Tonsillitis

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is tonsillitis?

Tonsillitis is inflammation of the tonsils. The tonsils are lymph glands at the back of the throat. There is one on either side of the throat. They are often visible through the mouth. As part of the lymph system, they help rid the body of infections. Their location makes them an important defense against germs that come in through the nose and mouth. Most often, tonsillitis is due to a viral infection. Common viruses, such as cold and flu viruses, are frequent culprits. Less commonly, bacterial infections, namely strep throat from Streptococcus bacteria, cause tonsillitis.

Tonsillitis causes red swollen tonsils, sore throat, and difficulty swallowing. You may also notice swollen lymph nodes in the neck that can be tender. Sometimes, fever and other symptoms, such as stomachache, can happen depending on the infectious cause.

Bacterial and viral tonsillitis look the same. Your doctor can tell the difference by taking a throat swab or throat culture. When bacteria are the cause, tonsillitis treatment will involve a course of antibiotics. Antibiotics will not work against viruses. It simply takes time for the body to clear a viral infection. Home remedies and over-the-counter medicines can help keep your child comfortable while the body fights the infection.

Tonsillectomy—or removal of the tonsils—is not as common a treatment today as it was in the past. However, there are still some cases that benefit from the surgery. Doctors typically recommend it today when tonsillitis recurs frequently or causes complications.

Seek prompt medical care if your child has a sore throat that persists for more than two days. Seek immediate medical attention if your child has difficulty breathing, can’t swallow, or is drooling because of throat complaints.

What are the symptoms of tonsillitis?

Acute tonsillitis comes on quickly. Tonsils appear red and inflamed. They may or may not have white or yellow patches or streaks on them. These symptoms may spread to the uvula, soft palate (roof of the mouth), and back of the throat.

Common symptoms

Other common acute tonsillitis symptoms can include:

Serious symptoms that might indicate a serious condition

In some cases, tonsillitis can cause serious complications. Seek immediate medical care (call 911) if your child any of these potentially serious symptoms including:

  • Difficulty breathing

  • Difficulty opening the mouth

  • Drooling or severe problems trying to swallow

When a sore throat lasts for more than two days, it’s important to contact your doctor. It may be necessary to take a throat swab to find out if a bacterial infection is causing the problem. If so, prompt treatment with antibiotics can relieve symptoms and prevent complications.

What causes tonsillitis?

Infectious tonsillitis is not contagious, but the microorganisms that cause the infection are. About 70% of tonsillitis cases are due to a viral infection. Cold and flu viruses are common causes. However, several other viruses can also cause it. Examples include Epstein-Barr virus, herpes simplex virus, and the measles virus. The remaining cases are usually due to a bacterial infection. The most common bacterial cause is group A Streptococcus. Strep throat is the everyday name for this infection.

What are the risk factors for tonsillitis?

Anyone can get tonsillitis. However, it is more common in school-aged children between the ages of 5 and 15 years. It is rare in very young children under 2. It is also rare in adults, as the tonsils play a less prominent role in their immune system defense.

Reducing your risk of tonsillitis

The germs that cause tonsillitis are contagious. Practicing good hygiene may help lower the risk of tonsillitis. This includes:

  • Avoiding touching your eyes, nose and mouth unless your fingers are clean

  • Keeping away from close contact with sick people

  • Not eating or drinking after others, including sharing food, utensils and beverages

  • Washing your hands often, especially before eating

To avoid spreading germs, keep children home when they are sick with a sore throat. They should stay home until they are no longer contagious. In general, this means 24 hours after symptoms begin to improve and they no longer have a fever. For strep throat, they need to be fever-free and have taken antibiotics for at least 24 hours.

How is tonsillitis treated?

If a throat culture comes back positive for a bacterial infection, a course of antibiotics will be necessary. It’s important to finish the whole course, even after symptoms improve. Failing to do so increases the risk of complications. Antibiotics are not appropriate for viral tonsillitis because they will not work. Using antibiotics for a viral infection contributes to antibiotic resistance. Viral infections will clear on their own in about a week to 10 days.

Regardless of the type of infection, there are several ways you can improve comfort and relieve symptoms. This includes using throat lozenges, saltwater gargles, and over-the-counter fever and pain reducers. Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) are generally safe for children. Talk with your child’s doctor or pharmacist if you have questions about dosing.

It’s also important to get plenty of rest and drink fluids. If drinking is painful, sucking on ice chips or popsicles may work better. It’s important to take in enough fluids to avoid dehydration. Fluids also keep the throat moist, which can help ease symptoms. Using a humidifier can be helpful as well.

Surgery to remove the tonsils may be necessary in some cases. Children are candidates for tonsillectomy when tonsillitis recurs frequently. Doctors define this as at least:

  • Seven episodes of tonsillitis in the last year

  • Five episodes each year for the last two years

  • Three episodes each year for the last three years

Doctors may also recommend tonsillectomy when complications develop.

What are the potential complications of tonsillitis?

Potential complications of tonsillitis include recurrent tonsillitis and chronically enlarged tonsils. Persistently large tonsils can interfere with swallowing, breathing or speaking. In some children, large tonsils can cause snoring and trouble breathing during sleep.

Chronic tonsillitis can also lead to a peritonsillar abscess. This is a pocket of infection around the tonsil, which can spread into surrounding structures. It can also pop, spreading infection into the chest. Surgery may be necessary for any of these complications.

Tonsillitis due to strep throat can cause complications without a full course of antibiotic treatment. The infection can result in inflammatory damage to the heart and joints (rheumatic fever) and kidneys (poststreptococcal glomerulonephritis).

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Jan 23
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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  6. Tonsillitis. Nemours Foundation. https://kidshealth.org/en/parents/tonsillitis.html?ref=search