The typical symptoms of acute tonsillitis are a very sore throat with bright red, swollen tonsils. The onset of pain may be rapid or gradual. These symptoms may be accompanied by any of the following:
- A white or yellow coating or spots on the tonsils
- Drooling and difficulty swallowing saliva
- Ear pain when swallowing
- Bad breath
- Swollen and tender lymph nodes in the neck under the jaw
- Repeated infection may cause the formation of small depressions, called crypts, on the surface of the tonsils.
- hese crypts can harbour bacteria and may contain pus.
- Sometimes small hard secretions called "tonsilloliths" develop in these crypts. These hard secretions may contain sulphur and give off a characteristic "rotten egg" smell when crushed. This contributes to the patient’s bad breath.
- Tonsilloliths may also cause the unpleasant sensation of having something caught in the back of the throat.
Tonsillar abscess (Quinsy's abscess)
In addition to inflamed tonsils, a tonsillar abscess can result in:
- Severe pain and tenderness around the area of the soft palate, at the roof of the mouth
- Difficulty swallowing
- Muffled speech caused by swelling from the abscess
- Difficulty opening the mouth
Hypertrophic tonsils (enlarged tonsils)
Enlarged tonsils and adenoids can obstruct breathing. This can result in:
- Disturbed sleep patterns, including:
- Sleep apnoea (when the child stops breathing for brief periods while asleep)
- Frequent awakening from sleep
- Restless sleep
- Bed wetting
Such sleep-related problems can lead to the development of mood changes, excessive sleepiness, poor appetite and sometimes even heart problems.
- Chronic mouth breathing. This may sometimes result in the teeth to becoming poorly aligned (malocclusion).
- Chronic enlargement and infection of the tonsils, in combination with adenoidal infection, can cause infections in other nearby structures:
- The air passages in the region of the nose may become infected (sinusitis) and problems with nasal drainage or obstruction can develop.
- The Eustachian tubes of the ears may also be affected, resulting in chronic ear infections.
Reviewed by Prof Eugene Weinberg, Paediatrician Health24, February 2015.