What Is Tonsillitis? Causes, Symptoms, Treatment, and More
Key takeaways:
Most tonsillitis infections are caused by viruses responsible for common upper respiratory infections. The bacteria that causes strep throat is also an important cause of tonsillitis.
A physical exam can easily diagnose tonsillitis. A healthcare professional may use throat swabs to figure out the cause.
Tonsillitis usually gets better on its own. For bacterial tonsillitis, antibiotics help clear the infection. If episodes are frequent, you may consider surgery.
Table of contents
Everyone has a sore throat (pharyngitis) at some point in their life. Sore throats can be caused by many things like smoking, allergies, or infections. Most of the time, sore throats go away on their own after a few days. Sometimes the germs that cause a sore throat can also lead to tonsillitis, a painful infection that may need treatment.
What is tonsillitis?
Tonsillitis is a condition where your tonsils become inflamed. Tonsils are soft tissue masses located on each side of the back of your throat. Tonsils help your body fight off respiratory germs. But they can sometimes become infected, leading to tonsillitis. Tonsillitis is common and makes up about 5% of medical visits in the U.S. It occurs most often in the winter and spring.
Tonsillitis symptoms
When tonsils are healthy, they’re pink, similar to the rest of your throat. Their size varies from person to person, and they won’t cause a problem with swallowing. But with tonsillitis, common symptoms may include:
Swollen or enlarged tonsils
Red tonsils
Difficult or painful swallowing
Fever
White patches or pus on the tonsils
Snoring or mouth breathing
Tender lymph nodes in the neck
Headache
Stomachache
Bad breath
Loss of appetite
Fatigue
Chills
Quiz: Do I Have Strep Throat?
What causes tonsillitis?
The cause of tonsillitis is usually a virus. In children, bacterial causes are more common. But viruses remain the most frequent cause for tonsillitis across all age groups. Some viruses that can cause tonsillitis include:
Adenovirus
Epstein-Barr virus (which can also cause mononucleosis)
Coronavirus (COVID-19)
Influenza virus (flu)
Parainfluenza virus (which can also cause croup or laryngitis)
Rhinovirus (which can also cause the common cold)
The most common bacterial cause of tonsillitis is Streptococcus (strep throat). Strep throat causes tonsil infections in up to 15% of adult cases. But for children between the ages of 5 and 15 years old, it causes tonsillitis up to 30% of the time. Strep throat is less likely to be the cause of sore throats in children younger than 5 years old.
Do you need antibiotics for your sore throat? Probably not. Here are eight common reasons for a sore throat.
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Some sexually transmitted infections (STIs) can also cause tonsillitis. These include:
How do you get tonsillitis?
School-aged children and young teens between 5 and 15 years old are most at risk for tonsillitis. The germs that cause tonsillitis are contagious, meaning they can spread from person to person. Bacteria and viruses can be spread many different ways, including:
Respiratory droplets from laughing, singing, coughing, or sneezing
Sharing food, drinks, or eating utensils
Touching a contaminated surface (like doorknobs or countertops) and then touching your eyes, mouth, or nose
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Once these germs are inside your body, they travel to your tonsils. If the immune cells in your tonsils can’t fight off the germs, the tonsils can become infected, causing tonsillitis.
How do you diagnose tonsillitis?
If you think you have tonsillitis, a healthcare professional can do a physical exam to make the diagnosis. To find the tonsillitis cause, they may swab your throat for a rapid strep test in the office. They may also do a throat culture to check for strep throat or other bacterial infections, but these results can take several days.
Is tonsillitis contagious?
Yes, respiratory droplets easily spread the germs that most often cause tonsillitis. These droplets can be released when someone:
Sneezes
Kisses
Coughs
Talks
Sings
Exercises
Breathes
Viral tonsillitis is less contagious once you haven’t had a fever for 24 hours. For strep throat, you’re unlikely to spread the infection once you’ve started antibiotics and no longer have a fever. To stop being contagious and prevent the transmission of tonsillitis, you’ll need to take antibiotics for at least 12 hours.
Other ways you can reduce the risk of spreading tonsillitis include:
Avoiding close contact with others when you’re sick
Not sharing food and drinks
Washing your hands frequently
Covering your cough to prevent spreading germs
Tonsillitis treatment
When tonsillitis is caused by a virus, it often gets better on its own. Most treatments aim to help with fever or pain. These can often be managed with medication or home remedies.
Medicine for tonsillitis
Relief of symptoms can help with both viral and bacterial tonsillitis. Over-the-counter (OTC) medications like ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) can help manage pain and fever.
If you have strep throat, you’ll likely need treatment with antibiotics. While symptoms can improve without treatment, antibiotics help prevent complications like:
Tonsillar abscess
Rheumatic fever (which can lead to heart disease)
Strep-related arthritis
Glomerulonephritis (kidney inflammation)
Autoimmune neurological disorders
Experts recommend penicillin or amoxicillin to treat strep throat. If you have a penicillin allergy, there are other antibiotics you can try. Common antibiotic medications are:
Home remedies
Many home remedies may relieve tonsillitis symptoms. For example
Honey may help decrease inflammation and speed up recovery. (Note: Honey isn’t safe for children under 12 months.)
Warm saltwater gargles may help decrease pain.
Hot drinks may help reduce the symptoms of sore throat.
Herbal teas may help decrease inflammation. Herbal infusions of licorice, barberry, thyme, or oregano may be effective.
When should I seek medical care for tonsillitis?
You may need a medical evaluation for tonsillitis if you have severe symptoms. These symptoms may include severe pain, trouble swallowing, or a muffled sound to your voice.
Other signs that need medical care include:
Trouble opening your mouth
Drooling
The uvula (the floppy tissue hanging down at the center of your throat) is pushed to one side
A sore throat lasting more than 72 hours with worsening pain or no improvement
Shortness of breath
Neck pain on one side
Red or brown urine
Swelling in your eyes or legs
Should I get my tonsils removed?
If you have recurrent tonsillitis, a healthcare professional may recommend a tonsillectomy. This is the case when you’ve had more than six episodes of the following in a year:
Sore throat
Fever
Swollen lymph nodes
Positive strep tests
If you have 5 or more sore throats per year for 2 years, you may also need to consider a tonsillectomy. This procedure will prevent future tonsillitis infections, but it won’t prevent all causes of sore throats.
Frequently asked questions
Tonsillitis and strep throat aren’t the same thing. Strep throat is an infection caused by a specific bacteria called group A Streptococcus (GAS). A GAS infection can lead to tonsillitis and is the most common cause of bacterial tonsillitis. But most cases of tonsillitis are actually caused by a viral infection.
Being run down doesn’t cause tonsillitis, but exhaustion has been shown to weaken your immune system. If you’re not getting enough sleep and are chronically tired, your immune system will have a harder time fighting off infections that can cause tonsillitis.
Antibiotics are used to treat strep throat and kill the bacteria causing tonsillitis. Penicillin or amoxicillin are usually the first choices for treatment, unless you have an allergy. If you’re allergic to penicillin, cephalosporin, azithromycin, or clindamycin may be used instead.
Tonsil stones don’t typically cause tonsillitis, but they can form as a result of tonsillitis. In fact, tonsil stones are more likely to occur if you have frequent episodes of tonsillitis. Tonsil stones usually don’t need treatment and can wash away on their own. Gargling with mouthwash or warm salt water can also help. In rare cases, an ENT (ear, nose, and throat) specialist may have to assist in removing the stone.
The bottom line
Tonsillitis is a common condition. It’s most often due to viral infections. In many cases, it will get better on its own. If it’s caused by strep throat, antibiotics are important to prevent issues. Treatment often includes OTC fever and pain relievers. But some home remedies may provide some additional relief. If you’re having severe symptoms along with your sore throat, it’s always a good idea to get medical care.
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References
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