Tonsillitis

Tonsillitis is an inflammatory condition of the tonsils, the two fleshy glands at the back of the throat. It can be caused by either a virus or, less commonly, a bacterial infection. The condition can affect people of any age, but is most common in children between 5 and 10 years of age. 1

The characteristic symptoms of tonsillitis are a sore throat and difficulty swallowing, though ear pain, headaches and fever, among other symptoms, may also occur. In most cases, the condition will clear up on its own after three to four days, without specific treatment. 2 If a bacterial infection is the cause, however, antibiotics may be prescribed.

Tonsillitis itself is not contagious, but the infections that cause it often are. These include the same viruses that cause colds and flu, as well as the streptococcal bacteria that causes strep throat. For this reason, it is important for people with tonsillitis to stay away from other people as much as possible until the infection passes and to take extra care in practicing good hygiene, such as washing their hands often and covering their mouth and nose when sneezing.

Generally, tonsillitis is considered a non-serious condition. In rare cases, however, its symptoms can become severe or complications can develop. If symptoms persist for more than four days or are particularly severe, medical attention should be sought as soon as possible. 3 People worried about the symptoms they are experiencing can also carry out a symptom assessment using the free Ada app.

There are three main types of tonsillitis: 4

• Acute tonsillitis tends to last for between a few days and two weeks, with symptoms generally coming on quickly.
• Chronic tonsillitis is when the symptoms of the condition last continuously for a significant amount of time.
• Recurrent tonsillitis is when a person experiences multiple episodes of acute tonsillitis over the course of a year, generally five or more. 5

It is the duration for which symptoms are experienced and their frequency which differentiates the three types of tonsillitis. The symptoms themselves remain relatively consistent across all three types, though the severity may differ.

The most common symptoms of tonsillitis include: 1 2

• A sore throat
• Difficulty and/or pain when swallowing
• Foul smelling breath
• tender neck lymph nodes
• Fever
• A hoarse or lost voice
• Coughing
• Feeling sick
• Tiredness
• Pain in the ears
• Headache

Upon inspection, the throat may also be red, while the tonsils may appear swollen and feature spots of white pus. Often, tonsillitis may also cause the lymph glands of the neck to become swollen and the affected person to experience exceptionally or newly onset bad breath. 2 These symptoms are more common in cases of chronic or recurrent tonsillitis.

If symptoms persist for more than four days or are particularly severe, medical attention should be sought. The free Ada app can also be used to carry out a symptom assessment.

The tonsils are the two big balls of lymphatic tissue at the side and towards the back of the throat, usually visible through the mouth. Their main function is to trap and process viruses and bacteria that have been inhaled and in doing so help the body to prevent or fight illness quickly. 6

However, the tonsils themselves are vulnerable to infection from both viruses and bacteria. When they become infected, tonsillitis occurs.

The majority of cases of tonsillitis are caused by a virus. A variety of virus types can cause the infection, with some of the most common including: 3

• Rhinovirus, which can also cause the common cold
• Influenza virus
• Parainfluenza virus, which can also cause a kind of sore throat or pharyngitis without inflamed tonsils
• Enteroviruses, which may also cause, for example, hand, foot and mouth disease
• Adenoviruses, which can also cause, for example, diarrhea and pink eye
• Rubeola virus, which also causes measles
• Rarely, the Epstein-Barr virus, which also causes glandular fever

These viruses are spread via the small droplets released when an infected person coughs or sneezes. Coming into direct contact and inhaling these droplets can pass on these viruses, as can coming into contact with the droplets via a contaminated surface or object.

Roughly one in three cases of tonsillitis are caused by bacteria, with this being more common in children than adults. 7 A variety of different types of bacteria can cause tonsillitis, but the most common are group A streptococcus bacteria, which cause streptococcal pharyngitis, or strep throat, a kind of throat infection that often causes very inflamed tonsils.

Read more about Strep Throat »

Good to know: Although the two terms are often used interchangeably, tonsillitis and strep throat are not the same condition. Strep throat is one of a variety of causes of tonsillitis. Many people with tonsillitis do not have strep throat, but instead a viral tonsillitis infection caused by one of the viruses mentioned above. This is an important distinction to make, as it can impact the course of treatment. As a bacterial infection, strep throat can be treated with antibiotics, whereas tonsillitis caused by a viral infection will not get any better by taking antibiotics. This is the reason why they will not be prescribed.

In many cases, tonsillitis will not require professional medical evaluation. If, however, symptoms persist for four days or longer, or they are particularly severe, making it difficult to eat or drink, for example, it is recommended that the affected person see a medical doctor.

Good to know: In rare cases, extremely swollen tonsils can lead to difficulty breathing. This is a medical emergency requiring urgent medical attention.

A doctor will typically be able to diagnose tonsillitis based upon an examination of the symptoms present. Generally, they will look inside the mouth, specifically at the tonsils, for signs of swelling and/or pus, and check to see if the glands of the neck are swollen. Sometimes a swab test of the throat may also be carried out. Less commonly, blood tests may be ordered, for example, if glandular fever is suspected.

Most people will not require specific treatment for tonsillitis. In the majority of cases, symptoms will clear up in under a week, and antibiotics will not be required. There are, however, a number of ways in which the condition can be supportively managed at home.

Some of the most commonly recommended self-care techniques for managing tonsillitis at home include: 2 3

• Getting plenty of rest and staying home from work or school if necessary
• Drinking plenty of fluids; some people find that warm or chilled fluids provide the best relief
• Gargling with a solution of warm water and salt, which may provide some pain relief
• Taking over-the-counter medications such as ibuprofen and paracetamol, making sure to follow the advice of the pharmacist or doctor and to read and follow the instructions provided within the packaging
• Sucking throat lozenges

If symptoms persist for longer than four days, affected people are advised to visit a doctor for evaluation.

Antibiotics are ineffective against viral infections. 8 If tonsillitis is caused by a virus, the infection will need to run its course naturally, although oral pain relievers and/or surface numbing agents, like lozenges containing benzocaine, may be prescribed. ref11 9 If the infection is caused by bacteria, antibiotics may be prescribed.

If antibiotics are prescribed, it is important that the affected person reads the enclosed instructions thoroughly. It is also important that they take the entire prescribed course, even if symptoms clear up before this time. This helps to reduce the chances of building up resistance to the medication.

People who experience recurrent tonsillitis may be advised by doctors to consider surgery to remove their tonsils completely, a procedure known as a tonsillectomy.

The criteria to be considered for a tonsillectomy may vary, depending on where you live or your specific circumstances; in the UK for instance a person should have experienced: 10

• Seven or more incidences of tonsillitis in the previous year, or
• Five or more incidences of tonsillitis in each of the previous two years, or
• Three or more incidences of tonsillitis in each of the previous three years

Generally, the bouts of tonsillitis must also impact the day-to-day life of the affected person; requiring, for example, time off work or school.

Surgical removal of the tonsils prevents further episodes of tonsillitis, but does not prevent the possibility of other types of throat infection or the possibility of a sore throat.

A tonsillectomy is generally considered a minor procedure, though, as with all types of surgery, there are risks. These risks will be explained in full by the doctor or surgeon before surgery.

Tonsillitis generally leads to no further health problems. However, in some cases, complications can occur.

Sometimes, the infection causing tonsillitis can also spread to other parts of the body, causing, for example, an ear infection, sinus infection or chest infection.

Another complication of tonsillitis occurs when an abscess forms on or around the tonsils, a condition called a peritonsillar abscess or quinsy. Symptoms of quinsy may include: 2 7 10 11 12

• Severe pain in the throat, which is usually worse on one side
• Muffled or “hot potato” voice
• Ear pain on one side upon swallowing
• Fever
• Neck pain and possibly decreased neck mobility
• Large, swollen neck lymph nodes
• Difficulty swallowing and/or difficulty opening the mouth
• Difficulty breathing

Quinsy is usually treated with antibiotics, as well as a minor surgical procedure to drain the abscess of pus. People experiencing possible symptoms of quinsy should seek medical attention as a matter of urgency. If breathing is restricted, emergency care should be sought without delay. The free Ada app is also available to carry out a symptom assessment.

The best way to prevent tonsillitis is to attempt to limit exposure to the viral or bacterial infections that cause the condition. To do this, be sure to wash the hands thoroughly with water and soap throughout the day and avoid close contact with people displaying symptoms associated with tonsillitis, as well as conditions such as the common cold or the flu.

People who have tonsillitis should avoid spreading the causing agent by staying home from work or school until the infection has passed and by maintaining proper hygiene. For further information on how to maintain good hygiene, take a look at this resource from The Centers for Disease Control and Prevention.

Q: When should I see my doctor about tonsillitis?
A: Generally, people experiencing symptoms of tonsillitis should seek medical attention if their symptoms do not subside in three to four days or if the following symptoms are present: 6

• Severe throat pain
• Difficulty swallowing, breathing and/or opening the mouth; if you have difficulty taking in liquids, this is a matter of utmost urgency, and having difficulty breathing is an emergency that should be treated without any delay!
• Persistent fever
• Pain is located on one side of the throat

When these symptoms occur, it could be a sign that it is a more complicated case of tonsillitis, possibly needing additional treatment or a complication of tonsillitis may be present.

Q: Are tonsillitis and strep throat the same thing?
A: No, tonsillitis and strep throat, or streptococcal pharyngitis, are related but not the same. Both conditions can involve inflammation of the inside of the throat, but tonsillitis typically mainly affects the tonsils, while strep throat, a special type of sore throat, typically leads to inflammation of the entire back of the throat, often also including the tonsils. However, whereas strep throat is always caused by Streptococcus bacteria, tonsillitis can also be caused by other types of bacteria, as well as various viruses. Strep throat also involves a wider range of symptoms and is often more severe and longer lasting than tonsillitis.

Q: What are the white spots on the tonsils which sometimes appear with tonsillitis?
A: Although not all people with tonsillitis will develop white spots on their tonsils, some will, often in more severe cases of the condition. These white spots are pus. 6 They sometimes also have a yellowish color and usually disappear once the infection has passed.

Q: Is tonsillitis contagious?
A: Although tonsillitis itself is not contagious, the viral and bacterial infections that cause the condition often are. These include the infections that cause the common cold, the flu and strep throat.

Q: What is the difference between tonsillitis and adenoiditis?
A: The adenoids are glands located in the roof of the mouth, where the nose and the throat meet. Like the tonsils, the adenoids play a role in fighting infections, but can themselves sometimes become infected. If this happens, the adenoids become inflamed, and a condition known as adenoiditis results. The symptoms of adenoiditis can in some cases be confused with tonsillitis, but they are different conditions. Symptoms of adenoiditis may include noisy breathing, snoring and nasal speech, among others. Treatment may include antibiotics, or, in severe cases, the surgical removal of the adenoids through a procedure known as an adenoidectomy. 13

Q: What is the difference between tonsillitis and pharyngitis?
A: Pharyngitis is an inflammation of the pharynx at the back of the throat and is often just simply referred to as “sore throat”. Tonsillitis, due to the position of the tonsils, involves a part of the throat, but occurs when the inflammation primarily affects the tonsils. Tonsillitis and pharyngitis can occur separately or together, in which case it is called pharyngotonsillitis. If pharyngitis causes no inflammation of the tonsils, this is not tonsillitis. 14