Tonsillitis is inflammation of the tonsils, two oval-shaped pads of tissue at the back of the throat — one tonsil on each side. Signs and symptoms of tonsillitis include swollen tonsils, sore throat and difficulty swallowing. Most cases of tonsillitis are caused by infection with a common virus, but a bacterial infection also may cause tonsillitis.


Because appropriate treatment for tonsillitis depends on the cause, it's important to get a prompt and accurate diagnosis. Surgery to remove tonsils, once a common procedure to treat tonsillitis, is usually performed only when tonsillitis occurs frequently, doesn't respond to other treatments or causes serious complications.


Common symptoms of tonsillitis include:


  • red and/or swollen tonsils;
  • white or yellow patches on the tonsils;
  • tender, stiff and/or swollen neck;
  • sore throat;
  • painful or difficult swallowing;
  • cough;
  • headache;
  • sore eyes;
  • body aches;
  • earache;
  • fever;
  • chills;
  • nasal congestions.


Acute tonsillitis is caused by both bacteria and viruses and will be accompanied by symptoms of ear pain when swallowing, bad breath, and drooling along with sore throat and fever. In this case, the surface of the tonsil may be bright red or have a grayish-white coating, while the lymph nodes in the neck may be swollen. 


Tonsilloliths occur in up to 10% of the population frequently due to episodes of tonsillitis.


Tonsillitis is most often caused by a common cold virus, but other viral and bacterial infections can also be the cause.


The most common bacterium causing tonsillitis is Streptococcus pyogenes, or group A streptococcus, the bacterium that causes most cases of strep throat.


Why do tonsils get infected?


Tonsils produce certain types of disease-fighting white blood cells. So the tonsils are believed to act as the immune system's first line of defense against bacteria and viruses that enter your mouth.


This function may make the tonsils particularly vulnerable to infection and inflammation. However, the tonsil's immune system function declines after puberty — a factor that may account for the rare cases of tonsillitis in adults.


At-home care


Whether tonsillitis is caused by a viral or bacterial infection, at-home care strategies can make your child more comfortable and promote better recovery.


If a virus is the expected cause of tonsillitis, these strategies are the only treatment. Your doctor won't prescribe antibiotics. Your child will likely be better within seven to 10 days.


At-home care strategies to use during the recovery time include the following:


  • Encourage rest. Encourage your child to get plenty of sleep and to rest his or her voice.


  • Provide adequate fluids. Give your child plenty of water to keep the throat moist and prevent dehydration.


  • Provide comforting foods and beverage. Warm liquids — broth, caffeine-free tea or warm water with honey — and cold treats like ice pops can soothe a sore throat.


  • Prepare a saltwater gargle. If your child can gargle, a saltwater gargle of 1 teaspoon (5 milliliters) of table salt to 8 ounces (237 milliliters) of warm water can help soothe a sore throat. Have your child gargle the solution and then spit it out.


  • Humidify the air. Use a cool-air humidifier to eliminate dry air that may further irritate a sore throat, or sit with your child for several minutes in a steamy bathroom.


  • Offer lozenges. Children older than age 4 can suck on lozenges to relieve a sore throat.


  • Avoid irritants. Keep your home free from cigarette smoke and cleaning products that can irritate the throat.


  • Treat pain and fever. Talk to your doctor about using ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others) to minimize throat pain and control a fever. Aspirin has been linked with Reye's syndrome, so use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.




If tonsillitis is caused by a bacterial infection, your doctor will prescribe a course of antibiotics. Penicillin taken by mouth for 10 days is the most common antibiotic treatment prescribed for tonsillitis caused by group A streptococcus. If your child is allergic to penicillin, your doctor will prescribe an alternative antibiotic.


Your child must take the full course of antibiotics as prescribed even if the symptoms go away completely. Failure to take all of the medication as directed may result in the infection worsening or spreading to other parts of the body. Not completing the full course of antibiotics can, in particular, increase your child's risk of rheumatic fever and serious kidney inflammation.


Talk to your doctor or pharmacist about what to do if you forget to give your child a dose.




Surgery to remove tonsils (tonsillectomy) may be used to treat frequently recurring tonsillitis, chronic tonsillitis, or bacterial tonsillitis that doesn't respond to antibiotic treatment.


Frequent tonsillitis is generally defined as:


  • More than six episodes in one year.
  • More than four episodes a year over two years.
  • More than three episodes a year over three years.


A tonsillectomy may also be performed if tonsillitis results in difficult to manage complications, such as:


  • Obstructed sleep apnea.
  • Breathing difficulty.
  • A peritonsillar abscess that doesn't improve with antibiotic treatment.


Tonsillectomy is usually done as a one-day surgery. That means your child should be able to go home the day of the surgery. A complete recovery usually takes seven to 10 days.

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