Tonsillitis: symptoms, what the throat looks like and what causes it

The morning doesn't start with coffee but with a quiet "my throat hurts" — and your thoughts immediately race: a cold, tonsillitis, or something worse. Children bring everything home from kindergarten, adults put it off until the last moment. Let's sort it out calmly: what this illness is, what the throat looks like and when it's time to see a doctor.

Tonsillitis: what it is

Tonsillitis is the everyday name for acute tonsillitis (from the Latin tonsillae — tonsils). It is an infectious disease in which the lymphoid pharyngeal ring becomes acutely inflamed, most often the palatine tonsils. The same word is used for an exacerbation of chronic tonsillitis.

What happens inside: the tonsils are clusters of lymphoid tissue at the entrance to the pharynx. When the tonsils become inflamed, a sore throat appears, especially when swallowing. A sore throat is a very common complaint, and it usually resolves on its own within a week.

How tonsillitis begins: first signs and symptoms

The onset is easy to mistake for a cold: the throat is dry and scratchy, swallowing is unpleasant, especially saliva. Redness is visible deep in the mouth, there may be an unpleasant odor, a mild cough and enlarged lymph nodes in the neck. In children the picture is the same, but a high temperature more often rises and the child becomes lethargic.

With streptococcus, symptoms appear 2–5 days after contact. The temperature rises suddenly and is usually highest on the second day, with chills added, a red sore throat with white patches, pain when swallowing, and tender cervical lymph nodes. There may be malaise, headache, nausea. Sometimes a rash resembling scarlet fever appears: it starts on the neck and chest and feels like sandpaper to the touch.

• pain when swallowing;
• a red throat and white coating on the tonsils;
• fever and chills;
• tender lymph nodes in the neck;
• in a child — a high temperature and lethargy.

What the throat and tonsils look like with tonsillitis

The doctor sees what we usually don't examine: the throat is red, and there may be white coatings (spots) on the tonsils.

Examining the throat at home with a spoon is a parents' habit, but a diagnosis is not made from the appearance of the tonsils. Viruses, fungi, ordinary pharyngitis and laryngitis produce a similar picture, so if streptococcus is suspected, a test is needed.

Types of tonsillitis

Acute tonsillitis can be catarrhal, lacunar, follicular, membranous, and in the form of parenchymatous tonsillitis. The catarrhal form develops acutely: first burning, dryness and scratching, then mild pain when swallowing; the temperature is usually subfebrile.

Episodes that recur with periods free of complaints are called recurrent tonsillitis, although in practice people more often say "chronic tonsillitis". There is an ulcerative-membranous form, involving Vincent's spirochete and the fusiform bacillus, and a fungal form — often after prolonged antibiotic treatment.

What causes tonsillitis

More than half of cases (over 50%) are associated with group A β-hemolytic streptococcus. Less often the culprits are staphylococcus, pneumococci, Haemophilus influenzae, mycoplasmas and chlamydia. The viral cause is adenoviruses (types 1–9), Coxsackie enterovirus, herpes virus; fungi of the genus Candida also occur.

Streptococcus spreads by airborne droplets and through saliva, and is easily transmitted within a family. Children aged 5–15 are affected more often, although anyone can get sick. Triggers include exposure to cold, reduced immunity, trauma to the tonsils, impaired nasal breathing, and chronic inflammation in the oral cavity, nose and sinuses.

Complications and when a doctor is needed

Complications of untreated streptococcal infection: rheumatic fever, kidney inflammation (post-streptococcal glomerulonephritis), a peritonsillar abscess, scarlet fever, guttate psoriasis. That is why, with confirmed streptococcus, the doctor prescribes antibiotics even if things have gotten easier after a couple of days.

See a doctor if a sore throat does not go away within a week or returns often, if it concerns a child under 5 years old, with a feeling of a lump or thickening in the mouth and neck, or with a mouth ulcer lasting longer than 3 weeks. The tests are simple: a rapid strep test in the office (it is sometimes negative even when the bacterium is present) and a throat swab with culture, with results in 1–2 days.

The same day, without delay: a very high temperature, fever or chills, signs of dehydration (urinating less often, dark urine with a strong odor), weakened immunity due to diabetes or chemotherapy.

Tonsillitis itself is not a reason to call an ambulance. You should call 103 or 112 if it is hard to breathe or impossible to swallow, if saliva runs out of the mouth, if a high-pitched whistling sound is heard on inhalation (stridor), or if the condition is severe and rapidly worsening.

This material is for reference and does not replace a doctor's consultation: it is better to show your throat to a real person in a white coat.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer