Tonsillitis: causes, symptoms and treatment

Tonsillitis is a common condition, especially in children. But what exactly is it and how do you know if you have it? 

What is tonsillitis?

Your tonsils are a pair of soft tissue masses – one each side of the back of your throat. Tonsillitis is an infection of this area. The reason tonsils become infected so easily is because of where they’re located. They can stop germs like viruses and bacteria that enter through your nose or mouth from entering your throat. However, that means they’re more vulnerable to infection themselves from those same germs.

Types of tonsillitis

There are three main types of tonsillitis. Acute tonsillitis is a one-off infection that usually lasts for three to four days but can hang around for up to two weeks. Recurrent tonsillitis is when you have repeated bouts of the infection, often several times over a year. Chronic (long-term) tonsillitis is when you have an infection that lasts for more than two weeks.

Tonsils themselves can also be graded from zero to four. Grade 0 tonsils mean you’ve had your tonsils removed. Grade 1 tonsils are very small and occur in very young children. Grade 2 tonsils are normal-sized. Grade 3 tonsils are enlarged and grade 4 tonsils are very enlarged.

Causes of tonsillitis

Tonsillitis is usually caused by viruses but it can also be caused by bacteria. A bacterial infection such as strep throat, caused by streptococcus bacteria, can lead to tonsillitis.

Who is affected

Children are most commonly affected by tonsillitis, particularly those aged five to 15 years. However, younger and older children as well as adults can still get tonsillitis. In adults, those most at risk are the elderly.

Tonsillitis symptoms

Most of the time, tonsillitis feels like a bad cold or flu. The main symptoms in adults and children are: 

• Ache in the ear, neck or headache
• Fever
• Sore or swollen throat that appears red and can cause difficulty or pain when swallowing
• Stomach ache or nausea
• Voice sounds throaty, scratchy, or muffled

Sometimes the symptoms can progress and become more severe, such as:

• Bad breath
• Swelling of the glands in the neck
• Tonsils that appear red or have white or yellow patches

In babies and toddlers, it isn’t always easy to identify the symptoms of tonsillitis as they can’t describe how they feel. Things to look out for include:

• Being more fussy than usual
• Drooling because swallowing is painful or difficult
• Refusing to eat
• Vomiting

Risk factors

Age is the main risk factor for tonsillitis. Young children are more likely to get viral tonsillitis, while school-age children more commonly get bacterial tonsillitis. The elderly are also at risk of getting tonsillitis.

Exposure to germs will increase your risk of getting tonsillitis. Infections are easily spread at school or during play, and adults who spend a lot of time around children are also more at risk.

When to see a doctor

Tonsillitis will usually get better by itself after a few days, but if symptoms don’t start to go away after four days it’s a good idea to visit your GP. You should also see your GP if the symptoms become more severe, including if your throat is so sore you’re having difficulty eating or drinking, or if you can see white, pus-filled spots on your tonsils.

If you think a young child may have tonsillitis and they have a fever or difficulty breathing or swallowing, seek medical attention right away.

For symptoms that are mild to moderate, a pharmacist will be able to help. They can advise you on over-the-counter treatments and home remedies.

Diagnosis

Your GP will perform a physical exam, which includes looking at your throat and tonsils, checking your temperature, and possibly feeling the sides of your neck and checking your ears and nose for signs of infection. 

If your GP thinks you have tonsillitis they may want to perform a throat swab to determine if the cause is a virus or bacteria. They will use a cotton bud to swab the back of your throat. It can feel uncomfortable but won’t hurt and the results are usually quick. They may also want to do a blood test to check for glandular fever. 

Possible complications

Tonsillitis complications usually only occur if it is caused by bacteria. While most of the time, it will get better by itself with no problems, occasionally it can lead to complications, including:

• A pus-filled pocket (abscess) between the tonsil and throat, also called a peritonsillar abscess or quinsy 
• Ear infection 
• Infection of the deeper tissue around the tonsils called tonsillar cellulitis
• Obstructive sleep apnoea, when your breathing starts and stops while you are sleeping

If tonsillitis is caused by streptococcus bacteria, an untreated infection can lead to more serious problems, such as rheumatic fever, sinusitis, kidney infection or scarlet fever.

Treatment

In most cases, tonsillitis will get better by itself without medical intervention. It’s important to stay hydrated by drinking plenty of fluids and you may find that warm drinks or very cold drinks are more soothing if you have a sore throat.

Taking over-the-counter painkillers or numbing throat sweets can help with the pain and make it easier to swallow. You may also find it easier to eat foods such as soup and yoghurt.

Some people find gargling with warm salt-water helpful, and a humidifier or mist vaporiser can be soothing too.

For bacterial tonsillitis, a course of antibiotics may be needed.

Tonsillectomy

Children or adults with recurring tonsillitis may be offered a tonsillectomy to remove the tonsils. A tonsillectomy for children is a short operation lasting about 30 minutes, where the tonsils are removed and the wound sealed with dissolvable stitches. 

The operation is done under general anaesthetic so your child will be asleep and feel no discomfort. Often, they can go home on the same day but are sometimes kept in hospital overnight just to make sure everything is okay. Sometimes, the adenoids are removed at the same time if the child has been having problems with these too. 

A tonsillectomy for adults is much the same as it is for children. The short operation is done under general anaesthetic and is usually done as a day case.