What is Tonsillitis?

Tonsillitis is a condition where inflammation occurs in the tonsils. These are two flaps of soft tissue located at either side at the back of the throat. Their main role is to protect the body against germs and prevent sickness. However, when tonsillitis occurs, the tonsils become infected due to a virus or bacteria. Generally, a person with tonsillitis will experience sore and swollen tonsils. In Australia, tonsillitis is most commonly seen in children between the ages of 0-14 (1,2) but can also occur in adults. Each year, Australian general practitioners (GPs) will have 550,000 consultations because of tonsillitis alone [3]. Treatment will vary depending on the severity of tonsillitis, its cause and a person’s characteristics.

Tonsillitis Symptoms

Mainly, tonsillitis occurs as a result of tonsil infection due to a virus or bacteria. Although the main symptoms are a sore and swollen throat, here are some other symptoms that people may experience [2]:

Fever or high temperature
Pain when swallowing
Sore lymph nodes (located below the jaw and on either side of the throat)
Feeling unwell and tired
Bad breath
A scratchy and rough voice
Pain around the ears

Tonsillitis Causes

As previously mentioned, tonsillitis is an infection to the tonsils caused by a virus or bacteria. In roughly 40-60% of the time [4], they are caused by viruses, which can include [1]:

Adenovirus
Influenza
Common cold
Rhinovirus
Coronavirus

About 30% of children and 15% of adults with sore throats will have bacterial tonsillitis [4]. It’s crucial that bacterial tonsillitis is treated appropriately, or it can become serious. In most cases, bacterial tonsillitis is caused by Streptococcus pyogenes [5]. However, other bacteria that are found in the throat have also been known to cause this condition, including [1]:

Staphylococcus aureus
Pneumococcus or Streptococcus pneumoniae
Haemophilus influenzae

Differentiating between bacterial or viral tonsillitis can be difficult. However, it’s essential to see a doctor for appropriate advice and treatment to see if symptoms are getting worse or not improving.

Tonsillitis Diagnosis and Tests

Your doctor will perform a thorough medical history and physical examination for a diagnosis. Additional tests may be conducted to confirm this diagnosis and rule out other conditions depending on their findings. During the consultation, the doctor will try to determine whether the tonsillitis is caused by either a virus or bacteria [6]. Differentiating a viral or bacterial cause may change the management of this condition. However, there is no single test that can definitively distinguish between these two causes. If a bacterial infection is suspected, throat swabs and/or blood testing can be conducted to provide more information.

Throat Swab

During a throat swab examination, samples of your saliva are collected from the tonsils and back of the throat. You will be required to open your mouth so that a cotton bud can access the necessary locations. Afterwards, the sample will be sent to the laboratory for further analysis.

Blood Test

Although not always needed, sometimes a blood test will be ordered to help differentiate between a bacterial and viral infection or to exclude other conditions such as Glandular Fever which can present in a similar way to Tonsillitis. These blood tests will look for antigens or proteins belonging to bacteria or viruses, especially Streptococcus pyogenes [6].

CT Scans

In even rarer situations, imaging investigations like CT scans may also be recommended to rule out other conditions, such as peritonsillar abscess [6].

Is Tonsillitis Contagious?

Whilst tonsillitis itself is not contagious, the viruses and bacteria that cause tonsillitis can be transmitted.

How do you get tonsillitis?

Viruses, such as influenza and the common cold, are spread through coughing, sneezing or even talking. Droplets can be passed onto other people or even live on surfaces (e.g. door handles, tables). Bacterial infections are also transmitted through droplets and direct contact with infected individuals (e.g. mucus, saliva, etc.). These infections tend to spread more quickly in busy and confined areas, such as workplaces and schools. Children, in particular, will transmit bacterial tonsillitis more often. Proper hygiene protocols, such as washing your hands, sterilisation and cleaning the environment regularly, is crucial for preventing transmission.

Tonsillitis Treatment

Tonsillitis treatment will often depend on several factors, including whether it was caused by a virus or bacteria, the severity of the condition and the course of progression. In most situations, following a self-care regimen will be enough to ease symptoms and improve recovery. Examples of self-care practices that your GP include may recommend:

Drinking plenty of water to keep hydrated
Rest
Using lozenges ease sore throats
Eating soft foods, like jelly or potato mash, to prevent further irritation.
Anti-bacterial or saltwater gargles to speed up recovery.
Medications, such as paracetamol (i.e. Panadol) and ibuprofen (i.e. Voltaren, Nurofen) to help with pain, throat soreness and fever

Bacterial Tonsillitis Treatment

For bacterial infections, tonsillitis antibiotics may be prescribed to prevent further complications, such as scarlet fever, rheumatic fever and quinsy [2]. Typically, a 10-day course of penicillin will be [2] prescribed. However, those allergic to penicillin may be prescribed other types of medication. You must ensure that the full dose of antibiotics is taken (even when there are no symptoms) to prevent further complications.

Tonsil Surgery

Surgery may be recommended for those who are not improving, experience recurrent episodes or complications (i.e. peritonsillar abscess). During procedures such as a tonsillectomy or tonsillotomy [7], the tonsils are either fully or partially removed. Most procedures will be performed under general anaesthetic so that the patient will be asleep and unaware of what is happening. Although there can be some side effects, such as bleeding and pain [8], most children and adults will make a full recovery [2].

Complications

Whilst most people diagnosed with tonsillitis tend to recover quickly, some people experience complications. If not managed appropriately or early enough, some of those with bacterial tonsillitis may develop more serious conditions, such as scarlet fever, peritonsillar abscess, rheumatic fever, glomerulonephritis, Lemierre's disease plus others [2]. Additionally, some people may also experience recurrent tonsillitis. Children with tonsillitis for the first time and those whose symptoms are not improving should consult their GP as soon as possible.

Recovery

Generally, most people with tonsillitis will recover naturally with self-care. As noted earlier (see 'Complications' section), complications and recurrent tonsillitis are less common. However, most people with these complications and recurring problems will still have good outcomes with modern medicine. To reduce the likelihood of these problems, seeking early and appropriate medical treatment will speed up recovery.

References

Windfuhr, J. P., Toepfner, N., Steffen, G., Waldfahrer, F., & Berner, R. (2016). Clinical practice guideline: tonsillitis I. Diagnostics and nonsurgical management. European Archives of Oto-Rhino-Laryngology, 273(4), 973-987.
Anderson J, Paterek E. Tonsillitis. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544342/
Hibbert, P., Stephens, J. H., de Wet, C., Williams, H., Hallahan, A., Wheaton, G. R., ... & Braithwaite, J. (2019). Assessing the quality of the Management of Tonsillitis among Australian children: a population-based sample survey. Otolaryngology–Head and Neck Surgery, 160(1), 137-144. F
Kullar, P., & Yates, P. D. (2012). Infections and foreign bodies in ENT. Surgery (Oxford), 30(11), 590-596.
Tran, J., Danchin, M., Pirotta, M., & Steer, A. C. (2018). Management of sore throat in primary care. Australian journal of general practice, 47(7), 485.
Georgalas, C. C., Tolley, N. S., & Narula, P. A. (2014). Tonsillitis. BMJ clinical evidence, 2014, 0503.
National Institute of Health and Care Excellence. (2019, November 13). “Rapid tests for group A streptococcal infections in people with a sore throat.” https://www.nice.org.uk/guidance/dg38/chapter/2-The-diagnostic-tests
Windfuhr, J. P., Toepfner, N., Steffen, G., Waldfahrer, F., & Berner, R. (2016). Clinical practice guideline: tonsillitis II. Surgical management. European Archives of Oto-Rhino-Laryngology, 273(4), 989-1009.

Tonsillitis – Symptoms, Diagnosis, and Treatment