What Is Tonsillitis? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Tonsils play an important role in your immune system and are the first line of defense against viruses and bacteria that you inhale or swallow. This collection of lymphoid tissue in the back of your mouth is part of what’s known as Waldeyer’s tonsillar ring. It includes the palatine tonsil (commonly referred to as just the tonsil), the nasopharyngeal tonsil (also known as the adenoid), the tubal tonsils (also located in the nasopharynx), and the lingual tonsil (located on the back of the tongue). (1)

When the tonsils respond to potential foreign invaders, such as bacteria or another type of infection, they can become engorged or enlarged, says James Henri Clark, MBBCh, a physician and an assistant professor of otolaryngology and head and neck surgery at Johns Hopkins Medicine in Baltimore. This type of infection of the tonsils is called tonsillitis. (2)

Symptoms you may experience when you have tonsillitis can include the following: (2)

• Red, swollen tonsils
• White or yellow coating or patches on the tonsils
• Sore throat
• Difficult or painful swallowing
• Fever
• Enlarged, tender glands (lymph nodes) in the neck
• A scratchy, muffled, or throaty voice
• Bad breath
• Stomachache, particularly in younger children
• Stiff neck
• Headache
  

For a very young child who may not be able to verbalize the symptoms he or she is experiencing, look for the following:

• Fever
• Drooling due to difficult or painful swallowing
• Refusal to eat
• Unusual fussiness
  

If these tonsillitis symptoms sound similar to those of the common cold, it’s because tonsillitis is often caused by the same virus that causes the common cold — but symptoms tend to last longer and become more severe. The virus that starts with sniffles and a sore throat can turn into a tonsil infection.

Learn More About Signs and Symptoms of Tonsillitis

The suffix “-itis” means inflammation. And the term “tonsillitis” means (you guessed it) inflammation or infection of the tonsils. Tonsillitis is most often caused by a virus like those that cause the common cold, but it can also be caused by bacteria, such as Streptococcus pyogenes (group A streptococcus) — the bacteria that causes strep throat. (3)

The tonsils’ role as the first anatomical filter of the immune system makes them vulnerable to infection. Although tonsillitis itself is not contagious, the viruses and bacteria that cause the infection (and related symptoms) are.

Tonsillitis is most often the result of a viral infection, and increased exposure to others who may be carrying a virus (specifically infected droplets that they exhale or cough) increases your risk of getting a viral infection that turns into tonsillitis, says Nicholas Rowan, MD, an associate professor of otolaryngology and head and neck surgery at John Hopkins Medicine. 

An elementary school teacher, for example, who is exposed to many kids who run around and play together is probably more likely to get sick than someone who works in his or her own office or cubicle among others who stay mainly in their own offices or cubicles. Kids also tend to be at higher risk for infections that could lead to tonsillitis for the same reason: They tend to spend more time in close proximity to others.

Frequent hand-washing and not sharing cups or food can help stop the spread of viral infections that can turn into tonsillitis. Masks that cover the nose and mouth (for both infected persons and those in contact with them) can also reduce the spread of viral infections.

Young children and teenagers are also at a higher risk for tonsillitis because they have more prominent tonsil tissue, says Dr. Clark. “As we age [and our immune system matures] the tonsil tissue shrinks back a little bit and we tend to get fewer infections as a result,” he says.

The main risk factors for tonsillitis in adults are living or working closely with children and advanced age (which can weaken the body’s immune response and put you at higher risk for an infection that might turn into tonsillitis), according to Cooper University Health Care.

Learn More About Causes of Tonsillitis and Common Risk Factors

Many cases of tonsillitis resolve on their own (with appropriate symptom management) and may not get diagnosed at all. How do you know when to seek medical attention? Clark suggests a few guidelines on when to visit your healthcare provider or seek urgent care:

• Call your doctor if you have a fever of 101 degrees F or higher, you are unable to eat or drink anything, or if your throat pain has not improved or has worsened three days after you first felt sick.
• Seek urgent or immediate care if you are drooling much more than usual, have trouble breathing or swallowing, have a stiff or swollen neck, have severe pain in your mouth, or have a voice change (associated with your tonsillitis symptoms).
  

If you do see your doctor about symptoms that could be tonsillitis, he or she will ask you for details about the symptoms you’re experiencing and will perform a physical exam. Those two steps are the most important parts of determining if a person has tonsillitis, Dr. Rowan explains.

When he sees a patient who may potentially have tonsillitis, Rowan says he checks the back of the throat to see if the tonsils are red, are inflamed, or have white patches or pus, as well as to see if one side is more swollen than the other. He also feels the neck to see if the lymph nodes are swollen. All these factors are potential signs of infection.

If the doctor confirms that the tonsils are infected, the next step is to determine if the infection is bacterial, such as strep throat (since antibiotics would be needed in that case). If a viral infection is the cause of tonsillitis (as it usually is), antibiotics are not needed. (5)

RELATED: How Doctors Diagnose Strep Throat

A rapid strep test can be administered in the doctor’s office and yields results in just a few minutes. The test is not perfect, since it only detects one strain (or type) of strep and sometimes comes back negative even when strep bacteria are present. The doctor may order a throat culture — which also involves swabbing the back of the throat — to see if strep grows from the sample collected. It’s more reliable than the rapid strep test, but the results can take a day or two. (6)

If there are no complications, the prognosis for tonsillitis is excellent. In most cases tonsillitis will resolve on its own without the need for medication if symptoms are managed, Rowan says.

If the tonsillitis is caused by a virus, the infection and symptoms usually go away within five to seven days. Bacterial tonsillitis is treated with antibiotics and typically resolves in approximately 10 days, according to the Cleveland Clinic.

Many cases of tonsillitis will clear up on their own with appropriate supportive care (like plenty of rest, proper hydration, and mild over-the-counter medications for pain) in the same way the common cold clears up on its own. If symptoms persist or get worse, you should contact your healthcare provider, who might recommend the following options:

Medication Options for Tonsillitis

If a strep test comes back positive, indicating that a bacterial infection is causing tonsillitis, antibiotics are recommended. (5) Without medication, strep throat will still nearly always go away on its own, according to Rowan, but antibiotics help speed recovery and lessen the risk of complications.

Unless you have an allergy, penicillin or amoxicillin will most likely be the antibiotic prescribed, and you should take the medication according to directions from your doctor (even if symptoms disappear before the course of medication is complete).

If prescribed an antibiotic, you should start to feel better within one to three days of starting the medication, Clark says. Taking an antibiotic will not only shorten the amount of time you feel bad, it will also reduce the likelihood that you’ll get someone else sick, and it should prevent the development of complications, too, including acute rheumatic fever. (7)

If your strep tests come back negative, you most likely have viral tonsillitis and antibiotics are not recommended, Clark says. To help with pain or fever, use an over-the-counter pain reliever, such as acetaminophen (Tylenol) or ibuprofen (Advil), Clark adds. Aspirin should be avoided in children because of the risk of Reye’s syndrome. (5)

Full recovery should take anywhere from five to seven days, he adds. And if you don’t feel better after a week or your symptoms have worsened, you should contact your healthcare provider to be reevaluated.

Tonsillectomy

According to the Academy of Otolaryngology — Head and Neck Surgery Foundation (AAO-HNSF), a tonsillectomy (getting your tonsils surgically removed) is indicated when children have seven or more tonsil infections in one year, five per year for two years in a row, or three per year for three years. If frequent tonsillitis hasn’t reached that threshold, then watchful waiting is suggested.

A tonsillectomy reduces the number of throat infections that a person will have. If the tonsils are taken out, they can’t get infected, though other areas of tissue in the throat are still susceptible to strep infection, according to the Mayo Clinic.

Although it is more typical for children to get their tonsils removed, adults can benefit from having a tonsillectomy, too. Rowan says he considers whether a tonsillectomy might be appropriate for an adult when that individual has four or more infections of the tonsils per year.

At-Home Remedies and Supportive Care for Tonsillitis

Whether your tonsillitis is bacterial (and you’re taking antibiotics to manage your infection) or viral (and you’re letting the infection clear on its own), home remedies to ease symptoms and stay comfortable are an important part of your care.

To help your body heal itself, be sure to get plenty of rest, stay hydrated, eat soft foods (think applesauce or smoothies), and avoid irritants, such as cigarette smoke or acidic foods and beverages, Clark says.  

To help ease and soothe any throat pain you experience, try: (3)

• Sipping on cold or warm beverages, such as tea with honey or lemon (young children shouldn’t have honey, because of botulism risk) (8)
• Eating cold or frozen desserts
• Sucking on ice
• Sucking on throat lozenges (avoid giving these to children younger than 4, as they can be a choking hazard)
• Gargling with warm salt water

RELATED: Home Remedies to Help You Manage Tonsillitis

Alternative and Complementary Therapies for Tonsillitis

No supplements treat tonsillitis, although there is a lozenge that contains the probiotic BLIS K12 (also known as SsK 12), that may help reduce the chance of getting tonsillitis, says Tod Cooperman, MD, the president of ConsumerLab.com, an independent organization that reviews supplements and other types of products that impact consumer health, wellness, or nutrition. Research, however, suggests the probiotic may not yet have enough evidence for how and when it should be used.

A 2019 review concluded that K12 was safe and well-tolerated and may potentially be beneficial in protecting children from throat infection. According to the authors, further randomized controlled studies are needed to establish whether K12 could be an alternative to antibiotics (as it is not likely to be effective if given along with antibiotics) or if the probiotic could be used as a preventive treatment for people who get frequent bouts of tonsillitis.

Always talk with your doctor before trying a supplement because it may interact with other medications you are taking or have other side effects you should know about.

Learn More About Treatment for Tonsillitis: Medication, Alternative and Complementary Therapies, and More

“The best way to prevent tonsillitis is by washing your hands and practicing good hygiene,” says Clark.

In addition to frequent hand-washing, the following measures better your chances of avoiding tonsillitis: (2)

• Good oral care
• Avoid sharing food, dishes, water bottles, or utensils
• Replace toothbrushes after infection

Contact your healthcare provider if your symptoms don’t improve or if they worsen after the typical time window for recovery. Complications that can result from tonsillitis include the following:

• Tonsillar Cellulitis This is an infection that spreads deep into surrounding tonsil tissue.
• Quinsy or Peritonsillar Abscess This infection results in a collection of pus behind a tonsil.
• Middle-Ear Infection or Otitis Media A buildup of fluid can cause a secondary infection in the ear.
• Rheumatic Fever This is an inflammatory disorder that affects the heart, joints, and other tissues. (2)
• Post-Streptococcal Glomerulonephritis (PSGN) This inflammatory disorder of the kidneys results in inadequate removal of waste and excess fluids from blood. (9)
• Obstructive Sleep Apnea The swelling of the tonsils may cause an obstruction in the airway and result in sleep apnea (a chronic condition in which breathing stops temporarily during sleep) (2)
  

While there is no link between tonsillitis and cancer, sometimes they may have similar symptoms. In adults, frequent or chronic sore throat could be a sign of throat or tonsil cancer in rare cases. It’s important to see your doctor in order to rule out the possibility of cancer as an underlying cause of throat pain (even though such diagnoses are rare). (10)

Learn More About the Complications of Tonsillitis

Recurrent tonsillitis is when your tonsils become infected several times in a single year. It’s generally defined as: (5)

• More than seven episodes in one year
• More than five episodes per year during a two-year period
• More than three episodes per year during a three-year period

When an adult appears to have “recurrent” tonsillitis, something else may actually be to blame, as tonsillitis is not as common in adults (who tend to not be exposed to as many germs as kids), Rowan explains. The symptoms could be an indication of throat cancer or tonsil cancer — and though such a scenario is rare, your doctor will want to rule out that possibility.

Whether or not a doctor recommends tonsillectomy (surgery to remove the tonsils) for tonsillitis depends on the severity of an individual’s symptoms and their medical history. But guidelines recommend that doctors only consider tonsillectomy if tonsillitis meets the criteria for being recurrent, if the patient has had more than one peritonsillar abscess, or if the patient has multiple antibiotic allergies that would complicate adequate medical treatment, according to the AAO-HNSF.

Tonsillectomies are sometimes done to help improve difficulties with breathing during sleep in people with obstructive sleep apnea. (13)

How much tonsillitis impacts a person’s quality of life is one major consideration, Rowan says. If someone is missing a lot of school or work or taking antibiotics or other medicines repeatedly and feeling generally miserable, it’s probably time to consider a tonsillectomy.

Learn More About Recurrent Tonsillitis

Tonsillitis is very common, particularly in children. Most children in the United States will get tonsillitis at least once. Kids between ages 5 and 15 are more likely to get tonsillitis that is caused by a bacterial infection, whereas in younger children, tonsillitis caused by a virus is more common. Adults get tonsillitis less frequently than kids. (3)

Sore throats account for approximately 2 percent of doctor visits in the United States. (14)

Here’s what you should know about some of the conditions that can be related to tonsillitis:

Pharyngitis and tonsillitis both indicate inflammation of the throat. The difference is that pharyngitis is an infection that can affect different areas of the throat rather than just the tonsils. The causes, symptoms, and treatments for pharyngitis and tonsillitis are generally the same. (15)

Sleep Apnea can be caused by enlarged tonsils and adenoids in both adults and children and occurs when the glands or other tissues briefly block the airways while the individual is asleep. Sometimes the glands simply grow too large or an infection such as tonsillitis causes them to swell. (16)

Favorite Orgs for Essential Tonsillitis Info

FamilyDoctor.org

This website is published by the American Academy of Family Physicians. It offers medical advice about a variety of childhood illnesses and conditions, including tonsillitis.

MedlinePlus

MedlinePlus, a project of the National Institutes of Health (NIH) and the National Library of Medicine, provides health and wellness information in both English and Spanish. The information on tonsillitis covers many frequently asked questions.

ENT Health

This website is produced by the American Academy of Otolaryngology — Head and Neck Surgery. Find health information about ear, nose, throat and head conditions. The tonsillitis guide includes a list of questions to ask your doctor when seeking care.

KidsHealth

KidsHealth is run by Nemours Children’s Health, a not-for-profit pediatric health system and foundation based in Jacksonville, Florida. The organization’s stated mission is to provide life-changing medical care and world-changing research, education, and advocacy. Find a kid-friendly guide about tonsillitis on the website.