Tonsillitis natural history, complications and prognosis

Acute tonsillitis will usually present with erythema and edema of the tonsils rapidly upon infiltration of the pathogen. It is usually self-limited and symptoms will be resolved within 3-4 days. Recurrent tonsillitis will usually not resolve itself and will require antimicrobrial therapy or tonsillectomy when indicated. Complications of tonsillitis are caused by persistence and/or spread of the responsible pathogen – usually bacterial. The prognosis for acute tonsillitis without treatment is usually good, while the prognosis for untreated recurrent tonsillitis will vary based on presence of life-threatening complications. With treatment, the prognosis of acute and recurrent tonsillitis is usually good.

• Acute tonsillitis will usually present with erythema and edema of the tonsils rapidly upon infiltration of the pathogen.^[1]
  • Symptoms, including fever and sore throat, will usually manifest within 24 hours of infection.
• Acute tonsillitis is usually self-limited and will be resolved within 3-4 days.
• Recurrent tonsillitis will usually not resolve itself and will require antimicrobrial therapy or tonsillectomy when indicated.^[2]
  • Left untreated, recurrent tonsillitis may persist and recur over periods of time and can lead to infectious complications.

Complications of tonsillitis are caused by persistence and/or spread of the responsible pathogen – usually bacterial – and include the following:^[1]

• Otitis media
• Peritonsillar abscess
• Sleep apnea
• Scarlet fever
• Rheumatic fever
• Glomerulonephritis
• Tonsilloliths^[3]

• The prognosis for acute tonsillitis without treatment is usually good; the disease is usually self-limited and will resolve itself within 3-4 days.^[1]
• The prognosis for recurrent tonsillitis varies based on the presence of life-threatening complications.^[4]
• With treatment, the prognosis of acute and recurrent tonsillitis is usually good.

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