Tonsillitis refers to inflammation of the tonsils. It typically occurs due to an infection of the tonsils. Symptoms may include a sore throat and pain when swallowing.
The tonsils sit at the back of the throat. They are collections of lymphoid tissue that form part of the immune system.
Although tonsillitis can be uncomfortable and unpleasant, the condition is rarely a major health concern. Most people will recover from tonsillitis within a few days, whether they take medication or not. Most symptoms will resolve within 7–10 days.
In this article, we explain the causes, diagnosis, and symptoms of tonsillitis. We also provide some facts about treatment, including the removal of tonsils.
The most common symptoms of tonsillitis include:
- a sore throat and pain when swallowing
- red and swollen tonsils with pus-filled spots
- difficulty swallowing
- pain in the ears and neck
- difficulty sleeping
- swollen lymph glands
Less common symptoms may include:
- stomach pain and vomiting
- furry tongue
- changes in the sound of the voice
- bad breath
- difficulty opening the mouth
Some people may develop tonsil stones, which doctors also call tonsilloliths or tonsillar calculi. A tonsillolith is a calcified buildup of material in the crevices of the tonsils.
They are generally small, but in rare cases, they may be larger.
Tonsil stones can be a nuisance and sometimes difficult to remove, but they are not generally harmful.
When to see a doctor
Tonsillitis can sometimes cause the throat to swell so much that breathing becomes difficult. This is rare, but If it occurs, seek medical attention urgently.
Also, if a person experiences any of the following symptoms, they should visit their doctor:
- a high fever
- a stiff neck
- muscle weakness
- a sore throat that persists for longer than 2 days
To diagnose tonsillitis, a doctor will start with a general examination and will check for swelling around the tonsils, 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.
The doctor might take a swab of the infected area for closer inspection. Using this technique, they can determine whether the cause of the infection is viral or bacterial.
They 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 cells. This bloodwork can help a doctor supplement the information they have obtained from the swab.
In some cases, if the swab is inconclusive, a complete blood cell count can help the doctor determine the best treatment.
If a person cannot treat tonsillitis at home, a range of treatment options is available.
People can use over-the-counter (OTC) pain relieving medications to numb the symptoms of tonsillitis.
If a bacterial infection is causing tonsillitis, a doctor will usually prescribe antibiotics. However, they will not do so for a person with viral tonsillitis. Antibiotics are not effective against viruses.
Penicillin is the most common antibiotic. When on a course of antibiotics, a person must follow the full course and continue taking them, even if the symptoms have resolved. Stopping a course of antibiotics part of the way through might allow the infection to spread.
Previously, doctors regularly recommended surgery to treat tonsillitis. Today, a doctor will not recommend a tonsillectomy unless the condition is chronic and recurring.
Although the tonsils become less active after puberty, they are still a functional organ. For this reason, a surgeon will not remove them unless necessary.
A doctor might request a tonsillectomy if the tonsils are causing secondary issues, such as:
- sleep apnea, which involves problems breathing at night
- difficulties with breathing or swallowing
- an abscess that is difficult to treat
- tonsillar cellulitis, in which the infection spreads to other areas and leads to a buildup of pus behind the tonsils
If a tonsillectomy is necessary, doctors can choose from
Surgery has increasingly become the last port of call. The negative implications of surgery may outweigh the positives of tonsil removal.
While tonsillitis can be distressing and uncomfortable when it occurs, it will pass without any serious long term implications for most people.
A few simple remedies can help a person reduce symptoms of tonsillitis at home:
- Resting enables the body to preserve energy for fighting the infection rather than using it on daily activities.
- Drinking plenty of fluids will prevent the throat from drying out and becoming more uncomfortable. When the body is responding to an infection, it needs more hydration than usual. Warm, preferably caffeine free drinks can also have a soothing effect.
- Gargling with saltwater might reduce discomfort.
- Sucking throat lozenges may help soothe the throat.
- Dry air can irritate the throat. Using air humidifiers or sitting in a steamy bathroom can alleviate this.
- Avoiding irritants, such as tobacco and smoky locations, can help a person reduce symptoms.
- Taking medication, such as ibuprofen or acetaminophen, can help with pain and fever.
Tonsils are the first line of defense against potential diseases and infections. For this reason, they can easily develop an infection.
Tonsillitis is typically viral. Less commonly, bacteria can cause the infection.
A viral infection is the most common cause of tonsillitis. The most common types of virus that infect the tonsils include:
- adenovirus, which is a possible cause of the common cold and sore throat
- rhinovirus, which is the most common cause of the common cold
- influenza, or flu
- respiratory syncytial virus, which often leads to acute respiratory tract infections.
- two subtypes of coronavirus, one of which causes SARS
Less commonly, the following can cause viral tonsillitis:
The most common type of bacteria to infect the tonsils is Streptococcus pyogenes. However, less often, other species can cause tonsillitis, including:
- Staphylococcus aureus
- Mycoplasma pneumonia
- Chlamydia pneumonia
- Bordetella pertussis
- Neisseria gonorrhoeae
Different types of tonsillitis may occur. Doctors define them by their symptoms and recovery period.
- Acute tonsillitis: Symptoms usually last around 3–4 days but may last up to 2 weeks.
- Recurrent tonsillitis: A person has several different instances of acute tonsillitis in a year.
- Chronic tonsillitis: Individuals will have an ongoing sore throat and foul-smelling breath.
Diagnosing the type of tonsillitis will help a doctor decide the best course of treatment.
People often confuse tonsillitis with strep throat. However, there are important differences.
Viruses may also cause tonsillitis. However, strep throat is purely a bacterial infection.
Bacterial tonsillitis can lead to complications. However, this is rare and usually occurs in young children. Viral tonsillitis does not usually lead to complications.
- quinsy, or peritonsillar abscess, which is a build-up of pus between a tonsil and the throat wall
- obstructive sleep apnea, in which the throat walls relax while a person is asleep and affect breathing and the sleep cycle
Rarer complications include:
- scarlet fever
- rheumatic fever, which causes inflammation throughout the body and leads to jerky body movements and pain in the joints
- glomerulonephritis, in which the filtering mechanisms of the kidneys swell and trigger vomiting
Complications are usually rare. Tonsillitis clears up without issue for most people.