Tonsillitis describes inflammation of the tonsils, most often triggered by a viral infection but sometimes by bacteria. The tonsils are two oval-shaped lymphoid tissues located on each side at the rear of the throat, serving as an early defence against pathogens1. Symptoms typically intensify over two to three days and usually resolve within about a week. Anyone, regardless of age, can develop tonsillitis1.
Types of tonsillitis
There are three recognized forms:
- Acute tonsillitis, symptoms persisting from three days up to two weeks
- Recurrent tonsillitis, seven or more episodes in a single year; or five or more episodes per year over two years; or three or more per year over three years
- Chronic tonsillitis, a persistent, long-standing infection of the tonsils
Tonsillitis symptoms
The hallmark of tonsillitis is a painful throat that makes swallowing uncomfortable. Other common signs include:
- Red, enlarged, tender tonsils
- White spots or pus on the tonsils
- Difficulty swallowing
- Hoarseness
- Bad breath
- Swollen neck lymph nodes
- Stiff neck
- Fever
- Headache
- Ear pain
- General malaise
- Abdominal discomfort
- Loss of appetite
How do you get tonsillitis?
Most cases stem from viruses such as those causing colds or flu. About 15 percent are bacterial, usually due to Streptococcus species responsible for strep throat.
Is tonsillitis contagious?
While tonsillitis itself isn’t directly contagious, the viruses or bacteria that bring it on can spread via respiratory droplets when an infected person coughs or sneezes, or by touching contaminated surfaces then touching your face.
Who gets tonsillitis?
Although people of any age can develop tonsillitis, it’s more frequent in young children, especially those under seven, because their tonsils are larger relative to their throat and their immune systems are still developing. As children grow, outbreaks tend to decrease.
Risk factors for tonsillitis include:
- Age, Bacterial tonsillitis is most common in children aged 5–15, but older adults are also at risk
- High exposure, Those in close-contact environments (e.g. schools) face greater risk
How is tonsillitis diagnosed?
Diagnosis usually involves a physical exam: your doctor will inspect your throat and feel your neck. A throat swab may be taken to distinguish bacterial infections, and a blood test could be ordered if glandular fever (Epstein-Barr virus) is suspected.
Tonsillitis treatment
Bacterial, Antibiotics to clear the infection Viral, Symptom relief measures:
- Rest
- Over-the-counter pain relievers such as paracetamol or ibuprofen (avoid aspirin in children under 12)
- Staying hydrated
- Gargling with salt water or using throat lozenges
- Cooling foods and drinks (ice cream, jelly, ice chips)
- Avoiding tobacco smoke
Your pharmacist can recommend products best suited to your needs.
Surgery for tonsillitis
For those with frequent, severe episodes, a tonsillectomy may be advised. Indications include:
- Multiple painful flare-ups with fever
- Chronic tonsillitis unresponsive to antibiotics
- Repeated ear infections alongside tonsillitis
- Enlarged tonsils causing breathing issues
- Poor growth in children due to recurrent infections
Surgery is not usually the first approach.
Complications of tonsillitis
If left untreated or in severe cases, tonsillitis can lead to:
- Persistent (chronic) tonsillitis
- Spread of infection to sinuses, ears, or nearby tissues
- Formation of a peritonsillar abscess
- Breathing difficulties
Can you prevent tonsillitis?
Good hygiene is key:
- Wash hands thoroughly after using the toilet, before meals, and after coughing or sneezing
- Cover coughs and sneezes with tissues, then discard immediately
- Avoid sharing utensils, cups, and personal items
- Stay home when ill
- Replace your toothbrush following a tonsillitis diagnosis
When to see the doctor
Seek medical advice if your child experiences their first episode of tonsillitis or if they:
- Have trouble breathing
- Snore excessively during sleep
- Struggle to swallow
- Show signs of dehydration
- Cannot fully open their mouth
If your child drools heavily or has severe breathing difficulties, call emergency services (000), this could indicate life-threatening epiglottitis.