Overview

Tonsillitis is a common condition characterised by inflammation of the tonsils. The tonsils are two small, oval-shaped lumps of tissue located at the back of the throat, one on each side. They are part of the body's immune system and help to filter out bacteria and viruses that enter through the mouth or nose. When the tonsils become infected, they can become swollen, red, and painful, making swallowing difficult. Tonsillitis can affect people of all ages but is most common in children and young adults.

Symptoms and Causes

The most common symptom of tonsillitis is a sore throat. Other symptoms may include:

• Pain when swallowing
• Fever (a temperature over 37.5°C for adults and over 38°C for children)
• Earache
• Headache
• Feeling sick (nausea) or vomiting
• Feeling tired or generally unwell
• Swollen and tender lymph nodes (glands) in the neck
• White or yellow spots of pus on the tonsils
• Bad breath
• Changes in voice, such as sounding hoarse or muffled
• Loss of appetite

In some cases, tonsillitis can lead to a complication called quinsy, which is a collection of pus that forms between the tonsil and the wall of the throat. Quinsy can cause severe pain, difficulty swallowing, and even difficulty breathing.

Tonsillitis is usually caused by a viral infection, such as the common cold or flu. Less commonly, it can be caused by a bacterial infection, such as strep throat (caused by group A Streptococcus bacteria). Glandular fever, also known as infectious mononucleosis, is another viral infection that can cause severe tonsillitis along with other symptoms.

Diagnosis and Investigations

A doctor can usually diagnose tonsillitis by examining the throat and asking about symptoms. They may also take a throat swab, which involves gently rubbing a sterile cotton bud over the tonsils to collect a sample. This sample can be tested in a laboratory to determine whether the infection is caused by bacteria or a virus. A blood test may be performed to check for glandular fever.

Management and Treatment

The treatment for tonsillitis depends on the underlying cause and the severity of symptoms.

Viral Tonsillitis: Most cases of tonsillitis are caused by viruses, and antibiotics are not effective against viral infections. Treatment for viral tonsillitis focuses on relieving symptoms and may include:

• Rest: Getting plenty of rest helps the body fight off the infection.
• Fluids: Drinking plenty of fluids, such as water, juice, or soup, helps to prevent dehydration, especially if swallowing is painful.
• Pain Relief: Over-the-counter (OTC) pain relievers, such as paracetamol or ibuprofen, can help to reduce pain, fever, and headache. Ibuprofen is often preferred for adults with a sore throat, while paracetamol is usually the first choice for children. However, some people with certain medical conditions may not be able to take ibuprofen, so it's important to read the label carefully.
• Throat Lozenges and Sprays: Throat lozenges, such as Strepsils or Difflam, and throat sprays can provide temporary relief from sore throat pain. These are available over the counter at pharmacies.
• Gargling: Gargling with warm salt water can help to soothe a sore throat. Adults can also use a soluble aspirin or paracetamol gargle.
• Diet: Eating soft, cool foods, such as jelly or ice cream, may be easier to swallow than hard or hot foods.

Bacterial Tonsillitis: If a throat swab confirms that the tonsillitis is caused by bacteria, a doctor may prescribe antibiotics. It's important to complete the full course of antibiotics, even if symptoms improve before the medication is finished. Commonly prescribed antibiotics for bacterial tonsillitis in the UK include:

• Penicillin V (Phenoxymethylpenicillin): This is usually the first-choice antibiotic for bacterial tonsillitis. It is taken orally, typically four times a day for 10 days. Penicillin V is available only on prescription.
• Amoxicillin: This is another penicillin-type antibiotic that may be prescribed if penicillin V is not suitable or if the infection is severe. It is also taken orally, usually three times a day for 5-10 days. Amoxicillin is available only on prescription.
• Clarithromycin: This is a macrolide antibiotic that may be prescribed for people who are allergic to penicillin. It is taken orally, usually twice a day for 5 days. Clarithromycin is available only on prescription.
• Erythromycin: This is another macrolide antibiotic that can be used as an alternative to penicillin. It is taken orally, usually four times a day for 5-10 days. Erythromycin is available only on prescription.

Quinsy: If quinsy develops, a doctor may need to drain the pus using a needle or by making a small incision. Antibiotics are also prescribed to treat the underlying infection.

Tonsillectomy: In some cases, a doctor may recommend a tonsillectomy, which is an operation to remove the tonsils. This is usually considered for people who have frequent or severe episodes of tonsillitis that interfere with their daily life.

Prevention

Tonsillitis is contagious, meaning it can spread from person to person. To reduce the risk of spreading or catching tonsillitis:

• Wash hands frequently with soap and water, especially after coughing or sneezing.
• Avoid close contact with people who have tonsillitis or other respiratory infections.
• Cover the mouth and nose when coughing or sneezing, using a tissue or the inside of the elbow.
• Dispose of used tissues properly.
• Avoid sharing eating utensils, drinking glasses, or toothbrushes.
• Stay home from work or school if unwell to prevent spreading the infection to others.

Outlook / Prognosis

Most cases of tonsillitis get better within a week without any long-term complications. However, in some cases, tonsillitis can lead to complications such as:

• Quinsy: A collection of pus that forms between the tonsil and the wall of the throat.
• Otitis Media: An infection of the middle ear.
• Sinusitis: An infection of the sinuses.
• Rheumatic Fever: A rare but serious complication that can occur after a strep throat infection. Rheumatic fever can damage the heart valves.
• Glomerulonephritis: A rare kidney problem that can occur after a strep throat infection.

If you have any concerns about tonsillitis or if symptoms worsen or do not improve after a week, it's important to see a doctor.