Tonsillitis: Symptoms, Treatment, and When Surgery Is Needed

A sore throat can make swallowing, eating, and even talking uncomfortable. One possible cause is tonsillitis, an inflammation or infection of the tonsils at the back of the throat.

Tonsillitis is especially common in children and teenagers, but adults can develop it too. Most cases improve with supportive care and do not require surgery. However, when tonsillitis becomes frequent, severe, or causes problems such as obstructive sleep apnea, an ENT specialist may recommend a tonsillectomy, or the surgical removal of the tonsils.

What Is Tonsillitis?

Tonsillitis is inflammation or infection of the tonsils—the two areas of tissue located on either side of the back of the throat. The tonsils are part of the immune system and help recognize germs that enter through the mouth and nose.

Tonsillitis can be caused by viruses or bacteria. Viruses cause most cases, while group A Streptococcus, the bacteria responsible for strep throat, is one possible bacterial cause.

Because treatment depends on the cause, a healthcare professional may examine the throat and, when appropriate, perform a rapid strep test or throat culture.

What Are the Symptoms of Tonsillitis?

Common tonsillitis symptoms include:

• Sore throat
• Red or swollen tonsils
• Pain or difficulty when swallowing
• Fever
• Swollen or tender lymph nodes in the neck
• White or yellow patches on the tonsils
• Bad breath
• Hoarseness or changes in the voice

Children may also have a reduced appetite, irritability, or difficulty drinking because swallowing is painful.

How Is Tonsillitis Treated?

Treatment for tonsillitis depends on whether the infection is viral or bacterial.

Viral Tonsillitis

Most cases of tonsillitis are caused by viruses, and antibiotics do not treat viral infections. Symptoms usually improve within several days to about a week with supportive care.

This may include rest, plenty of fluids, soothing drinks, appropriate medication for pain or fever, and warm saltwater gargles when they can be done safely.

Bacterial Tonsillitis

When group A strep is suspected, your ENT specialist may recommend a rapid strep test or throat culture. If testing confirms group A strep, antibiotics are generally recommended. Penicillin or amoxicillin are commonly used as first-line treatments when appropriate.

Taking antibiotics exactly as prescribed can help treat the infection and reduce the risk of certain complications associated with group A strep.

When Should You See a Doctor for Tonsillitis?

Many mild cases can be managed at home. Medical evaluation is appropriate when symptoms are severe, persistent, worsening, or keep returning.

Consider seeing an ENT specialist if:

• A sore throat does not improve or continues to worsen
• Swallowing becomes increasingly difficult
• Fever persists or returns
• You or your child has repeated episodes of tonsillitis
• Symptoms interfere with eating, drinking, sleeping, school, work, or normal activities
• Strep throat or another bacterial infection is suspected

An evaluation can help determine whether testing or additional treatment is needed.

When Is Tonsillitis an Emergency?

Difficulty breathing or swallowing should be taken seriously.

Seek urgent medical attention if you or your child has difficulty breathing, cannot swallow, is drooling because swallowing is too painful, develops significant swelling in the mouth or throat, has difficulty opening the mouth, becomes dehydrated, or experiences rapidly worsening severe throat pain.

These symptoms can occur with serious complications, including a peritonsillar abscess, which may require prompt treatment.

When Is Tonsil Surgery Needed?

For children with recurrent throat infections, the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) recommends considering watchful waiting when infections occur less frequently than:

• Seven episodes in one year
• Five episodes per year for two consecutive years
• Three episodes per year for three consecutive years

Tonsillectomy may be considered when those frequency thresholds are met and the episodes are appropriately documented, including findings such as fever, swollen neck lymph nodes, tonsil exudate, or a positive group A strep test.

These numbers are not an automatic requirement for surgery. An ENT specialist also considers the severity of infections, complications, response to treatment, and how much recurrent illness affects a person's quality of life.

Certain circumstances may also influence the decision, including a history of peritonsillar abscess or other significant complications.

Frequently Asked Questions About Tonsillitis