Acute tonsillitis is one of the most common inflammatory conditions of the upper aerodigestive tract encountered in otorhinolaryngology practice, particularly among children and young adults. It is characterized by acute inflammation of the palatine tonsils, presenting clinically with sore throat, fever, odynophagia, cervical lymphadenopathy, and erythematous or exudative tonsils [1,2]. Although the condition is often self-limiting, recurrent, or improperly treated episodes can lead to significant morbidity, school absenteeism, antibiotic misuse, and progression to chronic tonsillitis or suppurative complications [3]. The etiology of acute tonsillitis is predominantly infectious, with viral agents accounting for a substantial proportion of cases; however, bacterial pathogens—most notably Group A β-hemolytic streptococci—remain clinically important due to their association with complications such as rheumatic fever and post-streptococcal glomerulonephritis [4,5]. Epidemiological patterns of acute tonsillitis are influenced by age, seasonality, overcrowding, nutritional status, and socioeconomic conditions, with higher prevalence reported in developing regions [6,7]. Despite its high burden, acute tonsillitis is frequently managed empirically, leading to irrational antibiotic use and increasing antimicrobial resistance. Several recent studies have emphasized the need for region-specific clinico-epidemiological data to guide rational management strategies and reduce unnecessary antibiotic exposure [8,9]. In India, data on the epidemiology of acute tonsillitis remain limited and heterogeneous, particularly from semi-urban and rural regions such as Central Gujarat. Understanding the local demographic profile, clinical presentation, and associated risk factors is essential for improving diagnostic accuracy, optimizing treatment protocols, and formulating preventive strategies. Therefore, the present study was undertaken to evaluate the Clinico-epidemiological characteristics of patients with acute tonsillitis presenting to a tertiary care center in the Central region of Gujarat.

This study was designed as a hospital-based observational study conducted over a period of one year in the Department of Otorhinolaryngology at a tertiary care teaching hospital located in the Central region of Gujarat. The study duration extended from October 2024 to September 2025, during which all eligible patients presenting to the ENT outpatient department and emergency services were evaluated. All patients of either gender and of all age groups who were clinically diagnosed with acute tonsillitis during the study period were included. Acute tonsillitis was diagnosed based on clinical criteria, including acute onset of sore throat, fever, odynophagia, enlarged and congested tonsils with or without exudates, and associated cervical lymphadenopathy. Patients with chronic tonsillitis, peritonsillar abscess, infectious mononucleosis, diphtheria, immunocompromised states, previous tonsillectomy, or those unwilling to provide informed consent were excluded from the study. After obtaining informed written consent from patients or guardians, detailed demographic and clinical data were collected using a predesigned and pretested proforma. The recorded variables included age, sex, socioeconomic status, seasonal distribution, presenting symptoms, duration of illness, associated upper respiratory tract infections, history of recurrent sore throat, and prior antibiotic use. A thorough general and ENT examination was performed in all cases, with particular emphasis on tonsillar size, surface characteristics, presence of exudates, and cervical lymph node involvement. Relevant investigations were carried out as clinically indicated. These included complete blood count and throat swab for microbiological analysis in selected cases, especially those with severe symptoms, recurrent episodes, or poor response to initial therapy. Management details, including conservative treatment, antibiotic prescription patterns, and symptomatic therapy, were documented. Patients were followed up during the course of treatment to assess clinical response and resolution of symptoms. Data were entered into a Microsoft Excel spreadsheet and analyzed using appropriate statistical software. Descriptive statistics were used to summarize demographic and clinical variables, which were expressed as frequencies, percentages, means, and standard deviations. Inferential statistical tests were applied where applicable, and a p-value of less than 0.05 was considered statistically significant. The study was conducted after obtaining approval from the Institutional Ethics Committee, and all procedures adhered to ethical principles outlined in the Declaration of Helsinki. Confidentiality of patient information was strictly maintained throughout the study.

During the one-year study period, a total of 200 patients clinically diagnosed with acute tonsillitis were enrolled and analyzed. Table 1. Age Distribution of Patients with Acute Tonsillitis (n = 200) Age group (years) Number Percentage (%) ≤10 72 36.0 11–20 58 29.0 21–30 36 18.0 31–40 22 11.0 >40 12 6.0 Total 200 100 Acute tonsillitis was most frequently observed in children aged ≤10 years (36%), followed by adolescents and young adults aged 11–20 years (29%). A progressive decline in incidence was noted with increasing age, indicating a predominance of acute tonsillitis in the pediatric and adolescent population. Table 2. Gender Distribution Gender Number Percentage (%) Male 118 59.0 Female 82 41.0 Total 200 100 A male predominance was observed, with males constituting 59% of cases, resulting in a male-to-female ratio of approximately 1.4:1. Table 3. Socioeconomic Status of Patients Socioeconomic class Number Percentage (%) Lower 86 43.0 Lower middle 62 31.0 Middle 38 19.0 Upper / Upper middle 14 7.0 Total 200 100 The majority of patients belonged to the lower and lower-middle socioeconomic strata (74%), highlighting a higher burden of acute tonsillitis among economically disadvantaged populations. Table 4. Clinical Presentation of Acute Tonsillitis Symptom Number Percentage (%) Sore throat 200 100 Fever 162 81.0 Odynophagia 148 74.0 Dysphagia 96 48.0 Cervical lymphadenopathy 84 42.0 Ear pain (referred) 32 16.0 All patients presented with sore throat. Fever and odynophagia were the most common associated symptoms, while cervical lymphadenopathy was observed in nearly two-fifths of cases. Table 5. Tonsillar Findings on Clinical Examination Tonsillar finding Number Percentage (%) Congestion and enlargement 132 66.0 Exudative tonsillitis 54 27.0 Follicular tonsillitis 14 7.0 Total 200 100 Congested and enlarged tonsils were the most common examination finding. Exudative tonsillitis accounted for 27% of cases, indicating probable bacterial etiology in a subset of patients. Table 6. Seasonal Distribution of Acute Tonsillitis Season Number Percentage (%) Winter 74 37.0 Monsoon 68 34.0 Summer 58 29.0 Total 200 100 A higher incidence of acute tonsillitis was noted during winter and monsoon seasons, suggesting a seasonal influence likely related to increased upper respiratory tract infections. Table 7. Management Pattern Treatment modality Number Percentage (%) Conservative (analgesics, antipyretics) 78 39.0 Antibiotics + supportive care 122 61.0 Total 200 100 Most patients (61%) required antibiotic therapy in addition to supportive care, while 39% were managed conservatively, indicating mild disease severity in a substantial proportion of cases. Table 8. Outcome at Follow-up Outcome Number Percentage (%) Complete recovery 188 94.0 Recurrent episode 10 5.0 Complications 2 1.0 Total 200 100 A favorable outcome was observed in the majority of patients, with 94% achieving complete recovery. Recurrent episodes were infrequent, and complications were rare, reflecting effective early diagnosis and appropriate management. The present observational study demonstrates that acute tonsillitis predominantly affects children and adolescents, with male predominance, higher prevalence in lower socioeconomic groups, seasonal variation, and excellent short-term outcomes when managed appropriately.

The present one-year observational study provides a comprehensive clinico-epidemiological overview of acute tonsillitis in patients attending a tertiary care hospital in the Central region of Gujarat. The findings highlight the demographic profile, clinical presentation, seasonal trends, and treatment outcomes, and are largely consistent with previously published national and international literature. In the present study, acute tonsillitis predominantly affected children and adolescents, with 65% of cases occurring in individuals below 20 years of age. The highest incidence was observed in the ≤10-year age group (36%). This age predilection is well documented and has been attributed to immunological immaturity, frequent exposure to respiratory pathogens in school settings, and hypertrophy of lymphoid tissue in childhood [10–12]. Similar age distributions have been reported by Adegbiji et al. and Alasmari et al., who observed peak incidence in the pediatric age group [1,8]. Joshi et al. from India also reported that more than two-thirds of acute tonsillitis cases occurred in children and adolescents, supporting the findings of the present study [3]. A clear male predominance was observed in the present study, with a male-to-female ratio of approximately 1.4:1. Male preponderance has been consistently reported in several studies, including those by Alghamdi et al., Bukhar et al., and Farooqi et al. [2,5,7]. This observation may reflect higher exposure to environmental risk factors, differences in immune response, and sociocultural factors influencing healthcare-seeking behavior, particularly in developing regions. Socioeconomic analysis revealed that nearly three-fourths of patients belonged to the lower and lower-middle socioeconomic classes. This finding is in agreement with multiple studies from low- and middle-income countries, where acute tonsillitis is more frequently reported among populations with overcrowding, poor sanitation, malnutrition, and limited access to primary healthcare services [38,13]. Priyadarshini et al. and Ohal et al. similarly emphasized the association between recurrent upper respiratory infections and lower socioeconomic status, reinforcing the role of social determinants in disease burden [4,9]. Clinically, sore throat was a universal presenting complaint, followed by fever (81%) and odynophagia (74%). These findings align closely with the classical symptomatology described in earlier studies [1,11,14]. Cervical lymphadenopathy was observed in 42% of cases, comparable to the rates reported by Gahleitner et al. and Alghamdi RM et al., who reported lymph node involvement in 40–55% of patients with acute bacterial tonsillitis [8,15]. Referred otalgia, though less frequent, was observed in a subset of patients and has been attributed to glossopharyngeal nerve involvement, as described in standard ENT literature [14]. On oropharyngeal examination, congested and enlarged tonsils were the most common finding, followed by exudative tonsillitis in 27% of cases. The presence of tonsillar exudates suggests a possible bacterial etiology, particularly Group A β-hemolytic Streptococcus, as reported by Bukhar et al. and Alasmari et al. [5,6]. However, the majority of cases were managed conservatively or with empirical antibiotics, reflecting current clinical practice in resource-limited settings where routine microbiological confirmation is often not feasible. Seasonal variation was evident, with higher incidence during winter (37%) and monsoon (34%) seasons. This seasonal clustering has been widely reported and is attributed to increased viral respiratory infections, humidity-related pathogen survival, and crowding during colder months [7,12]. Similar seasonal trends have been documented by Adegbiji et al. and Joshi et al., reinforcing the influence of climatic factors on disease occurrence [1,3]. Regarding management, 61% of patients required antibiotic therapy in addition to supportive care, while 39% were treated conservatively. This pattern is comparable to studies by Farooqi et al. and Alghamdi FA et al., who reported antibiotic usage in approximately 55–70% of cases [2,7]. The high rate of complete recovery (94%) and the low incidence of complications (1%) in the present study underscore the effectiveness of early diagnosis and appropriate treatment. Similar favorable outcomes have been reported across multiple studies, highlighting that acute tonsillitis generally carries an excellent prognosis when managed promptly [1,5,15]. Overall, the findings of the present study are consistent with existing literature and emphasize that acute tonsillitis remains predominantly a disease of childhood and adolescence, strongly influenced by socioeconomic and seasonal factors. The study reinforces the importance of early clinical recognition, rational antibiotic use, and preventive strategies targeting overcrowding and upper respiratory tract infections, particularly in economically disadvantaged populations.

Acute tonsillitis is a common ENT condition in Central Gujarat, predominantly affecting children and young adults, with a higher incidence among males and lower socioeconomic groups. Most patients present with sore throat and fever and respond well to conservative medical management. Early diagnosis, rational antibiotic use, and improved awareness can significantly reduce morbidity and prevent complications.

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