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Tonsillitis: Causes, symptoms, diagnosis and treatment

Tonsillitis: Causes, symptoms, diagnosis and treatment

Most cases of tonsillitis resolve on their own within a week. However, one requires adequate care and rest
Tonsillitis: Illustration of a man with throat irritation
Representational Image | Shutterstock

Tonsillitis refers to the inflammation and swelling of the tonsils, usually in response to a viral or bacterial infection. The tonsils are small glands or masses of lymphatic tissues, located in the pharynx (throat). Lymphatic tissues produce cells (lymphocytes) to fight infection.  

The tonsils are important to prevent infection, especially in children. As children grow and their immunity develops, the tonsils no longer play an important role and may start to shrink.  

 There are 4 distinct tonsillar glands –  

Palatine tonsils / faucial tonsils– These glands are commonly referred to as  “tonsils”. They are present on either side at the back of the throat and serve as the primary defence against microbes that enter the throat or respiratory tract. 

Pharyngeal tonsils – This is a single mass of tissue present on either side of the midline, on the roof where the nasal cavity meets the pharynx. When they get inflamed, they are referred to as adenoids. 

Lingual tonsils – These are relatively smaller masses of tissue on the surface at the posterior part of the tongue. They rarely get inflamed or infected. 

Apart from these, there is a small pair of tubal tonsils on either side where the middle ear connects to the back of the throat. 

 Typically, it is the inflammation and swelling of the palatine tonsils that is referred to as tonsillitis. It can occur at any age but is more common in children and among pre-teens. 

 Symptoms of tonsillitis

 In normal conditions the tonsils are pink in colour. In response to an infection, they become red and swollen. Other symptoms may be: 

  • A sore throat 
  • A coating over the tongue and glands, or white spots with pus, visible all over the tonsils 
  • Younger children may have nausea or vomiting along with stomach pain.  They may drool because of difficulty in swallowing saliva  
  • Bad breath and loss of appetite 
  • Coughing and a feeling of sickness that resembles a common cold or flu 
  • Pain and difficulty while swallowing as the throat is partially blocked by these swollen glands 
  • Fever, headache, and earache 
  • Swelling (of lymph nodes) in the neck region 
  • Changes in the voice 

 Often the symptoms subside after 4-5 days, especially if the infection was caused by a virus. 

 Causes of tonsillitis

  •  Viruses are responsible for most of the cases of tonsillitis. Some of the common viruses are rhinoviruses which cause the common cold, influenza virus and the adenovirus (which causes diarrhoea). 
  • Group A streptococcus bacteria can also cause tonsillitis along with a condition called strep throat. 

When children are infected by such microbes and the viral/bacterial load becomes high, the infection gets trapped in the tonsils, causing the glands to swell up in response. 

 Tonsillitis is not contagious,  however the viruses and bacteria that cause it can spread easily. When a person with tonsillitis coughs or sneezes, the virus  present in the droplets  can be directly inhaled by others present nearby. Infection can also spread indirectly when someone rubs their nose or mouth after touching a surface or object contaminated by such droplets. 


While a diagnosis of tonsillitis can be made by analysing the symptoms and examining the throat, clinically it is difficult to differentiate between tonsillitis caused by bacteria and one that is of viral origin. 

  • A thorough visual examination of the throat, ears, and nose is performed, as well as palpating (feeling) for enlarged lymph nodes around the neck and below the lower jaw. 
  • When the typical symptoms are present, a strep test or throat culture is done with a throat swab. Rapid antigen tests can be done to confirm bacterial infection and treatment planned accordingly. But these tests often come up with false negative results, in which case a throat culture is required. 
  • A blood test may also be done to rule out other conditions like glandular fever, especially in teenagers and adults. 

 Tonsillitis: treatment 

 Most cases of tonsillitis resolve on their own within a week.  

  • Children should be given plenty to eat and drink, to prevent headaches and lethargy. 
  • A doctor may prescribe painkillers to help effectively manage the pain 
  • Gargling with warm salt water or antiseptic solutions are often effective at relieving pain from a sore throat.  
  • A doctor may prescribe oral antibiotics after identifying or suspecting that the organism causing the infection is a bacterium. This is done when the symptoms of tonsillitis are severe and are not subsiding. 
  • Severe infections may require hospitalisation and intravenous antibiotics 


Sometimes surgery is performed to remove the tonsils. This procedure is called tonsillectomy and is indicated only under certain conditions –   

  • Recurrent or chronic tonsillitis that has caused sore throat several times in the past year 
  • If bacterial tonsillitis and the sore throat do not respond to antibiotic treatment 
  • In case of swollen lymph nodes in the neck region 
  • In case of complications like difficulty in breathing, obstructive sleep apnoea (Breathing is interrupted during sleep), and extreme difficulty in swallowing
  • Presence of an abscess (localised collection of pus) that does not clear with antibiotics 

 Complications from tonsillitis are not common, but can include –   

  • A peritonsillar abscess called quinsy, can develop between one of the tonsils and the wall of the throat, more often in adults. It can worsen very quickly with difficulty in speaking, swallowing and even breathing, and requires immediate medical intervention. 
  • Rarely, bacterial infections that cause tonsillitis may spread to the middle ear, or the sinuses, or down into the lungs, or even to the kidneys. 


  • Children are particularly susceptible to air-borne infections. They should be taught to wash their hands after using the restroom, and before eating 
  • They should be discouraged from sharing water bottles and other items in school 
  • Toothbrushes should be replaced after one recover from a sore throat 


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