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Tonsillitis is an inflammation of the tonsils. The most common bacteria which cause this disease include group A, B, C and G hemolytic streptococci. All of the hemolytic bacteria are connected with the development of rheumatic fever which is only one of the compilations of tonsillitis. The condition very rarely occurs due to infection caused by Bacteroides species, Hemophilus influenzae, Staphilococcus aureus, Moraxella catarrhalis and Mycoplasma pneumoniae. Extreme cases may include Corynebacterium diphteriae and Francisella tularensis. They are responsible for lethal membranous pharyngotonsillitis.

The severe complications are not so common but if they occur they include peritonsillar and intratonsillar abscess, deep neck space infections, inflammatory torticollis, hemorrhagic tonsillitis, postangilar sepsis and vascular complications.

Peritonsillar abscess is a collection of pus located in deep areas of the neck. This most frequent infection spreads along the connective tissue of the tonsils into the peritonsillar space. Sometimes this condition is treated by needle aspiration or by making an incision along with the drainage of the abscess. Another solution is tonsillectomy.

Intratonsillar abscess, also known as phlegmonous tonsillitis is rather rare and includes the formation of the very abscess within the tonsil. The symptoms and the treatment for this complication are the same as in the case of peritonsillar abscess.

Deep neck infections are not so frequent. What happens is that peritonsillar abscess may spread and affect deep tissues of the neck (mainly peripharingeal space but peripharingeal space can be affected as well). The condition is very dangerous and the patient shows the signs of fever and prostration. The diagnosis is set after the CT scan of the head and neck is performed. The treatment includes antibiotics and external drainage. The most severe cases can end with erosion of the internal carotid artery, thrombophlebitis of the internal jugular vein or mediastinitis and necrotizing fasciitis.

Inflammatory torticollis occurs when the infection spreads to the neck and the neck is in the wrong position either drawn down or rotated to one side with the chin facing the other side. This is due to spasm of sternocleidomastoid muscle. The treatment for this condition is immobilization of the neck. The spine films have to rule out the possibility of fracture and rotatory subluxation.

Vascular complications include the formation of hematoma which is a tense, purple or brownish change on the skin or mucosa. This is caused by peritonsillar abscess and deep neck abscesses. All the cases which include recurrent hemorrhage from the nose, ears or throat must be thoroughly examined. Lingering clinical course of several weeks or more may point to the occult abscess. Cranial neuropathies of the X and the XII and even a case of Horner's syndrome must be taken seriously as they may be caused by the hemorrhage.

Hemorrhagic tonsillitis is an extremely rare complication.

Postanginal sepsis is a complication of anaerobic tonsillitis. It starts with mild tonsillar infection and ends with life-threatening thrombophlebitis of the internal jugular vein. The symptoms include strong pain in the neck and palpable mass under the sternocleidomastoid muscle. High temperature, chills and stiff neck are present as well. This severe complication can lead to additional problems including potential septic embolisation and metastatic abscesses in the lungs, liver or brain or septic arthritis osteomyelitis. The diagnosis is set by CT scan and the treatment includes antibiotics with the emphasis on anaerobic coverage. Even drainage of the abscess is performed together with ligation or excision of infected veins if necessary.

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