02/09/2024
Tonsillitis:
About tonsillitis
Tonsillitis is inflammation of the tonsils. It's usually caused by a viral infection or, less commonly, a bacterial infection.
Tonsillitis is a common condition in children, teenagers and young adults.
The symptoms of tonsillitis include:
a sore throat and pain when swallowing
earache
high temperature (fever) over 38C (100.4F)
coughing
headache
Symptoms usually pass within three to four days.
When to see your GP
Tonsillitis isn't usually a serious condition. You only need to see your GP if symptoms:
last longer than four days and don't show any signs of improvement
are severe – for example, if you're unable to eat or drink due to the pain, or you have difficulty breathing
Your GP will examine your throat and ask you some questions about your symptoms. If necessary, a throat swab can be taken to confirm the diagnosis. The results usually take a few days to return.
If your tonsillitis is caused by a bacterial infection, they may prescribe antibiotics. Typical signs of a bacterial infection include white pus-filled spots on the tonsils, no cough and swollen or tender lymph glands.
If you develop severe tonsillitis as a teenager or adult, your GP may recommend a blood test for glandular fever.
The tonsils
The tonsils are two small glands that sit on either side of the throat. In young children, they help to fight germs and act as a barrier against infection.
When the tonsils become infected, they isolate the infection and stop it spreading further into the body.
As a child's immune system develops and gets stronger, the tonsils become less important and usually shrink. In most people, the body is able to fight infection without the tonsils.
Removal of the tonsils is usually only recommended if they're causing problems, such as severe or repeated episodes of tonsillitis (see below).
What causes tonsillitis?
Most cases of tonsillitis are caused by a viral infection, such as the viruses that cause the common cold or flu virus (influenza).
Some cases can also be caused by a bacterial infection, typically a strain of bacteria called group A streptococcus bacteria.
These types of infections spread easily, so it's important to try to avoid passing the infection on to others by:
staying away from public places, such as work, school or nursery, until your GP says it's safe to return (usually after the symptoms have passed)
coughing and sneezing into a tissue and disposing of the tissue
washing hands before eating, after going to the toilet and, if possible, after coughing and sneezing
Treating tonsillitis
There's no specific treatment for tonsillitis, but you may be able to reduce the symptoms by:
taking paracetamol or ibuprofen to help relieve pain
drinking plenty of fluids
getting plenty of rest
If test results show that your tonsillitis is caused by a bacterial infection, a short course of oral antibiotics may be prescribed.
If oral antibiotics aren't effective at treating bacterial tonsillitis, intravenous antibiotics (given directly into a vein) may be needed in hospital.
Chronic tonsillitis
In most cases, tonsillitis gets better within a week. However, a small number of children and adults have tonsillitis for longer, or it keeps returning. This is known as chronic tonsillitis and surgical treatment may be needed.
Surgery to remove the tonsils (a tonsillectomy) is usually only recommended if:
you've had several severe episodes of tonsillitis over a long period of time
repeated episodes are disrupting normal activities
Complications of tonsillitis
Complications of tonsillitis are rare and usually only occur if it's caused by a bacterial infection. They're usually the result of the infection spreading to another part of the body.
Possible complications of tonsillitis include:
a middle ear infection (otitis media) – where fluid between the eardrum and inner ear becomes infected by bacteria
quinsy (peritonsillar abscess) – an abscess (collection of pus) that develops between one of the tonsils and the wall of the throat
obstructive sleep apnoea (OSA) – where the walls of the throat relax during sleep, which causes breathing difficulties and poor sleep
Other complications of tonsillitis are very rare and usually only occur if an underlying bacterial infection is left untreated. They include:
scarlet fever – a condition that causes a distinctive pink-red skin rash
rheumatic fever – this causes widespread inflammation throughout the body, leading to symptoms such as joint pain, rashes and jerky body movements
glomerulonephritis – an infection (swelling) of the filters in the kidneys that can cause vomiting and a loss of appetite
Symptoms of tonsillitis
The main symptom of tonsillitis is a sore throat.
Your tonsils will be red and swollen, and your throat may be very painful, making swallowing difficult.
In some cases, the tonsils are coated or have white, pus-filled spots on them.
Other common symptoms of tonsillitis include:
high temperature (fever) over 38C (100.4F)
coughing
headache
earache
feeling sick
feeling tired
swollen, painful lymph glands in your neck
loss of voice or changes to your voice
The symptoms of tonsillitis usually get better after three to four days.
If you have tonsillitis that's caused by a viral infection, such as the common cold or flu, your symptoms may be milder.
If your tonsillitis is caused by a bacterial infection, such as a streptococcal infection, your symptoms will usually be more severe and you may also have bad breath.
It's difficult to tell just by looking at a person's throat whether they have tonsillitis as a result of a virus or a bacterial infection. Tests are needed to confirm this.
Antibiotics may be recommended if test results show that your tonsillitis is caused by a bacterial infection.
Causes of tonsillitis
Most cases of tonsillitis are caused by a viral infection.
Viruses known to cause tonsillitis include:
rhinoviruses – which cause the common cold
the influenza virus
parainfluenza virus – which causes laryngitis and croup
enteroviruses – which cause hand, foot and mouth disease
adenovirus – which is a common cause of diarrhoea
the rubeola virus – which causes measles
In rare cases, tonsillitis can also be caused by the Epstein-Barr virus, which causes glandular fever.
If this is the case, you'll probably feel very ill. You'll have a sore throat and the lymph glands in your throat may be swollen. You may also have a fever and feel very tired.
Bacterial tonsillitis
Bacterial tonsillitis can be caused by a number of different bacteria, but it's usually due to group A streptococcus bacteria.
In the past, serious bacterial infections, such as diphtheria and rheumatic fever, have been linked with tonsillitis. However, this is now rare, because these conditions are vaccinated against and treatment for them has greatly improved.
How tonsillitis is spread
Tonsillitis itself isn't contagious, but the infections that cause it are.
Viruses, such as those that cause colds and flu, are spread through coming into close contact with someone who's infected.
When an infected person coughs or sneezes, the virus is contained in the millions of tiny droplets that come out of their nose and mouth. You can become infected by breathing in the contaminated droplets. This is known as direct contact.
You can also become infected if you touch a surface or object that the droplets have landed on and then touch your face. This is known as indirect contact.
Treating tonsillitis
There's no specific treatment for tonsillitis and most cases get better within a week without treatment.
While waiting for the infection to clear up, there are a number of things you can do to help relieve your symptoms (see below).
If your child has tonsillitis, make sure they have plenty to eat and drink, even if they find it painful to swallow. Being hungry and dehydrated can make other symptoms, such as headaches and tiredness, worse.
Self-help
Over-the-counter painkillers, such as paracetamol and ibuprofen, can help relieve painful symptoms such as a sore throat.
If treating your children with painkillers, it's important to use the correct type and dosage. Younger children only need small dosages. Your pharmacist can advise you about this.
Children under 16 years of age shouldn't be given aspirin.
Over-the-counter treatments that can soothe a sore throat, such as lozenges and oral sprays, are also available. Some people find that gargling with a mild antiseptic solution can also relieve a sore throat.
Alternatively, you could try gargling with warm, salty water. Mix half a teaspoon of salt (2.5g) with a quarter of a litre (eight ounces) of water. It's important not to swallow the water, so this method may not be suitable for younger children.
Antibiotics
Antibiotics may not be prescribed, even if tests confirm your tonsillitis is caused by a bacterial infection. The two main reasons for this are:
in most cases, antibiotics won't speed up the recovery, but they can cause unpleasant side effects, such as stomach pain and feeling sick
the more an antibiotic is used to treat a non-serious infection, the greater the chance it won't be effective in treating more serious infections; this is known as antibiotic resistance
However, exceptions are usually made if:
symptoms are severe
symptoms show no sign of easing
you or your child has a weakened immune system
In these circumstances, a 10-day course of penicillin is usually recommended. If you or your child is known to be allergic to penicillin, an alternative antibiotic, such as erythromycin, can be used.
Hospital treatment may be required for particularly severe or persistent cases of bacterial tonsillitis that don't respond to oral antibiotics. In these cases, intravenous antibiotics (given directly into a vein) may be needed.
Antibiotics sometimes cause mild side effects, such as an upset stomach, diarrhoea or a rash.
Surgery
Surgery to remove the tonsils is known as a tonsillectomy.
For children with mild sore throats, watchful waiting is recommended rather than a tonsillectomy.
A tonsillectomy is only considered for a recurrent sore throat if certain criteria are met. You must have:
a sore throat caused by tonsillitis
episodes of sore throat that are disabling and stop you functioning normally
seven or more well-documented, clinically significant, adequately treated sore throats in the preceding year or
five or more such episodes in each of the preceding two years or
three or more such episodes in each of the preceding three years
Tonsillectomies are carried out under general anaesthetic, which means you'll be asleep during the procedure. Your mouth will be held open to allow the surgeon to see your tonsils and no cuts will be made in your skin.
The operation can be carried out in a number of ways, as described below.
Cold steel surgery – this is the most common method, where a surgical blade is used to cut the tonsils out. Bleeding is controlled by applying pressure or the blood vessels may be sealed using heat generated by diathermy.
Diathermy – a diathermy probe is used to destroy the tissue around 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 (60C). It's considered less painful than diathermy.
Lasers – high-energy laser beams are used to cut away the tonsils and seal the underlying blood vessels shut.
Ultrasound – high-energy ultrasound waves are used in a similar way to lasers.
Each of these techniques is relatively similar in terms of safety, results and recovery, so the type of surgery used will depend on the expertise and training of the surgeon.
You'll usually be able to leave hospital on the same day as you have surgery, or the day after.
After surgery
After surgery, it's likely you'll experience some pain at the site of the operation. This can last for up to a week. Painkillers can help to relieve the pain.
Children who have had a tonsillectomy should be kept off school for two weeks. This is to reduce their risk of picking up an infection from another child that will make them feel more uncomfortable.
Swallowing will probably be difficult after having a tonsillectomy. However, it's important to eat solid foods, because it will help your throat to heal more quickly. Drink plenty of fluids, but avoid acidic drinks, such as orange juice, because they'll sting.
Ensuring good oral hygiene by regularly brushing your teeth and using mouthwash can help prevent infection in the mouth.
The pain usually gets worse during the first week after having a tonsillectomy, before gradually improving during the second week. Earache is common with tonsillectomies, but isn't a cause for concern.
Post-operative bleeding
Bleeding at the site where the tonsils were removed is a fairly common complication of a tonsillectomy. This can occur during the first 24 hours following surgery or up to 10 days afterwards.
It's estimated that around 1 in 100 children and 1 in 30 adults will experience post-operative bleeding after having a tonsillectomy.
Minor bleeding isn't usually a cause for concern, because in most cases it resolves by itself. Gargling with cold water can often help stem the bleeding, because the cold helps to contract the blood vessels.
Occasionally, the bleeding can be more severe, causing people to cough up blood. Seek immediate medical advice if this happens. You should be given an emergency contact number before you're discharged from hospital. Alternatively, you can call NHS 24's '111' service.
Extensive bleeding may need to be treated with surgery or a blood transfusion.
