Angina tonsillaris

Tonsillitis is an inflammation of the tonsils and will often, but not necessarily, cause a sore throat and fever.

Types
There are 3 main types of tonsillitis: acute, subacute and chronic. Acute tonsillitis can either be bacterial or viral in origin. Subacute tonsillitis (which can last between 3 weeks and 3 months) is caused by the bacterium Actinomyces. Chronic tonsillitis, which can last for long periods if not treated, is almost always bacterial.

Symptoms
Tonsillitis is characterized by red, swollen tonsils. White patches may or may not appear on the tonsils. Other signs and symptoms of tonsillitis include a severe sore throat, painful/difficult swallowing, headache, fever and chills, enlarged and tender lymph nodes, pain in the tonsil area, and loss of voice.

Causes
Bacterial tonsillitis may be caused by Group A streptococcal bacteria, resulting in strep throat. Viral tonsillitis may be caused by numerous viruses such as the Epstein-Barr virus (the cause of infectious mononucleosis) or the Adenovirus.

Sometimes, tonsillitis is caused by a superinfection of spirochaeta and treponema, in this case called Vincent's angina or Plaut-Vincent angina.

Treatment
Treatments of tonsillitis consist of pain management medications and lozenges. If the tonsillitis is caused by bacteria, then antibiotics are prescribed. Penicillin is the most commonly used antibiotic.

In many cases of tonsillitis, the pain caused by the inflamed tonsils warrants the prescription of topical anesthetics for temporary relief. Viscous lidocaine solutions are often prescribed for this purpose.

Ibuprofen or other analgesic can help to decrease the edema and inflammation which will ease the pain and allow the patient to swallow liquids sooner.

When tonsillitis is caused by a virus, the length of illness depends on which virus is involved. Usually, a complete recovery is made within one week, however some rare infections may last for up to two weeks.

Chronic cases may indicate tonsillectomy (surgical removal of tonsils) as a choice for treatment.

Also using hot water and salt solution, and gargling may help kill the infection, though it's not a strong treatment.

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). Rarely, the infection may spread beyond the tonsil resulting in inflammation and infection of the internal jugular vein giving rise to a spreading septicaemia infection (Lemierre's syndrome).

In chronic/recurrent cases (generally defined as seven episodes of tonsillitis in the preceding year, five episodes in each of the preceding two years or three episodes in each of the preceding three years),  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 certainly still protected from infection by the rest of their immune system.

Bacteria feeding on mucus which accumulates in pits (referred to as 'crypts') in the tonsils, produce whitish-yellow deposits known as tonsilloliths. These "tonsil stones" emit a very pungent odour due to the presence of volatile sulphur compounds.

Tonsilloliths which occur in the crypts of the tonsils can only be completely cured by tonsillectomy or by resurfacing the tonsil by laser, but practicing good oral hygiene and use of a water pick may help lessen the symptoms.

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.

In very rare cases, diseases like rheumatic fever or glomerulonephritis can occur. These complications are extremely rare in developed nations but remain a significant problem in poorer nations.