Tonsillitis: Causes, Symptoms, Diagnosis, and Treatment

Who is this information for?

This information is for patients, families and carers of patients with tonsillitis.

What is tonsillitis?

The tonsils are a pair of lymph nodes found on each side of the back of the throat. These masses serve as filters for your airways that grab germs. They produce antibodies and aid in the fight against infection, but they can sometimes become overwhelmed. The inflammation and swelling that results are known as tonsillitis.

This condition is quite common, particularly for children. It can also occur in adults. It may happen only occasionally or it may happen repeatedly in a relatively short period of time.

There are three different types of tonsillitis:

Acute tonsillitis. When acute, tonsillitis symptoms can last anywhere from 3 days to 2 weeks.
Recurrent tonsillitis. When you experience tonsillitis symptoms multiple times in a year, it is considered recurrent.
Chronic tonsillitis. If your tonsillitis symptoms last for an extended period of time, it is considered a chronic condition.

It is important to note that tonsillitis is contagious. Fortunately, it is easy to diagnose. A visit to your doctor can help you to quickly determine whether you or your child has tonsillitis.

What causes tonsillitis?

There are numerous bacteria and viruses that can cause this condition, including strep throat or Streptococcal bacteria. Some other causes that can lead to tonsillitis include:

Herpes simplex virus
Epstein-Barr virus
Adenoviruses
Enteroviruses
Influenza virus

Viral tonsillitis

The most common causes of tonsillitis are viruses. The same viruses that cause common illnesses, including the common cold and mononucleosis, can cause tonsillitis as well.

Bacterial tonsillitis

It is estimated that bacteria cause between 15 and 30 percent of tonsillitis cases. Of those cases, most occur in children.

How is tonsillitis diagnosed?

Tonsillitis tends to cause symptoms that are easy enough for a doctor to identify – the swollen glands at the back of the throat are often obvious during a physical exam. However, the doctor can get more detailed information about the cause of the infection, like if it is viral or bacterial, by taking a throat swab or a blood sample for testing.

How is tonsillitis treated?

Tonsillitis symptoms can range from mild to severe and the condition can be caused by viruses or bacteria. The exact nature of your condition will determine which type of treatment is most likely to be successful.

If the symptoms are mild enough, you may not require any specific treatment beyond what can help you feel more comfortable – such as drinking fluids, getting plenty of rest, and taking simple pain relief. If the symptoms are significant enough that they require treatment, the doctor will need to determine whether the infection is viral or bacterial to decide which treatment is correct. Antibiotics are not effective for viral infections, for instance, so they are not prescribed for viral tonsillitis.

Some common treatments for tonsillitis include:

Antibiotics for tonsillitis

After taking a throat swab or a blood sample, the doctor can determine if you have a bacterial infection. If the infection is caused by bacteria, you may benefit from antibiotics. A prescription for antibiotics is not always necessary, however, and doctors may prefer to avoid giving antibiotics for patients that are not at risk from complications due to their tonsillitis. Antibiotics do have side effects and can lead to antibiotic resistance, so their application needs to be justified – which is not always the case with tonsillitis.
Penicillin is a common antibiotic used for bacterial tonsillitis resulting from group A streptococcus. However, other antibiotics can be used for those who have trouble with penicillin or when required based on the cause of the infection.
If you are prescribed antibiotics for bacterial tonsillitis, be sure to take them as prescribed. Most importantly, complete the entire course of antibiotics to ensure resolution of the infection. Some patients stop taking antibiotics once they start to feel better, which can lead to a resurgence of the infection that is more difficult to treat than it was originally, due to the resurgence of more antibiotic resistant organisms.

Tonsillectomy

If you are experiencing recurrent tonsillitis or chronic tonsillitis, or if you are struggling with complications resulting from tonsilitis, your doctor may recommend that you get a tonsillectomy. A tonsillectomy is a type of surgery to remove the tonsils. There is a general guideline doctors use to determine if you might need a tonsillectomy. If you have had tonsilitis 7 or more times in the past year, you may benefit from surgery. If you have had 5 cases of tonsillitis a year for the past two years, you may also benefit from surgery. These numbers of course are also modified by the impact these infections have on your quality of life – such as time away from work or study.

A tonsillectomy is also offered as an option for other conditions, including:

Trouble breathing
Repeated cases of strep throat
Cancer of the tonsils
Snoring that is regular and loud
Sleep apnea – where you stop breathing while sleeping
Tonsillar bleeding

There are several different surgical methods that can be used to remove the tonsils, including:

Cold knife (steel) dissection. With this method, the surgeon uses sharp dissection (scissors or blade) to cut away the tonsils.
Cauterization. This method utilizes heat to burn away the tonsil tissue and cauterize the wound
Coblation. This method uses low heat to ablate tissue, remove the tonsils, and seal the wound.
Ultrasonic vibration. This method uses sound waves to remove the tonsils.

Are there any risks associated with a tonsillectomy?

A tonsillectomy is a common procedure, one that is quite routine and considered relatively safe. Of course, it is a surgery, so there are always risks of complications like bleeding, swelling, airway narrowing and unwanted reactions to anesthetics. Thankfully, whilst important, these complications are uncommon, but will be discussed with you in detail if tonsillectomy is considered a treatment option in your particular condition, or that of your child.

What is recovery like following a tonsillectomy?

Patients usually go home the same day as their tonsillectomy, or stay overnight There can be some pain following the surgery, which worsens from day 3 to day 10 after surgery, often feeling like a severe sore throat. Because of where the surgery occurs, you can also experience some pain in the ears, jaw or neck. Your doctor will prescribe medications to help with pain and swelling. Be sure to take any medications as indicated by the doctor.

Your throat will be sore, but to help with healing and to help control the pain, it is recommended that you consume a diet as close as possible to your normal diet, ensuring to eat foods that require chewing. It would be advisable however to avoid very hot foods, spicy and acidic foods, which would be irritating and painful to the healing areas in the throat..

If you do experience complications like bleeding, fever, or trouble breathing, contact your doctor immediately. Snoring is common after a tonsillectomy and should go away in a few weeks.

Most patients are able to return to school or work two weeks after their procedure.

For more information, please see our page on tonsillectomy.

Concerns or questions?

You can contact your ENT Specialist at the Melbourne ENT Group (MEG):

Your GP is also the best contact for ongoing care and concerns.

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