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What Is Tonsillitis? Causes, Symptoms, Diagnosis, and Treatment - GoodRx
What Is Tonsillitis?
Written by Alicia Stevens, MD | Reviewed by Karla Robinson, MD
Published on May 26, 2022
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Key takeaways:
Most tonsillitis infections are due to viruses that cause common upper respiratory infections. The bacteria that causes strep throat is also an important cause of tonsillitis.
A physical exam can easily diagnose tonsillitis. Your healthcare provider may use throat swabs to figure out the cause.
Tonsillitis usually gets better on its own. Treatment focuses on symptom relief. For bacterial tonsillitis, antibiotics help to clear the infection. If you have frequent episodes of tonsillitis, you may consider surgery.
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Tonsillitis is a condition where your tonsils become inflamed. Tonsils are soft tissue masses that sit at the back of the throat at each side. Tonsils help your body fight off respiratory germs. But sometimes they can become infected, which can lead to tonsillitis. Tonsillitis is common and makes up about 5% of medical visits in the U.S. It occurs most often in the winter and spring.
What causes tonsillitis?
The cause of tonsillitis is usually a virus. In children, bacterial causes are more common. But viruses remain the most frequent reason for tonsillitis for all age groups. Some viruses that can cause tonsillitis include:
Adenovirus
Epstein-Barr virus (can also cause mononucleosis)
Influenza virus (flu)
Parainfluenza virus (can also cause croup or laryngitis)
Rhinovirus (can also cause the common cold)
The most common bacteria that leads to tonsillitis is Streptococcus (strep throat). Strep throat causes tonsillitis in up to 15% of cases among adults. But for children between the ages of 5 and 15 years old, it causes tonsillitis up to 30% of the time. Strep throat is less likely to be the cause in children younger than 5 years old.
Some sexually transmitted infections (STIs) can also cause tonsillitis. These include:
Do tonsil stones cause tonsillitis?
Tonsil stones don’t typically cause tonsillitis, but they can form as a result of tonsillitis. In fact, tonsil stones are more likely to occur if you have frequent episodes of tonsillitis. As your tonsils fight infection, debris can build up. Usually saliva washes away this debris that forms due to damaged tissue or cells. But any debris left behind can harden and become a stone.
Tonsil stones usually don’t need treatment and can wash away on their own. Gargling with mouthwash or warm salt water can also help. If you have a stubborn stone, using a cotton swab to push behind it may also help remove it. In rare cases, an ENT (ear, nose, and throat) specialist may have to assist you in removing the stone.
Symptoms of tonsillitis
When tonsils are healthy, they are pink in color like the rest of the throat. Normal tonsils will vary in size from person to person, and they won’t cause a problem with swallowing. With tonsillitis, you may have large, red tonsils. And it can be difficult or painful to swallow.
Some other common symptoms of tonsillitis may include:
Fever
White patches or pus on tonsils
Snoring or mouth breathing
Tender lymph nodes in the neck
Runny nose, cough, or congestion
Headache
Stomach ache
How do you diagnose tonsillitis?
If you think you have tonsillitis, your medical provider can do a physical exam to make the diagnosis. To find the cause, they may swab your throat to check for strep throat infection or other bacteria. They can do a rapid strep test in the office, but results from a throat culture can take several days.
Is tonsillitis contagious?
Respiratory droplets easily spread the germs that most often cause tonsillitis. Someone can release these droplets when they:
Sneeze
Kiss
Cough
Talk
Sing
Exercise
Breathe
Viral tonsillitis is less contagious once you haven’t had a fever for 24 hours. For strep, you’re not likely to spread the infection after starting antibiotics. To stop being contagious, you will have to take antibiotics for at least 12 hours and no longer have a fever.
Other ways you can reduce the risk of spread are to:
Avoid close contact with others when sick
Avoid sharing food and drinks
Wash your hands frequently
Cover your cough to prevent contaminating others
How do you treat tonsillitis?
When the cause is a virus, tonsillitis often gets better on its own. Most treatments aim to help with fever or pain. These can often be in the form of medication or home remedies.
Medications
Relief of symptoms can help with both viral and bacterial tonsillitis. To manage pain and fever, you can try over-the-counter medications like ibuprofen (Advil, Motrin) or acetaminophen (Tylenol).
If you have strep throat, you’ll likely need treatment with antibiotics. The symptoms can improve without treatment, but antibiotics are helpful to prevent complications. These can include:
Tonsillar abscess
Rheumatic fever (leads to heart disease)
Scarlet fever
Strep-related arthritis
Glomerulonephritis (kidney inflammation)
Autoimmune neurological disorders
Experts recommend penicillin or amoxicillin to treat strep throat. If you have a penicillin allergy, there are other antibiotics you can try. Common antibiotic medications are:
Cephalosporins (like cefdinir or cefixime)
Home remedies
Many home remedies may relieve tonsillitis symptoms. Here are some common home remedies:
Honey may help to decrease inflammation and speed up recovery. Of note, honey is not safe for children under 12 months.
Warm salt water gargles may help decrease pain.
Hot drinks may help reduce the symptoms of sore throat.
Herbal teas may help decrease inflammation. Herbal infusions of licorice, barberry, thyme, or oregano may be effective.
When should I see my provider about tonsillitis?
You may need a medical evaluation for tonsillitis if you have severe symptoms. This can include severe pain, trouble swallowing, or a muffled sound to your voice.
Other signs that you should get medical care are:
Trouble opening your mouth
Drooling
Uvula (floppy tissue hanging down in the center of your throat) is pushed to one side
Sore throat lasting more than 72 hours with worsening pain or no improvement
Shortness of breath
Neck pain on one side
Red or brown urine
Swelling in the eyes or legs
Should I get my tonsils removed?
If you have recurrent tonsillitis, your healthcare provider may recommend a tonsillectomy. This is the case when you’ve had more than six episodes in a year of:
Sore throat
Fever
Swollen lymph nodes
Positive strep tests
If you have 5 or more sore throats per year for 2 years, you may also need to consider tonsillectomy. This will prevent future tonsillitis infections — but not all causes of sore throat.
The bottom line
Tonsillitis is a common condition. It’s most often due to viral infections. And in many cases, tonsillitis will get better on its own. If it’s due to strep throat, antibiotics are important to prevent issues. Treatment often includes over-the-counter fever and pain relievers. But some home remedies may provide some relief, too. If you’re having severe symptoms along with your sore throat, it’s always a good idea to get medical care.
References
American Academy of Otolaryngology-Head and Neck Surgery. (2021). Clinical indicators: Tonsillectomy, adenoidectomy, adenotonsillectomy in childhood.
Ashurst, J. V., et al. (2022). Streptococcal pharyngitis. StatPearls.
Atkinson, J., et al. (2009). Annex C respiratory droplets. Natural Ventilation for Infection Control in Health-Care Settings.
Bakar, M. A., et al. (2018). Chronic tonsillitis and biofilms: A brief overview of treatment modalities. Journal of Inflammation Research.
Centers for Disease Control and Prevention. (2018). Pharyngitis (strep throat).
Haidara, A. W., et al. (2019). Tonsillitis and their complaints: Epidemiology, clinical and therapeutic profiles. International Journal of Otolaryngology and Head & Neck Surgery.
Kalra, M. G., et al. (2016). Common questions about streptococcal pharyngitis. American Family Physician.
Mistik, S., et al. (2015). Sore throat in primary care project: A clinical score to diagnose viral sore throat. Family Practice.
Nanda, M. S., et al. (2016). Role of honey as adjuvant therapy in patients with sore throat. National Journal of Physiology, Pharmacy and Pharmacology.
Ramalingam, S., et al. (2019). A pilot, open labelled, randomised controlled trial of hypertonic saline nasal irrigation and gargling for the common cold. Scientific Reports.
Sanu, A., et al. (2008). The effects of a hot drink on nasal airflow and symptoms of common cold and flu. Rhinology.
Wijesundara, N. M., et al. (2019). Herbal tea for the management of pharyngitis: Inhibition of Streptococcus pyogenes growth and biofilm formation by herbal infusions. Biomedicines.
What Is Tonsillitis? Causes, Symptoms, Diagnosis, and Treatment - GoodRx