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Strep is not the only cause of a throat or tonsil infection

DEAR DR.PAUL: My 7 year old daughter has swollen tonsils and has had for years. Is it normal for tonsils to be that swollen? And is Strep throat the same as a tonsil infection?

PEDIATRICIAN DR.PAUL Answers: I am glad you asked these questions which I get all the time from parents.

Both of the issues you raise are quite common but let me first discuss tonsils. Enlarged tonsils are quite common in children, and although we do not understand the role of tonsils, they may be related to some sort of protection against infection. They are part of the " Lymph" tissue of the body, like the adenoids, and appendix. We also know that the lymph tissue, including tonsils, grows, especially in the 5-10th years of life and then on their own, shrink down.

In the meantime, if the tonsils get repeatedly infected or block the child's ability to breath or swallow properly, and/or prevent the child from sleeping well, they are usually surgically removed .This procedure, performed under a general anaesthetic is called a "tonsillectomy". Fortunately, most children with enlarged tonsils are very normal and have no other problems related to the large tonsils. They grow up normally and the tonsils eventually shrink on their own. So even if they look quite big, enlarged tonsils may not necessarily be a problem, in an otherwise very well and thriving child.

The tonsils are in the throat area, so a tonsil infection usually means a throat infection. Children and adults can get throat infections even if they have no tonsils. This is called a "Pharyngitis". It is important to know that by far the most frequent cause of a throat or tonsil infection is a virus. Viral throat or tonsil infections go away on their own without antibiotics. However, Strep Throat or infection, caused by the " Streptococcus" bacteria, does require antibiotic treatment.

How can we tell if the infection is caused by a virus or by the Streptococcus bacteria? This can be quite difficult.

Sometimes the symptoms can help. Generally "Strep throat" symptoms are limited to the throat; a severe sore throat, difficulty swallowing and fever. In contrast a viral throat infection may also present with symptoms of a cold such as nasal congestion and cough. Trying to guess the cause of the infection simply by looking at the infected throat or tonsils is not helpful either. The only way to really know is to do a test called a "throat swab". Using a long Q-tip like "swab", the throat and tonsils are gently touched. This can sometimes be quite difficult to do especially on younger children.

The swab is then analyzed to see if the infection is caused by Streptococcus or not. If the swab test is negative, then antibiotics are not needed as the infection is presumed to be caused by a virus. A positive throat swab test means that the child has a "Strep" throat and requires antibiotic treatment.

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