Acute Tonsillitis: Definition, Causes, Symptoms, Diagnosis, Treatment and Prevention

The tonsils are part of the immune system, a glandular (lymphatic) tissue located on each side of the back of the throat.

They make antibodies and white blood cells ( lymphocytes ) to attack germs inside the mouth. This makes the tonsils part of the first line of defense against bacteria in food or air.

Tonsils are relatively small in the baby’s first year of life and increase in size as the child grows. They are usually at their greatest between the ages of four and seven.

Tonsillitis can develop in people of all ages; however, in adults, the disease generally does not occur as often as in children.

Causes of acute tonsillitis

Viruses and bacteria cause tonsillitis, and in rare cases, it can be caused by a fungus or a parasite.

Tonsillitis spreads through the air when an infected person breathes, coughs, or sneezes.

The individual can become infected after inhaling the bacteria contained in these droplets. Also, these drops, if they fall on the skin or some objects, can infect the individual if they come into contact with the mouth, nose, or eyes.


Complications of tonsillitis

Acute tonsillitis can lead to several complications, including:

Secondary infections

Chronic enlargement and infection of the tonsils, in combination with an adenoid infection, can cause infections in other nearby structures:

  • The airways in the nose region can become infected ( sinusitis ), and problems with nasal drainage or obstruction can develop.
  • The ear’s Eustachian tube can also be affected, leading to chronic ear infections.

Otitis media in children

Adenoids are part of the same group of lymph nodes as tonsils.

When the adenoids become swollen (usually when the tonsils are swollen), they can block the Eustachian tube, which runs from the back of the throat to the middle ear.

This is the thin tube that pushes the air out of the ears if this tube remains blocked most of the time, sticky fluid forms in the middle ear that interferes with hearing.

Quincy abscess

If the infection spreads to the tissue around the tonsils, an abscess may form in the throat.

This causes severe pain and can interfere with swallowing and even breathing. Antibiotics can help, but sometimes simple surgery is needed to drain the abscess.

Chronic tonsillitis

When the tonsil infection does not go away, the person may have chronic tonsillitis and require surgery to remove the tonsils.

Chronic mouth breathing

This can cause the teeth to misalign (malocclusion).

Symptoms of acute tonsillitis

Typical symptoms of acute tonsillitis are a very severe sore throat with bright red swollen tonsils.

The onset of pain can be rapid or gradual. Any of the following can accompany these symptoms:

  • A grayish-white discharge or spots on the tonsils.
  • Difficulty in swallowing.
  • Earache when swallowing.
  • Bad breath.
  • Babe.
  • Swollen and tender lymph nodes in the neck below the jaw.
  • Fever.
  • Headache.

Repeated infection can cause small depressions, called crypts, to form on the surface of the tonsils. These crypts can harbor bacteria and can contain pockets of pus.

Small stones called tonsilloliths are often found in these crypts. When crushed, these stones can contain high amounts of sulfur and emit a characteristic “rotten egg” smell. This contributes to bad breath for the patient.

Tonsilloliths can also give the patient the unpleasant sensation of having something caught in the back of the throat and obstructing breathing. The latter can result in:

  • Mosquitos.
  • Sleep apnea (when the child stops breathing for short periods while sleeping).
  • Wake up frequently from sleep.
  • I dream without rest.
  • Nightmares.

Such sleep-related problems can lead to the development of mood swings, excessive sleepiness, developmental delay, and sometimes even heart problems.


The doctor will give the patient a general ear, nose, and throat exam to see if they have red and swollen tonsils with spots or sores and will also do a review of the patient’s medical history.

The doctor will use a throat swab (which looks like a long cotton swab) to remove a small sample of mucus from the tonsils. This will be sent to a laboratory for analysis.

The samples are used primarily for patients in high-risk groups (those with weakened immune systems ) or if previous treatment has failed.

In some cases, the doctor will also do a blood test to check your blood count or for glandular fever.

Several different bacteria can cause bacterial tonsillitis, but the Streptococcus group usually causes it.

In the past, severe bacterial infections, such as diphtheria have caused tonsillitis, but now this is very rare due to vaccination and improved treatment of these diseases.

The viruses that cause tonsillitis are often the ones that frequently affect the respiratory system.

They include the influenza virus, parainfluenza virus (which causes laryngitis and croup), adenovirus, enterovirus, and rhinovirus.

In rare cases, tonsillitis can be caused by the Epstein-Barr virus, which is the virus that causes glandular fever. You may have swollen lymph nodes (glands) throughout your body and an enlarged spleen.

Treatment of tonsillitis

If a virus or bacteria causes tonsillitis, the immune system will likely clear the infection within a few days.

Be sure to eat and drink fluids, even if swallowing is painful. Poor diet and dehydration can worsen symptoms, also causing headaches and fatigue.

Pain relievers, lozenges, and throat sprays

Because viruses cause most attacks of tonsillitis, most treatment is aimed at helping to relieve symptoms such as pain and fever.

Paracetamol can help, along with rest. Cold drinks, ice blocks, and ice cream should be given. They usually go flat quickly when the infection is gone.

You can take acetaminophen or ibuprofen to relieve symptoms such as general aches, headaches, and fever. The instructions should always be followed to ensure that the correct dose is taken at the right time intervals when taking medications.

Ibuprofen should not be taken if you have a history of stomach ulcers, indigestion, asthma, or kidney disease.

If you are pregnant, do not take ibuprofen and only take acetaminophen as directed by your GP.

Over-the-counter treatments can also relieve a sore throat, such as tablets and oral sprays.

Some people find that gargling with a mild antiseptic solution can help relieve a sore throat, although there is limited research on its effectiveness.

Aspirin should not be given to patients under 20 years of age. This has been linked to a severe illness called Reye’s syndrome.


Since most cases of tonsillitis are caused by a virus, they do not respond to antibiotics.

Antibiotics can be used to treat bacterial tonsillitis. They may be prescribed if your tonsillitis worsens over time or if you have had a high temperature for a long time.

Studies have shown that antibiotics can reduce the risk of complications, such as rheumatic fever.

If you get tonsillitis frequently, this can affect the choice of treatment.


Treatments with pain relievers and antibiotics (in cases of bacterial tonsillitis) can help relieve your symptoms.

But if the symptoms are particularly severe, you have recurrent attacks of tonsillitis, if you don’t respond to antibacterial medications, or if the patient is allergic to antibiotics, surgery may be an option.

If it is severe enough to interfere with your daily life, your doctor may suggest that your tonsils be removed. This is done in operation known as a tonsillectomy.

Tonsillectomy is one of the most common operations performed on children.

Better care and the availability of effective antibiotics mean that surgical removal of the tonsils is less common today.

Surgery carries some risks, including bleeding during and after the operation in some people.

A sore throat and difficulty eating are common in the first days after the operation. Full recovery generally takes two to three weeks.

Peritonsillar abscesses can be drained with a needle and syringe or by making an incision with a scalpel. A tonsillectomy is an option for those with a history of Quincy abscesses.


Avoiding close contact with people who have tonsillitis is recommended to prevent transmission of the infection.

Children should be kept away from other family members and other people with tonsillitis as much as possible.

Hygiene measures should also be used to prevent the spread of infection. These include:

  • Regular and thorough hand washing and drying.
  • Use a tissue to cover coughs and sneezes.
  • Wash and dry your hands frequently.
  • Do not share food, liquids, or eat drinking utensils or containers.
  • Frequent cleaning of surfaces, especially in the kitchen and bathroom.