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Tonsillitis

Your tonsils are two small round lumps of tissue that lie at the back of your throat. They’re similar to lymph nodes, helping your body to fight infection.

Tonsillitis is inflammation of your tonsils, usually as a result of an infection. The infection may be viral or, less commonly, bacterial. You can get tonsillitis as an adult, but it’s more common in children. You’re most likely to get tonsillitis in the winter or spring, but it can happen at any time.

In most cases, tonsillitis gets better on its own. If you rest and drink plenty of fluids, your body will probably fight off the infection within about a week and you won’t need to see your GP.

An image showing the soft tissues of the mouth and throat

Details

  • Symptoms Symptoms of tonsillitis

    If you have tonsillitis, you’ll probably have a sore throat. However, having a sore throat doesn’t always mean you have tonsillitis.

    Other symptoms of tonsillitis may include:

    • pain when swallowing, which may be difficult to do
    • a raised temperature (over 38°C)
    • bad breath
    • a headache
    • tiredness and feeling generally unwell
    • feeling sick or vomiting – especially in children
    • tummy (abdominal) pain – especially in children

    You may also notice you have swollen tonsils and swollen glands in your neck.

    If these symptoms last longer than three to four days or get worse, contact your GP for advice. See our FAQ ‘When to see a doctor’.

  • Diagnosis Diagnosis of tonsillitis

    You can often manage tonsillitis at home. But if your symptoms are severe or not getting better after three to four days, then you may need to see your GP. They will ask about your symptoms and examine you. They’ll look inside your mouth, perhaps using a simple instrument called a tongue depressor. This lets them push your tongue down gently so they can get a better view of your tonsils. They may also feel around your neck to see if you have swollen glands.

    Your GP will usually be able to make a diagnosis based on your symptoms and the appearance of your throat and tonsils alone.

    The symptoms of tonsillitis may be similar to those of glandular fever. This is most likely in teenagers and young adults. If your GP suspects you may have glandular fever, they’ll recommend you have a blood test to check this.

  • Treatment Treatment of tonsillitis

    The most important thing to know about treating tonsillitis is that it usually gets better on its own. Nine out of 10 people with tonsillitis recover within a week. Antibiotics aren’t usually needed.

    Self-help

    If your tonsillitis is mild, you may not wish to have any treatment at all. If you want to help yourself feel better, there are several things you can do.

    • Rest and take it easy for a few days.
    • Ensure you drink plenty of fluids, especially if you have a raised temperature.
    • Gargle with a simple mouthwash such as warm salt water − this may help to ease the pain in your throat.
    • You may find that sucking throat lozenges or having cold desserts such as ice lollies makes your throat feel better.

    If you have pain, there are a number of over-the-counter medicines which may help to relieve it. These include paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.

    Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    If you decide to treat your tonsillitis yourself, see our FAQ ‘When to see a doctor’.

    Medicines

    Your GP probably won’t offer you antibiotics. This is because antibiotics don’t work against viral infections, which cause many cases of tonsillitis. Antibiotics are unlikely to make much difference to your symptoms.

    However, there are some situations where your GP may recommend antibiotics. They’ll explain why antibiotics might help in your particular circumstances. Your GP may prescribe them if they think you may have bacterial tonsillitis and especially if you:

    • are very unwell
    • are at increased risk of serious complications

    See our section on complications for more information.

    Your GP may offer you a delayed prescription for an antibiotic. This means that you have a prescription, but that you only actually get the medicine and take it under clearly agreed circumstances. These might include your symptoms not settling by a certain time, or getting worse.

    If you do need an antibiotic, your GP will probably offer you a 10-day course of penicillin. Because the usual treatment for tonsillitis is penicillin, it’s really important that you tell your GP if you are allergic to this medicine. If you’re allergic to penicillin, there are other antibiotics that you can have instead.

    You should complete the full course of antibiotics your GP prescribes, even if you start to feel better. This helps to make sure you get rid of all the harmful bacteria and reduces the risk of resistance (when antibiotics no longer work against the bacteria).

    Always read the patient information leaflet that comes with your medicine carefully. If you have any queries about your medicine, your pharmacist will be able to help you.

    Surgery

    Your GP may refer you to an ear, nose and throat (ENT) surgeon if they feel you may benefit from having your tonsils removed. The operation to remove your tonsils is called a tonsillectomy.

    Your doctor will usually suggest a tonsillectomy only if you have had tonsillitis:  

    • frequently and/or it interferes with normal functions, such as breathing
    • more than seven times in the last year
    • five times or more in each of the past two years
    • three or more times in each of the past three years

    Your doctor may also recommend a tonsillectomy if you’ve had a peritonsillar abscess (quinsy). See our section on complications.

    For children, your GP may recommend that you wait and see if the tonsillitis gets better on its own before considering surgery. As young children get older, tonsillitis becomes less common, so an operation isn't always best and, like all operations, it does come with some risks.

    Although surgery can help to prevent tonsillitis, having a tonsillectomy doesn’t guarantee that you won’t get a sore throat in the future.

    For more information, including the pros and cons of the operation, see our topic on adenoid and tonsil removal.

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  • Causes Causes of tonsillitis

    Most cases of tonsillitis are caused by a viral infection. The viruses which most commonly cause tonsillitis are those which also cause the common cold. These include rhinoviruses, coronaviruses and adenoviruses.

    Up to one in three cases of tonsillitis is caused by bacteria. Bacterial tonsillitis is more common in children than in adults. The type of bacteria most likely to cause tonsillitis is called a group A beta-haemolytic streptococcus. You may have heard people using the term ‘strep throat’ for tonsillitis. They are referring to infection caused by this type of bacteria.

  • Complications Complications of tonsillitis

    Tonsillitis usually gets better within a week and causes no long-term problems. You’re more likely to have severe infection or complications if you have other illnesses such as heart, lung, kidney or liver disease.

    Some people who get tonsillitis keep getting it again and again. This can mean taking a lot of time off work or off school. Recurrent tonsillitis like this may be a reason to consider having your tonsils removed (see our treatment section on surgery).

    Tonsillitis can sometimes lead to an abscess on or around your tonsils – this is called a peritonsillar abscess or quinsy. This is a complication of bacterial tonsillitis. You may have severe pain in your throat, which may become worse on one side. You’ll probably have a raised temperature, difficulty swallowing and difficulty opening your mouth. Peritonsillar abscess is more likely to affect teenagers and young adults but children can also get it. It’s usually treated with antibiotics and a surgical procedure to drain the pus. Your doctor may recommend having your tonsils removed if you’ve had a peritonsillar abscess.

  • FAQ: When to see a doctor I have a sore throat, should I see my GP?

    You can usually treat your sore throat yourself at home. Fewer than one in 20 people with a sore throat go to the doctor for treatment. Most people with tonsillitis get better within a week. See our treatment section on self-help for tips on how to ease your symptoms.

    However, you should contact your GP if your sore throat hasn't improved after three to four days or if you have:

    • difficulty breathing
    • difficulty swallowing saliva
    • difficulty opening your mouth
    • a persistent high temperature
    • a severe illness, especially if the symptoms are worse on one side of your throat
    • a sore throat that keeps getting worse
  • FAQ: Is tonsillitis catching? I’ve got tonsillitis – can others catch it from me?

    Respiratory infections like tonsillitis can be spread through the tiny droplets you produce when talking, coughing and sneezing. Try to keep close contact with other people to a minimum for the first few days that you have a sore throat. Simple steps, like covering your nose and mouth when you cough, and regular hand washing will help you avoid passing on the infection.

    More information

    Tonsillitis is caused by a viral or bacterial infection. These organisms are quite infectious, spreading through small droplets sent into the air when you talk, cough or sneeze.

    If you have tonsillitis, there’s a risk that you can pass the infection on to others around you. If you have viral tonsillitis you may be infectious from around the time you first feel unwell, to about five days after your illness starts. If you have bacterial tonsillitis and you have antibiotics, you won’t be infectious from 24 hours after you start your treatment. Without antibiotics, you may be able to pass on the bacteria for several weeks.

    Although experts say that you don’t need to keep your child off school if they have tonsillitis, you may wish to if they feel unwell. It’s best to avoid social occasions while you have a sore throat, and you may decide to stay away from work. It’s also important to avoid contact with anyone you know who is ill, or has a weakened immune system.

    There are some simple steps you can take to help stop spreading infection when you have tonsillitis.

    • Cover your nose and mouth when coughing or sneezing.
    • Wash and dry your hands often and carefully.
    • Throw tissues away in the bin after a single use.
    • Don’t share cups, crockery or cutlery.
  • FAQ: Duration of tonsillitis How long does tonsillitis last for?

    Nine out of 10 people with tonsillitis recover within a week. But you can get better more quickly than this. In four out of 10 people, the symptoms only last for three days. If your sore throat gets worse or doesn't start to improve after three to four days, contact your GP for advice.

  • FAQ: Tonsil removal My child often has tonsillitis, should her tonsils be removed?

    Your child’s doctor may recommend an operation to remove their tonsils if the tonsillitis is frequent and affects their breathing. This procedure is known as a tonsillectomy and, like all operations, it carries some risks. If your child only has mild sore throats, it may be better to wait and see if the problem clears up on its own. Usually, as a child gets older, tonsillitis becomes less common, so having a tonsillectomy may not be necessary.

    More information

    If your GP suggests surgery as a treatment option, they’ll usually refer your child to an ear, nose and throat (ENT) surgeon. This is a surgeon who specialises in surgery to treat conditions of these parts of the body.

    Your child's surgeon will discuss with you whether tonsillectomy is the best treatment for your child. There are guidelines to help your surgeon decide this – see our treatment section on surgery for more details.

    Most children who have a tonsillectomy benefit from the operation, but this benefit may only be small. You should note that surgery to remove your child’s tonsils doesn’t guarantee that they won’t get a sore throat in the future.

    Having a tonsillectomy is generally safe, but any type of surgery carries a risk. Discuss the risks and benefits of the operation with your child's surgeon before making a decision.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Tonsillitis. BMJ Best practice. bestpractice.bmj.com, last updated 17 February 2016  
    • Tonsillitis and peritonsillar abscess. Medscape. emedicine.medscape.com, published 9 July 2015 
    • Tonsillitis. PatientPlus. patient.info/patientplus, last checked 16 June 2014 
    • Peritonsillar abscess. PatientPlus. patient.info/patientplus, last checked 16 October 2014
    • Tonsillopharyngitis. The MSD Manuals. www.msdmanuals.com, last full review/revision November 2014 
    • Sore throat – acute. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised July 2015 
    • Management of sore throat and indications for tonsillectomy. Scottish Intercollegiate Guidelines Network (SIGN), 2010. www.sign.ac.uk 
    • Ear, nose, and throat. Oxford Handbook of General Practice (online). Oxford Medicine Online. www.oxfordmedicine.com, published April 2014  
    • Map of Medicine. Tonsillitis. International View. London: Map of Medicine; 2015 (Issue 1) 
    • Spinks A, Glasziou PP, Del Mar CB. Antibiotics for sore throat. Cochrane Database of Systematic Reviews 2013, Issue 11. doi:10.1002/14651858.CD000023.pub4 
    • Burton M, Glasziou PP, Chong LY, et al. Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis. Cochrane Database of Systematic Reviews 2014, Issue 11. doi:10.1002/14651858.CD001802.pub3 
    • Tonsils and adenoids. American Academy of Otolaryngology – Head and Neck Surgery. www.entnet.org, accessed 3 February 2016 
    • Tonsillitis. Parenting and Child Health. Women’s and Children’s Health Network. www.cyh.com, accessed 4 February 2016 
    • Streptococcal sore throat. SA Health. Government of South Australia. www.sahealth.sa.gov.au, accessed 4 February 2016 
    • Antibiotic guardian and antibiotic awareness key messages. Public Health England, September 2015. www.gov.uk 
    • Management of sore throat and indications for tonsillectomy – checklist for provision of information. Scottish Intercollegiate Guidelines Network (SIGN), 2010. www.sign.ac.uk
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  • Author information Author information

    Reviewed by Natalie Heaton, Specialist Health Editor, Bupa Health Content Team, May 2016.
    Peer reviewed by Mr Anil Banerjee, Ear, Nose and Throat Consultant.
    Next review due May 2019.

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