What are tonsils and what is tonsillitis?

Tonsils are made of soft glandular tissue and are part of the immune system. You have two tonsils, one on either side at the back of the mouth. The picture shows normal non-infected tonsils.

Tonsillitis is an infection of the tonsils. A sore throat is the common symptom. In addition, you may also have a cough, fever, headache, feel sick, feel tired, find swallowing painful, and have swollen neck glands. The tonsils may swell and become red. Pus may appear as white spots on the tonsils. Symptoms typically get worse over 2-3 days and then gradually go, usually within a week.

What is the treatment for tonsillitis?

  • Not treating is an option as many tonsil infections are mild and soon get better.
  • Have plenty to drink. It is tempting not to drink very much if it is painful to swallow. You may become mildly dehydrated if you don't drink much, particularly if you also have a fever. Mild dehydration can make headaches and tiredness much worse.
  • Paracetamol or ibuprofen ease pain, headache, and fever. To keep symptoms to a minimum it is best to take a dose at regular intervals as recommended on the packet of medication rather than 'now and then'. For example, take paracetamol four times a day until symptoms ease.
  • Aspirin gargles may ease the soreness. (There is little research evidence that confirms this. However, it is a popular treatment and may be worth a try.) Dissolve some soluble aspirin in water and gargle for 3-4 minutes. You can do this 3-4 times a day. Spit out the aspirin after gargling. (You should not give aspirin to children under 16.)
  • Other gargles, lozenges, and sprays that you can buy at pharmacies may help to soothe a sore throat. However, they do not shorten the illness.

Do I need an antibiotic?

Usually not. Most throat and tonsil infections are caused by viruses, although some are caused by bacteria. Without tests, it is usually not possible to tell if it is a viral or bacterial infection. Antibiotics kill bacteria, but do not kill viruses. However, even if a bacterium is the cause of a tonsil or throat infection, an antibiotic does not make much difference in most cases. Your immune system usually clears these infections within a few days whether caused by a virus or a bacterium. Also, antibiotics can sometimes cause side-effects such as diarrhoea, rash, and stomach upsets.

So, most doctors do not prescribe antibiotics for most cases of tonsillitis or sore throat.

An antibiotic may be advised in certain situations. For example, if the infection is severe, if it is not easing after a few days, or if your immune system is not working properly (for example, if you have had your spleen removed, if you are taking chemotherapy, etc).

Things to look out for

In nearly all cases, a tonsilitis or sore throat clears away without leaving any problems. The conditions below are uncommon, but for the sake of completeness are mentioned here.

Possible complications

Sometimes the infection can spread from the tonsils to other nearby tissues. For example, to cause an ear infection, sinus infection or chest infection.

Infectious mononucleosis (glandular fever)

Infectious mononucleosis is caused by a virus (the Epstein-Barr virus). It tends to cause a severe bout of tonsillitis in addition to other symptoms. See separate leaflet called 'Glandular Fever' for more details.

Quinsy - also known as peritonsillar abscess

Quinsy is an uncommon condition where an abscess (a collection of pus) develops next to a tonsil due to a bacterial infection. It usually develops just on one side. It may follow a tonsillitis or develop without a preceding tonsillitis. The tonsil on the affected side may be swollen or look normal, but is pushed towards the midline by the abscess next to the tonsil. Quinsy is very painful and can make you feel very unwell. It is treated with antibiotics, but also the pus often needs to be drained with a small operation.

None-infective causes of a painful or swollen tonsil

These are rare. For example, cancer of the tonsil is rare, but pain can be the first symptom.

The 'take home' message is ... see a doctor if symptoms of a tonsillitis are severe, unusual, or if they do not ease within 3-4 days.

What about having my tonsils taken out?

Removing the tonsils (tonsillectomy) may be an option if you have frequent and severe bouts of tonsillitis. That is, five or more infections over a year. Also, when each infection is severe enough to affect normal life (such as needing time off work or school). The value of tonsillectomy is uncertain. Throat infections are not prevented if the tonsils are removed. However, for some people, the number and severity of throat infections may be reduced after tonsillectomy.

Tonsillectomy is usually a straightforward minor operation. But note, as with all operations there is a risk. For example, there is a small risk of life-threatening severe bleeding from the throat during and just after the operation.