The oval collections of lymphoid tissue on either side of the back of the tongue, the tonsils are small or absent in adults but easily seen in children. The visible surface is covered with mucous membrane which indents the tonsilar tissue to form deep narrow pits or crypts in which inflammatory debris can accumulate when the tonsils are infected. The inner surface has a capsular sheath attached by loose connective tissue to the deeper pharyngeal wall. Each tonsil has its own chief artery entering on its deeper surface. Its lymph vessels end in glands or lymph nodes behind and below the angle of the lower jaw. These nodes enlarge when the tonsils become inflamed or infected.

The tonsils, like the adenoids at the back of the nose, commonly become inflamed and infected in the numerous upper respiratory tract infections of children because they are the first line of body defense against invasion by harmful microorganisms. The tonsillar tissue is capable of recognition of potentially harmful germs and mounts an appropriate defense response, reddening and enlarging as it deals with the invaders. White purulent material often accumulates on the surface and in the pits.

Acute tonsillitis most often occurs in children from about the age of five. The affected child is obviously ill, feverish and flush. A young child does not complain of a sore throat but refuses to eat because swallowing is painful; he may complain of abdominal pain. A child over six years old will complain of a sore throat and difficulty in swallowing. The tonsils are large, red, swollen, and may have whitish green specks of on them. There are usually painful lumps in the neck (glands).

Medical attention should be sought. Until the doctor comes, parecetamol elixir or soluble aspirin should be given with water every four hours, with plenty of fluids to drink. Dosage should be according to the instructions on the bottle.

The treatment of acute tonsillitis

Only about half the cases of tonsillitis are caused by a bacterium sensitive to antibiotics. If an antibiotic is given it is important that it is taken for the full course at regular intervals otherwise the tonsillitis will recur. The other causes are caused by viruses, (edenovirus, echovirus and influenza virus) and do not respond to antibiotic treatment.

Removal of children’s tonsils (tonsillectomy) is much less common than it once was. It is not necessary after only one or two attacks of tonsillitis in a child. Adult tonsillitis is similar to that of a child but is less common. In adolescents, the tonsils may become acutely inflamed in glandular fever.


The only common complication of tonsillitis is quinsy, an abscess of the peritonsillar space (the surrounding tissue of the tonsil). It only occurs about a week after the original tonsillitis. The patient is acutely ill with symptoms of high temperature, difficulty opening the mouth, and pain in the neck and the ear on the affected side.

Sometimes quinsy needs to be surgically drained (under a local anesthetic). At other times treatment with an antibiotic, usually penicillin, suffices.


European Archives of Oto-Rhino-Laryngology, Volume 265, Number 6, pp. 66-70(5), July 2006

Acute Tonsillitis – Tonsillitis Medical Information, Medicine Online