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OVERVIEW

What is tonsillitis?

Tonsils are the oval-shaped areas of pink tissue on each side at the back of your throat. They help fight infection by reacting to germs and bacteria that enter through the nose and mouth.

Tonsillitis occurs when your tonsils are infected by a virus or by bacteria. This causes your tonsils to become inflamed and swollen. In most cases, when you have a sore throat or pharyngitis, you also have tonsillitis.

SYMPTOMS

What are the symptoms of tonsillitis?

Tonsillitis symptoms can include any of the following:

• Red or swollen tonsils
• Sore throat
• Trouble swallowing
• Swollen lymph nodes (glands) in the neck
• Fever
• Chills
• Ear pain
• Headache
• Bad breath
• Loss of voice (called laryngitis)
• In children, abdominal pain (generally occurs when the tonsillitis is caused by strep bacteria)

If your tonsils become very swollen, you may also notice other symptoms. These may include sleep apnea (when breathing stops briefly during sleep), trouble swallowing food and a “throaty” voice.

When should I contact my healthcare provider?

Contact your healthcare provider if your child has a sore throat that won’t go away (even without a fever), if your child seems extremely ill, or if they are having trouble breathing or swallowing.

If you’re an adult who has symptoms of tonsillitis, you should contact your healthcare provider, especially if you have one or more of the following:

• A sore throat that lasts longer than two days (with or without abdominal pain)
• A fever above 39.4°C (103°F)
• A stiff neck
• Weakness

An adult or child who can’t breathe or who begins drooling because they can’t swallow should get emergency care right away.

CAUSES & RISK FACTORS

What causes tonsillitis?

Most cases of tonsillitis are caused by viruses. For example, the virus that causes mononucleosis (called the Epstein‑Barr virus) can cause tonsillitis. Tonsillitis is only caused by bacteria in about 15% to 30% of cases. Bacterial tonsillitis is most often caused by a certain type of streptococcus (or “strep”) bacteria. In these cases, the illness may be called “strep throat.”

DIAGNOSIS & TESTS

How is tonsillitis diagnosed?

Your healthcare provider will ask you what symptoms you have. They may also examine your ears, nose and throat to check for signs of infection.

Your healthcare provider may use a swab to take a sample from the back of your throat. This sample may be used for a rapid strep test or a throat culture. A rapid strep test can show whether your infection is caused by strep bacteria in just a few minutes. A throat culture can show whether you have strep or another bacterial infection, but the results from this test aren’t available for 24 hours or more.

In some cases, your healthcare provider may do a blood test to find out what is causing your infection. For example, a blood test can check for mononucleosis.

TREATMENT

How is tonsillitis treated?

If your tonsillitis is caused by a virus, antibiotics won’t help. But you can use some home treatments to relieve your symptoms. You may try the following:

• Drinking warm, soothing liquids, such as soup, broth, or tea with honey and lemon
• Gargling with warm salt water (1 ml/cc (1/4 teaspoon) of salt in 237 ml (eight ounces) of warm water.
• Taking acetaminophen (brand name: Tylenol) or ibuprofen (two brand names: Advil, Motrin) for fever and pain. Keep in mind that children should not take aspirin. Aspirin can cause a serious illness called Reye’s syndrome when it is given to children younger than 18 years of age.
• Sucking on a throat lozenge or hard candy
• Using a cool-mist humidifier to moisten the air
• Resting your voice

Antibiotics can treat tonsillitis caused by bacteria. If your healthcare provider prescribes an antibiotic, be sure to follow your healthcare provider’s instructions and take all of the medicine. If you don’t, your infection may come back. Also, taking your antibiotics properly helps you reduce the risk of infecting other people. You won’t be contagious after about 24 hours of treatment.

If your tonsils are so swollen that they are making it hard to breathe, your healthcare provider may prescribe treatment with steroids.

Will I need to have my tonsils taken out?

Surgery to take out the tonsils (called tonsillectomy) used to be fairly common. Now this surgery is only recommended in serious cases or if tonsillitis occurs frequently (called chronic tonsillitis). A tonsillectomy is usually an outpatient surgery, meaning you don’t have to stay in the hospital. However, adults rarely need a tonsillectomy.

If tonsillitis goes untreated, a collection of pus (called an abscess) can form in the back of the throat, behind the tonsils. If you have an abscess, your healthcare provider will need to drain it with a needle. In severe cases, a tonsillectomy may be necessary to remove the abscess.

PREVENTION

How can I avoid getting tonsillitis?

Tonsillitis is spread through contact with other people. Washing your hands frequently can help prevent the spread of bacteria and viruses. Don’t share drinking glasses or utensils. Also, avoid close contact with people who are sick.

QUESTIONS TO ASK YOUR HEALTHCARE PROVIDER

• My child gets tonsillitis a lot. Should we remove their tonsils?
• Should I take antibiotics?
• What problems could my child have later if they have a tonsillectomy?
• What can I do to make myself more comfortable?
• Is there any medicine I can take to help with the pain and fever?
• If I have strep throat, will I get tonsillitis?
• How long after I get tested will I know whether I have tonsillitis?
• When should I see my healthcare provider?
• I wake up a lot at night. Could this be related to tonsillitis?