Tonsillitis: Stages, Causes, Symptoms, Types, Diagnosis, Treatment and Complications

The tonsils are lymphatic tissue structures on both sides of the throat, above and behind the tongue.

Sometimes they can become inflamed when affected by bacteria or viruses; when they become swollen and inflamed, it is known as tonsillitis.

Tonsillitis is common, especially among children. The condition can occur occasionally or frequently.

When a person infected with bacteria or viruses breathes, coughs, or sneezes, the infection can spread to others nearby through airborne droplets, causing tonsillitis.

Tonsils are generally large during childhood, but they can cause problems when they become infected or grow too large.

Tonsillitis occurs when one or both tonsils become inflamed. Usually, the tonsils act as filters that help prevent germs from entering the lungs.

The tonsils can significantly reduce a person’s chances of getting throat and lung infections by blocking germs.


The tonsils also produce antibodies that further improve a person’s chances of avoiding disease.

Stages of tonsillitis

Tonsillitis is not multi-stage, but the severity of the condition can vary significantly. Mild tonsillitis refers to slight swelling.

Patients with mild tonsillitis usually have red, sore throats. It can be bothersome, but it usually doesn’t cause any medical problems.

As tonsillitis becomes more and more serious, so do its symptoms. It can cause patients to have difficulty swallowing and eating.

Pain can affect them so much that they cannot perform daily activities.

Advanced cases of tonsillitis can cause the tonsils to swell so much that they prevent patients from breathing through their mouths. At this point, the pain becomes quite severe.


The causes of tonsillitis can be due to viruses or bacterial infections. Strep bacteria is one of the most common causes of tonsillitis.

Numerous viruses can cause the tonsils to swell.

Common viruses associated with tonsillitis include:

  • Influenza (the flu).
  • Epstein Barr virus.
  • Virus parainfluenza.
  • Virus herpes simplex.


Tonsillitis most commonly affects children between preschool and mid-teens.

Common signs and symptoms of tonsillitis include the following:

  • Swollen and red tonsils.
  • Blisters or ulcers in the throat, with white or yellow coating on the tonsils.
  • Severe sore throat
  • Difficulty in swallowing.
  • Fever.
  • Tenderness of the jaw and throat.
  • Bad breath.
  • Headaches.
  • Enlarged and tender glands (lymph nodes) in the neck.
  • Possible irritability or lack of appetite among children too young to express themselves.
  • Earache.
  • I am shaking chills.
  • Often the loss of normal vocalization.
  • Pain in the ears or neck.
  • Difficult breathing

Types of tonsillitis

There are two types of tonsillitis:

  1. Recurrent tonsillitis, multiple episodes of acute tonsillitis occur in a year, with each episode lasting 4 to 10 days.
  2. Chronic tonsillitis, in which the episodes last longer than acute tonsillitis, with other symptoms such as chronic sore throat, bad breath, and tender lymph nodes in the neck.

Prevention and risks

Tonsillitis prevention relies on avoiding bacteria and viruses that cause the tonsils to swell.

Washing your hands frequently, using hand sanitizer, and avoiding sick people are some of the most effective ways to prevent tonsillitis.

Risk factors for tonsillitis in children are about the same as for the common cold in adults.

Enclosed spaces with many germs floating in the air and on surfaces are just as likely to affect children.

Only about 78% of adults have their tonsils.

Sometimes the tonsils, as well as the throat and surrounding areas, become infected.

This form of tonsillitis is known as pharyngitis, and it is more severe than tonsillitis.

Pharyngitis develops from tonsillitis.

People at higher risk of developing tonsillitis include:

  • Kids
  • Immune-deficient adults

Diagnosis and tests

The diagnosis of tonsillitis can be made quickly.

In most cases, the doctor needs to look at the swelling and inflammation of the throat to determine if it is tonsillitis, along with the list of symptoms.

When the tonsil is enlarged and visible, the doctor can confirm that the patient has tonsillitis.

The tonsils may also have white spots that indicate a more severe infection.

Lymph nodes around the jaw and neck may also be infected, presenting with swelling and tenderness to the touch.

A swab can be taken to determine if the patient is infected with Strep, the most severe and dangerous form of tonsillitis.

Although a doctor can diagnose tonsillitis simply by looking at the tonsils to see if they have become inflamed.

However, additional tests are required to determine the appropriate treatment for the underlying cause of tonsillitis, such as:

  • Strep test: a sterile swab is collected from the discharge from the throat and sent to the laboratory to test for strep bacteria and strep throat.
  • Blood test: A complete blood count may be ordered to help identify the cause of the infection.

Most doctors begin the diagnostic process by doing a rapid strep test or throat culture.

The results of a throat culture can take two to three days.

Some doctors prefer throat cultures because the test provides the most accurate results.

Although the rapid strep test takes less time, it has higher cases of false positives (when a test shows positive results in patients who do not have Strep).

If the test does not detect bacteria, your doctor may conclude that a virus is causing tonsillitis.


  • An infection of the middle ear (otitis media), where the fluid between the eardrum and the inner ear becomes infected with bacteria.
  • Difficult breathing
  • Interruption of breathing during sleep ( obstructive sleep apnea ).
  • Infection that spreads deep into the surrounding tissue (tonsillar cellulitis).
  • An infection causes a collection of pus behind a tonsil (peritonsillar abscess).

If the tonsillitis is caused by group A streptococci, the child is at increased risk for rare problems, such as rheumatic fever, an inflammatory disorder that affects the heart, joints, and other tissues; or an inflammatory disease of the kidneys that results in improper removal of waste and excess fluids from the blood.


Tonsillitis is contagious; at least, the germs cause tonsillitis. Children with signs of tonsillitis should be kept home away from school or daycare to avoid spreading the bacteria or virus.

Treatment to combat tonsillitis will depend on the cause of the condition.

Conservative treatment

Patients with bacterial infections can take medications to fight bacteria and reduce painful symptoms.

Most patients begin to feel better after taking oral antibiotics for three days.

However, the fact that the symptoms subside does not mean that the patients have been cured.

The course of antibiotics must be completed and not suspended. Otherwise, the infection may reappear.

They need to take the whole round of antibiotics to prevent bacterial infection.

Stopping antibiotics too soon can cause tonsillitis to return, which can also come in a more aggressive and severe form.

If the patient has been diagnosed with Strep and begins to show signs of infection in another part of the body, which may be a sign of a related disease known as strep glomerulonephritis.

Doctors may prescribe a single injection of antibiotics or several days of oral antibiotics.

Oral treatment should generally be continued for 10 to 14 days.

Sometimes a single dose of an antibiotic injection may also be suggested in patients allergic to pills or tablets.

When the patient is allergic to penicillin, erythromycin will be administered.

Never use aspirin in children with a viral infection as this can lead to Reye’s syndrome.

The sore throat and fever will be treated with medications such as ibuprofen or paracetamol.

Drink plenty of fluids to avoid dehydration.

The patient must be kept as comfortable as possible, and plenty of rest is required to allow the body to fight the infection.

Soft foods like yogurt, ice cream, and gelatin may be all that are tolerated in the early stages of tonsillitis.

Surgical treatment

Unfortunately, there may be a time when medical treatment (antibiotics) will not resolve chronic tonsil infections that affect the patient.

In other cases, you may have enlarged tonsils, causing loud snoring, upper airway obstruction, and other sleep disorders.

The best remedy for both of these conditions may be removing or reducing the tonsils and adenoids.

The goal of surgery is to reduce the number of throat and ear infections and improve airway obstruction.

Surgical removal of the tonsils is a procedure known as “tonsillectomy.” Doctors avoid this option unless necessary.

Since the tonsils play an essential role within the immune system, removing them is the last resort for people with recurrent tonsillitis.

The first tonsillectomy procedure was reported to have been performed by the Roman surgeon Celsus in 30 AD.

He described scratching the tonsils, plucking or lifting them with a hook, and removing them with a scalpel.

However, other procedures are available; the choice may be dictated by the extent of the system (complete removal of the tonsil versus partial tonsillectomy) and other considerations such as postoperative pain and bleeding.

A quick review of each tonsillectomy procedure is as follows:

Cold knife dissection (steel)

Removing the tonsils using a scalpel is the most common method practiced by otolaryngologists today.

The procedure requires the patient to undergo general anesthesia; the tonsils are removed with minimal postoperative bleeding.


Electrocautery burns tonsil tissue and helps reduce blood loss from cauterization.

Research has shown that the heat from electrocautery (400 degrees Celsius) produces thermal damage to the surrounding tissue.

This can lead to further discomfort during the postoperative period.

Harmonic scalpel

This medical device uses ultrasonic energy to vibrate its blade at 55,000 cycles per second.

Invisible to the naked eye, the vibration transfers energy to the tissue, providing simultaneous cutting and coagulation.

The temperature of the surrounding tissue reaches 80 degrees Celsius.

Proponents of this procedure claim that the result is a precise cut with minimal thermal damage.

Radiofrequency ablation

Monopolar radiofrequency thermal ablation transfers radiofrequency energy to the tonsil tissue through probes inserted into the tonsil.

The procedure can be performed under mild sedation or local anesthesia in an office setting.

After treatment is done, scarring occurs within the tonsil, causing it to decrease in size over several weeks. Treatment can be done several times.

The advantages of this technique are minimal discomfort, ease of operations, and immediate return to work or school.

The tonsil tissue remains after the procedure but is less prominent.

This procedure is recommended to treat enlarged tonsils, not chronic or recurrent tonsillitis.

Carbon dioxide laser

The otolaryngologist uses a handheld CO2 laser to vaporize and remove the tonsil tissue in laser ablation of the tonsils.

This technique reduces the volume of tonsils and eliminates the nooks and crannies in the tonsils that accumulate chronic and recurring infections.

This procedure is recommended for chronic recurrent tonsillitis, chronic sore throat, severe halitosis, or airway obstruction caused by enlarged tonsils.

The carbon dioxide laser is done in 15 to 20 minutes in an office under local anesthesia.

Post-tonsillectomy bleeding can occur in two to five percent of patients.

Previous research studies indicate that laser technology provides significantly less pain during postoperative recovery for children, resulting in fewer sleep disturbances, decreased morbidity, and less need for medications.

On the other hand, some believe that children are adverse to outpatient procedures without sedation.


The microdebrider is a continuous suction rotary shaving device often used during sinus surgery.

It consists of a cannula or tube connected to a handpiece, which is connected to a foot-controlled motor and a suction device.

The endoscopic microdebrider is used to perform a partial tonsillectomy, partially shaving the tonsils.

This procedure involves removing the obstructive portion of the tonsil while preserving the tonsil capsule.

A natural biological bandage is left over the pharyngeal muscles, preventing injury, inflammation, and infection.

The procedure produces less postoperative pain, a faster recovery, and perhaps fewer late complications.

The procedure produces less postoperative pain, a faster recovery, and perhaps fewer late complications.

However, the partial tonsillectomy is suggested for enlarged tonsils, not those with repeated infections.

Bipolar radiofrequency ablation (Coblation)

This procedure produces a layer of ionized saline that breaks molecular bonds without heat.

As energy is transferred to the tissue, ionic dissociation occurs.

This mechanism can remove all or just part of the tonsil.

It is performed under general anesthesia in the operating room and can be used for enlarged tonsils and chronic or recurring infections.

This causes the removal of the tissue with a thermal effect of 45 to 85 ° C.

The advantages of this technique are less pain, faster healing, and less postoperative care.

Healthy lifestyle tips

Mild cases of tonsillitis often respond well to home remedies that do not require a doctor.

These home remedies should not be used when fever with tonsillitis occurs.

A fever may indicate a more severe illness, such as Strep, that requires medical attention.

Common home remedies for tonsillitis include:

  • Take an over-the-counter pain reliever such as ibuprofen or acetaminophen.
  • Use of pills that contain menthol or anesthetics such as benzocaine.
  • Eat fresh, bland foods, such as ice cream and gelatin desserts.
  • Drink cold liquids.
  • Saltwater gargle.
  • Use a humidifier or vaporizer.
  • Making changes to your diet will improve your immune system.

The more effective the immune system works, the less likely healthy people will get tonsillitis because the body can fight bacteria and viruses before they cause problems.

Some ways to improve your immune system include:

  • Get regular exercise.
  • Eat a diet based on fruits, vegetables, and whole grains.
  • Get a good night’s sleep.
  • Minimize stress.

In most cases, tonsillitis is a condition that causes short-term discomfort. However, it can become a dangerous situation when left untreated.

Depending on your symptoms, your doctor may run a diagnostic test, administer antibiotics, or recommend taking time to recover.