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Tonsillitis: symptoms, treatment, causes

by Josephine Andrews
Published: Last Updated on 319 views

In the case of tonsillitis (medical: tonsillitis, angina tonsillaris), the tonsils are inflamed. This is usually noticeable with a sore throat and difficulty swallowing. Tonsillitis can often be treated with medication. Only if the tonsils become inflamed very frequently are they removed. Read all about symptoms, treatment and home remedies for tonsillitis!

quick overview

  • Common symptoms: sore throat , difficulty swallowing, reddened and coated tonsils, reddened throat wall, swollen lymph nodes, fever
  • Treatment: home remedies (neck wrap, gargling , lozenges, etc.), painkillers, antibiotics if necessary, surgery
  • Special form: chronic tonsillitis (recurrent tonsillitis)
  • Contagion: risk of infection is high in the first few days, via droplet infection
  • Tonsillitis – Duration: With proper treatment, acute tonsillitis usually heals within one to two weeks.
  • Possible complications: otitis media , sinusitis, earache, peritonsillar abscess, rheumatic fever, “blood poisoning” (sepsis)

Symptoms: This is how tonsillitis manifests itself

Typical symptoms of tonsillitis include sore throat and difficulty swallowing. They usually develop within a few hours. The palatine tonsils on both sides of the uvula are clearly reddened, swollen and may have a whitish or yellowish coating.

The pharyngeal wall is also reddened, and the lymph nodes in the angle of the jaw are often palpably enlarged. This is accompanied by an unpleasant bad breath (foetor ex ore) as another typical sign of tonsillitis. Patients often feel weak and listless. In many cases there is also a (high) fever. Tonsillitis without fever is also possible.

Differences between viral and bacterial tonsillitis

It is usually viruses such as rhino, corona or adenoviruses that cause tonsillitis. Those affected often suffer from a cold in addition to tonsillitis. Patients with viral tonsillitis therefore often complain

  • Sniffles
  • Cough
  • headache and body aches

In addition to viruses, bacteria, especially streptococci, can also cause tonsillitis less frequently. Pus on the tonsils – recognizable by white-yellowish dots or deposits – is a typical sign of bacterial tonsillitis. The distinction between viral and bacterial tonsillitis is usually difficult. In patients who are 15 years of age or older, a special criteria system (Centor score) helps the doctor to estimate the probability of streptococcal tonsillitis (more precisely: an infection with group A streptococci):

  • Fever over 38 degrees
  • no cough
  • swollen and painful neck lymph nodes
  • enlarged and coated tonsils

When all four symptoms of tonsillitis are present, about 50 to 60 percent of cases are caused by streptococcus . If three of the symptoms mentioned are present, the probability is still around 30 to 35 percent.

The Centor score can only indicate a trend, but cannot make a diagnosis. Whether streptococcal tonsillitis is actually present can only be shown with certainty by analyzing a tonsil swab.

The modified Centor score (McIsaac score) is used to assess tonsillitis in children. It can be used from the age of three. The McIsaac score contains the same criteria as the traditional Centor score. However, all children between the ages of three and 14 receive an additional point, and adults over the age of 45 receive one point less. There are other classification systems that can help differentiate between viral and bacterial tonsillitis.

Tonsillitis as a symptom and special forms

Tonsillitis is not just a clinical picture. It can also be a symptom that accompanies other diseases. There are also special forms. Examples are:

Tonsillitis – Symptoms of glandular fever: If tonsillitis is a symptom of this viral disease, the tonsils are covered with a dirty, white-grey surface. In addition, the lymph nodes in the jaw angle, in the neck, neck and groin area are often severely swollen.

Tonsillitis – Symptoms of Diphtheria: Diphtheria is a dangerous bacterial infection often accompanied by laryngitis or tonsillitis. The almonds are then covered by a greyish-white coating. If you try to remove the deposits, it usually bleeds. Affected people often have a putrid-sweet mouth odor, which is compared to fermenting apples.

Tonsillitis – symptoms of scarlet fever: Tonsillitis in scarlet fever is expressed in deep red tonsils, which are sometimes covered with purulent specks. The pharyngeal wall is also usually reddish in color. Small, whitish deposits can appear on the inside of the cheeks. Also typical is a white “raspberry or strawberry tongue” at the beginning, which gradually becomes red – the tongue resembles the surface of the fruit mentioned.

Tonsillitis – Symptoms of Herpangina: In tonsillitis caused by Coxsackie A viruses (Herpangina), the tonsils are only slightly swollen. In addition, small blisters (aphthae) form on the mucous membrane of the palate and cheeks, which leave flat, painful defects after they burst. Fever, difficulty swallowing and a distinct feeling of illness are other symptoms.

Tonsillitis – symptoms of angina Plaut-Vincent: Angina Plaut-Vincent is a rare form of bacterial tonsillitis that occurs mainly in younger men. Usually only the tonsil is inflamed on one side. It has ulcers and a green-grey mucus coating. There is also a bad smell from the mouth. Patients with this clinical picture usually do not have a fever and usually feel relatively healthy.

Tonsillitis – symptoms of syphilis and gonorrhea: Syphilis (syphilis) is a sexually transmitted disease that runs in several stages. In the second stage, tonsillitis sometimes develops. Symptoms of this so-called angina specifica are swollen, reddened tonsils with veil-like, grey-white coatings (plaques opalines) as they progress. A large, dark red rash is often visible on the oral mucosa (plaques muqueuses). Fever does not occur.

Gonorrhea – another sexually transmitted disease – can also lead to tonsillitis, among other things.

Tonsillitis – symptoms of fungal infection

A typical pathogen is the yeast fungus Candida albicans. Those affected usually have whitish coatings on their oral mucosa (thrush stomatitis) and on their tonsils. This disease, also known as soorangina, usually occurs in immunocompromised patients. The fungal tonsillitis can also be the result of cortisone sprays.

Tonsillitis – symptoms of tuberculosis

Tonsillitis associated with tuberculosis is very rare. In this case, flat mucosal defects appear on the tonsils.

Tonsillitis: treatment

Treatment for tonsillitis depends on its cause, severity, and whether it has happened before. Home remedies often help against mild sore throats caused by tonsillitis. Traditionally, doctors usually prescribe painkillers. They are usually also effective against any fever that may occur. Antibiotics are also used for bacterial tonsillitis. In the case of chronic or frequently recurring tonsillitis, an operation may be necessary.

If complications such as a peritonsillar abscess (encapsulated pus) occur, inpatient treatment in a hospital may be necessary. Doctors usually operate here, too.

Self-help for tonsillitis: what to do at home?

Mild tonsillitis often develops as part of a cold. With the help of physical rest and home remedies, you can then also support the healing of your tonsillitis yourself. The symptoms can often be successfully alleviated with the following tips, for example:

  • neck wrap
  • Gargling (with solutions and tea)
  • Medicinal herbal teas ( e.g. sage )
  • Inhale
  • bed rest
  • humid room air
  • drink enough (no acidic drinks, e.g. juice)
  • Eat preferably soft, lightly seasoned foods

Home remedies have their limits. If the symptoms persist over a longer period of time, do not get better or even get worse, you should always consult a doctor.

What else you can do at home and where the limits of home remedies are for tonsillitis can be read in the article tonsillitis: home remedies .

Tonsillitis: when to see a doctor?

Pain is the most annoying symptom of tonsillitis, especially in the first few days. First you can try to deal with the pain with measures such as neck wraps or lozenges, special lozenges and sprays and antiseptic and local anesthetic gargling solutions from the pharmacy.

If these measures are not enough, you can try over-the- counter pain relievers – for example acetaminophen or ibuprofen . The drugs have a pain-relieving (analgesic) and fever-reducing (antipyretic) effect, some also have an anti-inflammatory (antiphlogistic) effect. However, you may only use these substances if you are not allergic to the active ingredients.

If you are pregnant or chronically ill, for example with kidney , heart or liver, or have known stomach problems, allergies or blood clotting disorders, you should only take the medication after consulting a doctor! Paracetamol is also not advisable for glandular fever (EBV infection) as it puts additional strain on the liver.

Painkillers only relieve the symptoms, they do not fight the pathogens.

If, despite rest and “gentle support”, the immune system is not able to eliminate the disease-causing viruses or bacteria, or if the tonsillitis is very severe, you should consult a doctor.

You should also seek medical help for tonsillitis in the following situations:

  • abnormal breath sounds
  • difficult breathing
  • severe unilateral pain, especially when chewing, swallowing, or opening your mouth
  • Illness lasting more than three days without improvement
  • persistent increase in complaints
  • acute rheumatic fever in the family
  • severe general illnesses
  • high fever, especially if it cannot be brought down with medication

Medical treatment for bacterial tonsillitis

If the doctor can prove streptococcal tonsillitis or if this is very likely, the doctor usually prescribes antibiotics, primarily of the penicillin V type. Those who do not tolerate this active substance are given other antibiotics (such as cefadroxil or erythromycin), which also work well against streptococci .

Other antibiotics are only used if the disease-causing bacteria have become insensitive (resistant) to the standard active ingredients or the patient cannot take the latter.

What is important is that the antibiotics must be taken for as long as the treating doctor has prescribed them. Do not discontinue the medication prematurely – even if the symptoms improve before then! Some bacteria can still romp around in the body, which can then trigger inflammation again or form resistance to the antibiotic.

Resistant strains of bacteria can develop with any antibiotic therapy. Therefore, antibiotics should not be used prophylactically for tonsillitis, but should only be considered if a bacterial cause is proven or very likely.

Medical treatment for viral tonsillitis

Antibiotics only work against bacteria, so they are not used for viral infections. Doctors only use them for viral tonsillitis if there is an additional bacterial infection on the diseased mucous membranes (superinfection).

The treatment of viral tonsillitis is therefore usually limited to treating symptoms such as fever and pain. In addition to pain medication, home remedies and physical rest can accelerate the recovery process.

Physical protection is particularly important in the case of infections. Even initially harmless diseases can cause potentially life-threatening myocardial inflammation if subjected to excessive stress .

In glandular fever, internal organs ( spleen , liver) can swell and there is a risk of a ruptured spleen. This complication is life-threatening and requires inpatient treatment in a hospital. Therefore physical protection is also extremely important here.

Chronic tonsillitis: what to do?

Chronic tonsillitis occurs when the tonsil tissue becomes inflamed again and again or the inflammation never completely subsides. Either (dead) material from the germs collects in the depressions (crypts) of the tonsils, causing persistent inflammation. Or it comes back to acute infections again and again. The deposited cell material often serves as an ideal breeding ground for the pathogens. Doctors refer to recurring tonsillitis as recurrent tonsillitis .

You can learn more about symptoms and treatment of chronic tonsillitis in the article Chronic Tonsillitis .

Tonsillitis: When to operate

If tonsillitis occurs frequently, the tonsils are often completely removed. This so-called tonsillectomy is one of the most frequently performed medical procedures in this country. The surgeons remove the tonsils either with heat (eg laser treatment, radio frequency device) or with scissors or a snare.

There is also the option of partial removal of the tonsils (tonsillotomy). It is slightly gentler than complete tonsil removal. However, it is not certain how effectively a tonsillotomy can prevent tonsillitis from recurring in the long term.

You can find out more about the process, benefits and risks of tonsillectomy in the article on tonsillectomy .

Tonsillitis: Treatment with homeopathy

With the question “What helps with tonsillitis?” Many patients also turn to naturopaths. Among the alternative healing methods, homeopathy is particularly popular. However, it is not a substitute for necessary conventional medical treatment.

Depending on the symptoms, the homeopathic remedies Aconitum , Belladonna , Apis or Pyrogenium are recommended for acute tonsillitis.

The concept of homeopathy and its specific effectiveness are controversial in science and have not been unequivocally proven by studies.

Tonsillitis: where it comes from

Tonsillitis is an inflammation of the tonsils, which are located on the left and right side of the throat. It is one of the most common reasons people go to the doctor. Children and adolescents are more likely to get tonsillitis than adults.

Most often, viruses are the causative agent of tonsillitis. Rarely bacteria trigger tonsillitis, then mostly of the streptococci type. The specks, or yellow-whitish patches on the inflamed tonsils that are typical of bacterial tonsillitis, are made up of dead bacteria and dead immune system cells. Tonsillitis can occur on one or both sides.

Acute inflammation of the tonsils usually begins quickly. In the majority of patients, however, the symptoms improve significantly after just three days. Tonsillitis usually heals on its own within a week or two. In the case of bacterial tonsillitis, however, antibiotics may be necessary to support and accelerate the healing process.

Doctors speak of chronic tonsillitis when the inflammation has lasted for more than three months. The process can vary. The inflammation in the tonsils often smolders, patients are symptom-free or only have mild symptoms of tonsillitis. Now and then an acute inflammatory process flares up on this soil.

The currently valid guidelines refrain from using the term “chronic tonsillitis”. Instead, the experts speak of recurrent tonsillitis, a recurring tonsillitis. You can read more about this in our article Chronic Tonsillitis .

Tonsillitis: causes and risk factors

Tonsillitis can be triggered by various pathogens. These can easily get stuck on the fissured surface of the tonsils. In principle, this is even good:

As part of the immune system, one of the tasks of the tonsils is to intercept pathogens that have entered the pharynx and thus prevent them from infecting the respiratory tract. The tonsils contain numerous defense cells that render invading pathogens harmless. Basically, permanent natural inflammatory processes take place in the tonsils. However, if the organism is weakened, for example by an influenza infection, this defense can be disturbed, the inflammation can spread and tonsillitis can develop.

Bacterial tonsillitis – causative agent

In fact, in many cases tonsillitis is preceded by a viral infection (e.g. common cold), which may then be followed by a bacterial infection of the tonsils – mostly with ß-hemolytic streptococci of Lancefield group A (Streptococcus pyogenes). The result is bacterial (purulent) tonsillitis. There are other pathogens that can cause bacterial tonsillitis:

  • Various streptococci strains
  • staphylococci
  • Haemophilus influenzae type b
  • corynebacteria
  • nocardia
  • Neisseria gonorrhoeae

The special form of angina Plaut-Vincenti (ulcerative tonsillitis) is usually a mixed infection: screw bacteria (especially Treponema vincentii) and fusobacteria (especially Fusobacterium nucleatum) trigger tonsillitis here.

Viral tonsillitis – causative agent

In the case of viral tonsillitis, the inflammatory processes in the tonsil tissue are caused, for example, by typical “cold viruses” from the rhinovirus group. Other possible triggers are

  • coronaviruses
  • adenoviruses
  • Influenza viruses and parainfluenza viruses
  • Epstein-Barr virus (causative agent of glandular fever)
  • enteroviruses such as coxsackieviruses
  • RS virus especially of tonsillitis in children

Agranulocytotic angina

Some people, for example, have hardly any immune cells left after strong chemotherapy, as in the case of blood cancer, or other drugs such as metamizol . Doctors call this agranulocytosis . This can result in tonsillitis with dirty sores, bad breath and fever. In addition, those affected feel seriously ill. Lymph nodes typically do not swell, however, since the defense cells that collect there are scarcely present.

A tonsillectomy cannot be performed in the case of angina agranulocytotica!

Is tonsillitis contagious?

Since the pathogens can also be found in the saliva , tonsillitis is contagious – provided the infection actually causes tonsillitis, because an infection progresses differently depending on the pathogen and from person to person. Cold viruses are often the trigger for tonsillitis. But not all colds are accompanied by tonsillitis.

Other people can become infected with the usual pathogens of tonsillitis via droplets containing germs. Doctors speak of droplet infection.

Since the risk of infection with tonsillitis is particularly high in the first few days, you should avoid contact with other people as much as possible during this time.

If tonsillitis is treated with an antibiotic, the risk of infection can be greatly reduced after just one day. If none is prescribed, for example in the case of viral tonsillitis, the patient is contagious for one to two weeks.

Unlike chickenpox, for example, you are not immune to reinfection after tonsillitis.

Tonsillitis: investigations and diagnosis

Severe sore throat and difficulty swallowing, exhaustion and fever often lead those affected to the doctor. He will first ask you a few questions about your medical history ( anamnesis ). Possible questions are for example:

  • How long have the complaints existed?
  • What are the symptoms (fever, sore throat, skin rash, shortness of breath, etc.)?
  • Do you experience pain when chewing, swallowing or opening your mouth?
  • Is the tonsillitis new (acute tonsillitis) or is it a recurring problem (chronic tonsillitis)?

Physical examination

The doctor then checks whether there is redness, swelling or a coating on the throat and tonsils. He also feels the lymph nodes, especially in the neck and back of the head. They may be swollen with tonsillitis.

The examination and the symptoms described are usually sufficient for the doctor to be able to diagnose “tonsillitis”.

throat swab

If there is a suspicion that the tonsillitis is caused by certain bacteria (group A beta-hemolytic streptococci, or GABHS for short), the doctor will take a throat swab. To do this, he rubs a special cotton swab along the back of the throat wall to take a sample of the saliva there. Any streptococci present in the smear can then be detected with a rapid test or in the laboratory: the result of the rapid test is available after just a few minutes, but the test does not detect every streptococcal infection. The analysis of the smear in the laboratory is more reliable – using a bacterial culture. But that takes a day or two.

Further investigations

In some cases, further investigations may be necessary. For example, if the doctor suspects an encapsulated focus of pus ( abscess ), he will carry out an ultrasound examination. In some cases, blood tests can also be useful, for example to rule out other diseases.

Tonsillitis: course of the disease and prognosis

The course of tonsillitis depends on many factors. These include the type of tonsillitis and the patient’s physical condition and immune system.

In the case of acute tonsillitis, the symptoms usually decrease significantly after just a few days. Within a week or two, the symptoms disappear completely. It may take a little longer for the swelling of the tonsils to go down.

Bacterial tonsillitis that is treated with antibiotics shortens the duration of the disease.

Complications of tonsillitis

Sport should be avoided with (purulent) tonsillitis, as the immune system already needs a lot of energy to fight germs. Otherwise, tonsillitis can become chronic or lead to complications. Physical exertion also increases the risk of bacteria being carried to other organs via the bloodstream.

In addition, complications often arise when a bacterial, purulent tonsillitis was not treated with antibiotics at all or was treated too briefly. There is also an increased risk of complications during pregnancy.

Here is an overview of important complications of purulent tonsillitis:

Inflammation of the middle ear and paranasal sinuses

A middle ear infection (otitis media) usually occurs when ventilation of the so-called auditory tube (connection from the nasopharynx to the middle ear ) is prevented by swelling of the mucous membrane. The situation is similar with a sinus infection. Earache or pressure pain over the maxillary and frontal sinuses are then typical symptoms. Inflammation of the middle ear and paranasal sinuses are common comorbidities and/or consequences of tonsillitis, especially in childhood.

peritonsillar abscess

In tonsillitis with a peritonsillar abscess, an inflammatory focus is isolated between the tonsil and the surrounding connective tissue (peritonsillitis). In most cases, the pharyngeal wall then bulges significantly inwards on the affected side. Affected people also often have severe sore throat and swallowing pain and can only open their mouth minimally (jaw clench). Other symptoms are

  • clunky language
  • increased salivation
  • “Wryneck” with head tilted to one side
  • breath sounds ( stridor )
  • possibly shortness of breath with increasing swelling and thus narrowing of the airway

People who smoke while they have tonsillitis are more likely to develop an abscess. Another risk factor is poor oral hygiene.

Rheumatic fever

Streptococcal tonsillitis can lead to rheumatic fever. This is a type of autoimmune reaction that is triggered by cell components of the streptococci. In most cases, those affected get a fever again. In addition, a circular, reddish skin rash (erythema annulare rheumaticum) and painful joint inflammation can occur. If the course is unfavorable, the latter can persist for many years or flare up again and again.

In addition, heart inflammation can develop in the course of rheumatic fever . Either the inner heart layer ( endocarditis ), the heart muscle (myocarditis) or the pericardium (pericarditis) is affected – or all structures (pancarditis). This inflammation can cause the heart to stop beating evenly. Endocarditis is decisive for the long-term prognosis because it can lead to permanent heart valve defects (mostly mitral valve , also aortic valve ).

Acute rheumatic fever can also affect the nervous system and manifest as so-called ” chorea minor “. This disease shows up a few weeks to months after the tonsillitis has subsided. Symptoms are sudden, shooting movements of the arms, throat and throat. These twitches come on suddenly and cannot be controlled.

Inflammation of the renal corpuscles (acute poststreptococcal glomerulonephritis)

In some patients, acute nephritis (more precisely: kidney corpuscle inflammation) is the result of tonsillitis. An example of this is blood in the urine . However, sometimes there are only very small amounts of blood that are barely visible to the naked eye and can only be reliably detected in the laboratory (occult blood). Other possible symptoms are

  • flank pain
  • Decreased urination due to less urine
  • high blood pressure (e.g. with headache )
  • edema
  • malaise

About half of those affected have no symptoms, but in some cases develop permanent kidney damage.

Streptococcal tonsillitis can also cause kidney inflammation in children. In severe cases, the kidney can even fail completely. However, children usually recover within a few days.

sepsis

Sometimes bacteria that caused tonsillitis enter the bloodstream and spread throughout the body. This is called bacterial blood poisoning (sepsis). It is a serious, life-threatening condition in which many body organs can lose their ability to function. Intensive medical care is required here.

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