About Tonsillistis: Types, Causes & Symptoms

What is Tonsillitis?

Tonsillitis is the inflammation of the tonsils, which are two oval-shaped glands located at the back of the throat. This condition is commonly caused by viral or bacterial infections and often results in symptoms such as sore throat, difficulty swallowing, swollen tonsils, and fever.

The tonsils play an important role in the immune system, particularly during childhood, by helping to trap and fight off harmful germs that enter through the mouth and nose. However, they can sometimes become infected themselves, leading to discomfort and other symptoms.

Tonsillitis can occur at any age, but it is more common in children and teenagers. It may appear suddenly (acute tonsillitis) or recur frequently, leading to chronic or recurrent tonsillitis. Most cases are mild and resolve within a few days, but some may require further medical evaluation, especially if symptoms are severe, persistent, or keep coming back.

Symptoms of Tonsillitis

Tonsillitis symptoms usually appear suddenly and may range from mild to severe. The most common signs include:

• Sore or scratchy throat
• Pain or difficulty when swallowing
• Red, swollen tonsils (may affect one or both sides – unilateral or bilateral tonsillitis)
• White spots or patches on the tonsils (can indicate follicular or exudative tonsillitis)
• Fever (typically above 38°C)
• Swollen lymph nodes in the neck, just below the jaw or ears
• Headache or ear pain
• Bad breath (especially in cases of bacterial tonsillitis)
• Voice changes or muffled voice
• Stomach pain, nausea or vomiting, more common in children
• Stiff neck or difficulty opening the mouth
• Fatigue or general discomfort

Causes of Tonsillitis

Tonsillitis is most often caused by viral infections, but bacterial infections can also be responsible. Identifying the cause helps guide proper treatment.

Viral Tonsillitis

• Viruses are the most common cause of tonsillitis, responsible for nearly 70% of all cases.
• Common viruses include those that cause the common cold, influenza (flu), Epstein-Barr virus (mononucleosis), adenovirus, and enteroviruses.
• Symptoms of viral tonsillitis are usually milder and may include low-grade fever, runny nose, and cough, alongside tonsil inflammation.

Bacterial Tonsillitis (Strep Throat)

• Caused by Group A Streptococcus bacteria, often referred to as strep throat or streptococcal tonsillitis.
• Bacterial tonsillitis typically causes more intense symptoms, such as high fever, pus on the tonsils, and swollen lymph nodes.
• Unlike viral tonsillitis, bacterial tonsillitis may not be accompanied by cold-like symptoms.
• It is important to seek medical attention if strep throat is suspected, as it can lead to complications if left untreated.

Types of Tonsillitis

Tonsillitis can be caused by viral or bacterial infections and may occur occasionally, frequently, or persist for a long time. Based on the duration, frequency, and cause, tonsillitis is classified into the following types:

1. Acute Tonsillitis

Acute tonsillitis is the most common form and usually develops suddenly. It is most often caused by a viral infection, but it can also result from bacterial infections, such as streptococcal tonsillitis (commonly known as strep throat).

Common signs of acute tonsillitis include:

• Sudden onset of symptoms such as sore throat, fever, pain while swallowing, red and swollen tonsils, or white spots at the back of the throat
• May be accompanied by enlarged lymph nodes, headache, or fatigue
• Typically lasts for 3 to 10 days

In most cases, acute tonsillitis resolves on its own with rest, fluids, and medication. However, if the infection is bacterial, antibiotics may be prescribed for faster recovery and to prevent complications.

2. Chronic Tonsillitis

When tonsillitis symptoms persist for several weeks or keep returning over a prolonged period, it is classified as chronic tonsillitis. This condition may cause ongoing throat pain, bad breath, and persistent inflammation of the tonsils.

Common signs of chronic tonsillitis include:

• Swollen tonsils that do not fully return to normal size
• Frequent sore throats
• Tonsil stones (small white or yellowish debris in the tonsil crevices)
• Mild but persistent throat discomfort

Chronic tonsillitis may be due to repeated infections, underlying allergies, or ongoing exposure to irritants. In such cases, your ENT specialist may recommend a tonsillectomy (surgical removal of the tonsils), especially if it affects quality of life or leads to complications.

3. Recurrent Tonsillitis

Recurrent tonsillitis, also known as frequent or repeated tonsillitis, refers to multiple episodes of acute tonsillitis within a short period of time. It is particularly common in children and may require more active treatment.

Doctors typically define recurrent tonsillitis as:

• 7 or more episodes in one year
• 5 or more episodes each year for two years
• 3 or more episodes per year for three years

Repeated inflammation can cause the tonsils to become permanently enlarged, known as kissing tonsils, which may lead to breathing issues, sleep disturbances, or difficulty swallowing.

When to See a Doctor for Tonsillitis?

While tonsillitis often clears up on its own or with simple treatment, it is important to know when medical attention is necessary. Delaying care may lead to complications, especially in young children or those with recurrent infections.

You should consult a doctor if you or your child experience any of the following:

• A sore throat that lasts longer than 48 hours
• Painful or difficult swallowing
• Swollen or sore tonsils with a fever
• Fatigue, weakness, or increased irritability in children
• White or red spots on the tonsils or at the back of the throat
• Frequent episodes of tonsillitis, especially within the same year

These signs may suggest a bacterial infection like streptococcal tonsillitis (strep throat), which requires antibiotics. If left untreated, bacterial tonsillitis may lead to complications such as peritonsillar abscess or spread of infection.

Diagnosis and Tests for Tonsillitis

Accurate diagnosis is important to determine the cause of tonsillitis. At Pristyn Care, our ENT specialists follow a thorough and clinically proven approach to diagnose all forms of tonsillitis, including acute tonsillitis, bacterial tonsillitis, viral tonsillitis, and streptococcal tonsillitis.

How Doctors Diagnose Tonsillitis

A diagnosis of tonsillitis typically begins with a detailed medical history and physical examination. Your doctor will:

• Ask about your symptoms, such as sore throat, pain while swallowing, fever, or swollen tonsils.
• Look for visible signs, including:
  • Red and swollen tonsils
  • White or yellow spots or coating on the tonsils (a sign of follicular tonsillitis or exudative tonsillitis)
  • Swollen lymph nodes in the neck
  • Ulcers, red spots, or white spots in the throat
  • Signs of tonsil infection such as bad breath or pus

Your doctor will also check for complications like peritonsillar abscess, especially if symptoms are severe or one-sided (unilateral tonsillitis).

Tests Used to Diagnose Tonsillitis

To confirm the type of infection and rule out other throat conditions like pharyngitis or viral pharyngitis, doctors may recommend the following tests:

1. Throat Swab Test (Rapid Antigen Test or Throat Culture)

• A sterile swab is gently rubbed over the back of the throat and tonsils to collect a sample.
• A rapid antigen test can detect streptococcal bacteria (strep throat) within minutes.
• If the rapid test is negative but bacterial tonsillitis is still suspected, the sample may be sent for a throat culture. Results usually take 24 to 48 hours.

2. Complete Blood Count (CBC)

• A blood test may be done in certain cases to check the levels of different types of white blood cells.
• Helps differentiate between viral and bacterial causes of tonsillitis based on the immune response.

3. Physical Examination of the Tonsils

• Using a lighted instrument, your doctor will check for signs of inflamed tonsils, white patches, enlargement, or signs of chronic or repeated tonsillitis.
• In some cases, imaging (such as a soft-tissue X-ray) might be used to assess enlarged or kissing tonsils that may be causing breathing issues.

Risks and Complications of Untreated Tonsillitis

If tonsillitis, whether acute, bacterial, or viral, is left untreated, it may lead to a range of health complications. Below are some potential outcomes of untreated or poorly managed tonsillitis:

1. Scarlet Fever – Untreated streptococcal tonsillitis (strep throat) can lead to scarlet fever, particularly in children. This condition is characterised by a red rash, sore throat, and high fever. While treatable with antibiotics, it may lead to more serious complications if ignored.

2. Rheumatic Fever – This inflammatory disease can develop after an untreated or poorly treated strep throat. Rheumatic fever affects the heart, joints, and nervous system and is more commonly seen in children. If not managed properly, it may cause permanent heart valve damage (rheumatic heart disease).

3. Peritonsillar Abscess (Quinsy) – A peritonsillar abscess is a painful collection of pus that forms near the tonsils, usually as a complication of untreated bacterial tonsillitis. This condition may cause severe throat pain, swelling, difficulty swallowing, and even airway obstruction. In such cases, surgical drainage or tonsillectomy may be required.

4. Spread of Infection – In some cases, the infection may spread beyond the tonsils to nearby areas such as the middle ear (causing otitis media), sinuses (leading to sinusitis), or even deeper tissues of the neck. In rare cases, it may lead to life-threatening infections like necrotising fasciitis or sepsis.

5. Breathing Difficulties and Sleep Disturbances – Enlarged tonsils, especially in children, can interfere with normal breathing and contribute to obstructive sleep apnoea (OSA). This can cause loud snoring, restless sleep, and daytime fatigue. In chronic or severe cases, surgical removal of the tonsils may be advised to improve breathing and sleep quality.

6. Chronic or Recurrent Tonsillitis – Repeated episodes of tonsillitis, also known as recurrent tonsillitis, can significantly impact a person’s quality of life. This often includes sore throats, persistent fever, and swollen glands.

How to Treat Tonsillitis?

Medications

Antibiotics (for bacterial tonsillitis) – If the infection is caused by bacteria, your doctor may prescribe a course of antibiotics such as penicillin, amoxicillin, or cephalosporins. These are effective against strep throat and other bacterial throat infections.

It is important to complete the full course of antibiotics, even if symptoms improve after a few days. Stopping early can result in the infection returning or complications like rheumatic fever or peritonsillar abscess.

Pain and Fever Relief – To manage discomfort from sore tonsils, fever, or throat pain, over-the-counter medicines like paracetamol (acetaminophen) or ibuprofen may be recommended. These help reduce inflammation and improve overall comfort.

Tonsillectomy (Surgical Treatment)

A tonsillectomy is the surgical removal of the tonsils. This is generally advised in cases of:

• Recurrent tonsillitis (more than 7 episodes in one year, or multiple episodes over several years)
• Chronic tonsillitis that doesn’t respond to medications
• Complications such as quinsy (peritonsillar abscess) or obstructive sleep apnoea due to enlarged tonsils

Home Remedy

For mild cases of viral tonsillitis or to manage symptoms during treatment, the following home remedies may provide relief:

• Warm liquids: Sip on warm water, herbal teas, or clear broths to soothe the throat.
• Salt water gargles: Gargling with warm salt water helps reduce swelling and discomfort.
• Throat lozenges: These can help ease irritation and provide temporary relief.
• Stay hydrated and well-rested: Drinking plenty of fluids and getting enough rest helps the body recover.

Please Note: Home remedies are supportive measures and should not replace medical treatment, especially in cases of bacterial tonsillitis.

Prevention Measures for Tonsillitis

Tonsillitis, whether viral, bacterial, or caused by allergic triggers, often spread through close contact with infected individuals. The best way to prevent the condition is by practising good hygiene and taking steps to reduce the spread of infections.

Here are some simple but effective ways to help prevent tonsil infections:

Encourage proper hygiene

• Wash your hands thoroughly and often, especially before eating and after using the toilet
• Avoid sharing food, drinks, utensils, or toothbrushes with others
• Replace your toothbrush after recovering from tonsillitis to prevent reinfection
• Keep hand sanitisers handy if soap and water are not available

Reduce the risk of spreading infection

If your child or someone in your household has sore throat tonsillitis, follow these steps to avoid infecting others:

• Keep them at home while they are unwell to prevent spreading viral or bacterial tonsillitis
• Consult your doctor to know when it is safe to return to school or public activities
• Teach children to cough or sneeze into a tissue or the elbow rather than their hands
• Ensure hands are washed immediately after coughing or sneezing

Strengthen your immunity

• Maintain a healthy, balanced diet with plenty of fruits and vegetables
• Stay hydrated to keep the throat moist and reduce irritation
• Avoid exposure to cigarette smoke, which can inflame the palatine tonsils and throat lining
• Get adequate rest to support your immune system

Avoid triggers

In cases of allergic tonsillitis, try to identify and avoid known allergens such as dust, pollen, or pet dander. Using air purifiers and keeping living spaces clean can help reduce flare-ups.