Navigation

Tonsillitis


Expert Reviewer Mr Anil Banerjee, Ear, Nose and Throat Consultant
Next review due October 2021

Tonsillitis is inflammation of your tonsils, which are at the back of your throat. It’s usually caused by a viral infection. You may have a sore throat, swollen tonsils and pain when you swallow.

An image showing the soft tissues of the mouth and throat

About tonsillitis

If you have tonsillitis, your tonsils are likely to be red, swollen and sore. 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’s infections. Your tonsils tend to get smaller as you get older.

Tonsillitis can affect people of all ages, but it’s more common in children and young adults. You can get tonsillitis at any time of the year. But you’re most likely to have viral tonsillitis in the summer or autumn, and bacterial tonsillitis in the winter or early spring.

Tonsillitis usually improves on its own after around a week. It’s most often caused by a viral infection, so antibiotics are unlikely to help. Even in bacterial cases, it will often settle without the need for antibiotics, apart from in certain situations. 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. See our FAQ on Should I see my GP about a sore throat?

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, even if they have a bacterial infection. If your symptoms aren’t getting any better, your GP may want to check your throat for another cause.

Your GP will ask about your symptoms and examine you. 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 to 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 diagnose tonsillitis from your symptoms and how your throat and tonsils look. They won’t usually need to do any other tests.

The symptoms of tonsillitis may be similar to those of glandular fever. Glandular fever is most likely to affect teenagers and young adults. Glandular fever can cause a very bad sore throat, extreme tiredness, slightly raised temperature and swollen glands in your neck. If your GP thinks you may have glandular fever, they may recommend you have a blood test.

Treatment of 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. But if your symptoms are not improving after a week, or are getting worse, you should speak to your GP.

Self-help for tonsillitis

If your tonsillitis is mild, there are several things you can do to ease your symptoms.

  • Rest and take it easy for a few days.
  • Drink plenty of fluids, especially if you have a raised temperature, to prevention dehydration.
  • Don’t drink hot drinks as these can make your sore throat worse. It may help to drink ice drinks instead.
  • 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 can ease your sore throat.
  • Having frozen desserts such as ice lollies may make your throat feel better.

If your throat is very sore or you have a raised temperature, you may find over-the-counter medicines can help. 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 you’re unsure whether to see a GP about your symptoms, see our FAQ on Should I see my GP about a sore throat?

Medicines for tonsillitis

If you see your GP for tonsillitis, they probably won’t offer you antibiotics. This is because antibiotics don’t work against viral infections, which cause most cases of tonsillitis. Antibiotics are unlikely to make much difference to your symptoms. Most people with tonsillitis find their symptoms improve after around a week, whether or not they take antibiotics.

However, your GP may recommend antibiotics if they think you’ll benefit from taking them. 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 Complications of tonsillitis for more information.

Your GP may offer 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 will probably offer you a five- to 10-day course. You’ll usually be prescribed penicillin, so it’s important to tell your GP if you’re allergic to this medicine. If you are, you can take other antibiotics instead.

If your GP prescribes antibiotics, it’s important to use them properly. You should complete the full course of antibiotics, 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 you may benefit from having your tonsils removed. The operation to remove your tonsils is called a tonsillectomy. This won’t treat tonsillitis while you have an infection, but it 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 a peritonsillar abscess (quinsy). See our section on Complications of Tonsillitis.

For children, your GP may recommend that you wait to see if the tonsillitis gets better on its own before considering surgery. As young 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 also 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 for your immune response. This is because the tonsils are just the visible part of a wider ring of tissue at the back of your throat. When they are removed, enough of this tissue is left behind to keep fighting infections.

For more information on tonsillectomy, see Adenoid and tonsil removal.

Causes of tonsillitis

Most cases of tonsillitis are caused by a viral infection. Viral tonsillitis is usually due to a virus that also causes a cold, but it may also be due to other viruses, including the flu virus.

Around one in every three cases of tonsillitis is caused by bacteria. Most bacterial tonsillitis is caused by 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 (see Surgery for tonsillitis).

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, which may be accompanied by earache. You’ll probably also 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 get it too. The abscess is usually treated with antibiotics and surgery to drain the pus. Your doctor may recommend having your tonsils removed if you’ve had a peritonsillar abscess.

Frequently asked questions

  • 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. See Self-help for tonsillitis.

    If your sore throat isn’t getting any better after a week, you should contact your GP surgery for advice. 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 or it affects their breathing, their GP may recommend an operation to remove their tonsils. 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. Most children who have a tonsillectomy benefit from the operation, but this 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, as a child gets older, tonsillitis becomes less common, so having a tonsillectomy may not be necessary.

    Every child is different though. So, your child's surgeon will discuss with you the pros and cons of a tonsillectomy and whether it’s the best treatment for your child.

  • Most people with tonsillitis find it improves after around a week. But you may find your symptoms clear up more quickly than this. If your sore throat gets worse or doesn't start to improve after three to five days, contact your GP for advice.

  • Tonsillitis itself isn’t contagious but you can catch the infections that cause it. Tonsillitis is often caused by the 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 – through 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. Most people don’t develop tonsillitis if they have a sore throat. But if you have a sore throat or a cold, try to limit close contact with other people for the first few days. Simple steps, such as regular hand washing and avoiding kissing or hugging, will stop you passing on the infection. In particular, try to stay away from anyone who could develop complications if they have tonsillitis. This includes anyone who has a weak immune system, as well as very young children and older people.

    You don’t necessarily need to stay off work or school if you have tonsillitis, but it depends on how you (or your child) are feeling.

    You can take some simple steps to help stop spreading the 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.
    • Avoid sharing towels or flannels.
    • Avoid hugging and kissing other people.


About our health information

At Bupa we produce a wealth of free health information for you and your family. We believe that trustworthy information is essential in helping you make better decisions about your health and care. That’s why our content is produced to the highest quality standards. Look out for the quality marks on our pages below. You can find out more about these organisations and their standards on The Information Standard and HON Code websites.

Information standard logo  This website is certified by Health On the Net Foundation. Click to verify.

Learn more about our editorial team and principles >

Related information

    • Sore throat – acute. Clinical Knowledge Summaries. cks.nice.org.uk, last revised January 2018
    • Tonsillitis and peritonsillar abscess. Medscape. emedicine.medscape.com, updated March 2018
    • Tonsillitis. PatientPlus. www.patient.info, last checked June 2014
    • Tonsillitis. BMJ Best Practice. bestpractice.bmj.com, last reviewed July 2018
    • Tonsil and adenoid anatomy. Medscape. emedicine.medscape.com, updated July 2015
    • Tonsillopharyngitis. The MSD Manuals. www.msdmanuals.com, last full review/revision April 2018
    • Sore throat (acute): antimicrobial prescribing. NICE Guideline 84. www.nice.org.uk, published January 2018
    • Conditions of the eyes, ears, nose and throat. Oxford Handbook of Adult Nursing (online). Oxford Medicine Online. oxfordmedicine.com, published online June 2018
    • Ear, nose and throat examination. PatientPlus. www.patient.info, last checked October 2014
    • Infectious mononucleosis. PatientPlus. www.patient.info, last checked July 2016
    • Sore throat. PatientPlus. www.patient.info, last checked October 2016
    • Antimicrobial stewardship: changing risk-related behaviours in the general population. NICE Guideline NG63. www.nice.org.uk, published January 2017
    • Sore throat (acute): antimicrobial prescribing – Information for the public. NICE Guidance NG84. www.nice.org.uk, published January 2018
    • Peritonsillar abscess. PatientPlus. www.patient.info, last checked October 2014
    • Commissioning guide: Tonsillectomy. 2016. ENT UK and Royal College of Surgeons. Downloaded from www.rcseng.ac.uk, accessed September 2018
    • About children’s tonsil surgery. ENT UK. www.entuk.org, last updated November 2015
    • Common cold (coryza). PatientPlus. www.patient.info, last checked November 2016
    • Personal communication, Mr Anil Banerjee, Ear, Nose and Throat Consultant, 8 October 2018
  • Reviewed by Graham Pembrey, Lead Editor, Bupa Health Content Team
    Expert reviewer Mr Anil Banerjee, Ear, Nose and Throat Consultant
    Next review due October 2021



Has our health information helped you?

We’d love to know what you think about what you’ve just been reading and looking at – we’ll use it to improve our information. If you’d like to give us some feedback, our short survey on the right will take just a few minutes to complete. And if there's a question you want to ask that hasn't been answered here, please submit it to us. Although we can't respond to specific questions directly, we’ll aim to include the answer to it when we next review this topic.



ajax-loader