Tonsillitis

What is tonsillitis?

Tonsillitis is inflammation of the tonsils, the two small oval glands at the back of the throat, one on each side. The tonsils are part of the immune system and help fight infection, but they can themselves become infected and inflamed, causing tonsillitis. It is a common condition, particularly in children and teenagers, though people of any age can develop it.

Tonsillitis is usually caused by a viral infection, and less commonly by a bacterial one such as streptococcus (the same bacteria behind strep throat). It causes a sore throat, pain when swallowing, and often a fever. Most cases are not serious and clear up on their own within about a week, similar to other throat infections. Understanding whether it is likely viral or bacterial helps guide whether any specific treatment is needed.

Symptoms

Tonsillitis symptoms centre on the throat and can be more pronounced than a typical mild sore throat. Common symptoms include:

• •A sore throat, which can be severe
• •Pain or difficulty when swallowing
• •Red, swollen tonsils, sometimes with white or yellow patches of pus
• •A fever
• •Swollen, tender glands in the neck
• •Headache, earache, and a change to the voice
• •Bad breath and feeling generally unwell

Viral or bacterial tonsillitis

Tonsillitis can be caused by viruses or bacteria, and while it can be hard to tell them apart from symptoms alone, the distinction matters for treatment. Most tonsillitis is viral — often caused by the same viruses that cause colds — and clears up on its own without antibiotics, which do not work against viruses. Viral tonsillitis often comes with other cold-like symptoms such as a cough or runny nose.

Bacterial tonsillitis, often caused by streptococcus, is the type that may benefit from antibiotics. It is more likely when there is a severe sore throat with fever, swollen neck glands and pus on the tonsils, but without the cough and runny nose typical of viral infections. Because the two overlap, a doctor may use a throat swab or a scoring system to judge whether antibiotics are appropriate, avoiding their unnecessary use where the cause is likely viral.

Treatment and self-care

Most tonsillitis, being viral, clears up on its own within about a week, and treatment focuses on relieving symptoms. Self-care measures include resting, drinking plenty of fluids to stay hydrated (even though swallowing may be uncomfortable), and using paracetamol or ibuprofen for pain and fever as directed. Warm drinks, and for adults things like salt water gargles or throat lozenges, can soothe the throat.

If tonsillitis is thought to be bacterial, a doctor may prescribe antibiotics, and it is important to complete the full course. For most people, though, tonsillitis is managed with self-care while it resolves. In cases of very frequent, recurrent tonsillitis that significantly affects quality of life, removal of the tonsils (a tonsillectomy) is occasionally considered, but this is now reserved for specific situations, as most people simply grow out of frequent tonsillitis or manage occasional bouts with self-care.

Recovery, spread and complications

Most people recover from tonsillitis within about a week, whether or not antibiotics are used. During this time, staying hydrated and managing pain effectively makes the illness more bearable. Because the infections that cause tonsillitis are contagious, spread through respiratory droplets and close contact, good hygiene — handwashing, covering coughs and sneezes, not sharing cups or cutlery — helps reduce passing it to others.

While tonsillitis is usually straightforward, it is worth being aware of a few situations that need medical attention. Rarely, a collection of pus can form beside a tonsil (a quinsy or peritonsillar abscess), causing severe one-sided throat pain, difficulty opening the mouth, and difficulty swallowing even saliva — this needs prompt medical care. Difficulty breathing, being unable to swallow fluids, or drooling in a child are also urgent warning signs.

For most people, though, tonsillitis is an unpleasant but self-limiting infection that resolves with rest and time. Knowing the reassuring norm — sore throat, fever and difficulty swallowing that settle within a week — alongside the warning signs that need help, allows you to manage it confidently at home while seeking care in the less common situations that call for it.

Recurrent tonsillitis and when it keeps coming back

While many people have tonsillitis only occasionally, some — particularly children — experience it repeatedly. Recurrent tonsillitis means having multiple episodes over a period of time, which can be disruptive, causing repeated time off school or work and affecting quality of life. If tonsillitis keeps coming back, it is worth discussing with a doctor, who can assess the pattern and consider whether any further action is helpful.

In the past, removing the tonsils was a very common response to recurrent tonsillitis, but the approach has become more selective. Tonsillectomy is now generally reserved for cases where episodes are frequent and severe enough to significantly affect a person's life, as the benefits are weighed against the fact that many children naturally have fewer episodes as they grow older. A doctor can advise whether removal is appropriate based on how often and how severely someone is affected.

It is also worth being aware that a severe or lingering sore throat with swollen glands, particularly in teenagers and young adults, can sometimes be glandular fever (infectious mononucleosis) rather than ordinary tonsillitis. If a sore throat is unusually severe or prolonged, or comes with marked tiredness and widely swollen glands, a doctor can check whether glandular fever might be the cause, as it is managed a little differently.