Tonsillitis: Symptoms, treatment and types

Tonsillitis is the inflammation of the tonsils, which are lymph nodes found on both sides of the throat. This inflammation is usually of infectious, viral or bacterial cause, and is acquired by direct contact (saliva and contaminated objects) or through the air (cough and sneezes).

Here, renowned consultant ENT surgeon Mr Kwamena Amonoo-Kuofi, provides an expert insight into tonsillitis. The Hampshire-based specialist talks through the different types of tonsillitis, and what to do when the condition is chronic or frequent.

The most common cause of tonsillitis is a form of virus, of which there are hundreds: adenoviruses, influenza viruses and human parainfluenza, the Epstein-Barr virus (infectious mononucleosis), or herpetic viruses, among others. Tonsillitis can also be caused by bacteria, but this is less common. The most frequently occuring type of bacterial tonsillitis is called streptococcus pyogenes, but there are a large number of bacteria that can cause tonsillitis, and sometimes the illness is a combination of several.

Types of tonsillitis

There are different types of tonsillitis. The most common is acute infectious tonsillitis, which can be viral or bacterial. When this infection occurs repeatedly, it is called recurrent tonsillitis.

There are also cases in which the inflammation is chronic, leading to a considerable and permanent increase in the size of the tonsils (known as amygdala hypertrophy), and in some cases, an accumulation of a whitish material may be present in the tonsils. 

How easy is it to catch tonsillitis?

The viruses or bacteria which cause tonsillitis are contagious and can be picked up relatively easy, through direct contact with someone who already is carrying the virus/bacteria. This can be through coughs and sneezes, or through contaminated surfaces.

Children are much more susceptible to tonsillitis, as the tonsils act as the first barrier to infection in children before their immune system becomes more developed. In order to reduce the risk of catching tonsillitis, take precautions such as frequently washing your or your child's hands, cough or sneeze into a tissue, and if you do begin to show symptoms, stay away from public areas. 

Symptoms of tonsillitis

In acute tonsillitis, the incubation period from infection to the first symptoms is difficult to establish given the wide variety of microorganisms that can cause it, with the period ranging from just a few hours to a week.

The infection causes pain when swallowing, fever, swollen lymph nodes, and general malaise (feeling tired and simply generally unwell). Sometimes, symptoms can also display with a headache or stomach ache. The tonsils will also have a very reddish appearance, sometimes with the presence of pus plaques or a kind of whitish membrane on their surface.

Chronic tonsillitis causes constant discomfort in the throat, sometimes with loss of appetite and fatigue, the tonsils may be permanently inflamed and there may even be an infection in other organs of the body. If the tonsils are enlarged, they can obstruct breathing and cause sleep problems, as well as alterations in the development of the palate and teeth placement.

Treatment for tonsillitis in adults

A trip to the doctor’s is usually the first step towards treatment for tonsillitis to make sure the right tests and medications are given.

A quick test to detect streptococcus can be taken, and if it is positive, the bacterial infection causing the tonsillitis can be treated with antibiotics. The patient needs to complete the drug course, but symptoms usually improve in three to four days.

Some types of medication may also be prescribed to relieve pain and fever, treating the symptoms of viral tonsillitis rather than the infection itself. During this time, the patient is advised to eat soft foods at room temperature. Sour juices or hard foods should be avoided as they may inflame the throat even more.

Home remedies for tonsillitis

Tonsillitis usually simply has to run its course and be waited out, so many 'treatments' actually focus on relieving the symptoms with the use of home remedies. 

There are several types of ‘gargle’ remedy that can improve the symptoms of tonsillitis - salt, honey, thyme, and diluted antiseptic mouthwashes help prevent colonisation of germs in the throat. Avoid letting children use salt gargles. 

Ice lollies or cool drinks may soothe the throat, or warm drinks, depending on which feels better for the patient. 

The patient should rest at home, both to aid speedy recovery, and to reduce the potential spread of the disease. It is also important that the patient and any caregiver frequently wash their hands.

Surgical treatment of tonsillitis

Repeat infections or obstructive problems caused by tonsillitis may require surgery, after consulting an ENT specialist. Complete removal of the tonsils is called a tonsillectomy, while a reduction is often called a partial tonsillectomy. This can be performed using various techniques (laser, radiofrequency, electric scalpel).

Although not frequent, acute tonsillitis can be complicated by the formation of phlegm or abscesses around the lymph nodes of the neck, and rheumatic fever with cardiac, renal or joint involvement. In chronic tonsillitis, a syndrome of obstructive sleep apnoea may occur, as well as dental malposition and swallowing problems.

Signs of danger in these infections are high fever, difficulty swallowing or breathing, or the appearance of a reddish rash on the skin.

How long does it take to recover from tonsillitis? 

Most people who have tonsillitis recover within a week, and in just under half of patients, symptoms last for roughly three days. However, if you still have a sore throat or your symptoms don't improve after three to four days, it's best to contact your GP. 

Mr Kwamena Amonoo-Kuofi is a highly qualified consultant ENT surgeon with over 25 years' experience who specialises in the assessment and treatment of a range of adult and paediatric ENT conditions.

If you or your child require expert treatment and management for tonsillitis, don't hesitate to book an appointment with Mr Amonoo-Kuofi via his Top Doctors profile today.