Image drawing of normal tonsils
Normal tonsils

What is tonsillitis?

Tonsillitis is a general term that is used to describe inflammation of the tonsils, which may result in enlarged tonsils. Tonsils are oval-shaped pads on each side of the throat. They are a part of the body’s immune system, helping to trap germs that enter the nose and mouth. Tonsils can become inflamed for a variety of reasons.

What are the symptoms of tonsillitis?

Tonsillitis can produce a variety of symptoms, most notably sore throat, and sometimes it is accompanied by fever, pain with swallowing, and swollen lymph nodes. At other times, children experience only a few symptoms, such as snoring or dry cough, that are less acute but still bothersome.

What causes tonsillitis?

Tonsillitis is often the result of an upper respiratory infection, either viral or bacterial. A number of viruses can result in tonsillitis, including the common cold, influenza, adenovirus, parainfluenza, and infectious mononucleosis. Bacterial infections, including streptococcus (strep), can also cause tonsillitis. While viruses tend to produce more cases of tonsillitis, bacterial infections can bring children in for care more often because they tend to have more severe symptoms.

Is it contagious? How contagious? How does it spread?

While tonsillar inflammation is not itself contagious, the underlying illnesses can be. For example, an active, wet cough that sends aerosol droplets into the air can spread an underlying virus or bacteria. Sharing drinks, food, and utensils, and practicing poor handwashing techniques, can also spread tonsillitis.

Who is susceptible to getting tonsillitis?

Any child can develop tonsillitis, but children with compromised immune systems, including those with transplanted organs, can develop tonsillitis more easily or have more severe symptoms. The most common age range for developing tonsillitis is 5 to 15. Adults can also develop tonsillitis, but it’s not as common in adults as it is in kids.

How long does tonsillitis last?

It depends on the illness that prompted the tonsillitis. If it was caused by a bacteria and your child receives antibiotics, you can expect that he or she will feel better within two to three days of treatment onset. Since viral cases of tonsillitis are not treated with antibiotics, we practice watchful waiting and management of symptoms. It may take up to seven days for your child to feel better. If there isn’t improvement, we explore other causes of tonsillitis.

What is chronic tonsillitis?

Some children have chronic, or ongoing, tonsillitis. This is characterized by frequent episodes of sore throat and swollen tonsils or even near-constant throat discomfort. We do see tonsillitis more in certain families, though it is not something that’s specifically inherited.

What is the difference between strep throat and tonsillitis?

Strep throat is a specific variety of tonsillitis. In fact, strep throat is also called streptococcus tonsillitis. When we suspect strep throat, we perform a rapid strep test and/or a throat culture to check for the strep bacteria. While some people can carry strep in their throats without symptoms, we consider it strep throat when symptoms are present. Symptoms of strep throat include sore throat, fever, a whitish appearance to the tonsils, and swollen lymph nodes.

Are there complications of tonsillitis?

There can be serious but uncommon complications of tonsillitis resulting from strep bacteria, which include scarlet fever and rheumatic fever. Another complication is a peritonsillar abscess, where the tonsils or surrounding spaces fill with pus and may require draining, but this is a relatively rare occurrence.

How do you diagnose tonsillitis?

We perform a physical exam to check for swollen tonsils, and we take a history of your child’s symptoms. As ear, nose, and throat specialists, we often see children who have already been diagnosed with tonsillitis by a primary care provider and who are experiencing complications of tonsillitis or ongoing symptoms.

How do you treat tonsillitis?

If it’s determined to be a bacterial infection, we use antibiotics. If it is viral in nature, we watch and wait while providing supportive care, which may include pain relievers and fever reducers, to manage your child’s symptoms. In certain situations, we remove the tonsils.

When and why do you remove tonsils?

Removing tonsils is less common than it was in the past, and it is something we do not take lightly. We consider tonsillectomy when your child has repeated episodes of tonsillitis over time or if he or she has complications of tonsillitis. We follow research-based guidelines called the “Paradise Criteria” for tonsillectomy to determine when your child might need his or her tonsils removed. The guidelines state that if a child has had at least seven episodes in the past year, or five episodes in each of the previous two years, or three episodes in each of the previous three years, along with symptoms (fever, swollen lymph nodes, tonsillar exudate [fluid secreting from the tonsils] or a positive strep A test), we consider the child for tonsil removal. Tonsillectomy may also be warranted in special circumstances.

Does removing the tonsils affect my child’s immune system?

There are other areas of the body that help in the body’s defense, so having the tonsils taken out does not predispose your child to becoming immunosuppressed. In other words, removing the tonsils does not affect your child’s ability to fight off infections in the future.

How can I treat early tonsillitis symptoms at home?

We recommend a saltwater gargle because it can help your child feel more comfortable. Throat lozenges may also help numb the back of the throat. If the pain is unbearable, we recommend child acetaminophen or ibuprofen. Most important, make sure your child is well hydrated.

When should my child see a doctor for tonsillitis?

If your child’s symptoms do not improve after a few days or are getting worse, it’s time to see a doctor. Specifically, if your child’s fever is 101 or higher, you should see your primary care provider to rule out strep throat. If your child has chronic tonsillitis or advanced symptoms, the doctor might refer you to an ear, nose, and throat (ENT) specialist. Stanford Medicine Children’s Health has ENTs at specialty clinics throughout the Bay Area.