Tonsillitis

Overview

Tonsillitis is swelling and redness of the tonsils, which are two small glands at the back of your throat. It is most often caused by a viral infection, like the common cold, and it usually gets better on its own within a week.

Yes, tonsillitis is very common, especially in school-age children. Most people will have it at least once in their lifetime.

Tonsillitis most often affects children between the ages of 5 and 15, but it can occur in people of any age. It is less common in adults over 50.

Symptoms

Common symptoms

• Sore throat that makes swallowing painful
• Red and swollen tonsils, sometimes with white or yellow patches
• Fever (raised body temperature)
• Swollen glands in the neck

Symptoms in children

• Irritability and fussiness
• Not wanting to eat or drink
• Drooling more than usual
• Tummy pain

Symptoms in older adults

• Sore throat that may be less intense
• Difficulty swallowing
• Ear pain
• Fatigue or feeling unwell

Causes

Main causes

• Viral infections (such as the viruses that cause colds or influenza) – the most common cause
• Bacterial infections (such as group A streptococcus, which causes strep throat)

Risk factors

• Being a child or teenager
• Close contact with someone who has a sore throat or cold
• Weakened immune system (for example, due to another illness or medication)
• Smoking or being around secondhand smoke

When to see a doctor

See a doctor urgently if:

• If you or your child has trouble swallowing or breathing
• If you see white or yellow patches on your tonsils that are getting worse
• If you have a fever that lasts more than 3 days

Book a routine appointment if:

• If your sore throat lasts longer than a week
• If you get tonsillitis several times in one year
• If you have a weak immune system and suspect tonsillitis

Diagnosis

A doctor can often diagnose tonsillitis by looking at your throat and feeling your neck for swollen glands. They will also ask about your symptoms and medical history.

Tests that may be done

• Throat swab – a cotton bud wiped over the back of your throat to check for bacteria
• Blood test – occasionally used if there are signs of a more serious infection

What to expect at your appointment

A throat swab is quick and may cause a brief gagging feeling. The results take a few minutes to a day, depending on the method. Your doctor will let you know if you need treatment.

Treatment

Treatment depends on whether the cause is viral or bacterial. Most cases are viral and get better on their own. Bacterial tonsillitis may be treated with antibiotics, but only if prescribed by a doctor. Surgery (tonsillectomy) is reserved for people with very frequent or severe episodes.

Self-care at home

• Rest as much as possible to help your body fight the infection
• Drink plenty of fluids – cool drinks, warm tea, or soup to soothe your throat
• Take over-the-counter pain relievers (such as paracetamol or ibuprofen) as directed – always follow the instructions on the label
• Gargle with warm salt water (half a teaspoon of salt in a glass of warm water) to ease soreness
• Use a humidifier or breathe in steam from a bowl of hot water to moisten the air

Medical treatments

If a bacterial infection is confirmed, a doctor may prescribe a course of antibiotics to clear the infection. It is important to take the full course exactly as prescribed, even if you start to feel better. For viral tonsillitis, antibiotics do not help and are not recommended.

When is surgery considered?

A tonsillectomy (surgical removal of the tonsils) may be considered if someone has severe, recurrent tonsillitis – for example, 7 or more episodes in one year, or 5 episodes per year for 2 years. It is also considered if there are complications like an abscess that does not respond to other treatment.

Living with this condition

While you have tonsillitis, focus on rest and staying hydrated. Avoid talking too much to give your voice a rest. Keep your throat moist with sips of fluids. Most people feel better within a week.

Lifestyle tips

• Avoid smoking or exposure to smoke as it can irritate your throat
• Wash your hands frequently to avoid spreading the infection to others
• Use separate cups and utensils while you are sick

Diet and exercise

Stick to soft, cool foods like yogurt, smoothies, or soup. Avoid spicy, acidic, or rough foods that can hurt your throat. Light activity is fine once you feel up to it, but avoid intense exercise until you have fully recovered.

Mental health and emotional wellbeing

Tonsillitis can be uncomfortable and may cause anxiety, especially if you have trouble eating or sleeping. Repeated episodes can be frustrating. It is normal to feel low; talk to your healthcare provider if you are feeling stressed or upset.

Prevention

You cannot always prevent tonsillitis, but you can reduce your risk by practicing good hygiene, such as washing your hands regularly and avoiding close contact with people who have a sore throat or cold.

Vaccines

There is no vaccine specifically for tonsillitis. However, keeping up to date with recommended vaccines (for example, the flu vaccine) can lower your chances of getting viral infections that can lead to tonsillitis.

Screening programmes

There is no routine screening for tonsillitis. It is diagnosed when symptoms occur.

Complications

If left untreated

• Peritonsillar abscess – a collection of pus behind the tonsil that can cause severe pain and difficulty opening your mouth
• Obstructive sleep apnea – especially in children with large tonsils, but this is more common with chronic tonsillitis
• Rheumatic fever – a rare complication of untreated bacterial tonsillitis that can affect the heart and joints

Long-term outlook

For most people, tonsillitis improves on its own or with simple treatment. Even if you have repeated episodes, there are effective ways to manage them, and surgery is an option if needed. The outlook is very good, and complications are rare when you see a doctor for severe or persistent symptoms.

Find support

International organisations

• NHS (UK) - Tonsillitis ↗

Local organisations

• ENT UK (British Association of Otorhinolaryngology) ↗ · United Kingdom

Helplines

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