Tonsillitis

Tonsillitis is an infection of the tonsils. The tonsils are two small glands found at the back of the throat behind the tongue. The function of these glands is not entirely clear, but research suggests that they help to fight infections.

The main symptom of tonsillitis is a sore throat. There may be other associated symptoms such as coughing, headaches and a fever (see Symptoms for more information).

Tonsillitis can be caused by either a virus or bacteria, although most cases are viral. The incubation period (the time between picking up the infection and symptoms starting to appear) is usually two to four days.

Tonsillitis can spread from person to person through hand contact (then touching your mouth with contaminated hands), breathing in the airborne droplets after someone with tonsillitis has sneezed or sharing the utensils or toothbrush of an infected person.

Who is affected?

Children and adolescents aged 5-15 years old are most likely to get tonsillitis, but it can affect anyone.

Outlook

Tonsillitis often clears up on its own without the need for treatment, however, sometimes, if tonsillitis is caused by bacteria, antibiotics may be prescribed. In severe or recurring cases the tonsils may be removed in a common procedure called a tonsillectomy (see Treatment for more information).


The main symptom of tonsillitis is a sore throat. Other common symptoms include:

  • red and swollen tonsils,
  • pain when swallowing,
  • high temperature (fever) over 38°C (100.4°F),
  • coughing,
  • headache,
  • tiredness,
  • pain in your ears or neck,
  • white pus-filled spots on your tonsils, and
  • swollen lymph nodes (glands) in your neck.

Less common symptoms of tonsillitis may include:

  • vomiting,
  • constipation,
  • a 'furry' tongue,
  • bad breath, and
  • difficulty opening your mouth.

Younger children may also complain of a stomach ache, which can be caused by the swelling of the lymph nodes in the abdomen.

Related symptoms

There may also be related symptoms that depend on whether the infection is caused by a virus or by bacteria. For example:

  • if your tonsillitis is caused by a virus, such as the flu virus, you may have other flu symptoms such as a runny nose and aches in your body, or
  • if your tonsillitis is caused by bacteria, you may have a skin rash or a flushed face.

Glossary

Lymph nodes
Lymph nodes are small oval tissues that remove unwanted bacteria and particles from the body. They are part of the immune system.
Constipation
Constipation is when you pass stools less often than usual, or when you are having difficulty going to the toilet because your stools are hard and small.
Fever
A high temperature, also known as a fever, is when someone's body temperature is 38°C (100.4°F) or above.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.

Tonsillitis is most commonly caused by a virus, but it can also be caused by bacteria.

Viral tonsillitis

The viruses that cause tonsillitis are often the ones that frequently affect the respiratory (breathing) system. They include the flu virus, parainfluenza virus (which causes laryngitis and croup), adenovirus, enterovirus and rhinovirus.

In rare cases, tonsillitis can be caused by the Epstein-Barr virus, which is the virus that causes glandular fever. If this is the case, you will probably feel very ill. You may have swollen lymph nodes (glands) throughout your body and an enlarged spleen.

Bacterial tonsillitis

Bacterial tonsillitis may be caused by a number of different bacteria, but is usually caused by group A streptococcus bacteria. In the past, serious bacterial infections, such as diphtheria, have caused tonsillitis, but this is now very rare due to vaccination and improved treatment of these diseases.

See your GP if you think that you have tonsillitis. Your GP will examine your throat and ask you questions about your symptoms.

Based on your symptoms, the appearance of your throat and tonsils and the presence of swollen glands in your neck, your GP will be able to diagnose tonsillitis and determine whether it is viral or bacterial.

Throat swab

Sometimes, your GP will use a throat swab (which looks like a long cotton bud) to take a small sample of mucus from your tonsils. This will be sent to a laboratory for analysis and the results can take a few days to return.

Samples are mainly used for patients in high-risk groups (such as those with weakened immune systems) or if previous treatment has failed. A throat swab may also be used to determine if tonsillitis is caused by streptococcal bacteria, but it can often be difficult to tell whether the person is a carrier of the infection or is infected.

Blood test

In some cases, your GP will also do a blood test to check your blood count or to test for glandular fever.

Glossary

Aching
An ache is a constant dull pain in a part of the body.

Whether your tonsillitis is caused by a virus or bacteria, it is likely that your immune system will clear the infection within a few days. In the meantime, there are a number of things that you can do to help yourself or your child.

Make sure you have plenty to eat and drink, even if you find it painful to swallow. Being hungry and dehydrated can make other symptoms, such as headaches and tiredness, worse.

Treatments, such as painkillers and antibiotics (in cases of bacterial tonsillitis), may help to ease your symptoms. If your symptoms are particularly severe and you have recurring bouts of tonsillitis, surgery may be an option.

Painkillers, lozenges and throat sprays

You can take paracetamol or ibuprofen to ease symptoms such as pain, headaches and fever. When taking medication, always follow the instructions on the packet to ensure that you are taking the correct dose at the right time intervals.

Do not take ibuprofen if you have a history of stomach ulcers, indigestion, asthma or kidney disease. If you are pregnant, do not take ibuprofen and only take paracetamol as instructed by your GP or midwife. Children under 16 years of age should not take aspirin.

There are also over-the-counter treatments that can soothe a sore throat, such as lozenges and oral sprays. Some people find that gargling with a mild antiseptic solution can help relieve a sore throat, although research regarding its effectiveness is limited.

Antibiotics

As most cases of tonsillitis are caused by a virus, they do not respond to antibiotics.

Antibiotics can be used to treat bacterial tonsillitis. They may be prescribed if your tonsillitis gets worse over time or if you have had a high temperature for a long time.

Studies have shown that antibiotics can reduce illness time by about a day. They can also reduce the risk of complications, such as rheumatic fever, although complications are rare anyway.

Antibiotics sometimes cause mild side effects, such as an upset stomach, diarrhoea or a rash.

Surgery

If you have recurring bouts of tonsillitis (five or more episodes in a year) or it is severe enough to interfere with your everyday life, your GP may suggest removing your tonsils. This is done in an operation known as a tonsillectomy.

Tonsillectomy is one of the most common major operations carried out on children.

How it is performed

A tonsillectomy is done under a general anaesthetic, which means that you will be asleep during the procedure. Your mouth will be held open so that your surgeon can see your tonsils, and no cuts will be made in your skin. Your surgeon will use special scissors to remove your tonsils before closing the wound with dissolvable stitches.

The operation can be carried out in a number of ways:

  • Cold steel surgery. This is the most common method, which uses a surgical blade to cut the tonsils out. Bleeding is controlled by applying pressure or, occasionally, the blood vessels are sealed using heat generated by diathermy (see below).
  • Diathermy. An instrument called a diatherma (a probe that creates heat from an electrical current) is used to destroy tissue surrounding the tonsils and to remove the tonsils. At the same time, the heat seals the blood vessels to stop any bleeding.
  • Coblation (or cold ablation). This method works in a similar way to diathermy but uses a lower temperature (60°C). It is considered less painful than diathermy.

Risks

Many thousands of tonsillectomies are performed every year without any problems.

Occasionally, you may have some bleeding around the operation site, usually in the first few days after a tonsillectomy. This is usually minor, but see your doctor if the bleeding is significant. Serious bleeding after a tonsillectomy is uncommon.

Although surgery can help people with severe or recurring tonsillitis, having your tonsils removed will not guarantee that throat infections will be prevented in the future. You can discuss the risks and benefits of surgery with your GP or surgeon.

Recovery

After the tonsils have been removed, the throat appears white. The new lining of the throat forms under the white coating. As the throat heals, the white coating gradually disappears. This takes about two weeks.

On average, cold steel surgery has the shortest recovery time (between five and seven days). You will feel uncomfortable for up to two weeks following the operation.

Children who have had a tonsillectomy should be kept off school for two weeks. This is to reduce the chance of them picking up an infection from another child that will make them feel more uncomfortable.

You will probably find swallowing difficult after a tonsillectomy, but it is important to eat solid foods as this will help the throat heal more quickly. Drink plenty of fluids but avoid acidic drinks, such as orange juice, as they will sting. 

It is important to clean your teeth regularly as this helps fight infection in the mouth.

The pain usually gets worse during the first week after the operation and gradually improves during the second week. Earache is common with tonsillectomies and no cause for concern.

Glossary

Antibiotic
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. Examples of antibiotics include amoxicillin, streptomycin and erythromycin.
Indigestion
Heartburn, also known as indigestion, is a painful, burning discomfort felt in the chest, usually after eating.
Ulcer
An ulcer is a sore break in the skin or on the inside lining of the body.
Dose
Dose is a measured quantity of a medicine to be taken at any one time, such as a specified amount of medication.
Anaesthetic
Anaesthetic is a drug used to either numb a part of the body (local) or to put a patient to sleep (general) during surgery.
Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and others are good for you.
Stomach
The sac-like organ of the digestive system. It helps digest food by churning it and mixing it with acids to break it down into smaller pieces.
Painkillers
Analgesics are medicines that relieve pain. Examples include paracetamol, aspirin and ibuprofen.
Kidney
Kidneys are a pair of bean-shaped organs located at the back of the abdomen. They remove waste and extra fluid from the blood and pass them out of the body as urine.

Complications resulting from tonsillitis are uncommon, but some of the problems that can occur are outlined below.

  • Middle ear infection (also known as otitis media) is a build-up of mucus in the middle ear, between your ear drum and inner ear. In most cases, the infection clears by itself.
  • Quinsy is a rare condition that sometimes develops when infection spreads from a swollen tonsil to the surrounding area, causing an abscess (pus-filled swelling) in the throat. Abscesses can be easily treated using antibiotics, although a small operation to drain the pus may sometimes be needed.
  • Swelling of the face and neck, although rare, can potentially block the airways and prevent a person from breathing. Chronic tonsillitis can cause obstructive sleep apnoea, which prevents some of the oxygen from getting to your brain and may lead to disturbed sleeping patterns.
  • Blood poisoning (septicaemia) can occur if bacteria get into your bloodstream and multiply. The bacteria can be destroyed using antibiotics.
  • Glomerulonephritis (very rare) is inflammation (swelling) of the filters in your kidneys, caused by streptococcal bacteria.
  • Rheumatic fever is a rare condition that causes widespread inflammation (swelling) throughout the body.
  • Lemierre's syndrome is a rare condition in which bacteria spread from your throat to major veins in your neck. Small 'clumps' of bacteria then travel through your bloodstream to your lungs, joints and bones. Lemierre's syndrome can be easily treated with antibiotics but can be fatal if it is not diagnosed quickly.

Glossary

Kidney
Kidneys are a pair of bean-shaped organs located at the back of the abdomen. They remove waste and extra fluid from the blood and pass them out of the body as urine.
Abscess
An abscess is a lump containing pus, which is made by the body during infection.
Brain
The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Swellings
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Oxygen
Oxygen is an odourless, colourless gas that makes up about 20% of the air we breathe.
Chronic
Chronic usually means a condition that continues for a long time or keeps coming back.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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