Tonsillitis - Tonsil Infections

Tonsils and their function

The tonsils are two small sacs of lymphoid tissue near the root of the tongue. Normal tonsils are usually about the same size and have the same pink color as the surrounding area.

Tonsils form Waldeyer's tonsillar ring -- a ring of lymphatic tissue around the entrance of the pharynx. The tonsils are named according to their location. The palatine tonsils are located on the lateral walls of the oropharynx. The lingual tonsils are located at the base of the tongue. The adenoids (pharyngeal tonsils) are high in the throat behind the nose and the roof of the mouth (soft palate), and are not easily visible through the mouth. The tubal tonsils are located in the roof of the nasopharynx.

The basic function of tonsils and adenoids is to help the body to build up immunity to infectious organisms entering into the body through the mouth or nose. They protect the throat and lungs from infection.

Tonsils and adenoids are most active in childhood when many infections are encountered for the first time, and reach the full size when the child is six or seven. The tonsils work as a filter which fights and protects the entire human system against the foreign organisms. Tonsils produce antibodies, which fight against the infection, stopping its further spread to other parts of the body.

The most common problems occurring with the tonsils are recurrent or chronic infections and significant enlargement (adenotonsillar hyperplasia).


Tonsillitis is an inflammatory condition of the tonsils due to bacteria, virus, allergies, or respiratory problems. The term tonsillitis generally refers to inflammation of the palatine tonsils. When inflamed, tonsils become swollen and red with a grayish or yellowish coating. Tonsillitis usually begins with a sudden sore throat and painful swallowing. Tonsillitis causes tonsils and throat tissues to swell obstructing air from passing in and out of the respiratory system. The tonsils infection is common in children and teenagers but rare in adults.

Acute Tonsillitis
Acute tonsillitis is an infection of the tonsils caused bacteria or viruses. Acute tonsillitis lasts for about 4 to 6 days. It is an uncomplicated form which commonly affects children of ages 5-10.

Chronic Tonsillitis
Chronic tonsillitis is a persistent infection of the tonsils and can cause tiny stone formation. It is diagnosed when a sore throat is present for at least 3 months with tonsillar inflammation, and tender cervical nodes. Persistent tonsillar infections can lead to enlargement of tonsils. Despite antibiotic treatment, the tonsillar area can remain infected.

Recurrent tonsillitis
This diagnosis is made when an individual has 6-7 episodes of acute tonsillitis in a year. Frequent infections lead to certain changes in the lymphoid tissues of the tonsils making them enlarged in size. They may get enlarged to an extent that they may touch each other. Recurring septic tonsillitis may lead to some scarring on the tonsils making them less capable to fight against the future infection.

Causes of tonsillitis

Viral tonsillitis

Viruses are the most common pathogens responsible for tonsillitis in children under the age of 6 years[5]. A number of respiratory viruses can cause tonsillitis, including the Reovirus, Adenovirus, Enterovirus, Epstein-Barr virus (EBV), Influenza virus, Echoviruses, Coxsackie’s A virus [4].

EBV infections may cause infectious mononucleosis.

Bacterial tonsillitis

Streptococcus pyogenes (Group A beta-haemolytic streptococci) is the most frequent cause of bacterial tonsillitis. Bacteria cause tonsillitis more frequently in older children and adults than in young children. Staphylococcus aureus and Haemophilus influenzae are also frequent causes of tonsil infection[3]. Klebsiella pneumonia, Streptococcus pneumonia, Escherichia coli and Enterobacter may also cause tonsillitis, however are more prevalent in adults[1], [2].

Other causes

In rare instances, tonsillitis can also be caused by fungi or parasites.

Is tonsillitis contagious?

Viral and bacterial tonsillitis are contagious illnesses and are typically spread through airborne droplets.

If tonsillitis is due to a chronic condition (e.g. allergy) it is unlikely to be contagious.

Signs and symptoms

The main symptom of tonsillitis is severe pain in the anterior neck area. Tonsillitis typically causes the tonsils to become visibly red and swollen. You may also notice patches of white discharge on infected tonsils. Tonsillitis symptoms include:

  • Red swollen tonsils
  • Sore throat
  • Difficulty and pain during swallowing
  • Difficulty in breathing
  • White spots or yellow or grey coating over the tonsil (exudate)
  • Fever
  • Swollen lymph nodes (glands) in the neck
  • Bad breath (halitosis)
  • Voice changes, loss of voice

When should the tonsils be removed?

Today tonsils are no longer routinely removed after one or two episodes of acute infection. If one or more of the following conditions are present, surgery to remove the tonsils (tonsillectomy) may be recommended:

  • Enlarged tonsils that make breathing or swallowing difficult
  • Obstructive sleep apnea (OSA)
  • Chronic or recurring tonsil or throat infections:
    • Five or more episodes in one year
    • Three or more episodes per year for two years
    • Infections that do not respond to treatment

Tonsillectomy is considered in those patients who are suffering, or may suffer serious complications of infection. These include peritonsillar abscess, history of streptococcal complications (rheumatic heart disease, glomerulonephritis), or neck abscess.

Treatment and self help for swollen tonsils

  • Antibiotics. A common bacterium that causes tonsil infection is called streptococcus pyogene. When tonsillitis is caused by bacteria, it can be treated with antibiotics.
    Virally transmitted infections do not respond to any currently known antibiotics. Viral tonsillitis may completely heal on its own within a week. Your body develops antibodies that fight off the infection quickly.
  • Over-the-counter medications. Throat pain and fever may be reduced with over-the-counter pain relievers such as ibuprofen (Motrin), naproxen (Naprosyn) or acetaminophen (Tylenol).
  • Gargle with warm salt water (1 teaspoon of salt in 1 cup of water).
  • Suck on throat lozenges or hard candy.
  • Use a cool-mist vaporizer or humidifier in the room where you spend the most time.
  • Drink plenty of fluids. Soup, broth and tea are good choices.
  • Get plenty of rest. Sleep helps the body fight infection.
  • Boost intake of Vitamin C.

There are many effective natural alternatives to OTC medicines and antibiotics routinely prescribed for tonsillitis. Natural herbal and homeopathic remedies can help to safely reduce the symptoms of these conditions, clear the infection, cut recovery time and also strengthen the immune system to prevent recurring infection.


  • 1. Loganathan A, Arumainathan UD, Raman R. Comparative study of bacteriology in recurrent tonsillitis among children and adults. Singapore Med J. 2006 Apr;47(4):271-5. PubMed
  • 2. Kocaturk S, Demiray T, Incesulu A, Kandirali E, Erkam U, Mert A. Comparison of adenoid and tonsil core cultures in chronic adenotonsillitis. Kulak Burun Bogaz Ihtis Derg. 2003 Mar;10(3):105-9. PubMed
  • 3. Radosz-Komoniewska H, Rogala-Zawada D, Zientara M, Rudy M, Nowakowska M. Bacterial flora in pharyngitis and tonsillitis. Med Dosw Mikrobiol. 1998;50(1-2):63-8. PubMed
  • 4. Gudima IA, Vasil'eva LI, Bragina LE, Suchkov IIu. Viral-bacterial-fungal associations in chronic tonsillitis in children. Zh Mikrobiol Epidemiol Immunobiol. 2001 Sep-Oct;(5):16-9. PubMed
  • 5. Putto A, Meurman O, Ruuskanen O. C-reactive protein in the differentiation of adenoviral, Epstein-Barr viral and streptococcal tonsillitis in children. Eur J Pediatr. 1986 Aug;145(3):204-6. PubMed

Created: August 18, 2006
Last updated: February 24, 2016

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