Swollen Tonsils (Tonsillitis)

Tonsils are two oval-shaped masses of tissue in the back of the throat, one on each side. As part of the immune system, they help identify and fight infection. Swollen tonsils typically mean they are infected. Infected tonsils are called tonsillitis. The terms "swollen tonsils" and "tonsillitis" are often interchangeable.

This article will discuss the symptoms, causes, diagnosis, and treatment of swollen tonsils and outline when to call a healthcare provider.

Symptoms of Swollen Tonsils

Swollen, infected tonsils can cause symptoms such as:

• Sore or scratchy throat (pain may be localized on the sides of the neck)
• Pain and/or difficulty with swallowing
• Swollen throat
• Irritation in the throat
• Visible redness of the throat/tonsils
• Blisters or small ulcers on tonsils
• Hoarse voice or loss of voice
• Pain when talking
• Difficulty breathing
• Grayish-yellow or white coating or spots in throat/on tonsils
• Ear pain
• Foul-smelling breath ("bad breath")
• Nausea or vomiting
• Headache
• Fever/chills
• Fatigue
• Tenderness of the jaw/throat
• Sleep problems, including snoring and/or sleep apnea (breathing stops briefly while sleeping)
• Swollen lymph nodes (glands) in the neck

Babies and young children with tonsillitis may:

• Refuse to eat
• Drool excessively (because of difficulty swallowing)
• Be unusually fussy or fatigued
• Have difficulty breathing
  

Causes of Swollen Tonsils

Swollen tonsils usually result from:

• Viral infection
• Bacterial infection

Viral infections are the most common cause of swollen tonsils. Viruses that are associated with swollen tonsils include:

• Adenoviruses: Cause colds, bronchitis, and other related conditions
• Epstein-Barr Virus (EBV): Causes mononucleosis
• Herpes simplex virus: Causes cold sores on the lips but can also cause blisters on the tonsils leading to swelling
• Measles: Affects the respiratory system and can cause swelling in the throat and airways

Strep throat (caused by Streptococcus bacteria, also called strep) is tonsillitis's most common bacterial cause. About 15–30% of tonsillitis cases are caused by bacterial infection.

Tonsillitis caused by viruses is more common in younger children, while cases caused by bacteria are more common in kids and teens ages 5–15. Tonsillitis is uncommon in adults.

How to Treat Swollen Tonsils

Treatment for swollen tonsils depends on the cause of the infection and the severity of the symptoms.

Home Care

Swollen tonsils may not require medical treatment. Your healthcare provider may choose a "wait and watch" approach to see if your body clears the infection.

Whether or not you are receiving medical treatment, there are things you can do at home to feel better, such as:

• Staying hydrated with cool or warm (not hot), bland liquids, like water, warm tea, broth, or popsicles
• Eating soft foods
• Getting plenty of rest
• Gargling with warm saltwater
• Using a humidifier, especially during sleep
• Sucking on throat lozenges (not for children under 4 because it is a choking hazard)
• Avoiding smoking, secondhand smoke, and other irritants
  

Medication

Antibiotics can treat bacterial infections. If prescribed antibiotics, it's important to finish all the medication as directed, even if you feel better. This helps prevent it from returning, spreading to others, or leading to more serious complications, such as rheumatic fever caused by strep, which can damage the heart.

Viral infections are not treated with antibiotics, but antiviral medications may be prescribed in some cases.

Medications such as Tylenol (acetaminophen) or Advil/Motrin (ibuprofen) may help to lower fever and ease pain or discomfort from swollen tonsils. Never give an infant, child, or teenager aspirin because it may cause a rare but serious condition called Reye's syndrome.

Surgery

Surgery to remove the tonsils (called a tonsillectomy) is a last-resort treatment for swollen tonsils. It may be recommended if any of these guidelines are met:

• Seven or more episodes in the past year
• Five or more episodes in each of the past two years
• Three or more episodes in each of the past three years

Surgery may also be considered in special circumstances such as:

• Symptoms aren't responding to other treatments
• There are complications such as breathing difficulties or sleep apnea

The surgery usually takes about 20–30 minutes. It is typically an outpatient procedure, but very young children or people who experience complications may stay overnight at the hospital.

The surgery is performed through the open mouth. The surgeon performs the procedure with a special tool that uses sound waves or heat to remove the tonsils and stop any bleeding.

Complications Associated With Swollen Tonsils

Tonsillitis usually clears up on its own or with treatment, but in some cases, complications can arise. These include:

• Chronic tonsillitis: Repeated or persistent episodes of infection that don't respond to treatments such as antibiotics
• Peritonsillar abscess: Bacteria from the infected tonsil spreads to the surrounding tissue causing pus to collect and require draining (if not hospitalization or surgery)
• Tonsillitis and adenoiditis: Infection in the tonsils and adenoids which can cause serious complications if untreated

If the tonsillitis is caused by strep throat, it must be treated to avoid rare but serious complications from strep bacteria.

Are There Tests to Diagnose the Cause of Swollen Tonsils?

To determine the cause of swollen tonsils, a healthcare professional will:

• Discuss symptoms and medical history
• Perform a physical examination, checking the ears, neck, mouth, and throat
• Perform a throat culture to see if a virus or bacteria is causing the infection
• Perform other diagnostic tests if necessary, including an endoscopy (a long, flexible tube with a light used to examine the adenoids), an X-ray, blood tests, or a sleep study

If strep throat is suspected, the healthcare provider may use a rapid strep test in-office, which can show results within minutes. The sample may also go to a lab for a throat culture if the rapid strep test is negative or to confirm the results of the rapid test. The results of this test can take a few days.

When to See a Healthcare Provider 

Get emergency care right away if there is:

• Trouble breathing
• Trouble swallowing
• Drooling (which can indicate trouble swallowing in young children)

Contact your healthcare provider if:

• Symptoms such as sore throat last for more than a few days
• Symptoms are severe, or you are in great discomfort
• You have a fever of 101 degrees Fahrenheit (38.3 degrees Celsius) or higher
• You're experiencing extreme illness, fatigue, or weakness
• There is pus in the back of the throat
• A red rash appears that feels rough and causes increased redness in the skin folds
• Lymph nodes in the neck are tender or swollen
• One tonsil is larger than the other
• You are an adult and have tonsil swelling that doesn't go away and/or without other symptoms (which could be an indication of cancer)
  

Summary

"Swollen tonsils" typically refer to an infection of the tonsils called tonsillitis. Tonsillitis is usually caused by a virus but can also result from a bacterial infection (usually strep throat).

Tonsillitis can cause symptoms such as a sore throat, fever, bad breath, yellow or white patches in the throat, pain or difficulty with swallowing, and/or sleep problems.

Swollen tonsils can heal independently, or they may need treatment such as medication or surgery.