Tonsillitis: Symptoms, Causes, and Recovery Guide

Tonsillitis is a common condition where the tonsils—the two small lumps of soft tissue at the back of your throat—become inflamed and swollen. It is particularly common in children and teenagers, though it can affect adults of any age.

The tonsils act as the body's first line of defence against pathogens entering through the mouth. Because of this role, they are highly susceptible to infection. While the condition can feel very uncomfortable and make swallowing difficult, most cases are not serious and resolve within three to seven days.

The main symptom of tonsillitis is a severe sore throat that often comes on suddenly. However, it is usually accompanied by other physical signs that help differentiate it from a standard cold.

• Swollen, red tonsils: If you look in a mirror with a torch, the back of your throat may look bright red and the tonsils may be visibly enlarged.
• White or yellow spots: You might notice pus-filled spots or a coating on the tonsils.
• Painful swallowing: This can sometimes be so severe that it is difficult to drink fluids.
• Fever: A high temperature (above 38°C) and shivering are common.
• Swollen glands: You may feel tender, pea-sized lumps on the sides of your neck.
• Other symptoms: These can include a headache, earache, or loss of voice (laryngitis).

Understanding the cause of tonsillitis is essential for determining the right treatment path. In the UK, the majority (around 80%) of tonsillitis cases are caused by viruses, such as the common cold virus or the flu. In these cases, antibiotics will not work.

Bacterial tonsillitis is most commonly caused by group A streptococcus (Strep A). Common indicators that the infection might be bacterial include the absence of a cough, very high fever, and the presence of pus on the tonsils. Medical professionals often use the 'FeverPAIN' or 'Centor' criteria to assess the likelihood of a bacterial infection before deciding whether to prescribe medication.

For most people, tonsillitis can be managed effectively at home while the immune system fights the infection. Following these steps can help manage pain and prevent dehydration:

• Rest: Allow your body the energy it needs to recover.
• Hydration: Drink plenty of water. If swallowing is painful, try small, frequent sips or sucking on ice cubes.
• Pain relief: Paracetamol or ibuprofen can help reduce fever and soothe throat pain. Ensure you follow the dosage instructions on the packet.
• Gargling: Adults may find relief by gargling with warm salty water (this is not recommended for children).
• Humidity: Using a humidifier or sitting in a steamy bathroom can help soothe an irritated throat.

While tonsillitis usually clears up on its own, medical intervention is sometimes necessary to prevent complications or manage severe symptoms. You should consult a GP if:

• Your symptoms have not started to improve after 3 or 4 days.
• The pain is so severe that you are unable to eat or drink.
• You have a very high temperature or feel generally very unwell.
• You are experiencing recurrent bouts of tonsillitis that interfere with work or school.

An online GP can assess your symptoms via video consultation, provide advice on pain management, and—where appropriate—issue a prescription for antibiotics or a sick note for your employer.

If a GP suspects a bacterial infection, they may prescribe a course of antibiotics, most commonly penicillin or erythromycin (if you have an allergy). It is crucial to finish the entire course of antibiotics, even if you start to feel better after a day or two, to ensure the bacteria are fully eradicated.

For chronic or recurrent tonsillitis—typically defined in the UK as seven or more episodes in one year—a GP may refer you to an Ear, Nose, and Throat (ENT) specialist to discuss a tonsillectomy (surgical removal of the tonsils). However, surgery is generally considered a last resort.