Tonsillitis

Tonsillitis means that your tonsils are inflamed (swollen). This can happen when the tonsils become infected by a common virus or bacteria. It is a common childhood infection, but it can happen to anyone at any age.

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Symptoms of tonsillitis

  • Swollen tonsils or redness. This may only be on one side.
  • White or yellow spots on tonsils or back of the throat.
  • Sudden sore throat.
  • Pain or tenderness when swallowing.
  • Swollen, tender glands on the sides of the throat (lymph nodes).
  • Scratchy or throaty voice.

Other symptoms

If you have chronic tonsillitis, you may also experience:

  • Bad breath.
  • Tonsil stones.

Children with tonsillitis may not be able to describe their symptoms. Be on the lookout for:

  • Loss of appetite.
  • Increased fussiness.
  • Excessive drooling. This is because swallowing may be painful and difficult.
  • Blisters, sores or ulcers on your throat.
  • Headaches.
  • Ear pain.
  • Loss of appetite.
  • Fever.
  • Chills.
  • Fatigue.
  • Snoring.
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When to seek medical attention

The symptoms of tonsillitis may look like other conditions or health problems. Always see your healthcare provider for a diagnosis. You should seek immediate medical attention if you or your child:

  • Have a fever over 103° F.
  • Experience bleeding.
  • Have a lot of trouble breathing.
  • Start drooling excessively.

Tonsillitis: causes and types

Both bacteria and viruses can cause tonsillitis. Viral tonsillitis is more common. The germs that commonly cause tonsillitis include:

  • Epstein Barr virus, which causes infectious mononucleosis (mono or “kissing disease”). You may have mono and develop tonsillitis as a secondary infection.
  • Herpes simplex virus.
  • Rhinovirus (common cold).
  • Streptococcus bacterium, or strep. In particular, the bacteria that causes strep throat is usually the cause of tonsillitis. Bacterial tonsillitis makes up only 15% to 30% of cases.

Many other bacteria and viruses can also cause tonsillitis.

There are three types of tonsillitis:

  • Acute tonsillitis. Your tonsils are swollen and infected for a few days and up to two weeks. Acute tonsillitis can usually go away with antibiotics and home remedies.
  • Recurrent tonsillitis. You have tonsillitis a few times a year. If you have tonsillitis more than 7 times in one year, you may need to have your tonsils removed.
  • Chronic tonsillitis. Your tonsils are inflamed and infected for a month or more. Chronic tonsillitis can cause cryptic tonsils, or tonsils with small holes in them. Bacteria, old cells and food can fill these holes and form tonsil stones. Tonsil stones may fall out on their own, or they may need to be removed.

How is tonsillitis diagnosed?

If you have symptoms of tonsillitis, you should see your doctor. They will ask you about your symptoms, medical history and family history.

They will also perform a physical exam. This may involve:

  • Looking at the back of your throat with a light.
  • Feeling the lymph nodes on the side of your neck.
  • Listening to your lung sounds.
Provider with stethoscope examining older woman

You will also get tested for strep bacteria. Strep bacteria can cause tonsillitis, and can lead to serious complications. There are two ways to test for it:

  • Rapid strep test. Your doctor swaps the back of your throat and tests the swap in the clinic for strep bacteria. This test takes about 15 minutes. If the test comes back negative, your doctor may also do a throat culture, since rapid tests aren’t 100% accurate.
  • Throat culture. Your doctor swabs the back of your throat and sends it off to a lab. There, the bacteria found in the swap are grown and looked at under a microscope. This can give you a definitive diagnosis.

You may also undergo a complete blood cell count (CBC). In a CBC, your doctor takes a sample of your blood and tests whether you have elevated levels of white blood cells (immune cells). This can help determine the cause of your tonsillitis if it isn’t related to strep. A CBC is not always necessary.

Treatments for tonsillitis

Tonsillitis home remedies

If you have a mild case of tonsillitis, you may be able to treat it at home. This is especially the case if your tonsillitis is caused by a virus, like the common cold. Try the following home remedies:

  • Get plenty of sleep, and avoid physical activities. If you can, call in sick to work or keep your child home from school. The bacteria and viruses that cause tonsillitis are contagious.
  • Drink plenty of clear fluids, like tea and water.
  • Try warm tea with honey or popsicles to help with the sore throat.
  • Gargle warm salt water. Add a half teaspoon of salt to a cup of warm water. Gargle it for a minute or more and then spit it out. This helps with swelling and sore throat.
  • Treat pain and fever with over-the-counter medications. Use acetaminophen (Tylenol) to reduce pain and break low fevers.
  • Try sucking on a throat lozenge to reduce your sore throat. However, do not give lozenges to children under the age of four.
  • Avoid cigarettes or other throat irritants, like cleaning supplies.
  • Use a humidifier.

Medications

If your tonsillitis is caused by strep bacteria, you will need to take an antibiotic. These medications kill the bacteria by preventing them from carrying out their life functions.

Your doctor will likely prescribe a course of penicillin to be taken over 10 days. If you are allergic to penicillin, you will get a different antibiotic. Always follow your doctor’s instructions exactly and finish the whole course of medication. Even if you begin to feel better, be sure to finish all the medication to kill any remaining bacteria. Not finishing a course of antibiotics increases the risk of complications like rheumatic fever and kidney inflammation, especially in children.

Surgery

Tonsils play an important role in the immune system, so doctors don’t usually recommend removing your tonsils (tonsillectomy). But your doctor may recommend a tonsillectomy if you have recurrent, severe or chronic tonsillitis. You may be a candidate for a tonsillectomy if you:

  • Had tonsillitis 7 times in the past year, or 5 times a year for two years.
  • Have chronic tonsillitis that is hard to manage.
  • Have severe tonsillitis that leads to complications like an abscess or severe breathing difficulty.

A tonsillectomy is usually performed as an outpatient surgery, meaning you get to leave the hospital the same day that you arrive. A full recovery usually takes seven to 14 days. Your doctor will recommend some diet modifications and teach you how to clean the wound during this time.

Complications of tonsillitis

Tonsillitis is usually a mild, uncomplicated infection. However, if left untreated, it can cause other complications, including:

Peritonsillar abscess. This complication is caused by untreated bacterial tonsillitis. This can cause a more severe sore throat and trouble opening your mouth.

Tonsillar cellulitis. This is when untreated tonsillitis spreads deep into the surrounding tissue and causes other problems.

Obstructive sleep apnea. If your tonsils get too swollen, they can block the movement of air as you sleep. You may wake up gasping or choking and have trouble getting enough sleep.

Tonsillitis and strep infection complications. Untreated tonsillitis that is caused by strep can lead to other, more severe infections.

Among these more severe infections include:

  • Scarlet fever. A strep infection that comes with a prominent red rash.
  • Rheumatic fever. A dangerous infection that leads to swelling in your joints and of your heart.
  • Kidney inflammation, or post-streptococcal glomerulonephritis.

References

MedlinePlus: National Library of Medicine. Tonsillitis (https://medlineplus.gov/tonsillitis.html)

National Center for Biotechnology Information (NCBI): National Library of Medicine. Tonsillitis (https://www.ncbi.nlm.nih.gov/books/NBK544342/)