Overview
The tonsils are two soft pads of tissue at the back of the throat, one on each side. They are part of the body's defence against infection and are busiest in childhood.
Tonsillitis is inflammation of those pads, almost always because of an infection. The throat is sore, swallowing hurts, and there is often a fever. It is commonest in children and teenagers but happens at any age.
Most tonsillitis clears within three or four days, although it sometimes lasts longer. Treatment is mainly about keeping the person comfortable, and about picking out the smaller number of cases that need .
Symptoms
A sore throat is the main symptom, often severe, with pain on swallowing, red and swollen tonsils, and sometimes white or yellow patches of pus on them.
There may also be fever, swollen and tender glands in the neck, headache, earache, cough, tiredness, feeling sick and bad breath. Young children may simply refuse food and drink and seem unusually unwell.
A cough, a runny nose, a hoarse voice and red eyes point towards a viral cause. A sudden sore throat with fever, tender neck glands and pus on the tonsils, without a cough, is more suggestive of strep throat.
When to see a doctor
Get help the same day if there are pus-filled spots on the tonsils, or if the throat is too painful to eat or drink.
Make an ordinary appointment if symptoms have not started to improve after about a week, if a rash appears with the sore throat, or if tonsillitis keeps coming back several times a year.
Causes
Most tonsillitis is viral, caused by the same viruses that cause colds and flu. Viral tonsillitis is especially common in younger children.
A smaller share is bacterial, most often group A streptococcus, the germ behind strep throat. Strep throat is commonest between about five and fifteen years of age, and its symptoms usually start two to five days after coming into contact with the germ.
These germs spread in coughs and sneezes, in close contact, and through shared glasses, bottles and utensils. Tonsillitis itself is not passed on, but the infections behind it are.
Risk factors
- Being a child or teenager, especially of school age
- Close contact at school, at home or in crowded places
- Living with someone who has strep throat
- Sharing glasses, bottles, spoons or food
- Frequent colds and other viral infections
- A weakened immune system
Complications
Most tonsillitis passes without trouble. Complications are uncommon and follow mainly from bacterial infection that is not treated:
- Quinsy, a collection of pus beside a tonsil, with severe one-sided pain
- Ear infection and sinus infection
- Tonsils so enlarged that they interfere with breathing in sleep
- Rheumatic fever, which can affect the heart and joints
- A kidney problem that can follow a streptococcal infection
Prevention
- Washing hands well and often, especially after coughing or blowing the nose
- Covering the mouth and nose when coughing or sneezing
- Not sharing glasses, bottles, spoons or food
- Keeping a child at home while they have a fever and feel unwell
- Finishing any course of exactly as prescribed
Diagnosis
A doctor looks at the throat and tonsils, feels the glands in the neck and checks the temperature. The pattern of symptoms gives a good idea of whether a virus or a bacterium is the likelier cause.
When strep throat is suspected, a cotton swab is rubbed over the tonsils and the back of the throat. A rapid test gives an answer within minutes, and a throat culture takes a day or two but picks up more cases.
Treatment
Viral tonsillitis is treated by keeping the person comfortable while the body clears it: rest, plenty of fluids, cool drinks and soft food, and pain relief such as paracetamol or ibuprofen. Aspirin should not be given to anyone under sixteen. Adults may find gargling with warm salt water helps, although it is not suitable for young children.
Bacterial tonsillitis is treated with , which shorten the illness and lower the risk of complications. The full course is taken even once the throat feels better, because stopping early can let the infection return.
Removing the tonsils, an operation called tonsillectomy, is uncommon. It is considered when tonsillitis is severe and keeps coming back over a long period, when it does not respond to antibiotics, or when enlarged tonsils are blocking breathing or swallowing. It is done under general anaesthetic, and an ENT surgeon will weigh up whether the benefit is worth it for that person.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Tonsillitis comes from ice cream, cold drinks and sitting under a fan.”What is true?
Fact
Tonsillitis is an infection. It is caused by viruses, the same ones behind colds and flu, or sometimes by bacteria such as the streptococcus behind strep throat. Cold food and drink do not cause it, and cool drinks are in fact one of the things that soothe a sore throat.
Myth“A sore throat always means an antibiotic is needed.”What is true?
Fact
Viruses cause most sore throats. Only around one in ten adults and three in ten children with a sore throat have strep throat, and antibiotics do nothing for the rest. A cough, a runny nose, a hoarse voice or red eyes usually point to a virus.
Myth“Tonsils do no useful work, so they should come out at the first sign of trouble.”What is true?
Fact
The tonsils are part of the body's defence against infection, and the operation is not a small one. Removing them is uncommon and is considered when tonsillitis is severe and keeps returning, when it does not clear with antibiotics, or when enlarged tonsils are getting in the way of breathing or swallowing.
Myth“Tonsillitis is not catching, so there is no need to be careful at home.”What is true?
Fact
Tonsillitis itself does not pass from person to person, but the viruses and bacteria that cause it certainly do, through coughs, sneezes, close contact and shared glasses and spoons. Hand washing and covering coughs protect the rest of the household.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
How long does tonsillitis last, and when can my child go back to school?
Symptoms usually settle within three or four days, though they sometimes last longer. A child can go back once the fever has gone and they feel well enough. If antibiotics have been started for a bacterial throat infection, ask the doctor how long to stay at home, because the germ can still pass to others early in the course.
Do I need a throat swab?
Not always. A swab is taken when the picture suggests strep throat rather than a virus, for example a sudden severe sore throat with fever, tender neck glands and pus on the tonsils but no cough. A rapid test gives an answer within minutes, and a culture takes longer but finds more cases.
What can I take for the pain?
Paracetamol or ibuprofen are the usual choices for the pain and fever, taken as directed on the packet or by your doctor. Aspirin should not be given to anyone under sixteen. Cool drinks, soft food and, for adults, gargling with warm salt water all help.
Should my tonsils be removed if tonsillitis keeps coming back?
Possibly, but surgery is reserved for people whose tonsillitis is severe and returns repeatedly over a long period, whose infections do not clear with antibiotics, or whose enlarged tonsils are affecting breathing or swallowing. An ENT specialist will look at how many attacks there have been and how much they have disrupted life before advising.
