, help to eliminate the infection and prevent complications. It’s important to complete the full course of antibiotics even if symptoms improve before the medication is finished.

Over-the-counter pain relief

Medications like ibuprofen or acetaminophen can help reduce pain and fever associated with tonsillitis. These can be purchased without a prescription and are useful for symptom management.

When surgery (tonsillectomy) is necessary

In some cases, tonsillitis may become a recurring problem or lead to chronic issues. If a teenager experiences frequent episodes of tonsillitis, a doctor may recommend a tonsillectomy, which is the surgical removal of the tonsils. This procedure is usually only recommended after multiple infections or if tonsillitis causes significant health issues, such as breathing difficulties or sleep apnea.

Complications if left untreated

While most cases of tonsillitis resolve without complications, leaving tonsillitis untreated can lead to more serious health problems. Some potential complications include:

Possible spread of infection

If the infection is caused by bacteria and is not treated, it may spread to surrounding areas, leading to an abscess (a collection of pus) near the tonsils. This can cause severe pain and may require drainage.

Risk of recurrent tonsillitis or chronic tonsillitis

If a teenager experiences frequent tonsillitis, it may develop into chronic tonsillitis. This can lead to ongoing discomfort and health issues, including difficulty swallowing or breathing.

Long-term effects like sleep apnea or breathing issues

In severe cases, tonsillitis can cause the tonsils to become so enlarged that they obstruct breathing, especially during sleep. This condition, known as sleep apnea, can lead to poor sleep quality and other health problems if not addressed.

Prevention of tonsillitis

Preventing tonsillitis involves good hygiene and maintaining a strong immune system. Here are some steps that can help reduce the risk:

Good hygiene practices

Encourage teenagers to wash their hands regularly, especially before eating and after coughing or sneezing. They should avoid sharing utensils, drinks, or other personal items with others to prevent the spread of germs.

Strengthening the immune system

A healthy lifestyle can boost the immune system and reduce the likelihood of infections. Eating a balanced diet, getting regular exercise, and ensuring adequate sleep are important factors in preventing tonsillitis and other infections.

When to seek medical advice early

If a teenager develops a sore throat or other symptoms of tonsillitis, it’s important to seek medical advice early. Timely diagnosis and treatment can prevent complications and ensure a quicker recovery.

Summary

• Tonsillitis is common among teenagers due to their developing immune systems, frequent exposure to germs, and lifestyle factors like stress and lack of sleep
• Understanding the causes, symptoms, and treatments for tonsillitis can help parents and teenagers manage the condition effectively
• In most cases, tonsillitis resolves with home care or medical treatment, but it’s essential to prevent complications by seeking medical advice when needed
• By practising good hygiene and maintaining a healthy lifestyle, teenagers can reduce their risk of getting tonsillitis and other infections