Tonsillitis

Tonsillitis is inflammation of the tonsils, the two oval pads of soft tissue at the back of the throat, one on each side. The tonsils are part of the immune system and help trap germs entering through the mouth and nose. When they become infected they swell, redden and can develop white or yellow patches.

The condition is very common, especially in children and teenagers, but people of any age can get it. Most episodes are short-lived and uncomplicated, though the sore throat can be quite painful while it lasts. Some people experience tonsillitis repeatedly over months or years, which is described as recurrent tonsillitis.

The main symptom is a sore throat that can make swallowing uncomfortable. Other common features include red or swollen tonsils, white or yellow patches on the tonsils, a high temperature, bad breath, a headache, tiredness, earache and tender, swollen glands in the neck.

In young children who cannot describe a sore throat, signs may be less obvious and can include refusing food, dribbling, irritability or a general feeling of being unwell. Symptoms usually build over a day or two and then ease as the infection clears.

Most cases are caused by common viruses, such as those responsible for colds and flu. A smaller proportion are caused by bacteria, most often group A streptococcus, the germ behind strep throat. The infection spreads through droplets from coughs and sneezes and through close contact, which is why it is common in schools and busy households.

It is not always possible to tell a viral from a bacterial cause by symptoms alone, which is one reason a clinician may examine the throat or carry out a swab when the picture is unclear.

A clinician usually diagnoses tonsillitis by asking about symptoms and examining the throat, mouth, ears and neck glands. The appearance of the tonsils, the presence of a fever and tender neck glands all help build the picture.

If a bacterial infection such as strep throat is suspected, a throat swab or a rapid strep test may be used to confirm it. This helps decide whether antibiotics are likely to help, since they make no difference to viral infections.

Most cases are managed with self-care while the body clears the infection. Rest, drinking plenty of fluids, and over-the-counter pain relief such as paracetamol or ibuprofen, used according to the label, can ease throat pain and bring down a fever. Soothing measures like warm or cool drinks and, for adults and older children, lozenges or salt-water gargles may also help. Children under 16 should not take aspirin.

If a bacterial infection is confirmed or strongly suspected, a course of antibiotics may be prescribed. It is important to complete the full course even once the throat feels better. Surgery to remove the tonsils, called tonsillectomy, is generally considered only for people who have frequent, severe episodes that significantly disrupt daily life, or for certain complications.

Seek urgent or emergency care if a sore throat is accompanied by difficulty breathing, severe difficulty swallowing, drooling or being unable to swallow saliva, a muffled voice, or difficulty opening the mouth. These can be signs of a serious complication such as a collection of pus beside the tonsil (quinsy) or swelling that narrows the airway.

Also contact a doctor if symptoms are severe, last longer than about four days without improving, or keep coming back, or if you are unsure how to care for a child who is very unwell.

Because tonsillitis is usually caused by common viruses and bacteria, it cannot always be prevented. Good everyday hygiene lowers the chance of catching or spreading the infections that cause it: washing hands regularly, covering coughs and sneezes, not sharing cups or cutlery, and staying away from others while feverish.

The outlook is generally very good. Most episodes clear within about a week and cause no lasting problems. People who experience frequent recurrent tonsillitis can discuss longer-term options, including whether tonsil surgery might be appropriate, with an ear, nose and throat clinician.