Tonsillitis symptoms include:

• sore throat
• pain when swallowing
• loss of voice or change in voice
• high body temperature
• tiredness
• coughing
• sickness
• headaches
• earache
• swollen tonsils
• throat redness

If you notice any of these signs of tonsillitis, speak with your pharmacist who will be able to offer you treatment and advice. If these symptoms of tonsillitis persist, you should visit your GP.

In more severe cases of tonsillitis, you might also experience:

• white spots at the back of the throat
• painful and swollen neck glands
• bad breath
• grey furry tongue

If you are experiencing these more severe symptoms, you should speak with your GP who will be able to offer you advice and treatment for your tonsillitis.

The tonsillitis incubation period is 2 to 4 days. This means symptoms start to appear 2 to 4 days after catching the infection. During this period, you can still pass on tonsillitis to others despite not displaying any symptoms of inflamed tonsils.

Tonsillitis can feel different depending on whether it is caused by a viral or bacterial infection. Symptoms are often milder when they are caused by a virus. Bacterial tonsillitis symptoms can be more severe and may be accompanied by bad breath.

Read Chapter 2 to find out about the differences between bacterial tonsillitis symptoms and viral tonsillitis symptoms.

When you have tonsillitis, your tonsils will often appear red, enlarged and swollen, with redness of the throat. If you have a more severe tonsillitis caused by a bacterial infection, you might also notice whitish pus-filled spots on your tonsils, a swollen uvula and a grey furry tongue.

For pictures of tonsillitis, see Chapter 10.

Complications of tonsillitis mostly affect children aged 2 to 4. However, it is very rare for complications of tonsillitis to occur. Quinsy is a result of a pocket filled with pus, also known as an abscess, forming between your tonsils and the wall of your throat.

Symptoms of quinsy:

• severe sore throat that quickly gets worse
• swollen mouth and throat
• bad breath
• difficulty speaking
• difficulty swallowing
• difficulty breathing
• difficulty opening your mouth
• drooling

It is important to see a GP urgently or visit A&E if you believe you might have quinsy tonsils.

When you catch an infection, your tonsils help your body to fight off that infection. As part of your immune system, they work similarly to how your lymph nodes (glands in your neck) work, as the first line of defence against infection. As your tonsils fight infection, they usually become red and start to swell, causing your throat to become sore.

Most tonsillitis infections are viral, usually resulting from the common cold or flu. The symptoms of viral tonsillitis are usually milder than its bacterial counterpart and cannot be treated with antibiotics.

Up to one in three cases of tonsillitis are a result of a bacterial infection. Bacterial tonsillitis usually has more severe symptoms than viral tonsillitis and can be accompanied by bad breath. Children are the most likely to get bacterial tonsillitis.

There a few important differences between viral and bacterial tonsillitis, including:

• Causes. Viral tonsillitis is caused by viral infections such as the common cold and flu, whereas bacterial tonsillitis is caused by bacteria, most commonly group A streptococcus.
• Likelihood. Most tonsillitis infections are caused by a viral infection in both adults and children, not bacterial.
• How they look. With viral tonsillitis, the tonsils appear swollen and red with redness of the throat. Bacterial tonsillitis might also be accompanied by a swollen uvula, whitish spots on the tonsils and a grey, furry tongue.
• How they are treated. In most cases, viral tonsillitis can be treated with at-home care and over-the-counter medicines, not antibiotics. However, bacterial tonsillitis will often require antibiotics to fight the infection.

Diagram of bacterial and viral tonsillitis:

While tonsillitis can often be treated at home, there are some cases where you will need to see a GP:

• If you have severe tonsillitis that makes it difficult to eat or drink.
• You have whitish pus-filled spots on your tonsils. This is a sign of bacterial tonsillitis which may require antibiotics from your GP.
• Your symptoms have not passed after four days.

Acute tonsillitis can often be treated at home:

• Rest often. Resting can help speed up the process of healing tonsillitis.
• Drink cool drinks. Drinking cool liquid can help to soothe your throat and keep you hydrated.
• Take painkillers. You could try taking paracetamol or ibuprofen to help relieve the pain of tonsillitis.
• Humidify the air. When you have tonsillitis, you might experience a dry mouth. Using a humidifier can help to prevent dry air from further irritating your throat by adding moisture to the air. Keep your humidifier on while you sleep at night until the symptoms of tonsillitis have passed.

If your tonsillitis is caused by a bacterial infection, your doctor might prescribe you with a course of antibiotics to help fight the infection. In most cases, you will be prescribed with a 10-day course of penicillin or amoxicillin to help fight bacterial tonsillitis infections. If you are allergic to penicillin, there are alternative medicines that your GP can prescribe.

It is important to complete the entire course of antibiotics, even if your symptoms have gone before your course is finished. If you fail to complete a full course of antibiotics, you risk the infection worsening and spreading to other parts of the body. This can increase your risk of developing serious kidney inflammation and rheumatic fever.

Your doctor will use the centor criteria to decide whether to prescribe antibiotics or adopt a ‘watch and wait’ approach. The suggested management depends on your score:

• No further testing or antibiotics (score 0-1)
• Throat swab culture (score 2-3)
• Antibiotics or culture (score 4+)

Centor criteria table:

Tonsillectomy is a surgery which involves removing your tonsils. This is a rare procedure and is only necessary in cases of severe tonsillitis that keeps coming back.

Although tonsillectomy can be a cure for tonsillitis, you can still get infections or a sore throat after your tonsils have been removed. However, having your tonsils removed has been shown to be effective at getting rid sore throats for many patients.

In most cases, tonsillitis can be treated by a GP and does not require your tonsils to be removed. If you think you need a tonsillectomy, speak with your doctor to see if you meet the criteria.

During a tonsillectomy surgery, most of your tonsil tissue is removed. However, some tissue might remain which can result in tonsils occasionally regenerating. Despite this, it is unlikely for your tonsils to ever fully grow back to their original size after having them surgically removed. The younger you are when your tonsils are removed, the more likely it is that they will grow back.

During your appointment, your GP will ask about your symptoms and examine the back of your throat. This will help them to determine the cause of your tonsillitis and provide you with the best treatment plan.

In some cases, your GP might swab the back of your throat with a cotton bud to test for bacteria. If you have severe tonsillitis, your GP might also refer you to have a blood test to determine whether or not you have glandular fever.

Gargling warm salt water and rinsing your mouth with warm salt water can help to soothe your sore throat. It is important to note that this is not suitable for small children. Watch this video on how to gargle warm salt water:

It can often be difficult to eat with tonsillitis as many foods can irritate your throat. The best foods to eat with tonsillitis are:

• Soft foods. Bananas, avocados, rice and mashed potatoes are all foods that you can enjoy without causing much irritation to your tonsillitis.
• Smoothies. Cold smoothies are great to drink when you have tonsillitis as they are an easy way of consuming fruit and vegetables while also having the cold temperature soothe your throat.

Natural remedies for tonsillitis include:

• Throat lozenges. Your pharmacist will be able to offer you medicated throat lozenges that can help soothe a sore throat.
• Using something cold like popsicles or frozen drinks for your infection can be an effective way of soothing the pain.
• Tea with honey. Drinking tea with honey can help to relieve the symptoms of tonsillitis as raw honey has anti-inflammatory benefits.
• Ginger. Studies show that ginger might help with pain and inflammation, helping you to remedy your tonsillitis naturally.
• Liquorice can be used with caution. Too much has the potential to raise blood pressure and reduce potassium levels in the body. It is also best avoided if you are on blood pressure medication. Many liquorice flavoured products do not actually contain any liquorice, instead they are flavoured with aniseed which has a similar taste to liquorice but lacks its anti-inflammatory benefits.

If you are struggling to relieve your tonsillitis symptoms using these methods, you might need to see a doctor for treatment. Bacterial infections such as strep throat will require antibiotics and natural remedies for tonsillitis might not work. Speak with your GP who will be able to suggest the best treatment for your tonsillitis.

Ultra chloraseptic anaesthetic throat spray can be used to help relieve the symptoms of a sore throat caused by tonsillitis. It contains the active ingredient benzocaine, a local anaesthetic. When sprayed at the back of your throat, it quickly numbs the pain of a sore throat caused by tonsillitis.

⚠ You should not use this spray if:

• You have difficulty breathing, noisy breathing or you struggle to swallow. Instead, speak to your GP.
• You are allergic to benzocaine or any other ingredients in the spray.
• You have a rare blood condition called methaemoglobinaemia.
• You are pregnant or breastfeeding.
• You are under the age of 6.

How to use throat spray for tonsillitis:

1. Read the instructions that come provided with the spray.
2. Rotate the nozzle so that it points away from the bottle.
3. Before using the spray for the first time, activate it by pressing on the pump three times, spraying into the sink.
4. Place your index finger on the pump while holding the bottle in your hand, ready to spray.
5. Point the nozzle to the back of your throat with the nozzle just inside your mouth. For the first few times, you may find it easier to do this while standing in front of a mirror.
6. Hold your breath and spray by pressing down on the pump. It is important not to exceed the stated dosage on the label.

Ultra chloraseptic anaesthetic throat spray can be purchased from your local pharmacy. It is worth noting that there is little evidence to suggest that non-medicated throat sprays help with tonsillitis symptoms. If you experience any side effects while using a throat spray, talk to your GP or pharmacist.

A 2017 study published in the International Archives of Otorhinolaryngology found that smokers may encounter more chronic or recurrent tonsillitis episodes than non-smokers. It was also found that smokers were significantly more likely to experience bleeding tonsils after undergoing tonsillectomy surgery. The authors concluded that quitting smoking might help to reduce episodes of tonsillitis and post tonsillectomy bleeding.

Researchers have also found that children of parents who smoke have an increased chance of acquiring tonsillitis (2014 study published in the European Journal of Pediatrics).

It is worth noting that quitting smoking comes with many health benefits. The following resources can be used to help you quit smoking:

• Smokefree National Helpline. Call 0300 123 1044 for free expert advice on quitting smoking from the NHS. Available for residents in England only.
• Smokefree 28 day programme. Expert advice and tips on how to quit smoking sent to your email inbox for 28 days.
• Local Stop Smoking Service. Free support is available in your local area to help you stop smoking.
• Online chat. Smokefree offer an online chat with their expert advisors to help you quit smoking.

If you are struggling to quit smoking on your own, speak to your GP or pharmacist who will be able to offer you support.

In most cases, tonsillitis will clear up within 7 to 10 days. However, tonsillitis can be resolved in as little as 3 days. If after 3 or 4 days your tonsillitis does not start to improve, speak with a GP who will be able to examine your tonsillitis and assess the best course of action for you.

Bacterial tonsillitis symptoms can disappear within 24 hours and the infection can clear within 5 to 7 days after taking antibiotic treatment from your GP. Even if your tonsillitis symptoms disappear before your antibiotic course has ended, it is important to take the full course to prevent the infection from worsening and spreading to other parts of your body. Without treatment, bacterial tonsillitis will usually persist for 10 to 14 days.

Tonsillitis is contagious for about 7 to 10 days if the infection was viral and up to 2 weeks for untreated bacterial infections. During this tonsillitis contagious period, others might become infected. It is the infections that cause tonsillitis that is contagious, not tonsillitis itself.

Recurrent tonsillitis is when you have tonsillitis that keeps coming back. This is generally defined as:

• more than 7 episodes of tonsillitis in the previous year
• 5 or more episodes of tonsillitis in each of the previous 2 years
• 3 or more episodes of tonsillitis in each of the previous 3 years

If you have recurrent tonsillitis, your GP might suggest that you undergo tonsillectomy surgery as a last resort to reduce your chances of tonsillitis coming back. To learn more about tonsillectomy, see Chapter 3.

Chronic tonsillitis is when you have tonsillitis for an extended period of time (when symptoms have persisted for longer than 2 weeks). If you have chronic tonsillitis, speak to your GP as you might require antibiotics to help clear the infection. As a last resort, your GP might recommend having your tonsils surgically removed.

Tonsillitis itself is not contagious but the infections which cause it are. Tonsillitis causes differ depending on whether the infection is viral or bacterial. Being in close proximity to someone with an active infection is usually what causes tonsillitis.

You can reduce your chances of getting tonsillitis by carrying out strict hygiene practices and staying clear of people who are infected by tonsillitis. If you already have tonsillitis, try to stay away from others until your infection clears up to lessen the chances of it spreading.

Children who have not undergone tonsillectomy are the most susceptible to tonsillitis. The condition is rare in adults as the function of the tonsils in the immune system as the first line of defence against infection declines after puberty. However, it is still possible for people of all ages to have tonsillitis.

Tonsillitis infections are highly contagious and can be caught by kissing or coming into close contact with an infected person. Symptoms of tonsillitis might not show for up to 48 hours after being infected.

When you undergo tonsillectomy, some tonsil tissue can remain and regenerate over time. Therefore, it is still possible to get tonsillitis after having your tonsils removed. However, tonsillectomy has been shown to significantly reduce your chances of getting tonsillitis. To learn more about tonsillectomy, see Chapter 3.

While not all cases of tonsillitis can be prevented, you can reduce your chances of getting tonsillitis by practicing good hygiene. This involves frequently washing your hands with warm, soapy water to help prevent the spread of infection. When you don’t have access to water, alcohol-based sanitisers can help to kill bacteria on your hands. You should also take measures to disinfect the surfaces in your home.

Tonsillitis symptoms include:

• Persistent sore throat
• Abdominal pain
• Pain when swallowing
• Loss of voice or change in voice
• Refusing to eat. If you’re having more difficulty than usual feeding your child or toddler, it might be due to their sore throat making it difficult for them to swallow food.
• Earache. Pulling on their ears is a sign of tonsillitis in children and toddlers.
• Fever and chills
• Snoring or breathing from their mouth while sleeping
• Drooling. Tonsillitis might cause your child or toddler to drool because it hurts to swallow.
• Tiredness
• Coughing
• Sickness
• Headaches

Some signs that could indicate tonsillitis are:

• Enlarged glands in their neck and jaw
• Swollen tonsils
• Throat redness
• Bad breath
• White spots at the back of their throat
• Grey furry tongue

If you notice any of these signs of tonsillitis, speak with your pharmacist who will be able to offer you treatment and advice for your child. If symptoms persist, you should take your child to see a GP.

Tonsillitis can usually be treated at home. Here are some ways to make your child more comfortable:

• Offer cold fluids or popsicles. The cold can help to soothe your child’s sore throat.
• Place a hot water bottle on your child’s neck. It is important not to use boiling water in a hot water bottle as this can burn your child.
• Painkillers. Paracetamol and ibuprofen are a safe and effective way of managing the symptoms of tonsillitis. Make sure to read the label and give your child the correct dose.
• Humidify the air. Adding moisture to the air can help your child with a sore dry throat.
• Keep cigarette smoke away from children.

The symptoms of tonsillitis will usually clear up within 3 to 4 days, depending on the type of infection which caused it. If your child has more severe bacterial tonsillitis, you might need to take them to see a GP for a course of antibiotics to help fight the infection and speed up recovery.

Remember that tonsillitis is a very common childhood illness. If symptoms do persist or tonsillitis keeps reoccurring, take your child to see a GP. Your doctor might be able to help by prescribing antibiotics for tonsillitis caused by bacterial infections.

It can be difficult to prevent your child from getting tonsillitis. However, you can reduce the chances of your child getting tonsillitis by making sure they wash their hands with warm soapy water and carry out best hygiene practices.

To reduce the chances of tonsillitis spreading around the home, keep surfaces disinfected. Tonsillectomy is not recommended as a way of preventing tonsillitis and is only carried out as a last resort for children suffering from recurrent tonsillitis.

Mild cases of tonsillitis will not require treatment. Instead, a ‘watchful waiting’ approach is recommended as your baby recovers naturally while ensuring they get proper nutrition and plenty of rest. For cases of bacterial tonsillitis, your baby will need antibiotics from your GP to help fight the infection. In rare cases, your GP might recommend tonsillectomy to help deal with severe and recurrent tonsillitis.

It can be difficult to tell whether a baby has tonsillitis when they cannot describe how they are feeling. There are some signs that you can look out for to tell if your baby has tonsillitis:

• Drooling more than usual. It can be painful to swallow with tonsillitis so if you find that your baby is drooling more often than they usually do, it could be a sign of tonsillitis or a sore throat.
• Difficulty feeding. It can be painful for babies to swallow food with tonsillitis so if you find that you are having more difficulty feeding them than usual, it could indicate that your baby has tonsillitis or a sore throat.
• Ear pain. If your baby is pulling on their ears, it might signal that they are experiencing ear pain which can be a sign of tonsillitis.
• Loss of voice or change in voice.
• Throat redness.
• Swollen tonsils.
• Bad breath.
• Grey furry tongue.
• Fever >38°C.

Tonsillitis in babies will usually go away on its own within 3 or 4 days. If symptoms persist for longer than this, you might need antibiotics from your GP to treat a bacterial infection causing your baby’s tonsillitis.

It is natural for parents to worry about their babies while they have tonsillitis. However, it is important to remember that tonsillitis is a common childhood illness that will usually go away on its own within a few days. If symptoms are not showing signs of improvement within this time, antibiotics from your GP might help to speed up your baby’s tonsillitis recovery.

It can be difficult to prevent tonsillitis as it can be very common in babies. However, there are some things that you can do to reduce the chances of your baby catching tonsillitis:

• keep your home clean and disinfected to prevent the spread of infections that can cause tonsillitis
• feed your baby nutritious meals and ensure they get plenty of exposure to fresh air and sunlight to help improve your baby’s immune system

In most cases, you will be able to treat a tonsillitis infection when pregnant at home. See chapters 3 and 4 to find out more about how tonsillitis can be treated.

If you find that your symptoms are not getting any better after a few days, speak to a GP who will be able to examine you and prescribe a course of appropriate antibiotics for pregnancy if you have tonsillitis that was caused by a bacterial infection.

Paracetamol is a safe and effective way of reducing the pain associated with tonsillitis while pregnant. If you are suffering from tonsillitis caused by a bacterial infection, see your GP can prescribe you with antibiotics that are suitable for pregnancy to help fight the infection.

In most cases, it is not dangerous to have tonsillitis while pregnant. Symptoms will usually clear within 3 to 4 days for viral infections. If you have tonsillitis caused by a bacterial infection like strep throat, your GP will be able to treat the infection with a course of antibiotics.

If your symptoms have not improved within a few days, consult your GP who will be able to examine you and provide you with the best course of action to treat your tonsillitis.

Tonsillitis can be difficult to prevent, especially as you are slightly more prone to infection while pregnant, but there are some things you can do to reduce your chances of a tonsillitis infection while pregnant:

• Follow good personal hygiene.
• Make sure you get plenty of rest.
• Keep well hydrated and eat nutritious meals.
• Quit smoking. Not only can smoking harm you and your baby, it can increase your chances of getting tonsillitis. For help and resources on how to quit, see Chapter 4.

These tonsils are healthy.

The two tonsils are enlarged, swollen and reddened which is a sign of active tonsillitis.

This shows that both tonsils are swollen and reddened. The whitish/yellowish exudate shows that there is an active infection. This kind of exudate can be a sign of bacterial tonsillitis.

This shows a right sided peritonsillar abscess which is a collection of pus which accumulates at one side of the throat around the tonsil. This can become pretty serious and it is imperative that you see a medical professional if you think you have this.

The Medicspot Clinical Station allows doctors to remotely look down your throat to effectively diagnose tonsillitis.

Find your nearest clinic.

Dr Maheinthan Yogeswaran qualified as a doctor from Aberdeen Medical School in 2007. He subsequently trained as a GP and now works as a GP for Medicspot alongside an NHS practice in Essex. He has a wide spectrum of experience; notably in palliative care. Dr Yogeswaran also works on training future generations of GPs as a GP trainer.

Professor Antony Narula is a otorhinolaryngologist (ENT surgeon). He practices general ENT and specialises in children with ear, nose and throat disorders and hearing problems. Antony was head of department at St Mary's Hospital Paddington, Charing Cross Hospital, Hammersmith Hospital, and Leicester Royal Infirmary until he took early retirement in 2014 to concentrate on his medical charity work and private practice.

Notably, Antony was Past President of ENT UK and a Past President of British Society for Otology, The Association of Otolaryngologists and Young Consultant Otolaryngologists. He was also an Honorary Consultant at Chelsea & Westminster and Royal Brompton Hospitals. Recently Antony co-founded The Global Tracheostomy Collaborative, an organisation committed to improving care for all children and adults with tracheostomies.

Dr Faiza Khalid is a Medicspot GP with 12 years of experience. Born and raised in the Home Counties, she pursued her passion for medical sciences at The University of Leeds and proceeded to read her degree in Medicine at The Leicester-Warwick Medical School. In addition to being a GP, she is a qualified GP trainer.

This article is for general information only and should not be used for the diagnosis or treatment of medical conditions. Medic Spot Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. In the event of an emergency, please call 999 for immediate assistance.