Tonsillitis

Published by Bupa's Health Information Team, April 2010.

This factsheet is for people who have tonsillitis, or who would like information about it.

Tonsillitis is inflammation of the tonsils, usually as a result of an infection by either a virus or bacteria.

About tonsillitis

The tonsils

Your tonsils are small lumps of tissue that lie at the back of your throat, one on each side. They help your body fight infection when you're young. After the age of three they are less involved with fighting infection and usually shrink.

What is tonsillitis?

Tonsillitis means inflammation of your tonsils. It affects people of all ages but it's more common in children.

Symptoms of tonsillitis

The most common symptom of tonsillitis is a sore throat. However, this doesn’t always mean you have tonsillitis.

Other symptoms of tonsillitis may also include:

• difficulty swallowing
• tiredness
• high temperature
• bad breath
• earache
• headache

You may also notice that:

• you have red and swollen tonsils
• the back of your throat is red
• there are white spots on your tonsils (this is pus from an infection)
• the glands in your neck are bigger than usual

If your tonsils are inflamed they can block your airways, making it difficult for you to breathe, especially when you're asleep. This can cause sleeping problems. Sometimes your inflamed tonsils can stop you from breathing for a short time - this is called sleep apnoea.

Complications of tonsillitis

Tonsillitis can sometimes lead to complications, including:

• middle ear infections
• an abscess on or around your tonsils - this is called a quinsy
• problems with breathing - if your tonsils are so big that that they restrict your airways, or you have a quinsy
• inflammation of your sinuses (sinusitis)
• a rash, which may develop if you have a group A beta haemolytic Streptococcus bacterial infection (scarlet fever)

Very rare complications may include:

• a lung infection, such as bronchitis or pneumonia
• inflammation of your kidneys (acute glomerulonephritis)
• a fever with painful, swollen or stiff joints (rheumatic fever)
• infection of your blood (septicaemia)

Causes of tonsillitis

Tonsillitis is most commonly caused by a virus, but it can also be caused by bacteria. These include the influenza (flu) virus, the Epstein-Barr virus (that causes glandular fever) and group A beta haemolytic Streptococcus bacteria.

The infection can be passed between people. If you're in close contact with an infected person, if you kiss them for example, or you're near them when they cough or sneeze, you can breathe in droplets of infected mucus or saliva and get the infection yourself. There is also a risk of you catching it if you share a toothbrush or eating utensils with an infected person.

Diagnosis of tonsillitis

Your doctor will ask about your symptoms and examine you. He or she may also ask you about your medical history. Your doctor will usually make a diagnosis based on your symptoms and examination alone.

It's rare, but some people may need to have a throat swab test. A throat swab is similar to a small round cotton bud and it's used to take a small sample of mucus from your tonsils. This will be sent to a laboratory for testing to determine what type of infection you have.

You may also be asked to have a blood test to see whether you have glandular fever.

Treatment of tonsillitis

It's likely your immune system will clear your tonsillitis within several days.

Self-help

If your infection is mild, you may not need treatment. There are several things you can do to help yourself feel better.

• Rest in a quiet, warm place and try to sleep.
• Ensure you drink enough fluids, as dehydration can make you feel worse.
• Gargle with salt water - this may ease the pain in your throat.

There are a number of over-the-counter medicines that may help to relieve the pain, including:

• paracetamol - particularly if you hold soluble paracetamol in your mouth
• non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
• gargling with soluble aspirin (aspirin isn't suitable for children under 16)

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

Medicines

If your tonsillitis is caused by a bacterial infection, your doctor may prescribe a course of antibiotics. Antibiotics can only be used to treat bacterial infections so your doctor won’t prescribe them if your tonsillitis is caused by a virus.

If your doctor does suggest that you take antibiotics, you will probably be prescribed a 10-day course, although some children may be given a shorter three-day course. It's important to complete the full course prescribed to you.

Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Antibiotics can only be used to treat bacterial infections so your doctor won't prescribe them if you have tonsillitis that is caused by a virus.

Surgery

It’s recommended that if you have had tonsillitis more than seven times in the last year, five times or more the year before and three or more times the year before that, your doctor may refer you to an ENT surgeon (a doctor who specialises in the surgical and medical treatment of conditions of the ear, nose and throat) to remove your tonsils. This operation is called a tonsillectomy.

You may also have your tonsils removed if you get an abscess on or around your tonsils (known as quinsy).

Before you choose this treatment it's important to discuss it with your surgeon to make sure that you understand the risks, benefits and possible alternatives to the procedure. For children, it may be recommended to wait and see if mild tonsillitis gets better on its own before considering surgery. As young children get older, tonsillitis becomes less common, so an operation isn't always necessary.

Although surgery can help some people with severe or recurring tonsillitis, having surgery to remove your tonsils won’t guarantee that you will not get throat infections in the future. Speak to your GP or surgeon about the risks and benefits of having your tonsils removed. For more information, see adenoid and tonsil removal.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.