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The tonsils are a pair of oval-shaped structures located at the side of the throat near the back of the tongue, one on either side.
These soft tissue organs are part of your body’s natural defense system and function to protect your throat from infection-carrying invaders.
The tonsils are among the body’s foremost defensive mechanisms against any germ, bacteria, or virus that finds its way into your throat through the respiratory route or the mouth.
They release antibodies that can help combat these pathogenic threats and deny them further access into the body.
However, there are cases when the tonsils themselves become infected by incoming viruses and bacteria.
Tonsils usually swell up during the infection, and inflammation of this kind is referred to as tonsillitis.
The enlargement of these structures can make swallowing difficult and is usually accompanied by a sore throat and nasal congestion.
The inflammation can spread to the adenoids and as far back as the lingual tonsils, which lie at the base of the tongue.
Tonsillitis is a common occurrence in children, but adults are not immune to it either.
What Causes Tonsillitis?
Tonsillitis, or enlargement of the tonsils, can be triggered by a number of airborne infections.
A person who has come down with a viral or bacterial infection may release contaminated droplets in the air while speaking, coughing, sneezing, or even breathing.
Depending upon the causative agent, tonsillitis can either be bacterial or viral.
While most tonsil infections are caused by viruses, most cases of bacterial tonsillitis can be traced back to specific strains of streptococcus bacteria.
However, the presence of these bacteria in your system alone does not guarantee the development of tonsillitis later.
Another more unusual bacterial infection that can lead to the inflammation of your tonsils is scarlet fever.
Tonsillitis can also be triggered by common viral infections such as the common cold or flu as well as other lesser known viral infections such as mononucleosis (also called “mono” or glandular fever). (2)
Is It Contagious?
Being in close proximity to the infected individual increases your risk of contracting the infection yourself. The infection-carrying droplets can be inhaled or land on your skin.
You can pick up the infection through indirect contact as well. Once the droplets are released into the environment, they can end up on any object or surface in the vicinity.
Coming into contact with a contaminated surface and then touching your face with contaminated hands allow easy entry of the pathogens into your mouth or nose.
Once you are infected, you become a threat to others. Thus, tonsillitis is essentially a contagious condition that needs prompt treatment to curb the spread of the disease.
Signs and Symptoms
Tonsillitis can present different symptoms in different individuals, but the following are some of the most commonly reported ones:
- The tonsils at the back of your throat may appear visibly enlarged or swollen.
- The normally pink tonsil tissue may turn unusually red.
- Yellow, gray, or white pus-filled patches may appear on the infected tonsils.
- You throat may be covered by painful blisters or sores.
- The infected tonsils tend to be extremely tender.
- Your throat may become increasingly sore and red.
- You may experience pain and difficulty while swallowing due to the swollen tonsils.
- You may even develop nasal congestion or a runny nose due to the virus that causes tonsillitis.
- You may experience fever and chills.
- You may lose your appetite
- You may tire easily.
- The inflammation can spread to your voice box (larynx) and give rise to laryngitis.
- You may suffer from nausea and vomiting.
- Tonsillitis, especially when caused by a virus, can also be associated with abdominal or stomach pains.
- The nasal congestion associated with the infection may force you to breathe through the mouth, worsening the condition.
- Tonsillitis may be accompanied by a headache.
- You may have coughing and sneezing spells.
- You may have bad breath especially in the case of bacterial infections.
- You may salivate more than usual.
- Tonsillitis and nasal congestion force you to breathe through your mouth, making you prone to snoring.
Viral tonsillitis is much more common and generally milder than bacterial tonsillitis.
Types of Tonsillitis
Tonsillitis can manifest differently in different people, but most cases fall into three broad categories:
1. Acute tonsillitis
It is perhaps the most common form of tonsillitis. It is characterized by a sudden onset of symptoms that may persist for a few days to 2 weeks.
In acute cases, the inflammation tends to be more widespread and may involve your throat (pharynx) as well.
When the swollen tonsils are accompanied by a swollen pharynx (throat), this is referred to as tonsillopharyngitis.
Moreover, the patient may:
- Run a high temperature
- Have a sore throat
- Have tender lymph nodes in the neck
- Find it difficult or painful to swallow
- Give off a foul breath
Acute tonsillitis affects children and young adults the most and is usually triggered by viral infections and, less commonly, by group A streptococci. (3)
2. Recurrent tonsillitis
It is when the condition recurs after being cured. Several episodes of acute tonsillitis over the span of a year qualify as recurrent tonsillitis. (4)
3. Chronic tonsillitis
It is referred to as a long-term form of tonsillitis that usually lasts for more than 2 weeks.
People with chronic tonsillitis either have unabated symptoms for an extended period or experience frequent relapses after recovery.
This prolonged type of tonsillitis typically stems from a stubborn infection that can lead to the formation of tonsil stones (tonsilloliths). In such chronic cases, the swollen tonsils are often surgically removed. (7)
How to Check Yourself for Tonsillitis ?
If you suspect that you have swollen tonsils, visually examining your throat may help you gain greater clarity.
- Push down your tongue with the inverted curve of a spoon to expose the back of the throat.
- Light a torch into your mouth to get a clear view of the tonsils.
- If the tonsils appear bright red, swollen or covered with white or yellow patches, you probably have tonsillitis.
You can even ask someone else to conduct this home examination for you. But to get a conclusive diagnosis, it’s better to visit a doctor.
To diagnose tonsillitis, your doctor will first take a detailed history of your symptoms and do a physical checkup.
Your ears, nose, and throat will be thoroughly examined for any signs of inflammation or infection.
Your doctor may collect a swab sample from the back of your throat and send it for further testing.
In most cases, a rapid strep test and a throat culture are performed to identify if there is a bacterial culprit behind the infection.
A rapid strep test provides instant results. However, it may be less accurate, so you cannot rule out the possibility of getting a false-negative result.
A throat culture, on the other hand, usually takes 2-3 days to process but provides more reliable results.
The doctor will consider both these tests to arrive at a definite diagnosis.
Who is at Risk?
Although tonsillitis is extremely common among children, it rarely affects those younger than two years old.
Children aged between 5 years and 15 years are more prone to bacterial tonsillitis, which is often traced back to the streptococcus species of bacteria.
Infants and toddlers under the age of 5 years frequently develop swollen tonsils in the wake of a viral infection.
Children rarely develop a peritonsillar abscess, which is more common among young adults. (5)
Standard Medical Treatment
It is not uncommon for children to develop enlarged tonsils and adenoids without any underlying infection. In such a case, the inflammation usually resolves without any medical or surgical intervention.
If a virus is responsible for the inflammation of your tonsils, the condition will subside on its own within 7-10 days.
“Treatment of tonsillitis is geared towards the cause. If it is a viral infection then supportive measures like rest, hydration and pain control are appropriate,” says Dr. Jordan Glicksman, MD, who is an Otolaryngologist with a fellowship training in Rhinology and Skull Base Surgery, and a part-time lecturer at Harvard Medical School.
“The American Academy of Otolaryngology – Head & Neck Surgery have guidelines specific to the treatment of recurrent tonsillitis. Generally, we try to avoid removal of the tonsils unless the patient has had frequent infections, and only when specifically caused by Streptococcus pneumoniae,” Dr. Glicksman adds.
1. O-T-C Medications
While there are no medications that can help combat the viral infection, you can consider over-the-counter painkillers to manage the symptoms associated with this condition.
However, the need for medical therapy rarely arises in the case of viral tonsillitis as the symptomatic discomfort is usually minimal.
If you have severe symptoms and/or a positive throat culture, your doctor may prescribe an antibiotic to promote fast recovery from bacterial tonsillitis.
In children, ensure that the right dosage is administered at the right time.
“Antibiotics are to be avoided in case of viral tonsillitis. When the underlying cause is bacterial, especially if the bacteria is Streptococcus pneumoniae (i.e. strep throat), treatment with antibiotics is recommended,” says Dr. Glicksman.
Dr. Glicksman further adds that antibiotics reduce the severity and duration of infection, and in the case of strep throat, antibiotics are critical for preventing complications like rheumatic fever.
When treating your child with over-the-counter pain medicines such as paracetamol and ibuprofen, you should follow your doctor’s guidelines regarding the dosage to avoid any side effects.
Under no circumstance should you give aspirin to a child under the age of 16 years during an acute infection. (8)
Surgery may be recommended if the tonsillitis keeps returning or if the infection does not respond to other forms of treatment and persists for a significant period of time.
Tonsillectomy (the surgical excision of tonsils) is a common but invasive procedure that usually requires general anesthesia.
It is imperative to discuss all the pros and cons of the surgery with your otolaryngologist before resorting to this option.
Moreover, prompt surgical treatment may be needed if the patient develops a peritonsillar abscess that does not respond to medical management before it becomes large enough to obstruct your airway.
People who have had a tonsillectomy usually report experiencing significant pain for 4-5 days at the site of the surgery.
The intensity of the pain gradually increases during the first few days after the surgery before peaking and then slowly resolves in 1-2 weeks.
You can use nonprescription painkillers to manage the pain; as some of these medications may increase the risk of bleeding from the surgical site, please discuss the appropriate use of these medications with your otolaryngologist.
Children are vulnerable after undergoing this surgery, and it is best to keep them home from school for at least 2 weeks after the procedure.
It is common to experience difficulty in swallowing (dysphagia) after you have had your tonsils removed.
You will be advised to drink lots of liquids and eat soft foods for the first few days. You can resume solid foods as the pain improves.
You should avoid hard, crunchy, salty, spicy, and citrus foods for the first few days after surgery as these foods will likely increase the pain.
“Every patient is unique, so if you are having frequent tonsil infections you should seek medical care specific to your needs,” recommends Dr. Glicksman.
Home Remedies and Self-Care
1. Gargle with saltwater
Gargling with warm salt water has been a go-to remedy for throat pain for hundreds of years, including throat pain caused by tonsillitis.
Salt water works as a mild antiseptic solution that may help soothe the irritated and swollen walls of your throat while combating the virus or bacteria at the source of the infection.
The effectiveness of this therapy is yet to be established clinically, but it enjoys overwhelming anecdotal success.
– To prepare this salt water solution, mix 1/4 to 1/2 teaspoon of salt in 250 ml of warm water. Check the temperature of the water before gargling to make sure it is not too hot.
Rinsing your sore, infected throat with salt water frequently throughout the day may provide quick relief without any adverse side effects. Thus, there is no harm in trying this safe and simple remedy. (1)
2. Get plenty of rest
A well-rested body is better equipped to fight an infection. It is essential that you get enough sleep regularly while you are in the throes of tonsillitis.
Your body repairs and re-energizes itself during sleep. Denying yourself proper rest and sleep will only delay your recovery process.
3. Increase your fluid intake
Tonsillitis can irritate the lining of your throat and make it feel increasingly scratchy, parched, and sore.
Moreover, the swollen tonsils can make it extra hard for you to gulp down fluids, which can render you dehydrated over time.
Keeping your body well hydrated is fundamental to the recovery process. In fact, you must consume more fluids than usual to help your body fight the infection better.
Besides, washing fluids down your throat may help alleviate the dryness, pain, and irritation associated with swollen tonsils.
It is best to stick to moderately warm liquids instead of hot or cold ones. Excessive consumption of hot or cold beverages can further irritate your throat and should be avoided.
Drink sips of cool or warm liquids frequently throughout the day for best results.
4. Consume soft foods
Enlarged tonsils constrict the passage of food and make swallowing considerably difficult and painful.
Thus, it may be best for you to eat soft foods, which go down easily through your throat.
Solid or hard foods can further irritate the sore throat.
5. Eat cold foods
Patients with tonsillitis are often advised to eat frozen foods such as ice cream, popsicles, and ice pops to soothe their irritated throat.
However, having cold desserts that contain a lot of sugar can be counterproductive.
To avoid any undue complications, discuss the appropriate options with your doctor.
6. Stay away from cigarette smoke
You must avoid both active and passive smoking, as inhaling tobacco fumes can worsen the underlying infection and delay recovery.
7. Consider over-the-counter treatments
You can suck on benzocaine-containing lozenges or use oral sprays to relieve the discomfort in your throat.
Lozenges are not recommended for children as they may try to swallow the hard tablet and end up choking on it.
8. Consuming honey to improve postoperative pain
A 2013 randomized, double-blind, placebo-controlled study that was conducted on 104 subjects who underwent tonsillectomy found honey to be useful in reducing the patient’s postoperative pain and dependence on pain medicine when taken along with routine analgesics. (6)
Moreover, honey is unlikely to cause any adverse side effects, making it safe for regular administration.
Conditions Mistaken for Tonsillitis
1. Tonsillitis and Strep Throat
People often confuse strep throat with tonsillitis or the other way around, but the two conditions are different.
While strep throat is a bacterial infection and may involve all the structures in the throat including the tonsils, tonsillitis is more specific and refers to the inflammation of the tonsils alone.
In fact, tonsillitis can be an after-effect of a strep throat infection.
The bacteria responsible for strep throat is streptococcus, which is also responsible for most cases of bacterial tonsillitis.
However, there are other strains of bacteria that can cause a throat infection and, consequently, tonsillitis.
To conclude, while strep throat is an infection caused by the streptococcus bacteria, tonsillitis is the enlargement of the tonsils due to an underlying viral or bacterial infection.
In rare cases, tonsillitis may be caused by a fungal or parasitic infection.
2. Tonsillitis and Tonsil Stones
Your tonsils can sometimes become inflamed due to the accumulation of debris, which gradually hardens to form small “stones” called tonsil stones or tonsilloliths.
This condition is usually accompanied by a foul breath and points towards a more serious underlying health problem.
In some cases, the buildup of this hardened material within the tonsils is triggered by an ongoing case of tonsillitis.
How to Prevent Tonsillitis?
As most types of infectious tonsillitis are caused by viruses and bacteria in the environment and from other sick people, it is essential to observe proper personal hygiene to reduce your risk of coming into contact with these germs.
Follow these guidelines to keep yourself from getting infected:
- Because tonsillitis is usually a “community-acquired” infection, it spreads easily from one person to the next.Thus, you should maintain a healthy distance from anyone who is currently struggling with this condition or even a sore throat.
- You should not share utensils and personal items with anyone who has active tonsillitis or is suffering from a sore throat.
- Proper hand hygiene is crucial to avoid all kinds of infections, including those responsible for tonsillitis.You come into contact with all sorts of contaminated objects and surfaces; thus, it is essential for you to wash your hands several times a day, especially before eating or touching your face.
Carry a hand sanitizer with you when venturing out to keep your hands clean at all times.
- Whenever you feel a cough or a sneeze coming, you must cover your mouth with your hands.Make sure to wash your hands thereafter. You can also keep a clean cloth handy for this purpose, especially when fighting a cold or flu.
- Try to keep your nose as clean as possible – use a nasal saline mist to protect yourself from inhaled germs.
- Practice good oral hygiene – in addition to regular toothbrushing and flossing, consider using over-the-counter antiseptic oral rinses during the cold and flu season, especially if you recently came in contact with an infected individual.
- Treat your allergies as needed because allergic inflammation makes you more susceptible to infection.
- Talk to your doctor about getting vaccinated. Bacterial vaccinations such as Prevnar, Pneumovax, and HiB offer protection from other airway infections and may reduce the risk of tonsillitis.
Complications of Tonsillitis
Given that viral tonsillitis is a relatively subdued form of this condition, it rarely proves to be a serious cause of concern.
Bacterial tonsillitis, on the other hand, can sometimes take a serious turn especially if the infection spreads to other parts of the body.
This can lead to several complications, including the following:
1. Obstructive sleep apnea (OSA)
Tonsillitis can affect the walls of the throat and render them increasingly lax during sleep.
As the walls of your throat close in involuntarily, you will find it difficult to breathe in the middle of your sleep.
This condition is known as obstructive sleep apnea and is characterized by frequent sleep disruptions on account of labored breathing.
2. Secondary infections
The underlying bacterial infection responsible for your swollen tonsils can trigger a number of secondary infections.
This happens when the bacteria advances to infect your nose, sinuses, ears, lungs, or bloodstream.
3. Glue ear (otitis media)
Children with tonsillitis may develop a condition called glue ear in which the air-filled space of the middle ear gets filled with viscous mucus.
Adenoids and tonsils belong to the same group of lymph tissue. Glue ear occurs when the swollen tonsils and adenoids block the opening of the Eustachian tube, which extends from the back of the nose to the middle ear.
This obstruction leaves no room for the mucous normally made by the middle ear to drain into the throat. This trapped mucus can lead to pressure and hearing loss.
In some cases of tonsillitis, the underlying infection may spread from the tonsils to the adjoining tissues in the throat.
The infected tissues then develop into a painful abscess, which is known as a peritonsillar abscess or quinsy.
A peritonsillar abscess is very painful, may lead to difficulty swallowing, and may even interfere with normal breathing.
This complication affects both the sexes equally but is more prevalent among those with chronic tonsillitis and those who have taken several courses of oral antibiotics for acute tonsillitis.
If a prolonged bacterial infection of the tonsils is not treated properly or timely, tonsillitis can pave the way for the following uncommon complications:
- Scarlet fever – Characterized by the appearance of a pink-red skin rash
- Rheumatic fever – Triggers inflammation in your entire body, which manifests in the form of painful joints, rashes, and body spasms
- Glomerulonephritis – Refers to an infection or inflammation of the filters in the kidneys and usually causes vomiting and loss of appetite
- Guttate psoriasis – An inflammatory condition of the skin
Myth and Facts
It is a general misconception that people who had their tonsils removed can never contract a strep throat infection.
Even though this bacterial infection primarily targets the tonsils, it can spread to other tissues in the throat as well.
So, it is entirely possible for a strep throat to occur even after tonsillectomy, but the chances of that happening are low.
The claim that tonsillectomy is an outdated procedure that is considered unsafe or unsuitable for children and teens is false.
Tonsil removal continues to be one of the most common and safest surgical procedures that are routinely recommended for children and teens with enlarged tonsils.
When to See a Doctor
You must seek prompt medical assistance if:
- You run a fever of 101 °F (38.3 °C) or higher.
- Swallowing becomes significantly painful or difficult.
- You experience an overproduction of saliva, which may lead to drooling, especially in the case of young children.
- The lymph glands in your neck become increasingly swollen or tender.
- You notice the formation of pus at the back of the throat.
- Your breathing becomes labored.
You may ask your doctor:
- Is tonsillitis contagious?
- How do I prevent it from spreading?
- Can my child attend school while suffering from tonsillitis?
- Should it be treated with medications or surgery?
- How much time will be needed to recover completely after surgery?
- Does diet have a role to play in tonsillitis?
- Can I have cold beverages while undergoing treatment?
Your doctor may ask you:
- What are the symptoms you are experiencing?
- Does it hurt to swallow food?
- Is the infection accompanied by a fever?
- Does the pain disrupt your sleep?
Expert Answers (Q&A)
Answered by Dr. Mike Dilkes, MBBS (Otolaryngologists)
Tonsillitis is more common in children than in adults because their immune system is young and their antibody library to infections can only expand by being exposed to pathogens (viruses and bacteria mainly). This happens over time.
So, they get more infections because they have never been exposed before. Adults, of course, have had most of the infections out there.
There is no evidence that bananas help acute tonsillitis, although they may soothe the surface of the tonsils and make the patient feel marginally better.
Antibiotics are not useful in the early stage of tonsillitis. Sometimes, tonsillitis develops into an abscess (quinsy). That is when antibiotics are required.
Otherwise, full supportive therapy with high fluid intake, paracetamol to bring the temperature down, and nonsteroidal anti-inflammatories such as ibuprofen should suffice, along with eating as normally as possible.
Tonsillitis pain is worse at night because the affected individual does not take the painkillers nor eat when asleep.
Also, the natural bodily steroid rhythm drops to its lowest point in the middle of the night. This means inflammation increases at this point.
Tonsillitis often causes earache, as the same nerve supplies the tonsils and the ear (the glossopharyngeal nerve). Pain in the ear with tonsillitis is called referred pain and is often the sign that the disease is worsening and possibly forming an abscess.
Dairy products will not affect recovery from tonsillitis. Maintaining a normal, healthy diet is very important.
Tonsillitis is a nasty condition and can lead to much time off school or work. Eventually, the patient has to consider surgical treatment to eradicate the disease forever.
Traditional tonsillectomy is known to be very painful and has a high bleeding rate in teenagers and adults.
The intracapsular approach, which uses a carbon dioxide laser or coblation, is recommended. The laser is particularly helpful as it can be used with a local anesthetic spray to remove the tonsils – a lunchtime treatment.
About Dr. Mike Dilkes, MBBS, FRCS: Dr. Dilkes is a consultant ENT (ear, nose, and throat) surgeon in London. He has 23 years of experience as a consultant and specializes in tonsil treatment, blocked noses, and snoring/sleep apnea.
He uses laser technology coupled with computers to minimize patient suffering and treats most of his surgical patients as day cases.