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Tonsillitis is an infection of the tonsils, which are the small glands found at the back of the throat behind the tongue. The function of these glands isn't completely clear but research suggests that they help fight infections.

One of the main symptoms of tonsillitis is a sore throat, but there are often several other symptoms which include coughing, headaches and a fever. Tonsillitis very often clears up spontaneously without the need for treatment, but in some more severe, or recurring cases, the tonsils may be removed in a procedure called a tonsillectomy.

Tonsillitis can be caused by either a virus or by bacteria, although most cases are viral. Children between 5-15 years of age are most likely to get tonsillitis, but it can affect almost anyone.

Tonsillitis can spread from person to person through throat or nasal fluids including saliva, hand contact, or airborne droplets. The incubation period (the period between picking up the infection and symptoms starting to appear) is normally between 2-4 days.

Tonsillitis Symptoms

The main symptom of tonsillitis is a sore throat. However, other common symptoms that you may have include:
Bulletred and swollen tonsils,
Bulletpain on swallowing,
Bulletfever (which can be very high in young children),
Bulletpain in your ears, or neck,
Bulletwhite pus filled spots on your tonsils, and
Bulletswollen lymph nodes (glands) in your neck.

Less common symptoms of tonsillitis may include the following:

Bulleta 'furry' tongue,
Bulletbad breath, and
Bulletdifficulty opening your mouth.
Younger children may also complain of a tummy-ache which can be caused by the swelling of the lymph nodes (glands) in the abdomen (stomach).

The symptoms of tonsillitis may vary depending on whether the infection is caused by a virus or by bacteria. If your tonsillitis is caused by a virus, such as the flu virus, you may have other flu symptoms, such as a runny nose, and aches in your body. If your tonsillitis is caused by bacteria, you may have a skin rash, or a flushed face.

Tonsillitis Causes

Tonsillitis is most commonly caused by a viral infection, but it can also be caused by certain bacteria.

The viruses that cause tonsillitis are often the ones that frequently affect the respiratory (breathing) system. They include influenza, the parainfluenza virus (which causes laryngitis and croup), as well as the adenovirus, the enterovirus, and the rhinovirus.

In rare cases, tonsillitis can develop as a result of the Epstein-Barr virus which is the virus that causes glandular fever. If this is the case, it is likely that you will feel quite ill. You may have swollen lymph nodes (glands) throughout your body and an enlarged spleen.

Bacterial tonsillitis may be caused by a number of different bacteria, but the most common ones are Streptococcus Group A bacteria. In the past, serious bacterial infections, such as diphtheria, and scarlet fever have caused tonsillitis, but this is now very rare, due to improved immunisation and treatment.

Tonsillitis Diagnosis

If you think that you have tonsillitis you should see your GP. He will examine your throat and ask you questions about your symptoms. Based on these symptoms, the appearance of your throat and tonsils, and the presence of swollen glands in your neck, your GP will then decide whether your tonsillitis is viral or bacterial.

Sometimes your GP will use a throat swab (which looks like a long cotton bud) to take a small sample of mucus from your tonsils. This will be taken for laboratory analysis but the results can take a few days to return. Samples are mainly used for patients in high-risk groups (such as those with damage to their immune system) or if previous treatment has failed. A throat swab may also be used to tell if the tonsillitis is caused by Streptococcal bacteria. However, it can often be difficult to ascertain whether the person is a carrier of the infection, or is actually infected.

In some cases, your GP will also do a blood test to check your blood count, or a Monospot test, which is a blood test that checks for glandular fever.

Tonsillitis Treatment

If you have tonsillitis, there are a number of things that you can do to help yourself. Make sure that you:

Bulletget plenty of rest, and
Bullethave plenty to eat and drink - even if you find it painful to swallow (becoming hungry and dehydrated can make other symptoms, such as headaches and tiredness, worse).
BulletWhether your tonsillitis is caused by a virus or by bacteria, it is likely that your immune system will clear the infection within a few days. Treatments, such as painkillers and antibiotics (in cases of bacterial tonsillitis), may help to ease your symptoms. However, if your symptoms are particularly severe, and you have recurring bouts of tonsillitis, surgery may be an option.

Treating viral tonsillitis

As most cases of tonsillitis are caused by a virus, they do not respond to antibiotics. They will usually go away on their own, but you can take paracetamol or ibuprofen to ease symptoms such as pain, headaches and fever.

When taking medication, you should always follow the instructions on the packet to ensure that you are taking the correct dosage at the right time intervals. This will ensure that it is effective in controlling your symptoms. You should not take ibuprofen if you have a history of stomach ulcers, indigestion, asthma, or kidney disease. If you are pregnant, do not take ibuprofen and only take paracetamol as instructed by your GP, or midwife. Children under 16 years of age should not take aspirin.

There are also treatments available from pharmacies that can soothe a sore throat, such as lozenges and oral sprays. Some people find that gargling with a mild antiseptic solution can help to relieve a sore throat, although research regarding the effectiveness of gargling as a treatment method is limited.

Treating bacterial tonsillitis

Antibiotics can be used to treat bacterial tonsillitis, such as that caused by streptococcal bacteria. However, research has shown that the effects of using antibiotics to treat the symptoms of a sore throat are limited. The results of a clinical study showed that the maximum benefit was seen by day three, and that, on average, the illness time was only reduced by about one day.

Tonsil Surgery

If you have recurring bouts of tonsillitis (five or more in a year) or it is severe enough to interfere with your everyday life, your GP may suggest removing your tonsils. This is done in an operation known as a tonsillectomy.

A tonsillectomy is done under a general anaesthetic which means that you will be asleep during the procedure. Your mouth will be held open so that your surgeon can see your tonsils, and no cuts will be made in your skin. Your surgeon will then use special scissors to remove your tonsils before closing the wound with dissolvable stitches. In some tonsillectomies, newer methods may be used to remove the tonsils, such as laser surgery, ultrasound, or freezing. If surgery is recommended, your surgeon will discuss the options with you.

As is the case with any type of surgery, there are risks associated with a tonsillectomy, such as excessive bleeding, and the effects of anaesthesia. However, many thousands of tonsillectomies are performed every year without any problems.

Although surgery can help people with severe, or recurring tonsillitis, having your tonsils removed will not guarantee that throat infections will be prevented in the future.

Tonsillitis Complications

Complications resulting from tonsillitis are uncommon, but some of the problems that can occur are outlined below.

BulletAbscesses - also called quinsy, or peritonsillar abscesses, can appear in the tissues around the tonsils. In some cases, the pus from the abscesses can spread to the surrounding areas, such as the roof of the mouth (palate), neck, chest and lungs. These abscesses can be easily treated using antibiotics, although sometimes a small operation to drain the pus may be needed.
BulletSwelling of the face and neck - this can sometimes block the airways and prevent a person from breathing. Chronic tonsillitis can cause obstructive sleep apnoea, which prevents full oxygen supplies from getting to your brain, and may lead to disturbed sleeping patterns.
BulletMiddle ear infection - also known as otitis media, is a build up of mucus in the middle ear, between your ear drum and inner ear. The mucus can sometimes become infected with bacteria but, in most cases, the infection clears by itself.
BulletBlood poisoning - or septicaemia can occur if bacteria get into your bloodstream and multiply. The bacteria can be destroyed using either oral antibiotics (taken by mouth) or intravenous antibiotics which are injected into your bloodstream.
BulletGlomerulonephritis - is inflammation (swelling) of the filters in your kidneys, caused by streptococcal bacteria. It can be treated with antibiotics such as penicillin.
BulletLemierre's syndrome - is a very rare condition in which bacteria spreads from your throat to major veins in your neck. Small 'clumps' of bacteria then travel through your bloodstream to your lungs, joints and bones. Lemierre's syndrome can be easily treated with antibiotics but it can be fatal if it is not diagnosed quickly.

Tonsillitis Prevention

The best way to avoid tonsillitis is to avoid close contact with people who have the viral or bacterial infections that lead to the development of the condition. Do not share toothbrushes with someone with tonsillitis, and avoid using the same eating or drinking utensils. Also, keep a high level of hygiene by washing your hands regularly.

May 2011
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