Tonsillitis affects millions of individuals each year. Although uncomfortable and unpleasant, the condition is rarely a major health concern.
The following article investigates the causes, diagnosis, and symptoms of tonsillitis. Treatment, both at home and by a doctor, will also be covered.
Contents of this article:
Fast facts on tonsillitis
Here are some key points about tonsillitis. More detail and supporting information is in the main article.
- Tonsillitis can be caused by a bacterial or viral infection
- The vast majority of tonsillitis cases will clear of their own accord within 10 days
- Tonsillitis can be diagnosed by examination of the throat and a bacterial swab
- There is a multitude of infectious agents that can cause the illness
- Tonsils are the body's first line of defense against external pathogens
What is tonsillitis?
Tonsillitis is an infection of the tonsils - two pads of tissue at the back of the throat. The infection is typically viral, but can sometimes be bacterial.
If the infection is due to a bacterium belonging to the group A streptococcus, it is referred to as strep throat.
The vast majority of people, whether given medication or not, will fully recover from the infection within a matter of days. Most symptoms will resolve within 7-10 days.
Symptoms of tonsillitis
Tonsillitis can be caused by either a viral or bacterial infection, and typically resolves within a couple of days.
The most common symptoms of tonsillitis include:
- Sore throat and pain when swallowing
- Red and swollen tonsils with pus-filled spots
- High temperature
- Difficulty swallowing
- Pain in the ears and/or neck
- Difficulty sleeping
- Swollen lymph glands
Less common symptoms can include:
- Stomachache and vomiting
- Furry tongue
- Changes in the sound of the voice
- Halitosis (bad breath)
- Difficulty opening the mouth
In some cases, tonsilloliths - also known as tonsil stones or tonsillar calculi - may be present. A tonsillolith is a calcified build-up of material in the crevices of the tonsils.
They are generally small, but in rare cases, tonsilloliths have been found reaching sizes of 30 centimeters and above.
They can be a nuisance and sometimes difficult to remove, but they are not generally harmful.
What are the tonsils?
Tonsils are collections of lymphoid tissue (part of the immune system) situated at the back of the throat. In total, there are four sets of tonsils in the human head, but, usually, when they are referred to as "the tonsils," it refers to the palatine tonsils.
The palatine tonsils are the only tonsils that are visible under normal circumstances.
Tonsils are at their largest size around the time of puberty and from that point on they slowly atrophy (breakdown).
The tonsils are the body's first line of defense against inhaled pathogens. Specialized M cells on their surface capture antigens from pathogens and alert B cells and T cells to mount an immune defense.
Tonsils also produce T cells, a type of white blood cell that plays a vital role in the immune response.
Causes of tonsillitis
The tonsils are the first line of defense of the human immune system.
Because the tonsils are the first line of defense against pathogens from the outside world, they are susceptible to infection themselves.
Tonsillitis, whether viral or bacterial, can be contagious and spread from person to person.
However, if the condition is caused by a secondary illness, such as sinusitis or hay fever, it is likely not to be infectious.
Tonsillitis is most commonly caused by a viral infection. The most common types of virus to infect the tonsils are the following:
- Adenovirus - causes the common cold among other illnesses
- Rhinovirus - the most common infectious viral agent in humans
- Influenza - often referred to as flu
- Coronavirus - there are six known strains, one of which causes SARS
- Respiratory syncytial virus - often causes respiratory tract infections
Less commonly, viral tonsillitis can be caused by:
- Epstein-Barr virus
- Herpes simplex virus
The most common type of bacteria to infect the tonsils is Streptococcus pyogenes (group A streptococcus). But, less often, it can be caused other species, including:
- Staphylococcus aureus
- Mycoplasma pneumoniae
- Chlamydia pneumoniae
- Bordetella pertussis
- Fusobacterium sp.
- Neisseria gonorrhoeae
Diagnosis of tonsillitis
The diagnosis of tonsillitis by a doctor will start with a general inspection. They will be looking for a swollen tonsil region, often with white spots.
Doctors may also inspect the exterior of the throat for signs of enlarged lymph glands and a rash that sometimes occurs.
A swab of the infected area will be taken for closer inspection by a laboratory, to determine whether the causal agent is viral or bacterial.
Doctors may also carry out a complete blood cell count. This test involves taking a tiny amount of blood to investigate levels of certain types of blood cell. This bloodwork can help supplement the information taken from the swab. In some cases, if the swab is inconclusive, it can help the doctor determine the best treatment.
Treatment of tonsillitis
The first line of tonsillitis care can be conducted at home, and if the infection is viral rather than bacterial, antibiotics will not be prescribed.
These are the simplest tactics to reduce suffering at home:
- Rest - during rest, your body can focus its energy on fighting the infection rather than expending it on daily activities.
- Fluids - fluids prevent the throat from drying out and becoming more uncomfortable, warm liquids (preferably caffeine-free) can also soothe. When the body is fighting an infection, it needs more hydration than normal.
- Saltwater - a saltwater gargle might help with discomfort.
- Humidify - air humidifiers or sitting in a steamy bathroom can remove the irritation of dry air.
- Avoid irritants - no smoking, avoid smoky locations.
- Medication - pain and fever can be treated with ibuprofen or acetaminophen.
If bacterial infection has caused the tonsillitis, antibiotics are often prescribed. Penicillin is most commonly used. The full course of antibiotics must be taken, whether symptoms are relieved or not. Failure to do so might allow the infection to spread and has the potential to cause rheumatic fever or kidney inflammation in the long term.
Surgery used to be a relatively common approach to dealing with tonsillitis. Nowadays, tonsillectomies are not used unless it is chronic and recurring.
For instance, seven occurrences within a single year, or three per year for 3 years in a row would warrant the consideration of surgery.
Although the tonsils are increasingly less active following puberty, they are still an active organ and therefore not removed unless entirely necessary.
However, a tonsillectomy might be called upon if the tonsils are causing secondary issues such as sleep apnea, difficulty in breathing or swallowing, or an abscess that is difficult to treat.
If a tonsillectomy is deemed necessary, there are a variety of methods that can be applied. Lasers, radio waves, ultrasonic energy, coblation (cold temperatures), or electrocautery (a needle heated by electricity) have all been successfully used to remove the tonsils.
Increasingly, surgery has become the last port of call. The negative implications of surgery are considered to outweigh the positives associated with the removal of the tonsils.
In general, although distressing and uncomfortable at the time, tonsillitis will pass, for the vast majority of patients, without any serious long-term implications.