Overview

Tonsillitis is the inflammation of tonsils, two small organs made of lymphoid tissue at the back of the throat. They work as a defence mechanism - filtering out bacteria that enter the body through the mouth or nose to prevent infection. When an infection develops on the tonsils, this is known as tonsillitis. Although this condition commonly occurs during childhood, it can affect adults and teenagers too.¹ 

Most cases of tonsillitis are caused by infection from a common virus but bacterial infections can also cause tonsillitis too. Although the condition itself is not contagious, the viruses and bacteria which cause tonsillitis are. In around 1 in every 3 cases, tonsillitis is caused by bacterial infection.¹ Most bacterial tonsillitis is caused by streptococcus bacteria, this is commonly known as ‘strep throat’. Without treatment, tonsillitis caused by strep throat can lead to serious complications. While complications of tonsillitis are rare and typically occur due to bacterial infections, it is possible that the infection can spread to other parts of the body and cause more severe problems.² 

In this article, we aim to identify the signs and symptoms indicating that tonsillitis is progressing to a more serious condition. 

Symptoms of tonsillitis

Tonsillitis most commonly affects children between 5 and 15 years old but can occur in adults and even younger children too.³ It is often described as feeling like a bad cold or flu and the tonsils at the side of the throat will appear swollen and red. 

The most common signs and symptoms in adults and children are:⁴

• Sore throat
• Difficulty swallowing
• Swollen, red tonsils with or without white patches
• High temperature
• Bad breath
• Fever and chills
• Coughing
• Headache and earache
• Stiff neck
• Enlarged lymph nodes in the neck
• Feeling tired

In young children who cannot express their symptoms verbally, indications of tonsillitis may include:

• Increased irritability and fussiness
• Drooling caused by pain
• Difficulty swallowing, especially dry and hard foods
• Refusal to eat

Symptoms usually improve without treatment after 3 to 4 days.⁵ In the meantime, getting plenty of rest, drinking cold liquids, and taking medications (such as paracetamol or ibuprofen) can help treat the symptoms of tonsillitis.

Signs indicating tonsillitis is worsening

While tonsillitis does not usually cause long-term problems, symptoms can worsen, especially if you have a weak immune system. If the symptoms persist for longer than a week, or keep reappearing in a short space of time, you should seek medical help.

The warning signs which suggest tonsillitis is becoming more severe are:⁵

• High fever
• Severe throat pain that intensifies, especially when swallowing
• Difficulty breathing due to airway obstruction caused by swelling of the tonsils or throat
• Inability to open the mouth fully due to pain or swelling
• Extreme fatigue and weakness causing inability to perform daily activities

Possible complications of tonsillitis

Although this is rare, tonsillitis can progress into a severe infection - worsening the condition of the tonsils and spreading to surrounding areas of the body, causing more serious symptoms that require medical intervention. Outlined below are the several complications that can arise from tonsillitis.

Peritonsillar abscess (Quinsy)

Quincy, also known as peritonsillar abscess, is a puss-filled pocket that forms near one of your tonsils when a bacterial infection spreads from the tonsils to the surrounding area. The infection pushes the tonsil inwards and makes the soft palate bulge. Other symptoms of a quincy include severe one-sided throat pain, difficulty swallowing, and a muffled voice.⁶ This is a bacterial infection so it responds well to antibiotics. The likelihood that a quincy will reoccur is between 1 in 5 and 1 in 10, and more likely in people who have frequent episodes of sore throat.⁷

Obstructive sleep apnoea (OSA)

Another possible complication of tonsillitis is obstructive sleep apnoea (OSA), which can happen when the swelling of the tonsils obstructs the airway during sleep, causing difficulty breathing and poor sleep. Characteristics of OSA appear during sleep and can be identified as: repeated pauses in breathing, loud snoring, choking, or gasping sounds.⁸ As the airways become narrow due to the inflamed tonsils, it becomes more difficult for air to flow freely, leading to disrupted sleep and a drop in oxygen levels. People with OSA often experience excessive daytime sleepiness, difficulty sleeping, and morning headaches.⁸ In children, the condition can lead to impaired growth and behavioural issues.⁹ If untreated, OSA can increase the risk of heart problems such as high blood pressure, heart disease, and diabetes. Recognising and addressing OSA early through medical intervention is important as it can help prevent further complications.

Sepsis

In very rare cases, the infection of the tonsils could spread beyond the tonsils and enter the bloodstream, possibly leading to sepsis, a life-threatening condition which causes damage to the organs. When the infection spreads beyond the tonsils and throat area, it can cause excessive inflammation of vital organs as the body’s normal defence mechanism breaks down. When tonsillitis complications such as severe difficulty swallowing and fever combine with sepsis symptoms such as confusion and lightheadedness, it is important to seek immediate medical care.

When to seek medical attention

It is important to know when to seek medical attention for tonsillitis, as some symptoms can signal the infection is worsening and possibly becoming a more serious condition. You should consult a doctor if you have: 

• Difficulty breathing or swallowing
• Persistent high fever with a temperature above 102°F (39°C) that will not subside
• Symptoms of peritonsillar abscess, obstructive sleep apnoea, or sepsis
• Sudden worsening of symptoms or new severe symptoms
• Symptoms that persist for longer than 4 days

Prevention and early intervention

In most cases, tonsillitis does not require medical intervention and subsides within 3-4 days. And while there is no specific treatment for tonsillitis, the symptoms can be helped with:

• Paracetamol or ibuprofen for pain relief
• Adequate rest 
• Drinking plenty of fluids 

If you seek treatment from your doctor and the test performed shows that your tonsillitis is caused by a bacterial infection, you may be prescribed oral antibiotics. In cases where the tonsillitis persists for a long period of time or frequently returns, surgery to remove the tonsils (a tonsillectomy) may be needed.

Frequently asked questions (FAQs)

Can tonsillitis go away on its own?

Yes, in most cases symptoms subside after 3-4 days, but it can last longer and require medical intervention if your condition worsens. In the meantime, drinking plenty of fluids, resting, and taking over-the-counter medications such as paracetamol and ibuprofen can help.

Is tonsillitis contagious?

Tonsillitis is inflammation as a response to the infection of the tonsils, so the condition itself is not contagious but the bacteria or viruses which cause it are. It is recommended that you stay off work or keep your child home until symptoms subside. 

How serious is tonsillitis in adults?

Tonsillitis does not usually cause any serious or long term health problems but if symptoms worsen or persist, complications can occur in some cases.

What is the difference between strep throat and tonsillitis?

Tonsillitis is the inflammation of the tonsils, whereas strep throat involves a specific type of bacteria (streptococcus pyogenes) entering the throat.

Summary

Tonsillitis is a bacterial or viral infection characterised by the inflammation of the tonsils. It typically causes symptoms such as a sore throat, problems swallowing and high temperature but usually subsides after 3-4 days. It is important to be able to identify if the condition is worsening due to the variety of possible complications which can arise without early intervention. If you notice any of the severe symptoms outlined in this article, consult a healthcare professional. Prompt treatment can make all the difference in your recovery whilst preventing future infections and improving your overall wellbeing.