Tonsillitis: Causes, symptoms, and treatment

Tonsillitis is an infection of the tonsils that affects millions of individuals each year.

Tonsils are situated at the back of the throat. They are collections of lymphoid tissue that form part of the immune system.

Although uncomfortable and unpleasant, the condition is rarely a major health concern. The vast majority of people, whether given medication or not, will fully recover from tonsillitis within a matter of days. Most symptoms will resolve within 7 to 10 days.

This MNT Knowledge Center article explains the causes, diagnosis, and symptoms of tonsillitis. Treatment, both at home and by a doctor, will also be covered.

Fast facts on tonsillitis

Here are some key points about tonsillitis. More detail and supporting information is in the main article.

Tonsillitis can be caused by a bacterial or viral infection.

The vast majority of tonsillitis cases will clear of their own accord within 10 days.

Tonsillitis can be diagnosed by examination of the throat and a bacterial swab.

There is a range of infectious agents that can cause the illness.

Tonsils are the body’s first line of defense against external pathogens.


diagram of tonsils
Tonsillitis typically resolves within a couple of days.

The most common symptoms of tonsillitis include:

a sore throat and pain when swallowing

red and swollen tonsils with pus-filled spots

high temperature


difficulty swallowing

pain in the ears and neck


difficulty sleeping



swollen lymph glands

Less common symptoms can include:


stomach pain and vomiting


furry tongue

changes in the sound of the voice

bad breath

difficulty opening the mouth

In some cases, tonsilloliths, also known as tonsil stones or tonsillar calculi, may be present. A tonsillolith is a calcified build-up of material in the crevices of the tonsils.

They are generally small, but in rare cases, tonsilloliths have measured 3 centimeters and above.

Tonsilloliths can be a nuisance and sometimes difficult to remove, but they are not generally harmful.

When to see a doctor

Although rare, tonsillitis can sometimes cause the throat to swell to such an extent that breathing becomes difficult. If this occurs, medical attention is necessary and urgent.

Additionally, if a person experiences any of the following symptoms, they should visit their doctor:

a fever of over 103˚ Fahrenheit

stiff neck

muscle weakness

a sore throat that persists for longer than 2 days


To diagnose tonsillitis, a doctor will start with a general examination and will be looking for a swollen tonsil region, often with white spots.

Doctors may also inspect the exterior of the throat for signs of enlarged lymph glands and a rash that sometimes occurs.

The doctor may also take a swab of the infected area for closer inspection by a laboratory, to determine whether the cause of the infection is viral or bacterial.

Doctors may also carry out a complete blood cell count. This test involves taking a tiny amount of blood to investigate levels of certain types of blood cell. This bloodwork can help supplement the information taken from the swab. In some cases, if the swab is inconclusive, a complete blood cell count can help the doctor determine the best treatment.


If tonsillitis cannot be treated at home, a range of treatment options is available.


Over-the-counter (OTC) painkilling medications, can be used to numb the effects of tonsillitis. Some pain relief medications are also available to buy online, including acetaminophen and ibuprofen.

If the tonsillitis is caused by a bacterial infection, a doctor will usually prescribe antibiotics. Antibiotics will not be prescribed for a viral case of tonsillitis.

Penicillin is the most commonly used antibiotic. People must take the full course of drugs, whether their symptoms are relieved or not. Failure to do so might allow the infection to spread, and has the potential to cause rheumatic fever or kidney inflammation in the long-term.


Surgery used to be a relatively common approach to dealing with tonsillitis. Today, tonsillectomies are not used unless the condition is chronic and recurring. For instance, if a person experiences tonsillitis seven times within a single year or 3 episodes per year for 3 consecutive years, a doctor would probably consider surgery.

Although the tonsils are increasingly less active following puberty, they are still an active organ and, therefore, doctors will not remove them unless necessary.

A tonsillectomy might also be called upon if the tonsils are causing secondary issues such as:

sleep apnea, which involves problems breathing at night

difficulty breathing or swallowing

an abscess that is difficult to treat

tonsillar cellulitis, when the infection spreads to other areas and causes a buildup of pus behind the tonsils

If a tonsillectomy is required, there are a variety of methods that may be used. Lasers, radio waves, ultrasonic energy, cold temperatures, or a needle heated by electricity have all been successfully used to remove the tonsils.

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