Definition and Facts About Tonsillitis

Picture of a girl getting an exam for tonsillitis
A doctor examines a girl for signs of tonsillitis.
  • Tonsillitis is a condition in which there are inflammation and swelling of the tonsils. It is most often an acute condition, although some individuals may suffer from chronic and recurring tonsillitis.
  • Tonsillitis frequently affects children and teens, although adults of any age can acquire it.
  • Tonsillitis is caused by an infection of the tonsils; the infectious agents are most often viral in origin, although bacterial tonsillitis is also frequently diagnosed (strep throat, for example).
  • Symptoms of tonsillitis commonly include
  • Tonsillitis is diagnosed by having a health-care professional perform a physical examination of the patient's throat, and sometimes a throat swab may be obtained.
  • Tonsillitis is treated with pain relievers and watchful waiting, although individuals with bacterial tonsillitis may need to be treated with antibiotics.
  • Tonsillectomy, a surgical procedure to remove the tonsils, may be required for chronic or severe tonsil infections.
  • The cure for tonsillitis is when the signs and symptoms of tonsillitis have resolved, although recurrence is possible.
  • Tonsillitis can be prevented by avoiding people with strep throat or upper respiratory tract infections when possible, and washing the hands frequently prevent the transmission of infection.
  • The prognosis for acute tonsillitis is generally good. The vast majority of individuals with tonsillitis have a full recovery without any long-term problems. However, complications can sometimes occur, especially with cases of bacterial tonsillitis.
  • The prognosis for chronic tonsillitis depends on the severity and frequency of symptoms. Some people may need to have their tonsils removed surgically.

What Is Tonsillitis?

Tonsillitis is an inflammation of the tonsils. The tonsils are a pair of soft tissue masses located at the back of the mouth, with one on each side of the throat. The tonsils are glands that form part of the immune system, and thus function to prevent infection from potential bacterial or viral organisms that enter through the mouth and nose. However, sometimes the tonsils themselves can become infected, leading to swelling and inflammation of this tissue.

Tonsillitis may be caused by either viruses or bacteria, although most cases are viral in origin and therefore resolve without the need for antibiotics. Acute tonsillitis usually resolves within 7-10 days. However, some individuals with chronic tonsillitis may suffer from recurrent or continuous symptoms of tonsillitis and the tonsils may need to be removed with tonsillectomy. Tonsillitis is most common in children and teenagers, although adults of any age can develop tonsillitis.

What Are the Signs and Symptoms of Tonsillitis?

Symptoms of tonsillitis may include:

  • Sore throat
  • Difficulty and/or pain with swallowing
  • Fever
  • Difficulty feeding (in babies)
  • Pain with swallowing
  • Fever
  • Headache
  • Abdominal pain
  • Nausea and vomiting
  • Cough
  • Hoarseness
  • Runny nose
  • Redness and swelling of the tonsils
  • Tenderness in the glands of the neck (swollen lymph glands)
  • White patches or streaks on the tonsils (exudate)
  • Bad breath
  • Redness of the eyes
  • Rash
  • Ear pain (caused by nerves that go to the back of the throat and also go to the ear)

Is Tonsillitis Contagious?

  • Tonsillitis is contagious, and transmission of the illness usually occurs from coming into direct contact with infected individuals.
  • The infectious organisms are typically transmitted either through airborne droplets released during coughing or sneezing, or indirectly via contact with infected surfaces (such as cups, tissue, or utensils).
  • Tonsillitis caused by a virus is often contagious for about 7 to 10 days.
  • Untreated bacterial tonsillitis may be contagious for about 2 weeks.
  • However, people with bacterial tonsillitis treated with antibiotics generally become non-contagious 24 hours after starting antibiotic treatment for strep throat. The child or adult can return to school or work after this period of time while taking the antibiotic.

What Causes Tonsillitis?

Tonsillitis is caused by either a viral or bacterial infection of the tonsils. Most cases of tonsillitis are caused by viruses. There are many different viruses that can cause tonsillitis, including

Bacterial tonsillitis is most often caused by Streptococcus pyogenes, the organism that causes strep throat.

Tonsillitis vs. Strep Throat, Are They the Same Infection?

  • Tonsillitis and strep throat have some similar symptoms; however, they are not the same infection.
  • Strep throat is caused by a specific bacterial infection (streptococci) of the throat tissues.
  • Tonsillitis is an infection of only the tonsils in the throat and may be caused by many different viruses and/or bacteria.
  • They are similar in location (throat tissues) and streptococci may cause both.

How Long Does It Take for Tonsillitis to Heal?

  • In general, the prognosis for tonsillitis is excellent, and most people recover without any complications or long-term problems.
  • Most cases of viral tonsillitis resolve within 7-10 days with watchful waiting.
  • When treated with antibiotics, strep throat can be cured most of the time with a single course of antibiotics, and individuals will begin to feel better within 24-48 hours.

When Should I Contact a Doctor for Tonsillitis?

The majority of people that develop tonsillitis will fully recover without medical care. People who may have bacterial tonsillitis that requires antibiotics should seek medical care, especially since it is often difficult to differentiate viral from bacterial tonsillitis based on symptoms alone. Seek immediate medical attention if you experience any of the following symptoms:

  • Severe pain or difficulty with swallowing
  • Unable to control your secretions; unable to eat, drink, or take medicines
  • Unable to open your mouth (trismus)
  • Swelling or redness of the neck
  • Change in voice, such as muffled speech or "hot potato" voice (speaking as if a hot object is being held in the mouth)
  • Difficulty breathing

In some instances, individuals with tonsillitis may experience complications, such as airway blockage from severely swollen tonsils, the extension of the tonsillar infection into the neck, or a peritonsillar abscess (a collection of pus requiring drainage that develops in the tissue surrounding the tonsil). In rare instances, patients with untreated strep throat can go on to develop rheumatic fever.

Complications can be serious. Some, like swelling of the throat, drooling, and/or difficulty breathing may be life-threatening. If you develop any of these symptoms, call 911 or go to an emergency department immediately.

Which Types of Doctors Treat Tonsillitis?

  • Most cases of uncomplicated tonsillitis can be managed by your primary care physician or by an urgent care/emergency department physician.
  • However, cases of severe or chronic tonsillitis may require referral to an ear, nose, and throat specialist (ENT). An ENT will also manage any surgical procedures that may be necessary, such as removal of the tonsils (tonsillectomy).
  • Rarely, hospitalization may be necessary for individuals with severe tonsillitis with complications leading to airway obstruction.

Is There a Test to Diagnose Tonsillitis?

Your health-care professional will conduct a physical examination, with special attention to the throat and neck area. Tonsillitis caused by viruses may look very similar to bacterial tonsillitis, therefore diagnostic testing (for example, throat culture, rapid strep test) may be required to differentiate between the two potential causes.

Your health-care professional will pay special attention to the following findings:

  • Signs of throat infection (redness, swelling, tonsillar exudate, enlarged lymph nodes in the neck)
  • Peritonsillar abscess formation (bulging of one tonsil toward the center with the deviation of the uvula)
  • Airway compromise (muffled speech, drooling, inability to swallow or open mouth, difficulty breathing)

Your health-care professional also may order a rapid strep test, which requires a swab from the back of the throat area. Results of the rapid strep test are generally available within 30 minutes. Sometimes a strep culture is sent to the lab for confirmation of strep infection, though this result may require 24-48 hours. In rare instances of severe or complicated tonsillitis, blood tests and/or imaging tests may be ordered. Furthermore, if other conditions that cause a sore throat are suspected, additional testing may be necessary.

Although your primary care doctor can treat the disease, you may also be referred to specialists such as infectious disease, pediatric specialist, surgeon, ENT specialists, or others, depending on complications that may develop.

What Over-the-Counter (OTC) Pain Medication and Home Remedies Help Tonsillitis Pain?

  • Throat pain and fever may be relieved with over-the-counter pain relievers such as ibuprofen (Advil) or acetaminophen (Tylenol).
  • Ease sore throat pain by gargling frequently with warm salt water (8 ounces of warm water mixed with 1 teaspoon of salt).
  • Throat lozenges may provide temporary pain relief.
  • Drink plenty of clear liquids to avoid dehydration.

What Antibiotics Treat and Cure Tonsillitis?

Because most cases of tonsillitis are caused by viruses, your body will fight off the infection and the illness will run its course. In these individuals, antibiotics are not necessary. However, in people with bacterial tonsillitis, antibiotics are generally prescribed. The penicillin class of antibiotics is the most commonly prescribed.

  • The penicillin may be given as a single-dose injection (a shot) or it may be prescribed orally (pills taken by mouth).
  • If you are allergic to penicillin, alternative antibiotics will be prescribed.
  • Treatment with oral antibiotics is typically prescribed for 10 days.
  • It is important to take all of the pills prescribed, even if the symptoms go away and you feel better before finishing the course of antibiotics.

Steroids may be prescribed in certain individuals with tonsillitis in order to decrease the inflammation.

Make sure to follow-up on all the tests your health-care professional performs and take all of the medications prescribed until finished.

If symptoms persist or get worse, contact a health-care professional.If you have had a surgical procedure performed, follow-up with your specialist as directed.

When Is Surgery (Tonsillectomy) Necessary for Tonsillitis?

In certain people with acute or chronic tonsillitis, a peritonsillar abscess can develop. This condition generally requires needle aspiration or incision and drainage in order to drain the pus and cure the condition. It can usually be done in an office setting.

Surgical removal of the tonsils (tonsillectomy) is sometimes recommended for certain people with chronic tonsillitis, recurrent tonsillitis not responsive to antibiotics, or difficulty breathing because of enlarged tonsils. An ENT specialist is consulted for treatment of these people.

In addition, the FDA has advised doctors to avoid prescribing codeine for tonsillectomy pain in children because of the increased risk of death due to respiratory distress.

Is Tonsillitis a Serious Condition?

In general, the prognosis for tonsillitis is excellent, and most people recover without any complications or long-term problems. Most cases of viral tonsillitis resolve within 7-10 days with watchful waiting. When treated with antibiotics, strep throat can be cured most of the time with a single course of antibiotics, and individuals will begin to feel better within 24-48 hours.

The prognosis for those individuals who develop complications from tonsillitis is dependent on the severity and extent of the complication. Death from tonsillitis or its complications is very rare.

Can Tonsillitis Be Prevented?

  • In certain instances, tonsillitis can be prevented by avoiding exposure to potential sources of infection.
  • Avoid contact with individuals with upper respiratory tract infections or strep throat.
  • Wash hands frequently to prevent the spread of the virus or bacteria that can cause tonsillitis.
  • Do not use utensils or other items touched by infected individuals.

When is tonsillectomy necessary?

While doctors may still debate the necessity for tonsillectomy and its effectiveness as a treatment, there are certain circumstances for which the tonsillectomy is definitely recommended, including:

  • Sleep apnea
  • An abscess around the tonsils (peritonsillar abscess)
  • Tonsil infection that results in febrile seizures
  • Any suspicion of cancer (very rare) in the area or another need for a biopsy to establish a diagnosis
American Academy of Otolaryngology - Head and Neck Surgery. "Tonsillitis." Updated Jan. 2011.

American Academy of Otolaryngology - Head and Neck Surgery. "Tonsils and Adenoids."

Shah, U. MD. "Tonsillitis and Peritonsillar Abscess." Medscape. Updated: Jan 19, 2017