Tonsillitis – symptoms, causes, complications and risk factors


This is a term which is used to describe an inflammation of the tonsils. Tonsils are oval – shaped pads of tissue which are located at the back of the throat. There are two tonsils, one tonsil on each side. Signs and symptoms of this type of inflammation include tender lymph nodes on the sides of the neck, difficulty swallowing, sore throat and swollen tonsils. In the most cases, tonsillitis is caused by infection with a common virus but also there are some cases when bacterial infections could also lead to tonsillitis. The appropriate treatment for this condition depends on the cause and this is a reason why it is very important to get prompt and accurate diagnosis. When tonsillitis causes serious complications, does not respond to other treatments or when the bacterial tonsillitis occurs frequently, then in these situations must be done surgery to remove tonsils. [1]

Tonsillitis symptoms

There are some studies in which are said that tonsillitis is most commonly affecting children who are between preschool ages and the mid – teenage years. [2] Below are given the most common signs and symptoms of tonsillitis:

  • Headache
  • Stiff neck
  • Stomachache, particularly in younger children
  • Bad breath
  • A scratchy, muffled or throaty voice
  • Enlarged, tender glands (lymph nodes) in the neck
  • Fever
  • Difficult or painful swallowing
  • Sore throat
  • White or yellow coating or patches on the tonsils
  • Red, swollen tonsils

Here are some signs of tonsillitis in young children who are unable to describe how they feel:

  • Unusual fussiness
  • Refusal to eat
  • Drooling due to difficult or painful swallowing

If you have noticed that your child has some signs and symptoms of tonsillitis, then you need to talk with his or her doctor because it is very important to get appropriate diagnosis and treatment. If your child is experiencing extreme weakness, fatigue or fussiness, then you should talk with his or her doctor. Also you need to talk with his or her doctor if your child has painful or difficulty swallowing or he or she has a sore throat that does not go away within 24 – 48 hours.

tonsillitis Tonsillitis causes

This condition is most commonly caused by viruses but also there are some cases when bacterial infections could lead to tonsillitis. Streptococcus pyogenes (group A streptococcus) is bacterium which is the cause for strep throat but also this bacterium is the most common cause for tonsillitis. We know that our tonsils are the first defense line of our immune system against viruses and bacteria that enter in our mouths. This function of tonsils is making them vulnerable to inflammation and infection. But the tonsil’s immune system function declines after the puberty. This is a factor which can account for the rare cases of tonsillitis in adults.

Risk factors: Here are some risk factors for tonsillitis:

  • Frequent exposure to germs: It is known fact that school – age children are in close contact with their peers and they are frequently exposed to bacteria or viruses that could lead to tonsillitis. [1,3]
  • Young age: This type of inflammation most often is happening in children but in rare cases is happening in children that are younger than 2. Tonsillitis that is caused by bacteria is most common in children that are between 5 and 15 age while younger children are having bigger risk of getting viral tonsillitis. [2,3]

Complications: It is known that the swelling or inflammation of the tonsils from the frequent or ongoing, chronic, tonsillitis can cause complications such as

  • Infection that results in a collection of pus behind a tonsil (peritonsillar abscess) [4]
  • Infection that spreads deep into surrounding tissue (tonsillar cellulitis) [5]
  • Disrupted breathing during sleep (obstructive sleep apnea) [6]
  • Difficulty breathing

Strep infection: If someone has tonsillitis that is caused by group A streptococcus or another strain of streptococcal bacteria and this condition is not treated, or if it is treated but the antibiotic treatment is incomplete, then your child has an increased risk of rare disorders such as:

  • Poststreptococcal glomerulonephritis: This is an inflammatory disorder of the kidneys which is resulting in inadequate removal of waste and excess fluids from the blood. [7]
  • Rheumatic fever: This is an inflammatory disorder which is affecting joints, heart and other tissues. [8]


[1] National Institutes of Health. Understanding recurrent tonsillitis. 2019. Retrieved from

[2] Stelter K. Tonsillitis and sore throat in children. GMS Current Topics in Otorhinolaryngology – Head and Neck Surgery. 2014;13:Doc07.

[3] La Jolla Institute for Immunology. Why your kid’s strep throat keeps coming back: A combination of genetic and immunological factors makes some children susceptible to the bacteria that cause strep throat. Science Daily. 2019.

[4] Castagnini LA, Goyal M, Ongkasuwan J. Tonsillitis and peritonsillar abscess. Infectious Diseases in Pediatric Otolaryngology. 2015:137–50.

[5] Sasaki CT. Tonsillar cellulitis and tonsillar abscess. MSD Manual Consumer Version. 2020. Retrieved from

[6] Cahali MB, Soares CFdP, Dantas DAdS, Formigoni GGS. Tonsil volume, tonsil grade and obstructive sleep apnea: is there any meaningful correlation? Clinics. 2011;66(8).

[7] Bhimma R. Acute poststreptococcal glomerulonephritis. Medscape. 2018. Retrieved from

[8] Rogers LS. Tonsillitis and rheumatic fever. A.M.A. Archives of Otolaryngology. 1958;67(5):569-76.


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