About Tonsillitis

Open your mouth wide in front of a mirror. Do you see your tonsils? They’re located on each side of your throat, just behind and above your tongue.

Years ago, many young children had their tonsils removed. In fact, surgery was once the standard treatment for recurrent tonsillitis — inflammation of the tonsils caused by a viral or bacterial infection.

Today, tonsils are recognized for their role in filtering harmful bacteria and viruses that could cause more serious infections. When tonsillitis strikes, the first line of treatment is typically self-care or antibiotics. Surgery is seldom necessary, unless tonsillitis recurs often or it interferes with breathing or swallowing.

Symptoms

Tonsillitis is characterized by red, swollen tonsils. You may also notice white patches on the tonsils. Other signs and symptoms of tonsillitis include:

  • Severe sore throat
  • Difficult or painful swallowing
  • Headache
  • Fever and chills
  • Enlarged, tender glands (lymph nodes) in the jaw and neck
  • Loss of voice

Causes

When bacteria and viruses enter your body through your nose or mouth, your tonsils act as a filter — engulfing the offending organisms in white blood cells. This may cause a low-grade infection in your tonsils, which stimulates your immune system to form antibodies against future infections. But sometimes the tonsils are overwhelmed by a bacterial or viral infection. The result is tonsillitis.

Various viruses and bacteria can cause tonsillitis, including the virus that causes mononucleosis (the Epstein-Barr virus) and the bacterium that causes strep throat (Streptococcus pyogenes).

Tonsillitis is a common condition, especially in children. Viruses and bacteria tend to flourish where people are in close contact, such as schools and child care facilities.

Diagnosis

The doctor will check your tonsils and the back of your throat for signs of infection, such as redness and pus. If your tonsils appear to be infected and you have other signs and symptoms of strep throat, you’ll need a throat swab. With this simple test, the doctor rubs a sterile swab over the back of your throat to get a sample of the secretions. It doesn’t hurt, but it may cause momentary gagging.

The sample will be checked in the lab for the presence of streptococcal bacteria. Test results are available within minutes to hours, depending on the testing method. If the strep test is positive, you’ll need antibiotics to treat the infection.

Left untreated, tonsillitis can lead to a collection of pus between a tonsil and the soft tissues around it. This is known as an abscess. The abscess may cover a large part of the soft area at the back of the roof of the mouth (soft palate). Sometimes the swelling can be so severe that the roof of the mouth and tongue meet, blocking airflow and making swallowing extremely difficult. Rarely, the abscess may spread into the bloodstream or into the neck or chest.

Some strains of streptococcal bacteria that cause tonsillitis can also cause kidney inflammation (nephritis) or rheumatic fever, a serious condition that can affect the heart, joints, nervous system and skin.

Treatment

Tonsillitis is typically treated with self-care or antibiotics. Although surgery is no longer the standard treatment for tonsillitis, it may be recommended in some cases.

Self-care

If tonsillitis is caused by a viral infection, you’ll need to let the virus run its course. Recovery may take a week or two. In the meantime, get plenty of rest. Drink warm, soothing liquids — such as soup, broth and tea — and gargle with warm salt water. Acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) can help reduce fever and decrease pain. Because of the risk of Reye’s syndrome — a potentially life-threatening illness — don’t give aspirin to children younger than age 12.

Antibiotics
If tonsillitis is caused by a bacterial infection, your doctor will prescribe antibiotics. Oral antibiotics typically need to be taken for at least 10 days. Although you’ll probably feel better in a day or two, it’s important to finish the full course of antibiotics. Stopping medication early may cause the infection to come back — which can lead to potentially serious complications.

If your child has a positive strep test, he or she needs to complete at least 24 hours of antibiotic treatment before returning to school or child care. If your child has difficulty swallowing, antibiotics may be given by injection.

Surgery
Surgical removal of the tonsils (tonsillectomy) is rarely needed for adults. During childhood, surgery may be recommended if:

  • Your child has seven or more episodes of tonsillitis in one year
  • Your child has five or more episodes of tonsillitis a year for two years
  • Swollen tonsils interfere with your child’s breathing or swallowing
  • An abscess develops in the tonsils

Tonsillectomy is usually done on an outpatient basis. That means your child will be able to go home the day of the surgery. A complete recovery may take up to two weeks, however.

After surgery, your child’s throat will be sore. He or she may have ear pain as well. Encourage your child to suck on ice cubes or frozen fruit pops, eat ice cream or sherbet, and drink cold liquids. You may want to use a cool-mist humidifier in your child’s bedroom. While your child is recovering, keep in mind that he or she will be more susceptible to infection than usual. Avoid crowds and exposure to anyone who may be ill. If your child begins to bleed from the mouth, report it to the doctor immediately.

Prevention

Frequent hand washing is the best way to prevent all kinds of infections, including tonsillitis. Wash your hands often, and encourage your children to do the same.

When you use soap and water:

  • Wet your hands with warm, running water and apply liquid or clean bar soap. Lather well.
  • Rub your hands vigorously for at least 15 seconds. Encourage your children to wash for as long as it takes to sing their ABCs, “Row, Row, Row Your Boat” or the “Happy Birthday” song.
  • Scrub all surfaces, including the backs of your hands, wrists, between your fingers and under your fingernails.
  • Rinse well.
  • Dry your hands with a clean towel.
  • Use a towel to turn off the faucet.

If soap and water aren’t available, use an alcohol-based hand sanitizer. Apply about 1/2 teaspoon of the sanitizer to the palm of your hand. Rub your hands together, covering all surfaces of your hands, until they’re dry.

Other common-sense precautions apply, too. Cough or sneeze into your elbow or a tissue. Don’t share drinking glasses or eating utensils. Avoid close contact with anyone who’s sick. Look for a child care setting with sound hygiene practices and clear policies about keeping sick children at home.

Self-care

A sore throat can make you miserable. These tips can help.

  • Drink more fluids. Warm liquids — such as soup, broth and tea — are good choices.
  • Gargle with warm salt water. Mix 1/2 teaspoon of salt in 8 ounces of warm water, gargle, and then spit out the water.
  • Use honey and lemon. Stir honey and lemon to taste into a glass of hot water. Allow it to cool to room temperature before you sip it. The honey coats and soothes your throat, and the lemon helps reduce mucus. Note: Don’t use honey or corn syrup in a drink for children younger than age 1.
  • Suck on a throat lozenge or hard candy. This stimulates saliva production, which bathes and cleanses your throat.
  • Humidify the air. Adding moisture to the air can reduce throat irritation and make it easier to sleep. Be sure to change the water in a room humidifier daily and clean the unit at least once every three days to help prevent the growth of harmful molds and bacteria.
  • Avoid smoke and other air pollutants. Smoke irritates a sore throat.
  • Rest your voice. Talking may lead to more throat irritation and temporary loss of your voice (laryngitis).

Think about others, too. If you’re not feeling well, take a few days off to avoid spreading your germs.