Tonsillitis

Medically Reviewed by Poonam Sachdev on May 09, 2023
8 min read

Tonsillitis is an infection of your tonsils, which are two masses of tissue at the back of your throat.

Your tonsils act as filters, trapping germs that could otherwise enter your airways and cause infection. They also make antibodies to fight infection. But sometimes, they get overwhelmed by bacteria or viruses. This can make them swollen and inflamed.

Tonsillitis is common, especially in children. It can happen once in a while or come back again and again in a short period.

There are three types:

  • Acute tonsillitis. These symptoms usually last 3-4 days but can persist for up to 2 weeks.
  • Recurrent tonsillitis. This is when you get tonsillitis several times a year.
  • Chronic tonsillitis. This is when you have a long-term tonsil infection.

The main symptoms of tonsillitis are inflamed and swollen tonsils, sometimes severe enough to make it hard to breathe through your mouth. Other symptoms include:

  • Throat pain or tenderness
  • Fever
  • Red tonsils
  • A white or yellow coating on your tonsils
  • Painful blisters or ulcers on your throat
  • Headache
  • Loss of appetite
  • Ear pain
  • Trouble swallowing
  • Swollen glands in your neck or jaw
  • Fever and chills
  • Bad breath
  • A scratchy or muffled voice
  • Stiff neck

In children, tonsillitis symptoms may also include:

Both bacterial and viral infections cause tonsillitis. If you have tonsillitis, it's important for your doctor to determine the correct cause in order to find the right treatment.

Viral tonsillitis

Several different viruses may make your tonsils inflamed, leading to tonsillitis. Some include:

  • Adenoviruses
  • Influenza virus
  • Epstein-Barr virus
  • Parainfluenza viruses
  • Enteroviruses
  • Herpes simplex virus
  • HIV

Generally, viral tonsillitis is less severe and more common than bacterial tonsillitis, making up about 70% of cases. This form of the condition should not be treated with antibiotics.

Sometimes, viral tonsillitis caused by Epstein-Barr virus can occur with mononucleosis (or mono). If you develop mono, you may also have fatigue, fever, muscle aches, and loss of appetite. In rare cases, you might develop hives, a racing pulse, and nosebleeds as well. If you think you might have mono, ask your doctor to perform a test to confirm. Mono is rarely life-threatening, but if you are diagnosed with the condition, you should avoid certain contact sports until the infection is cleared to prevent rupturing your spleen.

Bacterial tonsillitis

Another common cause of tonsillitis is Streptococcus (strep) bacteria, which can also lead to strep throat. Occasionally other bacteria, such as Staphylococcus aureus, can inflame your tonsils as well. These infections are usually treatable with antibiotics.

Bacterial tonsillitis sometimes leads to a condition called quinsy. This occurs when an abscess (or a buildup of pus) develops next to your tonsil, pushing it toward the center of your throat. Quinsy can be quite painful, and can even make it difficult to open your mouth. If this occurs, your doctor may need to perform a minor procedure to remove the abscess.

Tonsillitis vs. strep throat

Strep throat and tonsillitis often go hand-in-hand. If you have strep throat, there is a good chance that you will develop tonsillitis as well. But getting tonsillitis does not always mean that you have strep throat. Your doctor will need to swab the back of your throat and perform a culture to determine whether strep bacteria are present.

In addition to swollen tonsils and soreness, the symptoms of strep throat typically include fever, swollen lymph nodes, red spots on the roof of your mouth, and white streaks on the back of your throat. You may also experience nausea, headaches, stomach pain, or a rash. If you have a runny nose or cough in addition to tonsillitis, you probably don't have strep.

Repeated strep throat infections might indicate that you need to have your tonsils removed.

Is tonsillitis contagious?

Tonsillitis itself isn't contagious, but the infections that cause it can be. You can catch bacterial tonsillitis through contact with an infected person's saliva, including respiratory droplets. Viruses that cause tonsillitis are spread in a number of ways. You can pick them up from surfaces such as doorknobs and phone screens. Some, such as influenza viruses, are airborne, while others, such as Epstein-Barr virus, are passed along via contact with saliva—or, in the case of HIV, sexually transmitted.

Some things may increase your risk of getting tonsillitis:

  • Age. Children tend to get tonsillitis more than adults. When you are very young, your tonsils play an important role in your body's immune function. But as you age, they become less important. Experts believe this could explain why adults are so much less susceptible to tonsillitis than children. Kids in the age group of 5-15 years are more likely to get tonsillitis caused by bacterial infections. Tonsillitis caused by viral infections is more common in very young children. Elderly adults are at a higher risk for tonsillitis too.
  • Germ exposure. Children also spend more time with other kids their age in school or camp, so they can easily spread infections that lead to tonsillitis. Adults who spend a lot of time around young children, such as teachers, may also be more likely to pick up infections and get tonsillitis.
  • The weather. Some research suggests that atmospheric conditions can influence your risk of getting tonsillitis. Hotter weather and higher levels of smog are associated with an increased chance of tonsillitis. But humidity does not seem to impact your odds of developing the condition.
  • Immune cells. Certain people are predisposed to recurring bacterial tonsillitis infections. Research suggests that the balance of immune cells your body produces might determine whether you are more likely to have recurring episodes of tonsillitis.

Your doctor will do a physical exam. They’ll look at your tonsils to see if they’re red or swollen or have pus in them. They’ll also check for a fever. They may look in your ears and nose for signs of infection and feel the sides of your neck for swelling and pain.

You might need tests to find the cause of your tonsillitis. They include:

  • A throat swab. Your doctor will test saliva and cells from your throat for strep bacteria. They’ll run a cotton swab along the back of your throat. This might be uncomfortable but won’t hurt. Results are usually ready in 10-15 minutes. Sometimes, your doctor will also want a lab test that takes a couple of days. If these tests are negative, a virus is what caused your tonsillitis.
  • A blood test. Your doctor may call this a complete blood cell count (CBC). It looks for high and low numbers of blood cells to show whether a virus or bacteria caused your tonsillitis.
  • Rash. Your doctor will check for scarlatina, a rash linked to strep throat infections.

Complications usually happen only in the case of bacterial infections. They include:

  • A collection of pus around your tonsil (peritonsillar abscess)
  • Middle ear infection
  • Tonsil stones, or small lumps that form on your tonsils, which can cause bad breath
  • Breathing problems or breathing that stops and starts while you sleep (obstructive sleep apnea)
  • Tonsillar cellulitis, or infection that spreads and deeply penetrates nearby tissues

If you have strep bacteria and don’t get treatment, your illness could lead to a more serious problem, including:

Your treatment will depend in part on what caused your illness.

Tonsillitis medication

If your tests point to bacterial tonsillitis, you’ll get antibiotics. Your doctor might give you these drugs via a one-time injection or in pills that you’ll swallow for several days. You’ll start to feel better within 2 or 3 days, but it’s important to take all of your antibiotics for tonsillitis.

Tonsillitis home remedies

If you have viral tonsillitis, antibiotics won't help, and your body will fight the infection on its own. In the meantime, you can try some home remedies for tonsillitis self-care:

  • Get lots of rest.
  • Drink warm or very cold fluids to help with throat pain .
  • Eat smooth foods, such as flavored gelatins, ice cream, and applesauce.
  • Use a cool-mist vaporizer or humidifier in your room.
  • Gargle with warm salt water.
  • Suck on lozenges with benzocaine or other medications to numb your throat.
  • Take over-the-counter pain relievers such as acetaminophen or ibuprofen.

Tonsillectomy

Tonsils are an important part of your immune system, so your doctor will try to help you keep them. But if your tonsillitis keeps coming back or won’t go away, or if swollen tonsils make it hard for you to breathe or eat, you might need to have your tonsils taken out. This surgery is called tonsillectomy.

Tonsillectomy used to be a very common treatment. But now, doctors recommend this surgery only if your tonsillitis keeps coming back. That means you or your child has had tonsillitis more than seven times in one year, more than four or five times a year for the past 2 years, or more than three times a year for the past 3 years.

Usually, your doctor uses a sharp tool called a scalpel to take out your tonsils. But other options are available, including lasers, radio waves, ultrasonic energy, or electrocautery to remove enlarged tonsils.

Discuss your options with your doctor to decide the best treatment for you.

Tonsillectomy recovery

Tonsillectomy is an outpatient procedure, meaning you won’t need to stay in the hospital. It usually lasts less than an hour. You can probably go home a few hours after surgery.

Recovery usually takes 7-10 days. You may have some pain in your throat, ears, jaw, or neck after the surgery. Your doctor can tell you what drugs to take to help with this.

Get plenty of rest and drink lots of fluids while you’re recovering. But don’t eat or drink any dairy products for the first 24 hours.

You might have a low fever and see a little blood in your nose or mouth for several days after the surgery. If your fever is over 102 F (38.89 C) or you have bright red blood in your nose or mouth, call your doctor right away.

The best way to prevent tonsillitis is through good hygiene, including:

  • Washing your hands often
  • Not sharing food, drink, utensils, or personal items such as toothbrushes with anyone
  • Staying away from someone who has a sore throat or tonsillitis

Tonsillitis is characterized by inflammation in your tonsils and can be caused by either bacteria or viruses. It's important to figure out the underlying cause of your tonsillitis to determine the most appropriate form of treatment. While tonsillitis is certainly uncomfortable, it is rarely life-threatening and will usually clear up in a few days with rest, fluids, and sometimes doctor-prescribed treatment.

How long does tonsillitis last?

Most cases of viral tonsillitis last a week or less. Bacterial tonsillitis may clear up within 2 days after starting antibiotics. However, even if you are feeling better, it is important to finish the entire course of antibiotics to prevent reinfection.

What is the fastest way to cure tonsils?

The fastest way to relieve your tonsillitis symptoms involves home remedies, such as gargling with salt water, drinking warm tea, using throat lozenges, or taking over-the-counter pain relievers, such as acetaminophen (Tylenol).

For bacterial tonsillitis, antibiotics—usually penicillin—may be necessary to completely clear the infection. Technically, the fastest way to cure your tonsils is to remove them, although this is not usually necessary.