Tonsillitis Dr Trisha Macnair Inflammation of the tonsils can cause pain on swallowing, plus fever and flu-like symptoms.

In this article

What is tonsilitis? Symptoms

Causes and risk factors Treatment and recovery

Advice and support

Tonsillitis is caused by infection by a variety of different micro-organisms. The tonsils may become intensely inflamed, red, swollen and exude white or yellow pus, which may be tinged with blood.

The symptoms of tonsillitis include:

• Sore throat
• Difficulty swallowing
• Fever
• Headache
• Tiredness
• Vomiting
• Swollen, painful lymph nodes in the neck

Younger children may also complain of tummy ache (probably due to swelling of lymph glands in the abdomen).

Infectious mononucleosis or glandular fever is caused by Epstein-Barr virus. In younger children, the symptoms may be non-specific. In older children, they typically have severe tonsillitis. They may also have a fever, lethargy, a rash and may be jaundiced. The infection may last for up to three months.

Tonsillitis is common in children up to the age of about ten, but may occur at all ages. It is usually caused by a virus, but about one-third are caused by bacteria (for example, group A beta-haemolytic streptococci). It is not possible to tell the difference between viral causes and bacterial causes without doing tests.

One relatively common complication of tonsillitis is the development of an abscess in the tissues around the tonsil, known as a peritonsillar abscess, or quinsy.

Pus collects around the tonsil and may spread over the roof of the mouth (the palate) and to the neck, chest and lungs. Symptoms include swelling of the face and neck, problems opening the mouth, fever, and intensely foul smelling breath.

An abscess may block the airway causing breathing problems, which can be a life-threatening emergency.

Peritonsillar abscesses are often caused by a type of bacteria called Group A beta-hemolytic streptococci. Antibiotics must be given and a small operation is also usually necessary to drain the pus out of the abscess.

See your GP for advice - they'll diagnose tonsillitis based on a combination of symptoms and physical examination. Give pain-relieving syrup and plenty of fluids.

Although only a third of cases are caused by bacteria, antibiotics are usually given, particularly if the tonsillitis is severe. This used to be because of concern that a streptococcal infection, such as rheumatic fever might develop, but this is very rare nowadays.

Some GPs only give antibiotics if a throat swab shows these bacteria are present. Certain antibiotics can cause a fine widespread rash if the cause of the tonsillitis is the Epstein-Barr virus. There is no cure for Epstein-Barr virus; treatment is supportive.

Most children recover in a few days, but some get frequent bouts of tonsillitis.

If your child gets frequent severe tonsillitis, you may want to talk to your doctor about tonsillectomy. This operation to remove the tonsils is done less often nowadays but may still be recommended for children with recurrent tonsillitis or when the tonsils are so large they cause obstructive sleep apnoea, with poor performance at school and growth problems.

This article was last medically reviewed by Dr Orlena Kerek in March 2009