Throat & Tonsils

The Centor criteria help distinguish strep from viral: fever above 38°C, exudate (white patches) on the tonsils, swollen tender lymph nodes in the front of the neck, and absence of cough — each scores one point. A score of 3-4 suggests strep and warrants a rapid strep test or throat swab (or empirical antibiotics if testing is unavailable). A score of 0-1 is very likely viral — antibiotics not indicated. Cough, runny nose, hoarseness, and mouth ulcers all point toward viral. Penicillin (or amoxicillin) for 10 days remains the antibiotic of choice for strep throat. The reason a full course matters: preventing rheumatic fever, not just feeling better faster.

A peritonsillar abscess (quinsy) is a collection of pus that forms behind the tonsil, usually as a complication of tonsillitis. It causes severe one-sided throat pain (worse than any previous tonsillitis), difficulty swallowing, a muffled 'hot potato' voice, drooling (saliva painful to swallow), difficulty opening the mouth (trismus), and the uvula is pushed to the opposite side on examination. It is an ENT emergency — it needs drainage (either needle aspiration or incision and drainage) under local anaesthetic, antibiotics, and pain management. Left untreated, the abscess can spread to the deep neck spaces (parapharyngeal abscess, Ludwig's angina) — a potentially life-threatening infection. If you develop these symptoms, go to an emergency department, not a GP clinic.

Yes — untreated streptococcal tonsillitis can trigger rheumatic fever 2-4 weeks later in susceptible individuals. Rheumatic fever causes joint inflammation, but more importantly, it inflames the heart valves (rheumatic carditis). Repeated episodes of strep throat without treatment lead to repeated valve damage — ultimately causing rheumatic heart disease, narrowing and leaking of the mitral and aortic valves, and eventually heart failure requiring valve surgery. This was a common cause of heart disease in India decades ago and remains significant in parts of the country with poor antibiotic access. This is precisely why penicillin for strep throat and secondary prevention with monthly benzathine penicillin injections after rheumatic fever are still important public health measures in India.

Evidence-based indications: recurrent tonsillitis meeting the Paradise criteria (7+ episodes in 1 year, 5+ per year for 2 years, or 3+ per year for 3 years with each episode documented with fever, exudate, positive strep culture, or antibiotic treatment), peritonsillar abscess (especially recurrent), obstructive sleep apnea caused by enlarged tonsils (particularly in children), and suspected tonsillar malignancy. Tonsillectomy is not indicated for mild or infrequent tonsillitis, occasional sore throats, or 'large tonsils' alone without symptoms. In adults, recovery is significantly more painful than in children and takes 10-14 days. Post-operative bleeding (occurring in 1-3% of cases) is the main complication — any significant bleeding after tonsillectomy requires immediate return to hospital.

In adults, no — once the tonsils are surgically removed, they do not grow back. In children, a small proportion of tonsil tissue can regenerate if a small remnant was left during the original operation, but full regrowth is rare. Adenoids (the tonsil-like tissue at the back of the nasal cavity) can sometimes regrow in children after removal, as the adenoid tissue is more diffuse. Symptom recurrence after tonsillectomy — recurring sore throats, for example — is usually from other throat tissues responding to infection, not regrown tonsils. If symptoms return, evaluation for other causes (persistent strep carriage, acid reflux affecting the throat, other throat pathology) is more productive than attributing it to tonsil regrowth.