Tonsillitis: Symptoms, Causes, Risks, Diagnosis, Treatment, Complications, Prevention and Outlook

A mouth with tonsillitis


At the back of the throat, there lie the tonsils. These are masses of tissue that are used to filter germs and other pathogens that could enter the lungs through the airways.
These germs could eventually lead to respiratory infections. Moreover, the tonsils also help produce antibodies that work by fighting off infection.

However, overwhelmed by the germs that try to enter the body, the tonsils could get infected too. As a result, the infection may lead to the inflammation of the tonsils, called tonsillitis. Tonsillitis is the inflammation of the tonsils. Most cases of tonsillitis are caused by the infection brought about by a common virus. However, in some cases, bacteria may also cause tonsillitis.

Most tonsillitis cases may clear on their own within ten days. However, if the infection becomes worse, the doctor may recommend antibiotics. These drugs are only effective on bacterial infections. If the tonsillitis is caused by a virus, symptomatic treatment is recommended because viral infections are usually self-limiting and will go away within a couple of days.

Tonsillitis is common in children between the ages of 4 and seven years old. However, it’s rare for people who are over 40 years old and children below two years old. It also affects people of school age until adolescence.


The common signs and symptoms of tonsillitis include:

  • Red and inflamed tonsils
  • Throat pain and tenderness
  • Sore throat
  • Painful blisters on the throat
  • Fever
  • Enlarged or painful lymph nodes in the neck
  • Scratchy voice
  • Stiff neck
  • Headache
  • Loss of appetite
  • Difficulty swallowing
  • Bad breath
  • Ear pain
  • Chills

In young children, the signs and symptoms may include:

  • Stomachache
  • Refusal to eat
  • Nausea and vomiting
  • Drooling because of painful swallowing
  • Irritability
  • Unusual fussiness

Despite being rare, tonsillitis may lead to the inflammation of the throat that may make breathing difficult. If this happens, seek immediate and urgent care. Moreover, if you have the following symptoms, you need to see a doctor:

  • Fever more than 103 F
  • Muscle weakness
  • Stiff neck
  • A sore throat that persists for more than two days


The most common cause of a sore throat are viruses but bacterial infections may also lead to this condition. The tonsils are the body’s first line of defense against pathogens that may cause infections. These pathogens enter the mouth and if the tonsils are not there to filter them out, they may freely enter the respiratory tract.

After puberty, the tonsil’s natural immune function declines, leading to lesser cases in adults. There are two major causes of tonsillitis – viruses and bacteria.

Viral causes

The most common viruses that may cause tonsillitis include:

  • Adenoviruses
  • Epstein-Barr virus
  • Influenza virus
  • Enteroviruses
  • Herpes simplex virus
  • Enteroviruses
  • Parainfluenza viruses
  • Coronavirus
  • Rhinovirus
  • Respiratory syncytial virus

Bacterial causes

The most common bacteria that may cause a sore throat include:

  • Staphylococcus aureus
  • Chlamydia pneumonia
  • Mycoplasma pneumonia
  • Fusobacterium sp.
  • Bordetella pertussis
  • Neisseria gonorrhoeae

4Risk Factors

In some people, tonsillitis is more common. This is because of certain factors that increase their risk of developing the condition. These include:

Exposure to pathogens – Young kids, especially school-age children are in close contact with their classmates. This predisposes them to various types of bacteria and viruses that could lead to tonsillitis.

Suppressed immune system – Young kids and school-aged children who have a suppressed immune system may be at risk of contracting tonsillitis.

Age – Tonsillitis is often seen in children, but uncommon in those who are below two years old. Young children between the ages of 4 and seven years old are at highest risk. The infection may affect children until 15 years old.


To diagnose tonsillitis, the doctor will conduct a thorough physical examination. He may check for swollen tonsils and if there are white patches on the area. During a physical examination, the doctor will use a lighted instrument and look into the throat. He may also check the child’s nose and ears for signs of infection.

For further evaluation, the following diagnostic tests are usually recommended:

Complete blood count (CBC) – The doctor will order a complete blood count (CBC) to determine whether there is an active infection and if it’s caused by a virus or bacteria. However, this test is still inaccurate.

Throat swab – This is a simple test wherein the doctor will rub a sterile swab at the back of the throat. The swab will get samples of the secretions and these will be checked in the laboratory for the presence of streptococcal bacteria. The test results can be obtained within 24 to 48 hours.

If the test turns out positive, the doctor may prescribe antibiotics for seven days. However, if it’s negative, the infection may have been caused by a viral infection.


There is no specific treatment for tonsillitis. Most cases go away on their own and the patients get better within a week without any treatment. However, there are some ways to help relieve the symptoms.


There are many ways to relieve the symptoms of tonsillitis, especially in children.

  • Gargle with warm salt water solution if the child is older than eight years old.
  • Let the child drink warm or cold liquids to rehydrate him or her. You can give ear, soup, juice and rehydration drinks.
  • Let the child eat flavored ice pops to soothe the throat.
  • Encourage rest and plenty of sleep.
  • Provide adequate fluids to keep the throat moist and reduce the risk of dehydration, which is dangerous for young kids.
  • Humidify the air by using a cool-air humidifier to eradicate dry air that may further irritate the throat. You can also let your child have a warm shower or sit in the bathroom with the hot shower onto inhale the steam.
  • Offer lozenges for children who are four years old and above.
  • Reduce the exposure to irritants like cigarette smoke and the fumes from cleaning products.
  • Give pain medicines as prescribed by the doctor such as paracetamol for fever and pain relievers. However, do not self-medicate and read the instructions carefully. Do not give aspirin to people who are younger than 20 years old because it has been linked to the development of Reye’s syndrome.


For bacterial infection, the antibiotics may be prescribed if the throat culture reveals that the cause of the inflammation is bacteria. The antibiotics are usually prescribed by a doctor to be taken for seven days. It is important to finish the antibiotics to prevent the risk of antibiotic resistance.


Surgery is recommended when the inflammation of the tonsils occur regularly. Surgery to remove the tonsils is called tonsillectomy. The criteria for tonsillitis include:

  • A sore throat caused by the tonsillitis
  • Seven or more sore throats in the last year
  • Episodes of a sore throat that have been debilitating
  • Five or more tonsillitis occurrences in each of the preceding two years or three or more episodes in the preceding three years.


The swelling of the tonsils from recurrent infections may lead to serious complications including:

  • Obstructive sleep apnea or disrupted sleep breathing
  • Difficulty breathing
  • Infection that spreads to adjacent tissues or cellulitis
  • Infections that may lead to peritonsillar abscess
  • Middle ear infection (otitis media)
  • Streptococcal infection complications – When the patient has a group A streptococcus bacteria that has not been treated, it may lead to various complications, like:
  • Poststreptococcal glomerulonephritisthis is an inflammatory disease that affects the kidneys. This leads to an altered removal of the waste products in the body.
  • Rheumatic feverThis is an inflammatory disorder that affects the joints and the heart.
  • Scarlet fever a condition that may manifest a distinct pink-red skin rash


It’s not always easy to avoid contracting viral infections, which are spread when you come in contact with someone who has it. However, the key to preventing these infections is through good hygiene practices, which include:

  • Washing the hands thoroughly and frequently, particularly before eating and after using the toilet.
  • Replace the toothpaste once the child has been diagnosed with a sore throat
  • Avoid sharing food and drinking glasses or utensils
  • Teach your child to cover his or her mouth when coughing and sneezing
  • Keep him or her at home when sick
  • Clean the house especially the door knobs, the surfaces and telephone receivers
  • Make sure your child eats a well-balanced diet with fruits and vegetables
  • Let your child drink adequate amounts of water
  • Make sure your child sleeps about seven hours a day
  • Let your child engage in exercise and other physical activities.


Acute tonsillitis is a self-limiting infective condition that may resolve on its way completely with one week. However, some patients may develop recurrent bouts of the infection. In this case, tonsillectomy is the recommended treatment usually made by doctors.

In uncommon cases, tonsillitis may be linked to serious complications such as glomerulonephritis, neck abscess and rheumatic fever, which may lead to rheumatic heart disease.

Tonsillitis usually gets better on its own in just a couple of days. Treating the signs and symptoms of fever and sore throat will make the patient more comfortable. However, if the fever lasts for more than 48 hours, or if it reaches a temperature of above 102 degrees Fahrenheit, the patient should seek medical attention.