Tonsillitis

What is tonsillitis?

Tonsillitis occurs when your tonsils become infected. Tonsils are the two small lumps of soft tissue — one on either side — at the back of your throat. You can see your tonsils in a mirror by opening your mouth and sticking out your tongue.

Your tonsils are part of your immune system, and they help trap germs that make you sick. When your tonsils become infected, they get swollen and sore, and swallowing may hurt. The medical term for tonsillitis is “tonsillopharyngitis”, but most people call it a sore throat because that’s what it feels like.

Tonsillitis is most common in children and adolescents, but it can affect people of all ages. It rarely occurs in children under the age of 3. Most people have tonsillitis at least once in their lifetimes.

Symptoms of tonsillitis

Tonsillitis symptoms usually come on suddenly. They may include:

• Sore or scratchy throat.
• Pain or difficulty swallowing.
• Red, swollen tonsils and throat.
• White spots on your tonsils.
• White, yellow or gray coating on your tonsils.
• Fever above 100.4 degrees Fahrenheit (38 degrees Celsius).
• Swollen lymph nodes (glands on the sides of your neck below your ears).
• Stomachache or vomiting (more common in younger children).

What are the first signs of tonsillitis?

A sore throat is often the first symptom of tonsillitis. If you develop a sudden sore throat, keep an eye on your tonsils to see if they get red or swollen.

Tonsillitis causes

Viral infections are the most common cause of tonsillitis. But bacterial infections can cause it, too.

• Viral tonsillitis: Viruses like those that cause the common cold and the flu cause up to 70% of tonsillitis cases. Commonly, people with viral tonsillitis have milder symptoms than those with bacterial tonsillitis.
• Bacterial tonsillitis (strep throat): Bacteria, like Group A Streptococcus, cause other cases of tonsillitis. A common name for bacterial tonsillitis is strep throat. People without tonsils can still get strep throat. (In this case, it affects their throat instead of their tonsils.) Generally, bacterial tonsillitis causes more severe symptoms than viral tonsillitis.

How does tonsillitis spread?

The viruses and bacteria that cause tonsillitis are highly contagious. They’re passed along by:

• Kissing or sharing utensils, foods or drinks.
• Coming into close contact with someone who’s sick.
• Touching a contaminated surface and then touching your nose or mouth.
• Inhaling tiny particles that become airborne when a sick person sneezes or coughs.

Risk factors

You have an increased risk of getting tonsillitis if you’re:

• Between the ages of 5 and 15. Tonsillitis is most common in children and adolescents.
• Exposed to germs frequently. Those who work or go to school in buildings with lots of other people have a higher risk of encountering the germs that cause tonsillitis. (Teachers who work closely with children are one example.)

Complications of tonsillitis

Tonsillitis can sometimes result in complications like:

• Obstructive sleep apnea.
• Peritonsillar abscess.
• Tonsil stones.
• Tonsillar cellulitis.

People with untreated bacterial tonsillitis have a higher risk of developing:

• Poststreptococcal reactive arthritis (joint pain and swelling that occurs within 10 days of a strep infection).
• Rheumatic fever.
• Scarlet fever.
• Kidney inflammation.

How doctors diagnose tonsillitis

To diagnose tonsillitis, your healthcare provider will:

• Examine your throat for redness and swelling.
• Ask about other symptoms you’ve had, like a fever, cough, runny nose, rash or stomachache. This can help them rule out other conditions.
• Look in your ears and nose for other signs of infection.
• Feel the sides of your neck to see if your lymph nodes are swollen and tender.

Tests that are used

After confirming a tonsillitis diagnosis, your provider will need to determine whether the infection is viral or bacterial. To do this, they may request a bacteria culture test.

During this procedure, your provider will swipe the back of your throat with a long cotton swab to gather cells and saliva. Then, they’ll check the sample to see if it tests positive for Group A Streptococcus bacteria. If your results are positive, you have strep throat. If your results are negative, you have viral tonsillitis.

How is tonsillitis treated?

Tonsillitis treatment depends on the cause. While symptoms of viral tonsillitis and bacterial tonsillitis can be similar, their treatments are different. Treatment may include:

• Antibiotics, if your infection is bacterial. Your healthcare provider may prescribe antibiotics like penicillin, clindamycin or cephalosporin. It’s important to follow your healthcare provider’s instructions and take the full course of antibiotics, even if you’re feeling better after a couple of days. If you stop taking them too soon, the infection could get worse or spread to another part of your body.
• Pain-relieving medications. Your provider may also recommend over-the-counter (OTC) pain relievers like ibuprofen or acetaminophen to help with your sore throat.
• Tonsillectomy (tonsillitis surgery). If you have chronic or recurring (returning) tonsillitis, your healthcare provider may recommend a tonsillectomy. This is a procedure to surgically remove your tonsils.

Home remedies

In addition to your healthcare provider’s recommendations, you can relieve the symptoms of viral and bacterial tonsillitis by:

• Drinking warm liquids, like tea, apple cider or broth.
• Gargling with warm salt water.
• Sucking on throat lozenges.

Can tonsillitis be prevented?

You can’t totally prevent tonsillitis. But you can reduce your risk by practicing good hygiene habits:

• Wash your hands often, especially before touching your nose or mouth.
• Avoid sharing foods, drinks or utensils with someone who’s sick.
• Replace your toothbrush every three months and every time you get sick.

What can I expect if I have tonsillitis?

Most cases of viral tonsillitis clear up in a few days with fluids and plenty of rest. Antibiotics typically eliminate bacterial tonsillitis in about 10 days. Tonsillitis usually doesn’t cause any serious or lasting health problems.

How long does tonsillitis last?

In most cases, tonsillitis symptoms go away in three to four days. But if symptoms last longer, you should schedule a visit with your healthcare provider to rule out other, more serious issues.

When can I go back to work or school?

You should stay at home until your fever goes away and you can swallow comfortably again. This usually takes three to four days. If you’re unsure, ask your healthcare provider.

How do I take care of myself?

The best thing you can do is stay at home, get plenty of rest and drink lots of fluids. Following your healthcare provider’s guidance can ensure a speedy recovery.

When is tonsillitis an emergency?

You should contact your healthcare provider or an urgent care facility if you have:

• A sore throat for more than four days.
• A fever over 101 degrees F (38.33 degrees C).
• Difficulty breathing.

Will tonsillitis go away on its own?

Viral tonsillitis typically goes away on its own in about one week. Bacterial tonsillitis takes about 10 days to run its course, but you’ll likely need antibiotics to reduce your risk of complications.

What does tonsillitis look like?

Tonsillitis usually causes visibly red and inflamed tonsils. In some cases, you might have a whitish coating on your throat or white spots on your tonsils.

Tonsillitis vs. strep: What’s the difference?

Strep throat is another common name for bacterial tonsillitis. You can get strep throat even if you don’t have your tonsils anymore.

A note from Cleveland Clinic

You know that feeling — that scratchy sensation in the back of your throat. You keep your fingers crossed, hoping it’ll go away. But when you wake up the next morning, it hurts to swallow. If this sounds like you, it could be tonsillitis. And it’s best to make an appointment with your healthcare provider. With some rest and medication, you’ll be feeling like yourself again in a few days.