Ear, Nose & Throat ENT Disorders Causes, Diagnosis, and Treatment of Tonsillitis A condition most will experience before adulthood By Kristin Hayes, RN facebook twitter Kristin Hayes, RN, is a registered nurse specializing in ear, nose, and throat disorders for both adults and children. Learn about our editorial process Kristin Hayes, RN Medically reviewed by Medically reviewed by John Carew, MD on January 10, 2020 twitter linkedin John Carew, MD, is board-certified in otolaryngology and is an adjunct assistant professor at New York University Medical Center. Learn about our Medical Review Board John Carew, MD Updated on February 27, 2020 Print Table of Contents View All Understanding Tonsillitis Causes Symptoms Diagnosis Treatments Tonsillectomy Home Remedies to Try Related Complications We often think of tonsillitis as one of those rites of passages that children go through alongside chickenpox and braces. While the condition does commonly occur during the preschool to middle-teen years, it can happen at any time in life, for a variety of reasons. Illustration by Cindy Chung, Verywell The ways tonsillitis is diagnosed and treated have changed considerably in the past 30 years. There are now rapid tests that can help us pinpoint infections more quickly and newer drugs able to overcome resistant bacteria. With that being said, the rate of tonsillectomy (the surgical removal of the tonsils) has actually risen since the 1970s, according to a study from the Mayo Medical School College of Medicine. Understanding Tonsillitis Your tonsils are a part of the lymphatic system, which is responsible for eliminating toxins and harmful microorganisms (including viruses and bacteria) from your body. Your tonsils work by trapping inhaled particles and delivering them to the lymphatic system to be neutralized. There are three pairs of tonsils in your body: Nasopharyngeal tonsils, also known as adenoids, located at the roof of your mouth near where your nose connects to your throatLingual tonsils located behind the tonguePalatine tonsils located at the back of the throat Tonsillitis occurs when a virus or bacteria enters the mouth or nose and becomes trapped by the tonsils. When this happens, the immune system will target and attack the invaders and trigger an inflammatory response, causing fever and swelling. Tonsillitis is common, with most people experiencing at least one episode before adulthood, and it is highly contagious. It is most often seen in children ages five to 15 but can also occur between the ages of 15 and 25. The risk tends to decline as a person gets older. Causes The majority of cases of tonsillitis are caused by a virus, while anywhere from five percent to 40 percent are believed to be caused by bacteria. Some of the more common viral causes include: Cold viruses (including rhinoviruses and adenoviruses)Infectious mononucleosisCytomegalovirus (CMV)Epstein-Barr virus (EBV)Herpes simplex virus (HSV)Measles The most common bacterial causes include: Staphylococcus aureus (including MRSA)Whooping cough (pertussis)Bacterial pneumoniaStreptococcal pyogenes (strep throat) Non-infectious causes of swollen tonsils are rarer but may include cancer of the tonsils and cryptic tonsils. Symptoms Symptoms of tonsillitis tend to appear quickly and resolve within three to 14 days, often without treatment. The signs and symptoms may include: Painful swallowing (odynophagia)Difficulty swallowing (dysphagia)Inflammation and enlargement of the tonsilsPockets or patches of white on the tonsils (tonsillar exudates)Swollen lymph nodes, mostly around the neck (lymphadenopathy)FeverHeadacheFatigueSmall red or purple spots on the roof of your mouth (petechiae) The symptoms can vary by the type of virus or bacteria involved, as well as the age and health of the individual. While most cases of tonsillitis are acute—meaning they appear and resolve quickly—they can also be recurrent (relapsing multiple times per year) or chronic (lasting for more than three months). Diagnosis The diagnosis of tonsillitis is based first on a physical exam and a review of your medical history. In cases where there are symptoms of strep throat (fever, tonsillar exudate, swollen lymph nodes around the neck, and no coughing), the doctor will take a swab of your throat and have it cultured in a lab to confirm the presence of the strep bacteria. Lab results typically take between 24 and 48 hours. Newer, rapid genetic tests can be used and, while slightly less sensitive than a throat culture, are able to return results in as little as 10 minutes. Treatments The symptoms of tonsillitis tend to be more annoying than serious and usually require little medical intervention. If you have viral tonsillitis, the treatment will be focused on relieving pain and fever with over-the-counter pain relievers, such as Tylenol (acetaminophen) or Advil (ibuprofen). Prescription drugs, including antivirals, are typically not prescribed.By contrast, bacterial tonsillitis is commonly treated with antibiotics. Penicillin and amoxicillin are the standard, first-line choices, although erythromycin and newer antibiotics like linezolid may be used in cases of drug resistance. Tonsillitis symptoms usually go away within a few 24 hours of starting treatment. If the tonsils are so large that they interfere with breathing, the doctor may prescribe an oral corticosteroid (steroid) drug to help reduce their size. However, steroids of any sort should be used with caution due to their significant side effects. Tonsillectomy If you have chronic or recurrent tonsillitis that is impacting your quality of life, your doctor may recommend a tonsillectomy. There are several methods for performing this surgery, among them ultrasonic scalpels, high-frequency plasma scalpels, electrical cauterization, and traditional "cold knife" surgeries. While tonsillectomies are relatively common and safe, it is important to discuss both the risks and benefits of the surgery with your doctor. Tonsillectomy: Having Your Tonsils Removed Home Remedies to Try Whether or not you are prescribed treatment, there are home remedies that can greatly alleviate many of the symptoms of tonsillitis. In addition to using an over-the-counter pain reliever, try: Sipping warm fluids like teas or brothDrinking cold fluids or sucking on popsiclesSucking on anesthetic throat lozenges or using a throat spray containing benzocaineGargling with a solution of 1/2 teaspoon of salt combined with eight ounces of warm waterPlacing a cool compress or ice pack on your neckUsing a cool-mist humidifier It is important to note that aspirin should be avoided in children with any viral infection due to an increased risk of Reye’s syndrome, a potentially life-threatening inflammation of the brain and liver. Related Complications It's important to remember that most cases of tonsillitis resolve on their own without causing lingering problems. However, serious or recurrent cases can lead to complications such as otitis media (middle ear infection) or peritonsillar abscess (the formation of a pus-filled pocket near the tonsils). The tonsils can sometimes become so swollen that they interfere with breathing and swallowing. This can lead to a more serious condition known as obstructive sleep apnea. Sleep apnea is a condition where a person stops breathing for brief periods of time while sleeping. This can lead to daytime fatigue, depression, mood swings, and other, more serious health issues such as high blood pressure and heart disease. Obstructive sleep apnea is also a leading indication for tonsillectomies in persons with chronic or recurrent tonsillitis. An Overview of Sleep Apnea A Word From Verywell If someone in your family has tonsillitis, it is best to isolate that person and keep others, especially children, well away until the symptoms are resolved. If you’re treating a family member, wash your hands after touching them and consider wearing a face mask if there is any coughing or sneezing. Do not allow a child to go to school until she or he is fully recovered and no longer contagious. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Erickson, B.; Larsen, D.; St. Sauver, J. et al. Changes in incidence and indications of tonsillectomy and adenotonsillectomy, 1970-2005. GMS Curr Top Ortorhinolaryngol Head Neck Surg. 2009; 140(6):894-901; DOI: 10.1016/j.otohns.2009.01.044. Stelter, K. Tonsillitis and sore throat in children. GMS Curr Top Ortorhinolaryngol Head Neck Surg. 2013; 13:doc07; DOI: 10.3205/cto000110 Georgalas CC, Tolley NS, Narula A. Tonsillitis. BMJ Clin Evid. 2009;2009