What causes tonsillitis and adenoid infections?

The most common problems occurring with the tonsils and adenoids are

  • acute,
  • recurrent, or
  • chronic infections and significant enlargement (hypertrophy).

Acute tonsillitis

Acute tonsillitis is an infection of the tonsils caused by one of several possible types of bacteria or viruses. Symptoms of acute tonsillitis can either come on suddenly, or be of a gradual onset of a sore throat usually accompanied by a fever.

Other signs and symptoms of acute tonsillitis include:

  • Difficulty swallowing saliva
  • Drooling
  • Ear pain with swallowing
  • Bad breath
  • Tonsil surface may be bright red or have a grayish-white coating (exudate).
  • Lymph nodes in the neck may be swollen.
  • Fever

Strep throat is a specific type of infection caused by the Streptococcus bacteria. Strep tonsillitis can cause secondary damage to the heart valves (rheumatic fever) and kidneys (glomerulonephritis). It can also lead to a skin rash (for example, scarlet fever), sinusitis, pneumonia, and ear infections.

The Epstein-Barr virus causes acute mononucleosis and can lead to a very severe throat infection characterized by the rapid enlargement of the tonsils, adenoids, and lymph nodes of the neck. It also causes extreme malaise and tiredness. The sore throat and gland swelling can last for one week to a month and does not respond to the usually prescribed antibiotics.

Chronic tonsillitis

Chronic tonsillitis is a persistent infection of the tonsils. Repeated infections may cause the formation of small pockets (crypts) in the tonsils, which harbor bacteria. Frequently, small foul-smelling stones develop within these crypts. These stones (tonsilloliths) may contain high quantities of sulfa. When crushed, they give off the characteristic rotten egg smell, which causes bad breath. They may also give a patient the sense of something caught in the back of the throat.

Peritonsillar abscess

A peritonsillar abscess is a collection of pus around the tonsils that pushes one of the tonsils toward the uvula (the prominent soft tissue dangling from the back of the upper throat). It is generally very painful and is associated with decreased ability to open the mouth. If left untreated, the infection can spread deep in the neck causing life-threatening complications and airway obstruction.

Enlargement of (hypertrophic) tonsils and adenoids

Obstruction to breathing by enlarged tonsils and adenoids may cause snoring and disturbed sleep patterns that may lead to sleep pauses or sleep apnea.

Other signs and symptoms include:

Some orthodontists believe chronic mouth breathing from large tonsils and adenoids causes improper alignment of the teeth (malocclusion).

Chronic enlargement and infection of the adenoids may lead to infection of the air passages around the nose (sinusitis) or nasal drainage/obstruction, and/or may affect the Eustachian tube of the ears, leading to chronic ear infections.