Tonsillitis
Expert Reviewer, Mr Anil Banerjee, Ear, Nose and Throat Consultant
Content editor review by Liz Woolf, January 2021
Next review due January 2024
The tonsils are lymph glands at the back of your throat, one on each side. These are part of your immune system and help to protect against infection. If these are inflamed, you have tonsillitis. It’s usually caused by a viral infection. You may have a sore throat, swollen tonsils and pain when you swallow.
About tonsillitis
Your tonsils are two small round lumps of tissue at the back of your throat. They’re part of your immune system, helping your body to fight infections. Your tonsils tend to get smaller as you get older.
If you have tonsillitis, your tonsils are likely to be red, swollen and sore. Tonsillitis can affect people of all ages, but it’s more common in children and young adults. You can get it at any time of the year. But you’re most likely to have tonsillitis caused by a virus in the summer or autumn. Tonsillitis caused by a bacterial infection is more common in the winter or early spring.
Tonsillitis usually improves on its own after around a week. It’s most often caused by a virus, so antibiotics won’t help. Even if it’s a bacterial infection, it will often settle without antibiotics. You can ease your symptoms with self-help measures and over-the-counter medicines.
Symptoms of tonsillitis
If you have tonsillitis, you’ll probably have a sore throat. But having a sore throat doesn’t always mean you have tonsillitis.
Other symptoms of tonsillitis may include:
- pain when swallowing
- finding it hard to swallow
- ear pain
- a raised temperature (over 38°C)
- bad breath
- a headache
- feeling generally unwell
- feeling sick or vomiting – especially in children
- tummy pain – especially in children
You may also notice you have swollen tonsils and swollen glands in your neck. Your tonsils may be covered with a white coating or white flecks of pus.
Your symptoms may last for a week. If they’re getting worse or are very bad, contact your GP surgery for advice. There’s more about when to see your GP in the FAQ section on this page.
Diagnosis of tonsillitis
You can often ease tonsillitis at home without needing to see your GP. Most people find things improve within a week without antibiotics. If your symptoms aren’t getting any better, your GP may want to check your throat for another cause.
Your GP will usually diagnose tonsillitis from your symptoms and how your throat and tonsils look. They won’t usually need to do any other tests. They’ll ask about your symptoms and examine you. Then they’ll look inside your mouth, maybe with a bright light.
They may also use a tongue depressor (a flat wooden stick) to push your tongue down gently and get a better view of your tonsils. They may feel around your neck to see if you have swollen glands.
The symptoms of tonsillitis are similar to those of glandular fever. Glandular fever is most likely to affect teenagers and young adults. It can cause a very bad sore throat, slightly raised temperature and swollen glands in your neck. Glandular fever is also more likely to cause a white coating on your tonsils and tiredness may last longer. If your GP thinks you may have glandular fever, they may ask you to have a blood test.
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Self-help for tonsillitis
Tonsillitis usually improves on its own within a week without any antibiotics. You can use self-help measures and over-the-counter medicines to ease your symptoms.
- Rest and take it easy for a few days.
- Drink plenty of fluids to stop you getting dehydrated. This is particularly important if you have a temperature.
- Hot drinks can make your sore throat worse, but some people find warm tea with honey helps. Cold or iced drinks may also help.
- Gargling with a simple mouthwash (such as warm salt water) may help to ease the pain in your throat.
- You may find that sucking throat lozenges can ease your sore throat.
- Frozen desserts such as ice lollies may make your throat feel better.
Over-the-counter medicines can help if your throat is very sore or you have a temperature. These include paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist for advice.
If your symptoms are not improving after a week, or are getting worse, speak to your GP. If you’re unsure whether to see a GP about your symptoms, see our FAQ on this page.
Treatment of tonsillitis
If you see your GP for tonsillitis, they probably won’t offer you antibiotics because they are unlikely to make much difference to your symptoms. Antibiotics don’t work against viral infections, which cause most cases of tonsillitis. Most people with tonsillitis find their symptoms improve after around a week, whether they take antibiotics or not.
Your GP may recommend antibiotics if they think they’ll help. They may prescribe antibiotics if you:
- have very bad symptoms, which could suggest a more severe bacterial infection
- could be prone to serious complications (see our Complications section for more information)
Your GP may give you a delayed prescription for an antibiotic. This means they’ll give you a prescription, but you don’t collect the medicine from the pharmacy straightaway. You only collect and take the antibiotic if your symptoms are not improving after three to five days, or if they’re getting worse.
If you do need an antibiotic, your GP is most likely to prescribe a five- to 10-day course of penicillin. It’s important to tell your GP if you’re allergic to this. If you are, the GP will give you another antibiotic instead.
If your GP prescribes antibiotics, it’s important to take them properly. You should complete the full course, even if you start to feel better. This helps to 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. If you have any questions about your medicine, speak to a pharmacist.
Surgery for tonsillitis
Your GP may refer you to an ear, nose and throat (ENT) surgeon if they feel having your tonsils removed will help. This operation is called a tonsillectomy. This will prevent you from getting tonsillitis in the future.
Your doctor will usually suggest a tonsillectomy only if you have had tonsillitis:
- regularly and/or it affects your 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 an abscess on your tonsil (a peritonsillar abscess or quinsy). This can be a complication of tonsillitis.
For children, your GP may recommend waiting to see if the tonsillitis gets better on its own before considering surgery. As children get older, they become less likely to have tonsillitis. A tonsillectomy is a very common operation and is usually very successful. But, like all operations, it can cause complications. Having a tonsillectomy doesn’t mean you won’t get a sore throat in the future.
Although your tonsils are part of your immune system, having them removed doesn’t cause any problems fighting infections. This is because the tonsils are just the visible part of a wider ring of tissue at the back of your throat. When they’re removed, enough of this tissue is left behind to keep fighting infections.
Causes of tonsillitis
Viral infections cause most cases of tonsillitis. Viral tonsillitis is usually due to a common cold virus, but it may also be caused by other viruses, including the flu virus.
Around one in every three cases of tonsillitis is caused by bacteria. Most bacterial tonsillitis is caused by streptococcus bacteria – specifically group A beta-haemolytic Streptococcus bacteria. Streptococcal tonsillitis is sometimes called ‘strep throat’.
Streptococcal tonsillitis is most common in children aged five to 15. Viral tonsillitis is more common in younger children.
Complications of tonsillitis
Tonsillitis usually improves within a week and doesn’t cause any long-term problems. You’re more likely to have a severe infection or complications if you have a weak immune system. Complications are also more common in young children and older people.
Some people who get tonsillitis keep getting it again and again. This is called recurrent tonsillitis. It may mean you take a lot of time off work or children take a lot of time off school. Recurrent tonsillitis may be a reason to consider having your tonsils removed.
Bacterial tonsillitis can sometimes lead to a build-up of pus on or around your tonsils. This is called a peritonsillar abscess or quinsy. If you have a peritonsillar abscess, you may have very bad pain in your throat, often worse on one side. You may also have:
- earache
- a raised temperature
- difficulty swallowing
- difficulty opening your mouth
Peritonsillar abscess is more common in teenagers and young adults. But children can get it too. The abscess is usually treated with antibiotics and surgery to drain the pus. Your doctor may suggest removing your tonsils if you’ve had a peritonsillar abscess.
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You should be able to treat a sore throat at home without needing to see a GP. Most people with tonsillitis find their symptoms improve within a week.
If your sore throat isn’t getting any better after a week, contact your GP surgery. You should also contact your GP if you have:
- difficulty breathing
- difficulty swallowing saliva
- difficulty opening your mouth
- a high temperature that won’t go away
- very bad pain, especially if it’s worse on one side of your throat
- a sore throat that keeps getting worse
- one-sided neck or throat swelling
If your child keeps getting tonsillitis your GP may suggest an operation to remove their tonsils. Or the GP may recommend surgery if the tonsils are affecting your child’s breathing. This operation is called a tonsillectomy. Your GP will usually refer your child to an ear, nose and throat (ENT) surgeon.
Surgery to remove your child’s tonsils will stop them getting tonsillitis. But it doesn’t mean they won’t get a sore throat in the future. Tonsillectomy does help most children, but the benefit may only be small.
Like all operations, having a tonsillectomy carries some risks. If your child has only mild sore throats, it may be better to wait and see if the problem clears up on its own. Usually, tonsillitis becomes less common as children get older. So having a tonsillectomy may not be necessary.
Every child is different, though. Your child's surgeon will talk through the pros and cons of a tonsillectomy. Then you can both decide whether it’s the best treatment for your child.
Tonsillitis itself isn’t contagious but you can catch the infections that cause it. Tonsillitis is often caused by cold and flu viruses. You may also get tonsillitis if streptococcal bacteria affect your throat.
You catch these infections in the same way you catch a cold. Tiny droplets that pass into the air when you talk, cough or sneeze. You can also catch infections if you touch a surface that’s contaminated with the virus or bacteria.
Tonsillitis usually improves on its own within a week without any antibiotics. You can use over-the-counter medicines to ease your symptoms. Rest and take it easy for a few days and drink plenty of fluids to keep you hydrated. This is particularly important if you have a temperature.
Viral infections cause most cases of tonsillitis. Viral tonsillitis is usually due to a common cold virus, but it may also be caused by other viruses, including the flu virus.
Around one in three cases of tonsillitis is caused by bacteria. Most bacterial tonsillitis is caused by streptococcus bacteria. Streptococcal tonsillitis is most common in children aged five to 15. Viral tonsillitis is more common in younger children.
Adenoid and tonsil removal
Adenoid and tonsil removal is a procedure that involves taking away small lumps of tissue at the back of your nose and throat.
Antibiotics
Over-the-counter painkillers
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- Personal communication from Mr Anil Banerjee, Consultant Ear, Nose and Throat Surgeon
