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Tonsillitis – Causes, Symptoms and Treatment

Tonsillitis is an inflammation of the tonsils, most commonly caused by viral or bacterial infections. It typically presents with sore throat, difficulty swallowing, and fever.

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Things worth knowing about "Tonsillitis"

Tonsillitis is an inflammation of the tonsils, most commonly caused by viral or bacterial infections. It typically presents with sore throat, difficulty swallowing, and fever.

What is Tonsillitis?

Tonsillitis is an inflammation of the palatine tonsils – two oval-shaped masses of lymphatic tissue located at the back of the throat, one on each side. It is one of the most common conditions affecting the ear, nose, and throat and occurs most frequently in children and adolescents, though it can affect people of all ages.

There are two main forms: acute tonsillitis, which comes on suddenly and typically resolves within one to two weeks, and chronic tonsillitis, which involves recurrent or persistent inflammation of the tonsils over a longer period.

Causes

Tonsillitis is caused by infectious agents in the vast majority of cases:

Viruses (approximately 70% of cases): Common culprits include adenoviruses, rhinoviruses, the Epstein-Barr virus (causing infectious mononucleosis), and influenza viruses.
Bacteria (approximately 30% of cases): The most frequent bacterial cause is Streptococcus pyogenes (Group A Streptococcus), responsible for streptococcal throat infections.

Additional risk factors include a weakened immune system, close contact with infected individuals, colder seasons, and smoking.

Symptoms

The typical signs and symptoms of tonsillitis include:

Severe sore throat, sometimes radiating to the ears
Difficulty swallowing (dysphagia)
Fever, often above 38.5 °C (101.3 °F)
Red, swollen tonsils, sometimes covered with white or yellow patches or pus spots
Swollen lymph nodes in the neck
Bad breath (halitosis)
General malaise, fatigue, and headache

In children, nausea or stomach pain may also be present.

Diagnosis

Diagnosis is usually established through a physical examination of the throat. To distinguish between viral and bacterial causes, the following methods may be used:

Throat swab: A swab is tested for streptococcal bacteria – either via a rapid antigen test (results within minutes) or a throat culture.
Blood tests: Elevated inflammatory markers (CRP, white blood cell count) may suggest a bacterial infection.
Antibody test: If infectious mononucleosis is suspected, a monospot test can be performed.

Clinical scoring tools such as the Centor Score or McIsaac Score help physicians assess the likelihood of a streptococcal infection based on clinical features.

Treatment

Viral Tonsillitis

There is no specific antiviral treatment for most viral causes of tonsillitis. Management focuses on relieving symptoms:

Rest and adequate fluid intake
Pain-relieving and fever-reducing medications (e.g., ibuprofen or paracetamol)
Gargling with warm salt water or antiseptic solutions
Throat lozenges or sprays for local relief

Bacterial Tonsillitis

When a streptococcal infection is confirmed, antibiotic therapy is recommended. Penicillin V taken for 7 to 10 days is the first-line treatment. For patients with penicillin allergy, alternatives such as amoxicillin-clavulanate or macrolide antibiotics may be prescribed. Completing the full antibiotic course is essential to prevent complications such as rheumatic fever or post-streptococcal glomerulonephritis.

Surgical Treatment (Tonsillectomy)

In cases of recurrent or chronic tonsillitis, surgical removal of the tonsils – known as a tonsillectomy – may be considered. A common guideline threshold is at least 5 to 7 clinically significant episodes per year. The procedure is performed under general anesthesia by an ear, nose, and throat (ENT) surgeon.

Complications

In rare cases, untreated or severe tonsillitis can lead to complications, including:

Peritonsillar abscess: A collection of pus adjacent to the tonsil
Rheumatic fever: An inflammatory condition triggered by an immune response to streptococcal infection
Post-streptococcal glomerulonephritis: Kidney inflammation following streptococcal infection
Airway obstruction due to markedly enlarged tonsils

References

Shulman ST et al.: Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis. Clinical Infectious Diseases, 2012; 55(10): e86–e102.
Windfuhr JP et al.: European position statement on the indications, nomenclature and methods of tonsil surgery. European Archives of Oto-Rhino-Laryngology, 2016; 273(1): 117–129.
World Health Organization (WHO): Rheumatic Fever and Rheumatic Heart Disease – Report of a WHO Expert Consultation. Geneva, 2004.

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