The tonsils are part of the body’s immune defence system, but they are also prone to infection. When viruses or bacteria infect the tonsils, inflammation can develop, leading to tonsillitis. This common condition may cause sore throat, difficulty swallowing, fever, and other symptoms that can affect daily life. In some cases, it may also lead to complications if not properly treated. Understanding the symptoms, causes, diagnosis, and treatment of tonsillitis can help patients recognise the condition early and seek appropriate care.
The tonsils are two masses of lymphoid tissue located at the back of the throat, one on each side. They help the body fight infection by supporting the immune response and producing antibodies.
However, the surface of the tonsils contains small pits and crevices known as crypts. These areas can trap bacteria, viruses, food particles, and debris. When germs multiply there, the tonsils may become inflamed and swollen, resulting in tonsillitis.
Tonsillitis is commonly divided into three types: acute, recurrent, and chronic.
Acute tonsillitis is usually linked to an upper respiratory tract infection and is often caused by viruses or bacteria. Common symptoms include sore throat, painful swallowing, fever, and cough. Symptoms may last from several days to around two weeks.
Recurrent tonsillitis refers to repeated episodes of infection. In some patients, the condition may return frequently enough to interfere with work, school, sleep, and quality of life.
Chronic tonsillitis usually causes milder but longer-lasting symptoms. Patients may have ongoing throat discomfort, a sensation of something stuck in the throat, or mild pain over a prolonged period. Chronic inflammation may also lead to enlarged tonsillar crypts, allowing debris to collect and form tonsil stones, which can contribute to bad breath.
Tonsillitis may be caused by either bacterial or viral infection.
One common bacterial cause is streptococcal infection, often referred to as strep throat. This type of infection can be contagious and may require timely treatment to reduce the risk of complications.
Many viruses can also cause tonsillitis, including adenovirus, rhinovirus, influenza virus, parainfluenza virus, Epstein-Barr virus, and enteroviruses.
Symptoms may vary in severity, but common signs include:
Doctors usually diagnose tonsillitis based on symptoms, physical examination, and, where necessary, further tests.
The doctor will ask about the severity and duration of the sore throat, whether swallowing is painful, and whether symptoms such as fever, cough, or nasal congestion are present. A history of previous tonsillitis or recent contact with someone with similar symptoms may also be relevant.
The throat is usually examined with a tongue depressor. Red, swollen tonsils, white or yellow patches, pus, or inflammation at the back of the throat may suggest tonsillitis.
If bacterial infection is suspected, the doctor may take a throat swab for culture. This can help identify the organism involved and guide antibiotic treatment.
Blood tests, such as a full blood count, may also help assess the cause and severity of the infection.
Treatment depends on the cause of infection, the severity of symptoms, and whether the problem is acute, recurrent, or chronic.
If tonsillitis is caused by bacteria, especially when pus is present, antibiotics may be prescribed. Mild cases are often treated with oral antibiotics, while more severe cases may require hospital admission and intravenous antibiotics.
For recurrent or chronic tonsillitis, doctors may recommend tonsillectomy, or surgical removal of the tonsils. This may help reduce repeated infections and related complications. Advanced surgical techniques, including coblation, may be used to remove tissue more precisely and reduce heat damage to surrounding areas.
Although tonsillectomy is common, it still carries possible risks, such as throat pain, difficulty swallowing, and bleeding. In more serious cases, complications may occur and should be assessed promptly.
Tonsillitis should not always be dismissed as a minor throat problem. If symptoms are severe, keep coming back, or are associated with breathing difficulty, persistent fever, worsening throat pain, or significant swallowing problems, medical attention should be sought promptly. If you have persistent, recurrent, or concerning throat symptoms, please consult an ENT specialist for assessment and appropriate treatment.
