Tonsillitis: Types, Causes, Symptoms, Diagnosis & Treatment

Tonsillitis is an inflammation of the palatine tonsils, two masses of lymphoid tissue located at the back of the throat. This condition can be caused by either viral or bacterial infections. The medical term for tonsillitis is “tonsillopharyngitis”, but most people call it a sore throat because that’s what it feels like.

Your tonsils work as a defense mechanism and help prevent your body from getting an infection. When an infection develops on your tonsils themselves, the condition is called tonsillitis.

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 three. Most people have tonsillitis at least once in their lifetimes.

The germs that trigger tonsillitis can be transmitted to others, and a variety of common viruses and bacteria can cause it. Tonsillitis-causing microorganisms include Streptococcal bacteria. Tonsillitis caused by strep throat can lead to serious complications without treatment.

Signs and symptoms of tonsillitis include swollen tonsils, sore throat, difficulty swallowing and tender lymph nodes on the sides of the neck. Tonsillitis is easy to diagnose. Symptoms usually resolve within 7–10 days.

Treatment for tonsillitis depends on the cause, it’s important to get a prompt and accurate diagnosis. Surgery to remove tonsils, once a common procedure to treat tonsillitis, is usually performed only when tonsillitis occurs frequently, doesn’t respond to other treatments, or causes serious complications.

Key points about tonsillitis

• Tonsillitis means that your tonsils are inflamed.
• Both bacteria and viruses can cause tonsillitis. These are usually easily passed from one person to another.
• Tonsillitis caused by a virus is treated differently from tonsillitis caused by bacteria.
• You can help prevent tonsillitis by washing your hands often. You should also stay away from anyone with a sore throat or tonsillitis.
• You will need treatment right away if you develop a peritonsillar abscess. This can block your airway.

Types of tonsillitis

Tonsillitis can present in several different ways.

Acute tonsillitis

Tonsillitis is incredibly common in children. In fact, almost every child will probably get tonsillitis at least once.

If symptoms last around 10 days or fewer, a doctor will consider it acute tonsillitis. If symptoms last longer, or if tonsillitis comes back multiple times during the year, it may be chronic or recurrent tonsillitis.

The symptoms of acute tonsillitis usually improve with home treatments. But, in some cases, you may require other treatments, like antibiotics.

Chronic tonsillitis

Chronic tonsillitis is an ongoing infection of the tonsils. If you have chronic tonsillitis, you may need to have your tonsils removed.

Chronic tonsillitis symptoms continue longer than the acute type. You may have the following symptoms on a long-lasting basis:

• sore throat
• halitosis (bad breath)
• tender lymph nodes in the neck

Chronic tonsillitis may also cause tonsil stones, where materials like dead cells, saliva, and food build up in the crevices of your tonsils. Eventually, the debris can harden into small stones. These may come loose on their own, or a doctor may need to remove them.

A doctor may recommend a tonsillectomy to surgically remove your tonsils if you have chronic tonsillitis.

As with chronic tonsillitis, a standard treatment for recurrent tonsillitis is a tonsillectomy. Recurrent tonsillitis is often defined as:

• a sore throat or tonsillitis at least 6–7 times in 1 year
• occurrences of at least 5 times in each of the previous 2 years
• occurrences of at least 3 times in each of the previous 3 years

A 2018 review suggests that chronic and recurrent tonsillitis may occur due to biofilms in the folds of the tonsils. Biofilms are communities of microorganisms that have developed antibiotic resistance, and they can cause repeated infections.

Genetics may also be a reason for recurrent tonsillitis.

A 2019 study examined the tonsils of children who had recurrent tonsillitis. Researchers found that genetics may cause an insufficient immune response to group A streptococcus bacteria, which cause strep throat and tonsillitis.

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Symptoms of tonsillitis

Tonsillitis symptoms usually come on suddenly. Signs and symptoms of tonsillitis may include:

• 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
• Neck pain or stiff neck
• Headache

In young children who are unable to describe how they feel, signs of tonsillitis may include:

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

When to see a doctor

Talk with a doctor if you experience the following symptoms: 

• a fever that’s higher than 103°F (39.5°C)
• muscle weakness
• neck stiffness
• a sore throat that doesn’t resolve after 2 days

In rare cases, tonsillitis can cause the throat to swell so much that it causes trouble breathing. If this happens, seek immediate medical attention. 

While some tonsillitis episodes resolve without treatment, some may require other treatments.

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Causes of tonsillitis

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. Other viruses can also cause viral tonsillitis, including; rhinovirus, Epstein-Barr virus, hepatitis A, and HIV.
• Bacterial tonsillitis: 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.

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.

Difference between Tonsillitis and strep throat

A number of different bacteria or viruses can cause tonsillitis, including group A streptococcus bacteria. Group A streptococcus bacteria is the only cause of strep throat.

Both conditions are contagious, so try to avoid being near other people if you think you have either one.

In addition to tonsillitis symptoms, people with strep throat may develop:

• aches in other parts of the body
• nausea
• vomiting
• small red spots at the back of the mouth
• white pus around the tonsils
• a rash

A doctor can use the same tests to diagnose both conditions. Treatments for bacterial tonsillitis and strep throat are also similar.

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Risk factors of tonsillitis

Risk factors for tonsillitis may include:

• Young age. Tonsillitis most often affects children, and tonsillitis caused by bacteria is most common in children ages 5 to 15.
• Frequent exposure to germs. School-age children are in close contact with their peers and frequently exposed to viruses or bacteria that can cause tonsillitis.

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.

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Prevention of tonsillitis

To decrease your risk of getting tonsillitis:

• Avoid people with active symptoms. And if you have tonsillitis, try to keep your distance from others until the pathogens are no longer transmissible.
• Practice good hygiene. Make sure you and your child practice good hygiene habits. Wash your hands often, especially after coming into contact with someone who has a sore throat, or is coughing or sneezing.
• Avoid sharing food, drinking glasses, water bottles or utensils
• Replace your toothbrush every three months and every time you get sick.

To help your child prevent the spread of a bacterial or viral infection to others:

• Keep your child at home when he or she is ill
• Ask your doctor when it’s all right for your child to return to school
• Teach your child to cough or sneeze into a tissue or, when necessary, into his or her elbow
• Teach your child to wash his or her hands after sneezing or coughing

Diagnosis of 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 to diagnose tonsillitis

• Throat swab
• Complete blood cell count (CBC)

Throat swab. 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.

Complete blood cell count (CBC). Your doctor may order a complete blood cell count (CBC) with a small sample of your blood. The result of this test, which can often be completed in a clinic, produces a count of the different types of blood cells. The profile of what’s elevated, what’s normal or what’s below normal can indicate whether an infection is more likely caused by a bacterial or viral agent. A CBC is not often needed to diagnose strep throat. However, if the strep throat lab test is negative, the CBC may be needed to help determine the cause of tonsillitis.

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Treatment of tonsillitis

A mild case of tonsillitis doesn’t necessarily require treatment, especially if a virus, such as a cold, causes it.

Treatments for more severe cases of tonsillitis may include antibiotics or, less often, a tonsillectomy.

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.

Frequently recurring tonsillitis is generally defined as:

• At least seven episodes in the preceding year
• At least five episodes a year in the past two years
• At least three episodes a year in the past three years

A tonsillectomy may also be performed if tonsillitis results in difficult-to-manage complications, such as:

• Obstructive sleep apnea
• Breathing difficulty
• Swallowing difficulty, especially meats and other chunky foods
• An abscess that doesn’t improve with antibiotic treatment

A tonsillectomy is usually done as an outpatient procedure, unless if the patient is a child, very young, has a complex medical condition or if complications arise during surgery. That means the child should be able to go home the day of the surgery. A complete recovery usually takes seven to 14 days.

If a person experiences dehydration due to tonsillitis, they may also need intravenous fluids. Pain medications to relieve the sore throat can also help while the throat is healing.

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.

Use throat sprays rather than lozenges for young children, and always check with a pediatrician before giving children medications.

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.

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