Tonsillitis

What is tonsillitis?

Tonsillitis is an infection of the tonsils, the two small glands at the sides of the back of your throat. It causes them to become red, swollen and sore, and can feel like a bad cold or flu.

What are the symptoms of tonsillitis?

Symptoms often come on suddenly and can include:

• a sore throat
• pain or difficulty swallowing
• red, swollen tonsils, sometimes with white spots or a yellowish coating
• a high temperature (fever)
• swollen, tender glands in your neck
• a headache
• bad breath
• feeling tired, or feeling or being sick
• earache.

In younger children, a stomach ache or vomiting can be associated with tonsillitis.

What are the causes of tonsillitis and who is at risk?

Tonsillitis is usually caused by a virus, often the same ones that cause colds and flu. It can also be caused by bacteria, most commonly group A streptococcus, also known as strep throat.

Tonsillitis itself isn't contagious, but the viruses and bacteria that cause it are, and they spread through close contact, coughing and sneezing, or sharing food, drinks and utensils with someone who's unwell.

It's most common in children and teenagers, particularly between the ages of 5 and 15, and rarely affects children under 2. You're also more likely to catch it if you're frequently around lots of other people, such as at school or work.

Are there different types of tonsillitis?

Tonsillitis can be acute or chronic:

• Acute tonsillitis: This comes on quickly and is the most common form
• Chronic or recurring tonsillitis: This is when it keeps coming back, or symptoms don't fully clear up between episodes and the tonsils remain inflamed.

It's also sometimes described by its cause – most cases are viral tonsillitis, while others are bacterial tonsillitis, commonly known as strep throat.

How is tonsillitis diagnosed?

A doctor can usually diagnose tonsillitis by asking about your symptoms and examining your throat, ears, neck and skin to check for other signs of infection and rule out other causes.

They may use a scoring system based on things like your age, whether you have a fever, swollen neck glands, and whether pus is visible on your tonsils, to judge how likely a bacterial infection is.

If it's not clear whether bacteria are involved, they may take a swab from the back of your throat to test for streptococcus, and a blood test for glandular fever if your symptoms are severe or don't clear up.

How is tonsillitis treated?

Most cases of tonsillitis get better on their own within about a week, whether or not antibiotics are used.

Non-surgical treatment for tonsillitis

Self-care measures can ease your symptoms while the infection clears:

• Get plenty of rest and drink lots of fluids to avoid dehydration
• Take paracetamol or ibuprofen for pain and fever (do not give aspirin to children under 16)
• Gargle with warm salt water and spit it out afterwards (young children should not do this)
• Eat soft, cool foods, such as ice cream or jelly, and suck on throat lozenges.

There's no antiviral treatment for viral tonsillitis, so it simply needs time to clear. If your tonsillitis is caused by bacteria, a course of antibiotics, usually penicillin or a similar medicine, will typically be prescribed for 5 to 10 days.

It's important to finish the full course even if you feel better sooner, as stopping early can let the infection come back or spread.

Surgical treatment for tonsillitis

Surgery to remove the tonsils, known as a tonsillectomy, is rarely needed. It may be considered if you keep getting recurrent tonsillitis, often defined as 7 or more episodes in a year.

The operation is carried out under general anaesthetic, and you may go home the same day or stay in hospital overnight. In adults with frequent tonsillitis, research has found that having a tonsillectomy leads to fewer days with a sore throat than continuing with antibiotics and painkillers alone, though in children the benefit tends to be more modest.

When should I see a doctor?

See a GP if:

• your symptoms haven't improved within a week
• you keep getting tonsillitis or throat infections
• you have a high fever, or pain that keeps getting worse despite pain relief
• the pain is worse on one side of your throat.

Get urgent advice, for example by calling NHS 111, if you have pus-filled spots on your tonsils, or a sore throat so painful that it's difficult to eat or drink.

Call 999 or go to A&E if you have a severe sore throat that's quickly getting worse, swelling inside your mouth or throat, difficulty speaking, difficulty swallowing, difficulty breathing, or difficulty opening your mouth. These can be signs of quinsy, a collection of pus that can develop between your tonsils and the wall of your throat.