Tonsillitis is inflammation of the tonsils. The tonsils are 2 small glands on either side of the throat. When a person has tonsillitis their tonsils become inflamed, infected and swollen.
What do the tonsils do?
The tonsils play a key role in helping to protect the body against infection. This is especially important in young children, whose immune systems are still developing. The tonsils act as a barrier, trapping an infection and stopping it spreading to other parts of the body. The infection may stay in the tonsils, causing tonsillitis. As a person gets older their immune system becomes stronger, and the body doesn't rely on the tonsils as much to fight infection. That's why tonsillitis is more common in children.
What causes tonsillitis?
Most cases (around 80%) of tonsillitis are caused by a virus. Many types of viruses can cause tonsillitis, including cold and flu viruses. These can spread easily from person to person through coughing or sneezing, hand contact and direct contact with the virus on surfaces (e.g. door handles).
Some cases of tonsillitis are caused by a bacterial infection, usually the Streptococcus type of bacteria).
A common cause for tonsillitis is also infectious mononucleosis, or glandular fever virus.
What are the symptoms of tonsillitis?
Regardless of whether tonsillitis is caused by a virus or by bacteria, the symptoms may include:
- Sore throat;
- Pain with swallowing;
- A general feeling of being unwell;
- Bad breath;
- Painful, swollen lymph nodes (glands) at the side of the neck;
- Red, swollen tonsils;
- Pus or white spots on the tonsils;
- Pain in the ears.
If a skin rash is also present, it may suggest the cause is bacteria.
If a person has tonsillitis caused by the flu virus, they may also have flu symptoms such as aching muscles. People with a cold may also have a runny nose and cough. Sometimes younger children with tonsillitis may have nausea, vomiting and tummy pain.
Who gets tonsillitis?
Anyone can get tonsillitis, but it is most common in children. Some people have tonsillitis that keeps returning.
When should I see the doctor?
A child who is unwell with a sore throat and fever should be seen by a doctor. A person should also see a doctor if the symptoms last for more than a few days and are not improving, or if the symptoms are severe and stopping them from eating or drinking properly. Anyone who is having difficulty breathing or extreme difficulty swallowing should see a doctor.
A doctor may take a swab of the throat to collect some of the infected cells. This is sent to a pathology lab for testing, to see what is causing the tonsillitis. Sometimes a doctor may order a blood test to check for any abnormalities.
Complications of tonsillitis
In rare cases a person will develop complications from tonsillitis, generally only when the infection is caused by bacteria.
Complications may include:
- Breathing difficulties when sleeping: known as obstructive sleep apnoea.
- Middle ear infection called otitis media.
- Quinsy: an abscess (collection of pus) that develops between a tonsil and the side of the throat (also known as a peritonsillar abscess);
- Deep infection in the surrounding areas of the throat (tonsillar cellulitis).
In very rare cases the infection may spread and cause inflammation in other parts of the body, for example:
- Rheumatic fever: causes inflammation throughout the body, including in the joints and heart.
- Glomerulonephritis: inflammation of the kidneys.
- Scarlet fever: causes an itchy skin rash.
Treatment of tonsillitis
If a throat swab shows that tonsillitis is caused by a bacterial infection, a doctor may prescribe a course of antibiotics. If tonsillitis is caused by a virus, antibiotics are not effective.
The following steps may help to relieve the symptoms of tonsillitis whether it is caused by a virus or bacteria:
- Treat pain and fever: mild pain relieving medicine such as paracetamol (e.g. Panadol) or ibuprofen (e.g. Nurofen) may help with throat pain and fever. Note: children under the age of 16 should not take aspirin.
- Drink plenty of fluids: this is important to prevent dehydration.
- Get plenty of rest.
- Eat soft, cool foods such as jelly and custards: a person with tonsillitis may not feel like eating much, but their appetite should return to normal within a few days.
- Have cold drinks, ice to suck or ice blocks/ice cream: these may help to soothe throat pain.
- Gargle: adults and children who are old enough to gargle often get relief with salt water gargling. There are also other types of throat gargles available, e.g. anti-bacterial throat gargle, such as Betadine throat gargle.
- Consider throat lozenges or sprays: adults and older children may get some relief by sucking on throat lozenges or using a throat spray.
Do I need my tonsils out?
People who have frequent bouts of tonsillitis that stop them from functioning normally, cause difficulty breathing because of enlarged tonsils, or who have bacterial tonsillitis that doesn't respond to treatment may need an operation to remove the tonsils (called a tonsillectomy).
If a child has frequent episodes of tonsillitis and misses a lot of school, for example from disrupted sleep due to snoring, doctors may suggest a tonsillectomy.
Sometimes people develop other complications from tonsillitis (e.g. obstructive sleep apnoea (mainly children), severe problems swallowing or an abscess on the tonsils), and may also require surgery to remove the tonsils.
A tonsillectomy is done by an ENT (ear, nose and throat) surgeon. In children, sometimes the adenoids (lymph nodes in the throat) are removed at the same time.
A person having tonsillectomy will have the operation in a hospital under general anaesthetic, meaning they will be asleep during the operation. There are several ways that the surgeon can remove the tonsils, and all are done through the mouth. No incisions are made into the skin.
Most people can leave hospital on the same day or the next day after surgery. The throat will usually feel sore after the operation and swallowing may be difficult to start with. Pain relievers can help with the pain and make it easier to swallow. Most people can eat and drink anything they feel like, but it can be good to avoid citrus foods or drinks for a few days (e.g. orange juice) because it can cause pain.
Ear pain is common after surgery. It doesn't mean the person has an ear infection - it is referred pain from the throat and should settle in a few days.
Some people will have bleeding from where the tonsils were removed. This usually settles by itself, but it's important to see a doctor immediately if the person is coughing up blood.
Children who have had a tonsillectomy will usually need to miss school for around 2 weeks to stop them knocking the scar off the tonsil bed in rough play while things are healing.
Can tonsillitis be prevented?
It is difficult to prevent the spread of viruses that cause tonsillitis, but practising good hygiene can help to prevent infections from spreading.
- Wash your hands often.
- Try to avoid people who are unwell.
- Don't share eating and drinking utensils with someone who is unwell.
- Cough and sneeze into a tissue and then wash hands.
- Stay home if unwell.
- 1. NHS Choices. Tonsillitis (revised December 2015). http://www.nhs.uk/Conditions/Tonsillitis/Pages/Introduction.aspx (accessed March 2016).
2. Mayo Clinic.org. Tonsillitis (revised July 2015) http://www.mayoclinic.org/diseases-conditions/tonsillitis/basics/definition/con-20023538 (accessed March 2016).
3. eTG Complete. Pharyngitis and/or tonsillitis (revised Oct 2014). In: eTG Complete. Melbourne: Therapeutic Guidelines Ltd. http://online.tg.org.au/complete (accessed March 2016).
4. NPS Medicinewise. Tonsillitis (revised June 2012). http://www.nps.org.au/conditions/ear-nose-mouth-and-throat-disorders/ear-nose-and-throat-infections/tonsillitis (Accessed March 2016).