Tonsillitis is an infection that causes inflammation of the tonsils, which are located at the back of the throat and help protect the body against bacteria and viruses.

When the immune system is weakened due to illness or certain medications, viruses or bacteria can infect the tonsils, leading to symptoms such as a sore throat, difficulty swallowing, and fever.

Treatment for tonsillitis is prescribed by a primary care doctor or an ear, nose, and throat (ENT) specialist and varies depending on the underlying cause. It may include staying hydrated, taking anti-inflammatory medications, or using antibiotics to fight bacterial infections.

older man with hand on throat talking to male provider

Tonsillitis symptoms

The main symptoms of tonsillitis include:

Sore throat lasting more than 2 days;
Pain or difficulty swallowing;
Red and swollen throat;
Fever and chills;
Dry, irritating cough;
Headache or neck pain;
Loss of appetite;
Malaise and bad breath;
Swollen lymph nodes in the neck or jaw;
Voice changes;
Ear pain, in some cases.

When tonsillitis is caused by bacteria, white patches of pus may appear on the tonsils. In these cases, it’s important to see an ENT or a primary care provider so that antibiotic treatment can be started.

Confirming a diagnosis

Tonsillitis is diagnosed by an ENT specialist or a general practitioner based on an evaluation of symptoms and a physical exam of the throat.

In some cases, especially when pus is present, the provider may order a throat culture. This test involves collecting a sample of throat secretions to identify the bacteria causing the infection in order to choose the most effective antibiotic.

Possible causes

Tonsillitis is caused by infections from viruses or bacteria that lead to inflammation of the tonsils and related symptoms.

These microorganisms can spread through the air when an infected person coughs or sneezes, as well as through kissing or contact with contaminated objects.

Although rare, tonsillitis can also result from a fungal infection, particularly in people with weakened immune systems.

Types of tonsillitis

Tonsillitis can be categorized based on the cause of the infection and how long symptoms last:

1. Acute tonsillitis

Acute tonsillitis is characterized by symptoms that last about 3 to 5 days and usually improve even without specific treatment.

2. Chronic tonsillitis

Chronic tonsillitis involves long-lasting or recurring symptoms. People with this condition tend to have frequent episodes of tonsillitis. In these cases, a doctor may recommend individualized treatment, which could include surgical removal of the tonsils to prevent recurrence.

3. Bacterial tonsillitis

Bacterial tonsillitis is caused by a bacterial infection of the tonsils, most commonly by Streptococcus pyogenes. It can also be caused by Streptococcus pneumoniae, Staphylococcus aureus, or Haemophilus influenzae.

In some cases, bacterial tonsillitis may also result from infections caused by Treponema pallidum (syphilis), Neisseria gonorrhoeae (gonorrhea), or Chlamydia trachomatis (chlamydia).

4. Viral tonsillitis

Viral tonsillitis occurs when a viral infection affects the tonsils, most commonly caused by adenoviruses, rhinoviruses, influenza virus, respiratory syncytial virus (RSV), or coronavirus.

Other viral infections can also lead to tonsillitis, such as infectious mononucleosis, cytomegalovirus (CMV), rubella, hepatitis A, or HIV.

Treatment options

Tonsillitis treatment should always be guided by a primary care provider or ENT specialist and varies depending on the cause.

For viral tonsillitis, the doctor may recommend rest, proper hydration, and anti-inflammatory medications such as ibuprofen or acetaminophen (Tylenol) to relieve throat pain and reduce fever.

Gargling with warm salt water can also help soothe symptoms.

For bacterial tonsillitis, treatment involves antibiotics, typically penicillin-based drugs such as amoxicillin. However, if you are allergic to penicillin, your doctor may prescribe azithromycin or a cephalosporin antibiotic instead.

In more severe or recurrent cases, surgery to remove the tonsils (tonsillectomy) may be recommended.

Natural remedies

Drinking plenty of water, eating foods rich in vitamin C, and choosing soft or liquid meals can help relieve symptoms and support recovery.

A helpful home remedy for tonsillitis is gargling with warm salt water twice a day, as salt has mild antibacterial properties that can complement medical treatment.

Prevention strategies

To help prevent tonsillitis, it’s recommended to:

Avoid spending long periods in enclosed or crowded spaces with poor air circulation, such as shopping malls or gyms;
Avoid contact with people who have colds or the flu;
Clean your hands often with alcohol-based hand sanitizer;
Avoid touching your eyes, mouth, or nose with unwashed hands;
Do not share personal items that may come into contact with saliva or respiratory secretions, such as utensils, cups, or toothbrushes;
Always cover your mouth and nose when coughing or sneezing, using a disposable tissue or your sleeve.

It’s also important to wash your hands regularly with soap and water for at least 20 seconds before rinsing. This helps prevent tonsillitis and reduces the spread of infection.

Tonsillitis: Symptoms, Causes & Treatment