Overview Tonsillitis is inflammation or infection of the tonsils. Tonsils are lymphoid tissues that are situated on both side of the throat. Generally, the palatine tonsil are referred to as "the tonsils".

Tonsils: Collections of lymphoid tissue at the entrance to the pharynx, on either side of the uvula (the palatine tonsils). There are also lingual tonsils at the base of the tongue. All of these as well as the adenoids are part of Waldeyer’s ring
Tonsillitis: Inflammation of the tonsils. Usually refering to infection
Adenoids: Collection of lymphoid tissue near the opening of the Eustachian tube

Anatomy Nasopharynx and Oropharynx

Signs and Symptoms

  • Sore throat
  • Odynophagia (painful swallow)
  • Fever
  • Malaise
  • Enlarged cervical lymph nodes
  • Enlarged red tonsils

Differential Diagnosis

Differential Diagnosis  of the sore throat

  • Peritonsillar abscess (Quinsy)
  • Infectious mononucleosis (EBV)
  • Epiglottitis
  • Bacterial tracheitis
  • Retropharyngeal abscess


  • FBC
  • EUC
  • Paul-Bunnell or monospot blood test - Mononucleosis (glandular fever)


A typical attack of acute tonsillitis will last from 3 to 7 days. The main organisms implicated are as follow:

  • Viruses
  • Pyogenic bacteria:
    • Haemophilus influenzae
    • Pneumococcus spp.
    • Group A Haemolytic Streptococcus



  • Analgesia (paracetamol)
  • Fluids
  • Antibiotics (penicillins - first line)
  • Tonsillectomy is one of the most common operations performed in both adults and children.
Recurrent tonsillitis >6/year
Oropharyngeal obstruction (Sleep apnoea or swalling difficulty)
Abscess (Quinsy)

Complications and Prognosis


  • Peritonsillar abscess (Quinsy)
  • Retropharyngeal abscess
    • Paraphayrngeal abscess
      • Mediastinitis
      • Venous thombosis
  • Rheumatic fever
  • Glomerulonephritis
  • Septicaemia (very rare)
  • Otitis media
  • Obstructive sleep apnoea

Prognosis Most cases of acute tonsillitis resolve spontaneously with no ill-effects. However, it can be a serious disease particularly in the immuno-compromised patient



Overview Adenoids are a collection of lymphoid tissue.  They are part of a circle of lymphoid tissue known as Waldeyer’s ring that surrounds the entrance to the pharynx and respiratory tract.

Adenoids are very small and reach maximum size at 8 years of age, and then regress. Adults have little or no adenoid tissue. In children, repeated infections cause adenoids to enlarge and obstruct the airway.

Adenoid hypertrophy Management

  • Adenoidectomy (usually done with tonsillectomy)