Acute Tonsillitis

Overview

Acute tonsillitis is a sudden inflammation of the tonsils, the two oval pads of tissue at the back of the throat. The tonsils are part of the immune system and help fight germs, but they can themselves become infected, leading to a painful, swollen throat. Acute tonsillitis is very common, especially in children and teenagers, though it can affect people of any age.

Most cases are caused by common viruses, similar to those that cause colds, and clear up on their own within about a week. A smaller number are caused by bacteria, most often group A streptococcus (the cause of strep throat), which may need antibiotic treatment. Tonsillitis is usually a short-lived illness, but it can occasionally lead to complications, so it is helpful to recognize the warning signs.

Symptoms

Symptoms usually come on quickly and may include:

• Sore throat, often severe, with pain on swallowing
• Red, swollen tonsils, sometimes with white or yellow patches or coating
• Fever and chills
• Swollen, tender lymph nodes in the neck
• Headache, earache, or a scratchy or muffled voice
• Bad breath and, in young children, drooling, refusal to eat, or fussiness

Difficulty breathing, severe difficulty swallowing or opening the mouth, or drooling with a muffled voice are warning signs that need urgent medical attention.

Causes

Acute tonsillitis is caused by infection, most commonly viral but sometimes bacterial.

• Viruses: The most common cause, including the viruses behind colds and the flu, and the virus that causes glandular fever (infectious mononucleosis).
• Bacteria: Group A streptococcus, the cause of strep throat, is the most common bacterial cause and may need antibiotics.

The infection spreads through droplets from coughs and sneezes and by contact with contaminated surfaces or shared items. Close contact in schools and households makes it easy to pass on.

Risk Factors

• Young age, as tonsillitis is most common in children and teenagers
• Frequent close contact with others, such as at school or daycare
• Exposure to someone with a throat infection
• Crowded environments where germs spread easily

Diagnosis

A doctor usually diagnoses tonsillitis by examining the throat and may test for strep:

• Throat examination: Looking at the tonsils for redness, swelling, and white patches, and feeling the neck for swollen glands.
• Rapid strep test or throat swab: Checks whether group A streptococcus is the cause, which guides whether antibiotics are needed.
• Other tests: Occasionally blood tests are used, for example if glandular fever is suspected.

Treatment

Treatment depends on whether the cause is viral or bacterial.

• Supportive care: Most viral cases improve with rest, plenty of fluids, and pain and fever relief such as appropriate doses of paracetamol or ibuprofen.
• Soothing measures: Warm or cool drinks, soft foods, and saltwater gargles (for older children and adults) can ease the throat.
• Antibiotics: Prescribed when a bacterial cause such as strep is confirmed; it is important to finish the full course.
• Surgery: Removal of the tonsils may be considered only for very frequent or severe recurrent tonsillitis, not for a single acute episode.

Most people recover fully within a week or so.

Prevention

• Wash hands often, especially before eating and after coughing or sneezing
• Avoid sharing cups, utensils, or food
• Cover coughs and sneezes
• Stay away from others who have a throat infection where possible
• Keep children home from school until they are well, especially with strep

When to See a Doctor

See a doctor if a sore throat is severe, lasts more than a few days, comes with a high fever, or is hard to distinguish from strep throat. Seek emergency care immediately if there is:

• Difficulty breathing or noisy breathing
• Severe difficulty swallowing or drooling, especially with a muffled voice
• Inability to open the mouth fully
• Severe one-sided throat pain with swelling, which may suggest an abscess

These can signal serious complications such as airway swelling or a throat abscess that need prompt treatment.

Related Topics

Frequently Asked Questions

References

1. Mayo Clinic. Tonsillitis — Symptoms and causes.
2. MedlinePlus, U.S. National Library of Medicine. Tonsillitis.
3. Centers for Disease Control and Prevention (CDC). Strep Throat.
4. National Health Service (NHS). Tonsillitis.