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Tonsillitis

  1. What is tonsillitis?
  2. Symptoms
  3. Causes
  4. Diagnosis
  5. Treatment
  6. Prevention

What is 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.

Acute, chronic and recurrent tonsillitis

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.

Symptoms of tonsillitis

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.

Causes of tonsillitis

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.

Viral tonsillitis

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.

Bacterial tonsillitis

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.

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.

Diagnosing tonsillitis

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.

Treatment

The choice of treatment mostly depends on the cause (i.e. whether bacterial or viral). Anti-inflammatory medicines (such as ibuprofen) are helpful in reducing pain and swelling. Many people also eat cold, soft food to reduce their symptoms. If the condition is caused by bacteria, the treatment may involve antibiotics. Surgical removal of the tonsils may be required if the infections are persistent or recurrent.

Prevention

Taking care to prevent the spread of colds or the flu in the home and community can help prevent some cases of tonsillitis. People with tonsillitis, especially children, should avoid school or day care until their symptoms begin to improve.


  1. Patient. “Tonsillitis.” June 16, 2014. Accessed October 1, 2018.

  2. NHS. “Tonsillitis.” December 15, 2017. Accessed October 1, 2018.

  3. NHS Inform. “Tonsillitis.” May 1, 2018. Accessed October 1, 2018.

  4. Very Well Health. “Chronic and Recurrent Tonsillitis: What to Know.” September 30, 2018. Accessed October 2, 2018.

  5. American Family Physician. “Recurrent Tonsillitis.” November 1, 2001. Accessed October 2, 2018.

  6. Patient. “What do tonsils do?” Accessed October 2, 2018.

  7. Bupa. “Tonsillitis.” Accessed October 8, 2018.