Health A to Z
Tonsillitis is inflammation of the tonsils. It's usually caused by a viral infection or, less commonly, a bacterial infection.
Tonsillitis is a common condition in children, teenagers and young adults.
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The symptoms of tonsillitis include:
Symptoms usually pass within three to four days.
Tonsillitis isn't usually a serious condition. You only need to see your GP if symptoms:
Your GP will examine your throat and ask you some questions about your symptoms. If necessary, a throat swab can be taken to confirm the diagnosis. The results usually take a few days to return.
If your tonsillitis is caused by a bacterial infection, they may prescribe antibiotics. Typical signs of a bacterial infection include white pus-filled spots on the tonsils, no cough and swollen or tender lymph glands.
The tonsils are two small glands that sit on either side of the throat. In young children, they help to fight germs and act as a barrier against infection.
When the tonsils become infected, they isolate the infection and stop it spreading further into the body.
As a child's immune system develops and gets stronger, the tonsils become less important and usually shrink. In most people, the body is able to fight infection without the tonsils.
Removal of the tonsils is usually only recommended if they're causing problems, such as severe or repeated episodes of tonsillitis.
Some cases can also be caused by a bacterial infection, typically a strain of bacteria called group A streptococcus bacteria.
These types of infections spread easily, so it's important to try to avoid passing the infection on to others by:
Read more about the causes of tonsillitis.
There's no specific treatment for tonsillitis, but you may be able to reduce the symptoms by:
If test results show that your tonsillitis is caused by a bacterial infection, a short course of oral antibiotics may be prescribed.
If oral antibiotics aren't effective at treating bacterial tonsillitis, intravenous antibiotics (given directly into a vein) may be needed in hospital.
In most cases, tonsillitis gets better within a week. However, a small number of children and adults have tonsillitis for longer, or it keeps returning. This is known as chronic tonsillitis and surgical treatment may be needed.
Surgery to remove the tonsils (a tonsillectomy) is usually only recommended if:
Read more about treating tonsillitis.
Complications of tonsillitis are rare and usually only occur if it's caused by a bacterial infection. They're usually the result of the infection spreading to another part of the body.
Possible complications of tonsillitis include:
Other complications of tonsillitis are very rare and usually only occur if an underlying bacterial infection is left untreated. They include:
The main symptom of tonsillitis is a sore throat.
Your tonsils will be red and swollen, and your throat may be very painful, making swallowing difficult.
In some cases, the tonsils are coated or have white, pus-filled spots on them.
Other common symptoms of tonsillitis include:
The symptoms of tonsillitis usually get better after three to four days.
It's difficult to tell just by looking at a person's throat whether they have tonsillitis as a result of a virus or a bacterial infection. Tests are needed to confirm this.
Antibiotics may be recommended if test results show that your tonsillitis is caused by a bacterial infection.
Most cases of tonsillitis are caused by a viral infection.
Viruses known to cause tonsillitis include:
In rare cases, tonsillitis can also be caused by the Epstein-Barr virus, which causes glandular fever.
If this is the case, you'll probably feel very ill. You'll have a sore throat and the lymph glands in your throat may be swollen. You may also have a fever and feel very tired.
Bacterial tonsillitis can be caused by a number of different bacteria, but it's usually due to group A streptococcus bacteria.
In the past, serious bacterial infections, such as diphtheria and rheumatic fever, have been linked with tonsillitis. However, this is now rare, because these conditions are vaccinated against and treatment for them has greatly improved.
Tonsillitis itself isn't contagious, but the infections that cause it are.
Viruses, such as those that cause colds and flu, are spread through coming into close contact with someone who's infected.
When an infected person coughs or sneezes, the virus is contained in the millions of tiny droplets that come out of their nose and mouth. You can become infected by breathing in the contaminated droplets. This is known as direct contact.
You can also become infected if you touch a surface or object that the droplets have landed on and then touch your face. This is known as indirect contact.
There's no specific treatment for tonsillitis and most cases get better within a week without treatment.
While waiting for the infection to clear up, there are a number of things you can do to help relieve your symptoms (see below).
If your child has tonsillitis, make sure they have plenty to eat and drink, even if they find it painful to swallow. Being hungry and dehydrated can make other symptoms, such as headaches and tiredness, worse.
If treating your children with painkillers, it's important to use the correct type and dosage. Younger children only need small dosages. Your pharmacist can advise you about this.
Children under 16 years of age shouldn't be given aspirin.
Over-the-counter treatments that can soothe a sore throat, such as lozenges and oral sprays, are also available. Some people find that gargling with a mild antiseptic solution can also relieve a sore throat.
Alternatively, you could try gargling with warm, salty water. Mix half a teaspoon of salt (2.5g) with a quarter of a litre (eight ounces) of water. It's important not to swallow the water, so this method may not be suitable for younger children.
Antibiotics may not be prescribed, even if tests confirm your tonsillitis is caused by a bacterial infection. The two main reasons for this are:
However, exceptions are usually made if:
In these circumstances, a 10-day course of penicillin is usually recommended. If you or your child is known to be allergic to penicillin, an alternative antibiotic, such as erythromycin, can be used.
Hospital treatment may be required for particularly severe or persistent cases of bacterial tonsillitis that don't respond to oral antibiotics. In these cases, intravenous antibiotics (given directly into a vein) may be needed.
Antibiotics sometimes cause mild side effects, such as an upset stomach, diarrhoea or a rash.
Surgery to remove the tonsils is known as a tonsillectomy.
For children with mild sore throats, watchful waiting is recommended rather than a tonsillectomy.
A tonsillectomy is only considered for a recurrent sore throat if certain criteria are met. You must have:
Tonsillectomies are carried out under general anaesthetic, which means you'll be asleep during the procedure. Your mouth will be held open to allow the surgeon to see your tonsils and no cuts will be made in your skin.
The operation can be carried out in a number of ways, as described below.
Each of these techniques is relatively similar in terms of safety, results and recovery, so the type of surgery used will depend on the expertise and training of the surgeon.
You'll usually be able to leave hospital on the same day as you have surgery, or the day after.
After surgery, it's likely you'll experience some pain at the site of the operation. This can last for up to a week. Painkillers can help to relieve the pain.
Children who have had a tonsillectomy should be kept off school for two weeks. This is to reduce their risk of picking up an infection from another child that will make them feel more uncomfortable.
Swallowing will probably be difficult after having a tonsillectomy. However, it's important to eat solid foods, because it will help your throat to heal more quickly. Drink plenty of fluids, but avoid acidic drinks, such as orange juice, because they'll sting.
Ensuring good oral hygiene by regularly brushing your teeth and using mouthwash can help prevent infection in the mouth.
The pain usually gets worse during the first week after having a tonsillectomy, before gradually improving during the second week. Earache is common with tonsillectomies, but isn't a cause for concern.
Bleeding at the site where the tonsils were removed is a fairly common complication of a tonsillectomy. This can occur during the first 24 hours following surgery or up to 10 days afterwards.
It's estimated that around 1 in 100 children and 1 in 30 adults will experience post-operative bleeding after having a tonsillectomy.
Minor bleeding isn't usually a cause for concern, because in most cases it resolves by itself. Gargling with cold water can often help stem the bleeding, because the cold helps to contract the blood vessels.
Occasionally, the bleeding can be more severe, causing people to cough up blood. Seek immediate medical advice if this happens. You should be given an emergency contact number before you're discharged from hospital. Alternatively, you can call NHS 111.
Extensive bleeding may need to be treated with surgery or a blood transfusion.
Tessa Hughes, from Brixton in London, had a tonsillectomy when she was 15 years old.
"Tessa started having throat infections when she was about seven," says Tessa's mum. "Every winter it was the same. She would wake up with a throat like a razor blade and feeling like death. I would take her to the doctor, and she would get better for a few weeks, then the infection would come back and we’d be back where we started.
"When it first happened, I shone a torch down her throat. Her tonsils were all swollen and looked like two yellow golf balls. I suspected it was tonsillitis and the GP confirmed the diagnosis almost immediately.
"Over the next few years, the bouts of tonsillitis became more frequent and Tessa had to take more time off school. I talked with the GP about Tessa having her tonsils out, but as tonsillitis is supposed to get better with age, we decided to wait and see if it would go away naturally as she grew older.
"By the time she was 15 there was still no improvement, so our GP referred us to an ear, nose and throat (ENT) specialist at King's College Hospital in London. He took one look and suggested she have her tonsils out as soon as possible. There was a long waiting list at King's, so we were referred to a small hospital near Farnborough for the operation. Although the hospital was private, the treatment was still done on the NHS.
"Tessa sailed through the operation. Her throat was a bit sore for the next week or so, but she hasn’t had a throat infection since, which is a great relief to all concerned.
"We are delighted with the results and I would thoroughly recommend any mum to go ahead with the operation if a specialist suggests it could help their child. All surgery has risks, but a tonsillectomy is a simple operation and, for us, the benefits far outweighed the risks."