1 What is tonsillitis?

Tonsillitis is a condition caused by infected and swollen tonsils. Most people refer to the palatine tonsils as the ‘tonsils.’

The tonsils are masses of tissue and actually a part of the lymphatic system. There are pairs of tonsils at the back of the nose where it meets the throat (adenoids), at the base of the tongue (lingual tonsil), and near the Eustachian tube.

Tonsillitis is a very common condition and can be as common as a sore throat, colds, or flu. Tonsillitis is much more common in children, and frequent bouts are often considered a part of childhood. The reason for this is that children have somewhat larger tonsils compared to body size, and their immune systems are not fully developed. Note that children may experience difficulty breathing when they have tonsillitis, so they should be seen by the doctor right away.

Although their functions are not totally clear, tonsils are considered a part of the immune system, and they are the first line of defenses against bacteria or other infectious pathogens entering the mouth or nose.

The tonsils have surface irregularities called crypts that collect pathogens from the air or food, ‘sampling’ it for the immune system. Deep inside the tonsils are lymph tissues that contain white blood cells, which identify pathogens.

According to experts, this mechanism may help keep the immune system ‘on its toes,' making it vigilant in case serious pathogen invasion comes in.

Sometimes, the tonsils do become infected themselves, resulting in tonsillitis. Normally, tonsils are pink. White spots on tonsils are indicative of tonsillitis. Inflamed tonsils are somewhat red and swollen, sometimes to the point of almost blocking the throat. They can be painful, and you may find it difficult to swallow solids and drink. You may also feel other symptoms aside from discomfort on the tonsils.

Tonsillitis is caused by viral or bacterial infection. In most cases, the cause of infection is not fully known. Diagnosis is somewhat straightforward, as doctors can easily see it. Sometimes, other lab tests are done to determine other problems or rule out other conditions.

You may confuse tonsillitis with a sore throat and strep throat, which are also very common throat problems. A sore throat and strep throat involve the throat only. Strep throat is a sore throat caused by Streptococcus bacteria, and it is more serious but less common. However, note that sore throat, strep throat, and tonsillitis can occur together.

It is easy to treat tonsillitis. Medications are used to treat the infection. Some home remedies work really well to address discomfort. Solving the cause of irritation or inflammation of the tonsils also works.

Most cases of tonsillitis end up uneventfully and without complications.

If you or your child have frequent tonsillitis, your doctor may recommend a surgery called tonsillectomy to remove the tonsils. It is a quite short procedure.

Usually, tonsillectomy is needed if the swollen tonsils cause complications, or if the patient contracts tonsillitis often.

2 What causes tonsil stones?

You may find tonsil stones, or tonsilloliths, embedded in your tonsils.

Tonsil stones are composed of dead bacteria, foreign cells, and mucus trapped in the crypts of the tonsils.

Tonsil stones are more common in people with frequent tonsillitis. These tonsil stones form constantly and are usually harmless, but sometimes they become so big that they cause tonsillitis.

3 Is tonsillitis contagious?

Most of the viruses and bacteria that causes tonsillitis can be spread to others when you cough, sneeze, or through contact with saliva.

However, note that viruses and bacteria that cause a sore throat, flu, or common colds are also common causes of tonsillitis.

You are more likely to develop tonsillitis from throat or respiratory conditions rather than catching it from others. 

4 Symptoms

Tonsillitis causes the following signs and symptoms:


Children usually present fever and drooling due to problems in swallowing, aside from the aforementioned symptoms. You may also notice that the child is unusually fussy and has a reduced appetite.

Almost all cases of tonsillitis are minor. However, you should go to the doctor if you have difficulty in breathing, or painful or difficult swallowing. You should also speak to a doctor if you have a sore throat that does not go away after a day or two. You also need to bring the child to the clinic right away if there is difficulty breathing, drooling, and problems swallowing.

5 Why does tonsillitis occur?

Tonsils can swell or become inflamed due to infection by viruses or bacteria. Tonsils are often exposed to the outside environment because of their location. Tonsillitis is more likely to happen in people suffering from malnutrition or in those who live in overcrowded conditions.

The majority of tonsillitis cases are caused by viruses. Some of these viruses include Herpes simplex virus, Cytomegalovirus, Adenovirus, Measles virus, and Epstein-Barr virus. Because viruses are not affected by anti-microbial agents, antibiotics are not routinely used to treat tonsillitis.

Tonsillitis caused by bacteria is uncommon. Most cases are caused by Streptococcus pyogenes, the same bacteria involved in strep throat. Thus, having strep throat may also lead to tonsillitis.

The tonsils are part of the immune system. The crypts in tonsils come into contact with bacteria and foreign particles on a daily basis, and usually, the immune system works well to reduce the risk of infection. But sometimes, bacteria or virus is still able to cause infection and inflammation resulting to tonsillitis.

Children are more vulnerable to tonsillitis because they have weaker immune systems and because they have large tonsils. Tonsils shrink and lose its immune function after puberty. Therefore, tonsillitis in adults is somewhat rare.

6 How do doctors diagnose tonsillitis?

You should see a doctor upon the first signs of tonsillitis, especially if it is a repeated occurrence. Doctors can easily diagnose tonsillitis by inspecting the tonsils, sometimes with the help of a tongue depressor and a small flashlight.

The doctor usually performs a physical examination. Your body temperature may be taken to check for fever. Palpation of the neck will reveal swollen lymph nodes. Breathing sounds may be studied using a stethoscope, which will determine any problem in breathing.

Aside from checking on the tonsils, the doctor might ask questions about having fever, difficulty swallowing or breathing. You may be asked about other symptoms to determine if you have other health problems other than tonsillitis. You may have to give your medical history and medicines you take.

Some lab test may be ordered for tonsillitis. A throat swab requires swabbing your throat or tonsils with a cotton swab to get a sample of secretions, which is then sent to the laboratory for analysis. A throat swab helps check for strep throat. Most clinics have rapid diagnostic tests that provide results within 48 hours.

A complete blood count, which counts different types of blood cells, will help the doctor check if a virus or bacteria cause tonsillitis.

Imaging tests, often X-rays, may be required if there is involvement of the adenoids (nasopharyngeal tonsil, the topmost tonsil).

7 Treatment

Almost all cases of tonsillitis, even recurrent ones, can be easily treated. If you are an adult, you can easily recall having several bouts of tonsillitis in a year. Tonsillitis is easily treated at home, and you do not have to go to the hospital unless you have a tonsillectomy.

Tonsillitis caused by viruses usually get better within 10 days, and only simple home treatments are needed. These treatments will relieve discomfort, and these can prove helpful to children. Rest is always encouraged. You also have to stay away from irritants such as cigarette smoke, car exhausts, or smog, which can irritate the tonsils.

Consume enough fluids, as dehydration irritates the throat. Some foods are especially comfortable to eat when you have tonsillitis, such as broth, warm water with honey, ice pops, or caffeine-free tea. Of course, this is almost impossible if there is difficulty swallowing or drinking.

Some remedies to soothe inflamed tonsils include saltwater gargles, lozenges, and humidifying the air.

You can make a salt gargle by mixing a teaspoon of salt to a glass of warm water; gargle and spit it out.

Lozenges may also give relief and can be given to children at least 4 years old.

Placing a humidifier in the room may help prevent the throat from drying up and becoming irritated.

Take prescribed analgesics in the case of fever. Analgesics suitable for tonsillitis include ibuprofen and acetaminophen. Do not give aspirin for tonsillitis. Only give analgesics for moderate fever. Light fever can be managed at home under recommendation of your physician.

Antibiotics are prescribed for tonsillitis caused by bacteria. Among the most frequently prescribed is penicillin, and it is often used to treat Streptococcus pyogenes infection. It is usually taken for 10 days. Complete treatment as prescribed. Discontinuing without your doctor’s permission can cause the bacteria to become more resistant, which makes future infections more difficult to treat.

If tonsillitis becomes recurrent, if tonsils are badly infected, or if the tonsils swell to the point of blocking breathing or swallowing, the doctor may recommend a tonsillectomy.

Surgical removal of adenoids is called adenoidectomy, and it is also performed for the same reasons. Both procedures remove your tonsils in a short surgery, and you will be sedated throughout the procedure.

The recovery period for tonsillectomy is around 10 days, and you have to start first with bland foods that are soft and can be easily swallowed.

8 Prevention

Some of the following preventive measures for tonsillitis are:

  • washing hands regularly and thoroughly,
  • avoid sharing food or utensils,
  • replacing his/her toothbrush after being diagnosed with tonsillitis.

If a child is infected with tonsillitis then it is recommended to keep the child at home, teaching the child to cough or sneeze properly into a tissue and teaching the child to wash his or her hands after sneezing or coughing.

9 Risks and complications

There are several risks and complications associated with tonsillitis.

Risk factor of tonsillitis include:

  • young age- tonsillitis is most common in children ages 5 to 15,
  • frequent exposure to germs- school age children are continuously in contact with their peers and therefore,
  • frequently exposed to viral or bacterial infections.

Inflammation or swelling of the tonsils can lead to following complications:

  • difficulty breathing,
  • disrupted breathing during sleep (obstructive sleep apnea),
  • tonsillar cellulitis (infection that spreads deep into surrounding tissue),
  • peritonsillar abscess (collection of pus behind a tonsil).

If the reason of tonsillitis is streptococcus bacteria, then untreated cases may lead to rheumatic fever or poststreptococcal glomerulonephritis.