Inflammation of the tonsils. Tonsillitis occurs predominantly in children and young adults. So-called ‘common’ tonsillitis is caused by bacteria or viruses. In many cases a viral infection occurs first (while the patient has a cold, for example), which weakens the resistance of the tonsil cells and allows bacteria, almost always haemolytic streptococci, to invade. The symptoms of common tonsillitis are a sore throat, pain when swallowing, a general feeling of malaise, with fever, loss of appetite and headache. The fever can be high, and associated with shivering attacks. Examination of the throat reveals red and swollen tonsils with white spots on the surface, caused by accumulation of pus in the tonsils. Also the lymph nodes in the neck below the ear are enlarged and tender. Common tonsillitis almost always clears up spontaneously within a week. Measures that encourage recovery and help the patient to feel less unwell are bed rest, a light diet, drugs to reduce fever and pain, and wearing an ice pack around the neck. Gargling does not aid recovery; it is even possible that it will irritate the tonsils, and thus increase discomfort. Antibiotics are generally not necessary, first because the inflammation usually subsides of its own accord, and second because the viruses that cause most cases of tonsillitis are not affected by antibiotics. Only if the patient has high fever and there are strong indications that the inflammation is streptococcal are antibiotics (usually penicillin) prescribed. Tonsillectomy is the surgical removal of both tonsils. Recently tonsillectomy has been much less frequently performed. One reason against it is that there is increasing evidence that the tonsils in young children are an important part of the body’s defences against disease-causing agents entering via the throat; thus tonsillectomy can reduce resistance to diseases affecting the air passages. Nevertheless there are a number of conditions in which tonsillectomy might well be necessary: recurrent tonsillitis, gross enlargement of the tonsils leading to breathing and swallowing difficulties, and when complications occur, such as the formation of abscesses in the throat and lymph nodes. With small children a light anaesthetic is adequate for a tonsillectomy. The tonsils are removed with a special instrument (van Sluder knife) and the resulting wound heals within a few days. Streptococcal tonsillitis can cause a number of serious complications, but fortunately this is rare. The inflammation can spread beyond the tonsils and cause an abscess in the back of the throat (peritonsillar abscess), or to the lymph nodes, causing abscesses there. If the streptococci enter the bloodstream from the tonsils, inflammation reactions can occur in various other parts of the body. In the kidneys the glomeruli are affected, causing glomerulonephritis. Rheumatic fever is mainly a disease of children, characterized by inflammation of the joints and the heart. The symptoms manifest themselves about three weeks after an attack of streptococcal tonsillitis. The inflammation of the joints clears up quite quickly, but if one or more of the heart valves becomes inflamed deformation of the valves can result. In women rheumatic fever as a result of streptococcal tonsillitis is the most important cause of incompetent heart valves.