Tonsillitis

Overview

What is tonsillitis?

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

As part of your immune system, tonsils trap some of the germs that make you sick. When tonsils become infected, they get swollen and sore, and swallowing may hurt. Tonsillitis is also called tonsillopharyngitis, but most people call it a sore throat.

How common is tonsillitis?

Tonsillitis is very common. Most people have tonsillitis at least once in their lifetime.

Who is affected by tonsillitis?

Tonsillitis is most common in children, but it can affect people of all ages. Tonsillitis rarely occurs in children under the age of 3.

Symptoms and Causes

What are the symptoms of tonsillitis?

Symptoms of tonsillitis usually come on suddenly. Common symptoms include:

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

What causes tonsillitis?

A virus or bacteria causes tonsillitis. The two types of tonsillitis are:

  • Viral tonsillitis: Most cases (up to 70 percent) of tonsillitis are caused by a virus such as cold or flu (influenza).
  • Bacterial tonsillitis (strep throat): Other cases of tonsillitis are caused by group A Streptococcus bacteria. Bacterial tonsillitis is commonly called strep throat.

How do people get tonsillitis?

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

  • Kissing or sharing utensils, food or drink
  • Coming into close contact with someone who is 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

Diagnosis and Tests

How is tonsillitis diagnosed?

To diagnosis tonsillitis, your doctor will:

  • Examine your throat for redness, swelling or white spots on the tonsils
  • Ask about other symptoms you’ve had, such as a fever, cough, runny nose, rash or stomachache
  • Look in your ears and your nose for other signs of infection
  • Feel the sides of your neck to see if the lymph nodes are swollen and tender

After confirming a tonsillitis diagnosis, your doctor will need to determine whether the infection results from a virus or bacteria (strep throat).

How is strep throat diagnosed?

Your doctor may order a throat culture — also known as a strep test — to determine if you have strep throat. A throat culture is a simple test that checks for the presence of specific bacteria in your throat. During a throat culture:

  1. Your doctor will swipe the back of your throat with a long cotton swab to gather saliva and cells. The test may feel uncomfortable, but it is not painful.
  2. While you wait, your doctor will test the cells to check for bacteria. This test is called a “rapid strep test.” The results are ready in about 10-15 minutes.
  3. If the results are positive and the test does detect bacteria, your doctor will prescribe an antibiotic to treat you for strep throat.
  4. If the results are negative and the rapid strep test does not detect bacteria, your doctor may send the sample away to a lab for more thorough testing. This longer lab test usually takes 2-3 days to get results.
  5. If the lab test results come back negative, you’ll know the tonsillitis is viral, not bacterial.

How do I know if I have tonsillitis?

If you have a sore throat, swollen tonsils and pain with swallowing, you may have tonsillitis. You should visit your doctor to determine whether bacteria or a virus is causing the tonsillitis. The treatment varies based on the type of infection.

Management and Treatment

What are the treatments for tonsillitis?

The treatment you receive depends on the infection’s cause. While the symptoms of viral tonsillitis and bacterial tonsillitis can be similar, their treatments are different.

What is the treatment for strep throat?

Strep throat (tonsillitis caused by bacteria) is treated with an antibiotic medication. Antibiotics require a prescription from your doctor. You usually take antibiotics orally (by mouth) for about 10 days. The most common antibiotics for strep throat are:

  • Penicillin
  • Clindamycin
  • Cephalosporin

It is very important to follow your doctor’s instructions and take the full course of antibiotics, even if you are feeling better after a couple of days. You must finish the antibiotics so the infection doesn’t come back, get worse, or spread to another part of your body.

What are the side effects of the treatment for strep throat?

Side effects from antibiotics used to treat bacterial tonsillitis (strep throat) include:

What is the treatment for viral tonsillitis?

The antibiotics used to treat strep throat (bacterial tonsillitis) will not work on tonsillitis caused by a viral infection. To relieve the symptoms of viral tonsillitis, your doctor will recommend:

  • Plenty of rest
  • Fluids to stay hydrated
  • Over-the-counter pain relievers like ibuprofen or acetaminophen
  • Throat lozenges

What are the complications associated with tonsillitis?

Complications from tonsillitis are usually associated with strep throat and the streptococcal bacteria. They include:

  • Chronic tonsillitis: People who have tonsillitis more than 7 times a year may have chronic tonsillitis. Doctors may recommend surgery to remove the tonsils, especially if you are snoring or having trouble sleeping at night. This surgery is called tonsillectomy.
  • Scarlet fever: Strep throat can progress into scarlet fever, causing a red rash and fever. Scarlet fever occurs more often in children than adults, but it is not common.
  • Peritonsillar abscess: In severe cases of tonsillitis, an abscess (a collection of pus) can form around the tonsil. Peritonsillar abscesses occur more often in adults and adolescents than in children. Doctors often recommend surgery to drain the abscess.
  • Rheumatic fever: Although rare, rheumatic fever can occur if strep throat is not treated or you don’t complete the full course of antibiotics. Rheumatic fever occurs in children more often than adults. It can lead to permanent heart damage.
  • Spread of infection: When left untreated, streptococcal bacteria can spread from the throat to the middle ear, sinuses, or other parts of the body. This infection can lead to complications such as sinusitis, glomerulonephritis, or necrotizing fasciitis.

What can I do to help relieve symptoms of tonsillitis?

To relieve the symptoms of viral and bacterial tonsillitis, you can:

  • Take an over-the-counter pain reliever such as acetaminophen or ibuprofen.
  • Drink warm liquids, like tea, apple cider or broth.
  • Gargle with warm salt water.
  • Try throat lozenges.

Prevention

How can you prevent tonsillitis?

To reduce your risk of developing tonsillitis, you should:

  • Wash your hands often, especially before touching your nose or mouth.
  • Avoid sharing food, drink, or utensils with someone who is sick.
  • Replace your toothbrush regularly.

Outlook / Prognosis

What is the outlook for people who have tonsillitis?

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

Living With

When should I call my doctor about tonsillitis?

You should contact your doctor if you have:

  • Sore throat for more than 2 days
  • Fever over 101 degrees
  • Trouble or pain when swallowing
  • Difficulty breathing
  • Tonsils that are swollen or painful

Last reviewed by a Cleveland Clinic medical professional on 06/11/2019.

References

  • Merck Manual. Accessed 6/19/2019.Throat Infections. (https://www.merckmanuals.com/home/quick-facts-ear,-nose,-and-throat-disorders/mouth-and-throat-disorders/throat-infections?query=tonsillitis)
  • American Academy of Otolaryngology – Head and Neck Surgery. .
    Accessed 6/19/2019.Tonsillitis (https://www.entnet.org/node/1447.)
  • American Academy of Pediatrics. . Accessed 6/19/2019.Tonsillitis (https://www.healthychildren.org/English/health-issues/conditions/ear-nose-throat/Pages/Tonsillitis.aspx)
  • Georgalas CC, Tolley NS, Narula A. Tonsillitis. BMJ Clin Evid. 2009; 2009: 0503.

    Accessed 6/19/2019.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907808/ (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907808/)

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