Tonsillitis is an infection
or inflammation of the
tonsils. The tonsils are balls of
lymph tissue on both sides of the throat, above
and behind the tongue. They are part of the
immune system, which helps the body fight
Tonsillitis often goes away on its own after 4 to 10
Most often, tonsillitis
is caused by a virus. Less often, it is caused by the same bacteria that cause
strep throat. In rare cases, a fungus or a parasite
can cause it.
Tonsillitis is spread through the air in droplets
when an infected person breathes, coughs, or sneezes. You may then become
infected after breathing in these droplets or getting them on your skin or on
objects that come in contact with your mouth, nose, or eyes.
The main symptom of
tonsillitis is a sore throat. The throat and
tonsils usually look red and swollen. The tonsils may
have spots on them or pus that covers them completely or in patches. Fever is
If you feel like you have a cold, with symptoms such
as runny and stuffy nose, sneezing, and coughing, a virus is most likely the
If you have a sore throat plus a sudden and severe fever
and swollen lymph nodes, but you do not have symptoms of a
cold, the infection is more likely caused by bacteria. This means you need to
see a doctor and probably need a strep test.
Your doctor will
look at your throat to see if you have
red and swollen tonsils with spots or sores. These signs can mean you have
Your doctor may do a rapid strep test along with a
throat culture. These will show whether the tonsillitis is caused by
Your doctor may also ask about past throat
infections. If you get tonsillitis often, it may affect the choice of
You may have a test for
mononucleosis if your doctor thinks that you have
Tonsillitis caused by a virus
will usually go away on its own. Treatment focuses on helping you feel better.
You may be able to ease throat pain if you gargle with salt water, drink warm
tea, take over-the-counter pain medicine, and use other home treatments. Do not give aspirin to
anyone age 20 or younger. It is linked to a serious disease called
If your tonsillitis is
caused by strep, you need treatment with antibiotics. Antibiotics can help
prevent rare but serious problems caused by strep and can control the spread of
As a rule, doctors only advise surgery to remove
tonsils (tonsillectomy) when there are serious problems with the tonsils. These
include infections that happen again and again or long-lasting infections that
do not get better after treatment and get in the way of daily activities. You
and your doctor can decide if surgery is the right choice after a careful
review of your or your child's overall health.
Learning about tonsillitis:
Living with tonsillitis:
Health Tools help you make wise health decisions or take action to improve your health.
Tonsillitis is usually caused by a
virus. Bacteria can also cause tonsillitis. The most common bacterial cause of
tonsillitis is group A beta-hemolytic streptococcus (GABHS), which also causes
Tonsillitis can also be
caused by fungi or parasites. But these causes are rare in people who have
Tonsillitis is spread by
close contact with an infected person. Droplets of disease-causing agents
(pathogens) pass through the air when an infected
person breathes, coughs, or sneezes. You may then become infected after
you breathe in these droplets. Infection can also occur if pathogens get on your skin or on objects that come in contact with your mouth, nose, eyes, or other
mucous membranes. Symptoms usually appear about 2 to 5 days after exposure.
A person with tonsillitis caused by strep bacteria is contagious
early on and, without treatment, can remain so for up to 2 weeks. Antibiotics
shorten the contagious period, and an infected person is no longer contagious
about 24 to 48 hours after beginning antibiotic therapy.
The main symptom of
tonsillitis is a sore throat. More symptoms occur in
most cases. Some or all of the following may be present:
When you have sore throat plus cold symptoms such as nasal
congestion, runny nose, sneezing, and coughing, the cause is most likely a
virus. Viral infection of the tonsils usually goes away without treatment
within 2 weeks.
Sore throat with, swollen glands, a sudden fever above
101°F (38.3°C), and without symptoms of an upper respiratory tract infection may point to a bacterial infection like strep that needs to be treated with antibiotics.
Tonsillitis, in most cases, lasts 4 to 10 days. A bacterial sore throat may last slightly longer but usually gets better with antibiotics.
In some cases, tonsillitis can
become chronic. Surgical removal of the tonsils (tonsillectomy) may be
recommended for you or your child based on past health and results of physical
by strep bacteria that is not treated with antibiotics may result in
complications, such as ear and sinus infections or
pockets of infection outside the tonsils (peritonsillar abscess). More serious
complications, such as
rheumatic fever, are rare.
Recurrent and ongoing (chronic) tonsillitis may obstruct the upper airway
and cause problems, such as snoring, nasal congestion, and mouth breathing.
Sometimes chronic tonsillitis can lead to more severe conditions, including
obstructive sleep apnea and heart and lung problems.
But most children who have sleep apnea and enlarged tonsils do not have a history
Close contact with an infected
person is the main risk factor for
tonsillitis. Droplets of disease-causing agents (pathogens) pass through the air when an infected
person breathes, coughs, or sneezes. You may then become infected after
breathing in these droplets. Infection can also occur if pathogens get on your
skin or on objects that come in contact with the mouth, nose, eyes, or other
Nasal obstruction causes you to breathe through
your mouth, which increases the risk of tonsillitis.
Call your doctor if any of the
Watchful waiting is a period of time during
which you and your doctor observe your or your child's symptoms or condition
without using medical treatment. Watchful waiting is appropriate if tonsillitis
occurs along with cold symptoms such as runny nose, nasal congestion, sneezing,
and coughing. Tonsillitis with these symptoms is most often caused by a virus.
Viral infection of the tonsils can be treated at home and in most cases goes away
without treatment within 2 weeks. In general, the more like a cold the
condition is, the less likely it is that the condition is caused by strep
Watchful waiting is not appropriate if tonsillitis
occurs with a fever of
101°F (38.3°C) or higher or
with swollen lymph nodes in the neck, and without symptoms of an
upper respiratory tract infection. If these symptoms
occur together, see a doctor. You may have strep throat, which should be
Health professionals who can evaluate tonsillitis, perform quick tests or throat cultures, and prescribe antibiotic treatment, if needed, include:
If surgery to remove the tonsils (tonsillectomy) is
indicated, your doctor may refer you to an
otolaryngologist (ear, nose, and throat, or ENT,
To prepare for your appointment, see the topic Making the Most of Your Appointment.
tonsillitis is based on a medical history and a
physical exam of the throat. An accurate medical history is needed to find out whether tonsillitis is recurrent, which may affect treatment
If your symptoms suggest
strep throat, your doctor may want to confirm this
diagnosis by doing a
throat culture. Strep throat is more likely if 3 or 4
of the following signs or symptoms are present:
If a strep infection is suspected, your doctor may do a
rapid strep test or a
throat culture or both. Both of these tests can be
done in a doctor's office. You may want to discuss the
advantages and disadvantages of each test to see which
test is appropriate.
The results of these tests will determine
whether antibiotic treatment is needed. These results combined with an accurate
medical history will be considered in deciding whether surgery to remove the
tonsils (tonsillectomy) is recommended.
If the Epstein-Barr
virus, which can cause
mononucleosis, is suspected as a cause for the
test for mononucleosis may be done.
most often caused by a virus, which resolves on its own. But tonsillitis can be
caused by strep bacteria, which requires treatment with antibiotics. Watch for
signs of dehydration, such as a dry mouth and tongue.
Also, watch for signs of
complications, such as ear pain, from tonsillitis
caused by strep bacteria.
by a virus will usually go away on its own. Antibiotics are not effective
treatment for viral tonsillitis.
The virus that causes
mononucleosis (mono) can lead to tonsillitis that is
as severe as tonsillitis caused by bacteria and can take several weeks or more
before it goes away.
Home treatments such as gargling with salt
water, drinking warm tea, and taking over-the-counter pain medicine (such as acetaminophen or ibuprofen) may help relieve discomfort. Do not give aspirin to anyone younger than 20 because of its link to
Reye syndrome, a serious but rare problem.
Many nonprescription remedies such as antiseptic mouthwashes,
antihistamines contain extra ingredients that don't
relieve discomfort. These remedies are not recommended for children, because
they have not been proved to have any benefits in the treatment of acute
prescribed for tonsillitis caused by strep bacteria. A strep infection
will usually go away on its own, but antibiotic treatment is needed because
strep throat can cause serious
complications. For more information, see the topic
If antibiotics are
prescribed, be sure you take them exactly as directed by your
doctor. Antibiotics should be taken for the entire duration of the
prescription, even if the symptoms disappear completely before the prescription
is gone. If antibiotics used to treat tonsillitis are not taken as directed,
bacteria can become resistant to them (antibiotic resistance). In these cases, antibiotic treatment of future infections
may not work.
Surgical removal of the tonsils
(tonsillectomy) is still a common procedure, particularly for children. But it is
not done nearly as often as it was in the past. Tonsillectomy may be
considered to treat tonsillitis when a child has serious complications,
recurrent infections, or chronic infections that do not respond to treatment
and interfere with daily functioning. But the risks and benefits of surgery
need to be weighed carefully. Tonsillectomy should only be done after you
and your doctor carefully consider your or your child's overall health.
A wide variety of viruses and bacteria can
tonsillitis, so the best prevention is to follow basic
health and hygiene precautions. These steps are especially helpful for
The goal of home treatment of
tonsillitis caused by a virus is to manage symptoms as
the body fights off the infection. Home treatment eases the discomfort
of sore throat and symptoms such as runny nose, nasal congestion,
sneezing, and coughing.
Things that may help you or your child
feel better include:
Cough and cold medicines may not be safe for young children or for people who have certain health problems. Before you use these medicines, check the label. Antiseptic
antihistamines have not been proved effective for
tonsillitis and may result in harmful side effects.1
A sore throat along with sudden fever and
swollen lymph nodes, and without symptoms of an
upper respiratory tract infection, may point to a
bacterial infection. Anyone with these symptoms should see a doctor to be
strep throat, which requires treatment with
antibiotics. It is important to get plenty of rest and take all the prescribed
antibiotics exactly as directed. Keep your child home from school for the first
1 to 2 days of antibiotic treatment. He or she is still contagious during this
time and might pass the infection to others.
usually caused by a virus and does not require prescription medicine. Gargling
with salt water and taking
over-the-counter pain medicines such as acetaminophen
(Tylenol) can help manage symptoms as the body fights off the infection. Do not
give aspirin to anyone younger than 20 because of the risk of
Reye syndrome, a serious but rare problem.
antibiotic, usually amoxicillin or penicillin, is used to treat
tonsillitis caused by strep bacteria.
Although tonsillitis caused
by strep bacteria usually will go away on its own, antibiotics are used to
complications, such as
rheumatic fever, that can result from untreated
Cough and cold medicines may not be safe for young children or for people who have certain health problems. Before you use these medicines, check the label. Many over-the-counter remedies,
including antiseptic mouthwashes,
antihistamines, contain extra ingredients that don't
relieve discomfort. These remedies are not recommended for children, as these
ingredients have not been proved to have any benefits in the treatment of acute
If antibiotics are prescribed, be sure you take them
exactly as directed by your doctor until the medicine is gone. Even if the
symptoms go away completely before the prescription is gone, all pills should
be taken as directed to make sure the infection is completely destroyed.
Bacteria can become resistant to the antibiotics used to treat tonsillitis
(antibiotic resistance) if prescriptions aren't taken
as directed or if they are prescribed when they aren't needed.
tonsillitis is generally used for children who have
serious complications or recurrent infections that do not respond to other
treatment, especially when they interfere with daily life. But
tonsillectomy should only be done after you and your doctor
carefully consider your child's medical history and overall health.
Researchers in a recent study concluded that tonsillectomy may be no
better than watchful waiting for children who have mild symptoms, which was defined
as tonsillitis occurring fewer than 3 times a year.2
But for some children, tonsillectomy can greatly improve their
quality of life. Children who are most likely to benefit from tonsillectomy are
those who have:
Tonsillectomy for strep throat may be
done in cases of recurring tonsillitis that do not respond to antibiotics or if
an infection threatens the child's well-being.
Tonsillectomy is still the most
common major surgical procedure done on children in the United States. But it
is not done as often as it was in the past.
infections and tonsillitis usually occur less frequently as a child gets
older. Consider whether your child's tonsillitis
infections are manageable until you can wait to see if he or she outgrows them.
A child who has tonsillectomy will need special care and close
monitoring for at least a week after the surgery. Consider your ability to
provide this care for your child before deciding on tonsillectomy.
This American Academy of Pediatrics website has information for parents about childhood issues, from before the child is born to young adulthood. You'll find information on child growth and development, immunizations, safety, health issues, behavior, and much more.
The American Academy of Otolaryngology—Head and Neck
Surgery (AAO-HNS) is the world's largest organization of physicians dedicated
to the care of ear, nose, and throat (ENT) disorders. Its Web site includes
information for the general public on ENT disorders.
The American Academy of Pediatrics (AAP) offers a
variety of educational materials about parenting,
general growth and development, immunizations, safety, disease prevention, and more. AAP guidelines for various conditions and links to other
organizations are also available.
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health—from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
Cherry JD (2009). Pharyngitis (pharyngitis, tonsillitis, tonsillopharyngitis, and nasopharyngitis). In RD Feigin et al., eds., Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 6th ed., vol. 2, pp. 160–169. Philadelphia: Saunders.
Baugh RF, et al. (2011). Clinical practice guideline:
Tonsillectomy in children. Otolaryngology–Head and Neck Surgery, 144(IS): S1–S30.
Other Works Consulted
Baum SG (2005). Adenovirus. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 6th ed., vol. 2, pp. 1835–1841. Philadelphia: Elsevier Churchill Livingstone.
Georgalas C, et al. (2009). Tonsillitis, search date March 2009. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
Isaacson G (2012). Tonsillectomy care for the pediatrician. Pediatrics, 130(2): 324–334.
Simon HB (2006). Bacterial infections of the upper respiratory tract. In DC Dale, DD Federman, eds., ACP Medicine, section 7, chap. 19. New York: WebMD.
Suurna MV (2012). Management of adenotonsillar disease. In AK Lalwani, ed., Current Diagnosis and Treatment: Otolaryngology—Head and Neck Surgery, 3rd ed., pp. 362–368. New York: McGraw-Hill.
Wetmore RF (2011). Tonsils and adenoids. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 1442–1445. Philadelphia: Saunders.
December 6, 2012
Adam Husney, MD - Family Medicine
& Charles M. Myer, III, MD - Otolaryngology
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