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Tonsillitis occurs when there is an inflammation in the tonsils and in most cases it is caused either by a virus or bacterial infection. It can occur at any age and is a common health problem. In this article, we will explain the causes, symptoms and diagnosis of tonsillitis.
What Causes Tonsillitis
The tonsils are the two oval-shaped pads of tissue situated at the back of the throat. They act as a defence mechanism against potential bacteria and viruses, thereby making them more vulnerable to develop an infection  .
- Bacteria - Streptococcus pyogenes is the most common type of bacteria to cause tonsil infection. Other bacteria such as Fusobacterium, Staphylococcus aureus, Neisseria gonorrhoeae, Chlamydia pneumonia, Mycoplasma pneumonia, and Bordetella pertussis are also responsible  .
- Virus - The most common types of virus to infect the tonsils are rhinovirus, adenovirus, respiratory syncytial virus, and the virus that causes influenza or flu  .
Types Of Tonsillitis
- Acute tonsillitis- This type of tonsillitis is very common in children and the symptoms last for 10 days or less  .
- Chronic tonsillitis - People will experience an ongoing sore throat, bad breath and tender lymph nodes in the neck  .
- Recurrent tonsillitis - This type of tonsillitis has recurring episodes of a sore throat at least 5 to 7 times in 1 year.
A research study shows that both chronic and recurrent tonsillitis are caused due to biofilms in the folds of the tonsils  .
Symptoms Of Tonsillitis 
- Bad breath
- Sore throat
- A scratchy throat
- Difficulty in swallowing
- Stomach pain
- A stiff neck
- Red and swollen tonsils
- Swollen lymph glands
- Difficulty in opening mouth
Risk Factors Of Tonsillitis 
- Age (young children are increasingly affected)
- Frequent exposure to virus and bacteria
Complications Of Tonsillitis
- Obstructive sleep apnoea
- Difficulty in breathing
- Peritonsillar abscess 
- Tonsillar cellulitis
When To See A Doctor
If a person experiences a sore throat for more than 2 days, has high fever, stiff neck, difficulty in breathing, and muscle weakness, they should consult a doctor immediately.
Diagnosis Of Tonsillitis 
The doctor will first check for swelling or rash around the tonsils and then will recommend some tests, and these include:
- Throat swab - The doctor rubs a sterile swab on the back of the throat to collect a sample of the secretions produced, which is then checked for strains of bacteria or virus.
- Blood cell count - The doctor will take a sample of your blood to check for the presence of any bacterial or viral infection.
Treatment Of Tonsillitis 
Over-the-counter (OTC) pain-relieving medications are used to ease the symptoms of tonsillitis. If tonsillitis is caused by bacterial infection, the doctor will usually prescribe antibiotics.
Tonsillectomy is the surgery to remove the tonsils. This treatment option is generally not recommended until and unless it is chronic and recurring tonsillitis. It is suggested by the doctor if the tonsils are causing sleep apnoea, difficulty in swallowing and breathing, and pus build-up in the tonsils.
Home Remedies For Tonsillitis
- Gargle with saltwater to reduce throat discomfort
- Drink plenty of water
- Take plenty of rest
Prevention Of Tonsillitis
- Ensure that you and your child have good hygiene habits
- Avoid sharing food and drinking from the same glass
- Wash your hands thoroughly before eating and after using the toilet
-  Putto, A. (1987). Febrile exudative tonsillitis: viral or streptococcal?.Pediatrics,80(1), 6-12.
-  Brook, I. (2005). The role of anaerobic bacteria in tonsillitis.International journal of pediatric otorhinolaryngology,69(1), 9-19.
-  Goudsmit, J., Dillen, P. W. V., Van Strien, A., & Van der Noordaa, J. (1982). The role of BK virus in acute respiratory tract disease and the presence of BKV DNA in tonsils.Journal of medical virology,10(2), 91-99.
-  Burton, M. J., Towler, B., & Glasziou, P. (2000). Tonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis.The Cochrane database of systematic reviews, (2), CD001802-CD001802.
-  Brook, I., & Yocum, P. (1984). Bacteriology of chronic tonsillitis in young adults.Archives of Otolaryngology,110(12), 803-805.
-  Abu Bakar, M., McKimm, J., Haque, S. Z., Majumder, M., & Haque, M. (2018). Chronic tonsillitis and biofilms: a brief overview of treatment modalities.Journal of inflammation research,11, 329–337.
-  Georgalas, C. C., Tolley, N. S., & Narula, A. (2009). Tonsillitis.BMJ clinical evidence,2009, 0503.
-  Di Muzio, F., Barucco, M., & Guerriero, F. (2016). Diagnosis and treatment of acute pharyngitis/tonsillitis: a preliminary observational study in General Medicine.Eur. Rev. Med. Pharm. Sci,20, 4950-4954.