Tonsillitis
Tonsillitis is inflammation of the tonsils caused by infection and isn’t usually a serious condition. It tends to come on suddenly but starts to improve by itself after 3-4 days.
The tonsils are a pair of glands that sit on either side of the throat and form part of the immune system to protect the body from infections entering the mouth and nose. When the tonsils become infected, they isolate the infection and stop it spreading further into the body.
Inflamed tonsils become red and swollen and can cause a sore throat, earache, fever and headache.
The tonsils tend to be quite large in pre-teenage children because the immune system is actively developing but they usually shrink in size as we move into our teens and adulthood and the body’s immune system matures.
For this reason, tonsillitis is a common childhood illness; however, teenagers and adults can get it too. It will usually start to improve after 3-4 days without any specific treatment.
Around 70% of cases of tonsillitis are caused by viruses. Viral infections are usually self-limiting and do not require (or respond to) antibiotics.
A smaller proportion of cases of tonsillitis are caused by bacterial infection. These cases may require treatment with antibiotics if the symptoms are not improving by themselves.
In most cases, tonsillitis gets better within a week. However, a small number of children and adults have tonsillitis for longer, or it keeps returning. This is known as chronic tonsillitis.
Occasionally you can develop a pocket filled with pus (abscess) between the tonsils and wall of your throat. This is known as a peritonsillar abscess or quinsy. Complications such as quinsy are very rare and mostly affect teenagers and young adults but can occur in younger children.
Symptoms of peritonsillar abscess/quinsy include:
- Fever
- Severe throat pain
- Drooling
- Difficulty opening the mouth (called trismus)
- Muffled voice quality
- One tonsil may appear larger than the other
You should seek immediate medical assessment if you have symptoms suggestive of a peritonsillar abscess/quinsy
Causes
Most cases of tonsillitis are caused by a viral infection, such as the viruses that cause the common cold or flu virus (influenza).
Some cases can also be caused by a bacterial infection, typically a strain of bacteria called group A streptococcus bacteria.
These types of infections spread easily, so it’s important to try to avoid passing the infection on to others by:
- staying away from public places, such as work, school or nursery, until your GP says it’s safe to return (usually after the symptoms have passed)
- coughing and sneezing into a tissue and disposing of the tissue
- washing hands before eating, after going to the toilet and, if possible, after coughing and sneezing
Selfcare and more information
Managing tonsillitis
Symptoms can last for around 1 week, but most people will get better within this time without antibiotics, regardless of cause (bacteria or virus).
On average, antibiotics shorten the duration of bacterial tonsillitis symptoms by about 16 hours over 7 days, and the number of people improving with antibiotics is similar to the number experiencing adverse effects, such as diarrhoea.
To help ease symptoms try to:
- get plenty of rest
- drink cool drinks to soothe the throat
- you can take paracetamol or ibuprofen (don’t give aspirin to children under 16)
- gargle warm, salty water (children shouldn’t try this)
These products are cheap to buy and are readily available over the counter along with advice from pharmacies. Some self-care medicines are available from shops and supermarkets.
The following are not recommended due to a lack of evidence: non-medicated lozenges, mouthwashes, or local anaesthetic mouth spray without antiseptic.
To reduce spread of viral infections, it is important to cover your mouth/nose with your hand when coughing or sneezing. Remember to wash your hands after coughing or sneezing.
When to consult your GP
You should contact your GP urgently or go to A&E if you have:
- severe sore throat that quickly gets worse
- swelling inside the mouth and throat
- difficulty speaking
- difficulty swallowing
- difficulty breathing difficulty opening your mouth
You should contact your GP if:
- you have white, pus-filled spots on your tonsils
- you have a fever
- your sore throat is very painful, making it difficult to eat or drink
- your symptoms don’t go away/improved after 4 days
Your GP will be able to tell whether you have tonsillitis by asking about your symptoms.
Your GP may look at the back of your throat, although this is a high-risk examination in the current COVID-19 pandemic and won’t be routinely performed. It is helpful if you can look in the back of your own throat before seeing your GP.
Occasionally your GP may wipe a cotton bud (swab) at the back of your throat to test for bacteria.
If your symptoms are more severe and won’t go away, your GP may organise a blood test to rule out glandular fever.
Surgery (Tonsillectomy)
Surgery to remove the tonsils is known as a tonsillectomy.
For children with mild sore throats, watchful waiting is recommended rather than a tonsillectomy. Because the tonsils tend to shrink in size as the immune system matures (normally during the teens), the frequency of such episodes often diminishes with adolescence.
Tonsillectomy is rarely necessary. There are local commissioning policies in place for this condition.
This means that certain treatments will not be available to you on the NHS unless you might the agreed criteria. The reason for this is that the benefits of surgery need to be weighed against the risk of surgical complications.
Please click here for more information.
Under local commissioning guidelines tonsillectomy is only considered for a recurrent sore throat if certain criteria are met. You must have:
- a sore throat caused by tonsillitis
- episodes of sore throat that are disabling and stop you functioning normally
- seven or more well-documented, clinically significant, adequately treated sore throats in the preceding year or
- five or more such episodes in each of the preceding two years or
- three or more such episodes in each of the preceding three years
Tonsillectomy is not routinely commissioned solely for the management of snoring.
Tonsillectomy is not routinely commissioned for the treatment of tonsilloliths (tonsil stones).
Tonsillectomies are carried out under general anaesthetic, which means you’ll be asleep during the procedure. Your mouth will be held open to allow the surgeon to see your tonsils and no cuts will be made in your skin.
Useful information about tonsillitis
Videos about tonsillitis
Help with tonsillitis
Help with tonsillitis
NHS Lanarkshire | Published 9 April 2019
How to treat tonsillitis
NHS | Published 21 August 2017
Waiting for a specialist opinion
If you have been referred for a specialist opinion your details will be reviewed and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.
How long will I wait?
If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.