Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 29, 2016

Tonsillitis is a somewhat common ailment of young children between the ages of 3 and 7 and can affect adults with weakened immune systems and poor nutritional habits. Tonsillitis can be effectively recognized, diagnosed, treated and prevented through medical therapies and procedures.


Definition & Facts

Tonsillitis is defined as an inflammation of the tonsils. It results in a sore throat that can spread to the adenoids and the pharynx. The tonsils are located on the right and left side of the far back area of the throat. They are oval-shaped lymphatic tissues (part of the body's infection-fighting system), which benefit a child's health.

The tonsils aid the body in fighting respiratory infections as they contain antibodies that are structured to attack and clear infection, particularly for children. They filter germs, organisms, viruses, and bacteria that enter the body.

Tonsils increase in size from infancy and continue to grow larger up to the ages of 8 and 9. Within a few years they decrease significantly in size and remain smaller throughout life with the exception of actual surgical removal of the tonsils (tonsillectomy).

With a child's growth spurts, infections concerning the tonsils are not as frequent. Tonsillitis is not considered a serious condition unless abscesses with the tonsils occur. With abscesses, actual swelling of the tonsils can cause difficulties in breathing. Other resulting conditions may bring on ear infections and problems with the pharynx and adenoids, which are the swellings at the back of the nasal cavity directly above the tonsils.

Symptoms & Complaints

The symptoms of tonsillitis can include sore throat, red, swollen and inflamed tonsils, a white or yellow-like streaking or coating that appears directly on the tonsils and the throat area as well as fever, chills, vomiting, putrid breath, runny nose, congestion and stuffiness, muscle aches, troubled sleep, possible snoring, swollen neck glands, eye redness, hoarseness, rash, some coughing or sneezing, chronic ear infections and lethargy.

Complaints by tonsillitis sufferers consist of a continually sore and hurting throat, tenderness and pain around the neck area, dry mouth, earaches, difficulty hearing, eating, drinking, and swallowing, as well as feeling warm and uncomfortable from increased body temperature.


Most cases of tonsillitis are caused by infection from viruses, but bacterial infections also cause tonsillitis. The various viruses that can trigger tonsillitis are adenovirus, enterovirus, influenza virus, parainfluenza virus, Epstein-Barr virus, cytomegalovirus, measles virus, and herpes simplex virus.

With bacterial infections, Streptococcus is the common bacteria that can set tonsillitis in motion, as it is also the bacteria that is associated with strep throat. Other causes can come from different strains of strep, other bacteria, and viruses.

Since the tonsils play a big role in the immune system, and bacteria and viruses that enter through the mouth and nasal area can lodge directly in the tonsils, the tonsils themselves are susceptible to inflammation and infection.

Diagnosis & Tests

Diagnosis of tonsillitis is usually made through a general practitioner or an ear, nose, or throat specialist (ENT - otolaryngologist). The doctor will diagnose according to a patient’s medical history and an actual physical examination of the throat, nose and ears. He or she will also listen to the chest, feel the neck for lymph gland swelling and examine for other signs of infection.

Medical history is important to determine whether tonsillitis is a recurring condition and may require varying treatment options. A doctor will use a tongue depressor and a specialized light to look at the back of the throat and will determine whether a throat culture or a rapid strep test is necessary. If a virus like Epstein-Barr is suspected, which is associated with mononucleosis and can cause tonsillitis, a test for it may also be performed.

With either a bacterial infection such as strep, or a virus being the likely causes of the infection, a doctor will perform one or both of the tests and likely determine a course of treatment. These tests along with the recurring medical history will determine whether a more advanced procedure such as surgery for removal of the tonsils (tonsillectomy) is brought into consideration.

Treatment & Therapy

Treatment for tonsillitis that is caused by bacteria is usually through a course of prescribed antibiotics. Penicillin is commonly prescribed and is administered either through an injection (shot) or orally through a series of pills prescribed for a certain time frame, which is usually 10 days. Amoxicillin is also utilized for children due to its more acceptable taste. In order to kill all the bacteria, every pill should be taken even if symptoms subside and health is restored. If an allergic reaction to penicillin is encountered, other antibiotics such as erythromycin, azithromycin, and cephalosporins are administered.

If tonsillitis is caused by a virus, antibiotics will not be of help and the body will have to fight off the infection on its own. The suggested course of action or treatment for viral infection relief would be the administration of pain relievers such as ibuprofen, acetaminophen or throat lozenges. In addition, throat pain can be relieved through gargling with 8 ounces of warm salt water (1 teaspoon of salt). Consumption of warm liquids is important as well to soothe the throat, prevent dehydration, and clear the sinuses and relieve chest congestion.

Only when medical history suggests that tonsillitis has become a chronic condition with complications and other disease involvement should an operation to remove the tonsils be considered. A tonsillectomy should be given thought and only undergone if the conditions exist for removal, such as enlargement of the tonsils from infections that hamper breathing and other normal bodily functions.

Prevention & Prophylaxis

In most cases, tonsillitis can be prevented by avoiding contact or exposure to probable infection sources. Staying away from those who have respiratory infections or strep throat is one recommendation as is frequent hand washing, anti-bacterial hand sanitizers or wipes use, supplementing with immune boosting products, consuming nutritional foods and liquids, and not coming in contact with utensils or personal items handled by infected persons.

Recovery from tonsillitis is good and most patients recover without complications or problems. With the right medications and treatments, viral tonsillitis can be resolved within 7-10 days. Those with bacterial infections treated through a course of antibiotics can usually be healed and on the road to recovery within a one to two day period. More complicated tonsillitis cases require continual therapies that may result in actual surgical removal of the tonsils.