Tonsillitis
Tonsillitis is inflammation of the tonsils, the two pads of lymphoid tissue that sit on either side of the base of the tongue.
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Medicines commonly prescribed for Tonsillitis
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 750 mgActive substance: amoxicillinManufacturer: Laboratorios Normon S.A.Prescription requiredDosage form: TABLET, 500 mgActive substance: paracetamolManufacturer: Apotheke Laboratorios S.L.Prescription not requiredDosage form: TABLET, 650 mgActive substance: paracetamolManufacturer: Laboratorios Alter S.A.Prescription required
Tonsillitis is inflammation of the tonsils, the two pads of lymphoid tissue that sit on either side of the base of the tongue. They stand at the entrance to the airway and meet everything that passes through the throat, which is why they become inflamed so often, especially in children and teenagers. In most people the cause is an ordinary respiratory virus and the whole thing settles by itself within three to five days. Some episodes behave differently, though, and the difference shows in the details.
How it starts
Throat pain builds over a few hours and gets worse on swallowing, sometimes to the point where drinking is hard. The tonsils turn red and swollen, with white or yellowish spots and patches on them. The voice sounds muffled and the breath smells unpleasant.
Usually this comes with:
- fever, often with chills and aching all over;
- tender, movable lumps under the jaw and along the sides of the neck: enlarged lymph nodes;
- headache and complete exhaustion; in children, nausea and tummy pain;
- pain that shoots into the ear on swallowing, because the throat and the ear share nerves even though the ear itself is healthy.
In small children the picture is blurred: they do not complain about their throat but become listless and fretful, refuse food and drink, and dribble a great deal.
Virus or bacterium, and why it matters
Viral tonsillitis arrives with the rest of a cold: a runny nose, a cough, a hoarse voice, red eyes. Antibiotics do nothing for it.
The bacterial kind is usually caused by group A streptococcus: the throat hurts alongside a high fever, there is no runny nose or cough, the coating on the tonsils is thick and the neck glands are markedly tender. Nobody can tell the two apart by looking alone; that combination of signs only raises the probability of a bacterium, which is why a rapid test and a throat swab culture exist.
Streptococcus can do something a virus cannot: produce an abscess beside the tonsil and, weeks after an illness that has already been forgotten, inflammation in the joints, the heart or the kidneys. The antibiotic is not prescribed to make the throat feel better a day sooner but to stop that chain from starting. Hence the rule about finishing the full course even when swallowing is easy again by day three.
What looks the same
A red throat with a coating is not a diagnosis in itself: several conditions look almost identical.
- Glandular fever. The coating is heavy, nodes are enlarged all over the neck, the exhaustion lasts for weeks and the spleen is often enlarged, so contact sport is put on hold for that time. Another clue: the rash that appears after amoxicillin and is easily mistaken for a drug allergy.
- Viral ulcers. In children some infections produce small painful sores on the soft palate and deep in the throat: the pain is severe but there is no coating.
- Fungal coating. White and curd-like, it wipes off with a spatula and barely hurts. It follows a course of antibiotics, inhaled steroids for asthma, diabetes or weakened immunity.
- Blood problems. Rare but important: ulcers and a dirty grey coating together with bleeding gums, bruising and stubborn fever can be the first sign of a sharp fall in the white cell count. Such a throat does not respond to the usual treatment, and what is needed is a blood count rather than a second antibiotic.
- A one-sided ulcer that will not heal after more than three weeks, particularly in an adult who smokes, needs an ear, nose and throat specialist to rule out a tumour.
When waiting is not an option
Complications of tonsillitis are uncommon but develop fast, within hours. Call an ambulance if any of the following appears:
- breathing is difficult, noisy or wheezy;
- even saliva cannot be swallowed and it drools out of the mouth;
- the mouth barely opens, as if the jaw were jammed;
- pain suddenly worsens on one side, the voice sounds muffled and the neck swells on that side;
- sudden weakness and confusion; a child is floppy and not reacting as usual;
- the fever will not come down at all and violent shivering starts.
Most often the cause is an abscess between the tonsil and the wall of the throat, which is drained in hospital. Less common and more dangerous is swelling of the epiglottis, which closes off the entrance to the windpipe; very rarely the infection spreads to a vein in the neck. With breathing trouble, do not drive yourself.
What helps at home
In an ordinary case there is one aim: to get through a few days as gently as possible without becoming dehydrated.
- Drink little and often; cool drinks go down more easily than hot ones, and ice cream works here as pain relief.
- Keep food soft and bland: nothing sour, spicy or salty, no toast or crusts.
- Over the counter, paracetamol or ibuprofen at the dose for the person's age and weight. Aspirin is not given to children or teenagers.
- Gargling with warm salt water eases the pain for teenagers and adults; it is not suitable for children who might swallow the solution.
- Lozenges and sprays with a local anaesthetic dull the pain for a while but do nothing to the infection; throat sprays are not suitable for young children.
- Humid air and no tobacco smoke nearby reduce the scratchiness.
There is no point warming the neck with compresses: where there is pus, heat does harm.
What the doctor does
The doctor examines the throat and neck, checks whether the tonsils are enlarged symmetrically and feels the lymph nodes, the liver and the spleen. Depending on the picture a swab is taken: the rapid streptococcal test answers in minutes, while a culture is more accurate but slower. If the illness is severe or drags on, blood tests are added, including one for glandular fever.
When the test confirms streptococcus, an antibiotic is prescribed, usually from the penicillin group; if there is an allergy to those, another class is chosen. Mention separately if your immunity is reduced, if you take medicines that suppress it, or if you have already had an abscess in the throat: the approach is then more cautious.
When removing the tonsils is discussed
Surgery is needed by few people these days. It is considered when tonsillitis returns year after year, is confirmed each time and costs whole weeks of school or work. The doctor counts the episodes over several years rather than acting on one bad attack.
The second reason is not frequency but obstruction: overgrown tonsils narrow the airway, the child snores and pauses in their breathing during sleep. The third is repeated abscesses. Removal ends inflammation in the tonsils themselves, but it does not make anyone immune to colds.
Keeping it from spreading
Inflammation of the tonsils is not itself catching, but the viruses and the streptococcus behind it certainly are, through coughing, sneezing and shared crockery.
- stay at home while there is fever and heavy weakness;
- cough and sneeze into a tissue or the elbow, and bin the tissue at once;
- wash hands after coughing or sneezing and before eating;
- do not share glasses, bottles, spoons, towels or a toothbrush with the household;
- with confirmed streptococcus you can return to school or work a day after starting the antibiotic and once the fever has settled.
Online consultation
In an online appointment the doctor will ask how the illness began, what the fever is doing and whether there is a runny nose and a cough, will ask you to show the throat to the camera and will judge whether a swab is needed. They will match pain relief to the age, go through any treatment already prescribed, explain which signs mean calling for emergency help, and, where episodes keep repeating, help you assemble their history before the conversation with a specialist. An abscess cannot be drained remotely: with warning signs an in-person appointment is needed.
This material is for information only and does not replace medical advice.
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Discuss your symptoms and possible next steps for Tonsillitis with a doctor online.
