What is tonsillitis?

Tonsillitis is an inflammation of the tonsils, which are small organs located at the back of the throat that form part of Waldeyer’s Ring. The tonsils play a vital role in the body’s immune system by physically preventing pathogens from entering the body through the nose and mouth, and they also contain a large number of white blood cells that help fight infection and disease.

There are three different types of tonsils: the palatine tonsils, the adenoids and the lingual tonsils. Tonsillitis occurs when the palatine tonsils become inflamed. It is very common in children and adolescents, but adults can suffer from tonsillitis too.

What causes tonsillitis?

The tonsils are vulnerable to infection because they are one of the body’s first lines of defence in the immune system. Tonsillitis is caused by viral or bacterial infections, however, determining the cause is often difficult. 

Most cases of tonsillitis are caused by viruses. The most common form of viral tonsillitis is caused by Epstein Barr virus (EBV), one of the most common viruses that affect humans. Although most people will contract it in their lifestyle but remain asymptomatic, EBV can cause mononucleosis, more commonly called mono or Glandular Fever.

Streptococcal tonsillitis, particularly that caused by Group A Streptococcus (GAS), is the most common cause of bacterial tonsillitis. This is commonly referred to as strep throat. 

What are the risk factors?

Children are more susceptible to developing tonsillitis.  The tonsils play a vital role in the immune system in childhood, but they lose importance post-puberty, making the tonsils more likely to become inflamed during childhood. Additionally, children are often more exposed to germs as they are in close contact with their peers, particularly in school. Anyone who is in close contact with a child frequently may also be at risk.

Urban living can increase one’s chances of developing tonsillitis, due to the greater exposure to viruses or bacteria. Airborne pollutants, such as smoke, can increase the risk, so those who live or work in heavily industrialised areas may be more affected. People in colder climates also are more likely to suffer from tonsillitis.

A person with diabetes, obesity or cardiac disease is considered at higher risk than others.

What are the symptoms of tonsillitis?

If you have tonsillitis, your tonsils will be red and swollen. You will also have a combination of the following symptoms:

• Sore throat
• Fever (temperature of 38C or over)
• Headache
• Cough
• Fatigue
• Nausea
• Difficulty swallowing
• Earache
• White or yellow pus-filled spots on the tonsils
• Swollen glands in the neck
• Bad breath

Is tonsillitis contagious?

Although tonsillitis is not contagious, most of the common tonsillitis-causing infections are. Infection can spread if someone inhales droplets in the air when someone who has the infection coughs or sneezes, if they touch a contaminated surface, or if they are in close contact with bodily secretions (most often saliva) of someone who is infected. 

Can tonsillitis be prevented?

Tonsillitis can be prevented by practising good hygiene:

• Not sharing eating and drinking utensils.
• Avoiding contact with those infected.
• Washing hands frequently.

How is the spread of tonsillitis stopped?

If you have tonsillitis, to avoid spreading it, you can:

• Stay at home.
• Sneeze or cough into a tissue and dispose of it immediately.
• Washing hands thoroughly.
• Avoid sharing items with others. 

How is tonsillitis treated?

It is often difficult to determine the cause of tonsillitis, whether it is viral or bacterial. A GP may perform a swab test to distinguish. 

If your tonsillitis is caused by a virus, then at-home care is the only treatment for recovery. Viral tonsilitis will get better if left untreated but the following can be used to promote a quicker and more comfortable recovery:

• Throat lozenges
• Rest
• Staying hydrated
• Avoiding caffeine
• Gargling with salt water
• Using painkillers to manage discomfort

If your tonsillitis is caused by a bacterial infection, then you will be prescribed a course of antibiotics. These must be taken as instructed, and the full course finished.

What are the possible complications of tonsillitis?

Normally, the symptoms of tonsillitis subside after around seven days, and complications are rare. 

• Quincy is a potentially serious complication that can occur if pockets of pus form between a tonsil and the throat wall. This will need to be drained by a doctor. 
• In extreme cases obstructive sleep apnoea, difficulty breathing while sleeping due to an obstructed airway, may be a result of enlarged tonsils. 
• Tonsil cancer is very rare and isn’t a consequence of tonsillitis, rather it's due to excess smoking and alcohol consumption. 

When should operating be considered?

Tonsils may be surgically removed if patients experience reoccurring tonsillitis or if complications persist. This procedure is called a tonsillectomy. It may also be recommended if antibiotics aren’t improving a bacterial infection. Tonsillectomy is often used as the last resort to treat difficult cases.

What are the risks of removing the tonsils?

Like all surgeries, there are certain risks patients should be aware of. These include:

• Reaction to the anaesthesia
• Swelling.
• Bleeding during and after the procedure.
• Infection, which may require further treatment.

Prior to operating, the patient will be given instructions on how to prepare themselves to ensure the optimum outcome. Recovery will take between 10 days to two weeks.