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Tonsillitis: Overview

Created: ; Last Update: December 1, 2016; Next update: 2019.


Sore throats can have a range of causes. Common cold viruses are usually to blame. In rarer cases, sore throats are caused by an infection of the tonsils (tonsillitis). This infection is often bacterial, or sometimes viral. But it isn’t easy to tell what kind of germs are responsible for the infection. Children and teenagers are much more susceptible to tonsillitis than adults are.

Acute tonsillitis starts suddenly and usually goes away again within one to two weeks. But tonsillitis can return several times over the course of a year and may become chronic. In chronic tonsillitis, the bacteria become permanently settled in the tonsils, which are always slightly inflamed as a result. People who have chronic tonsillitis might keep getting acute infections with more severe symptoms too. Having chronic tonsillitis can be a real problem, and may also lead to complications in rare cases.


Typical symptoms of acute bacterial tonsillitis include the following:

  • Sore throat
  • Swollen and very red tonsils with a yellowish coating
  • Difficulty swallowing
  • Fever over 38°C (100.4°F)
  • Headache
  • Fatigue and tiredness
  • Loss of appetite
  • Bad breath
  • Swollen and painful lymph nodes in the neck

If it is a viral infection, typical cold symptoms such as a cough or a stuffy nose are likely too.

The throat is often inflamed (pharyngitis) as well, not only the tonsils. Tonsillitis refers to an inflammation that mostly affects the tonsils.

It can also cause atypical symptoms, especially in children. These include stomach ache, nausea or vomiting.


Bacteria and viruses may be spread through tiny droplets – in other words, when someone who is infected talks or sneezes, droplets containing the germs are released into the air. They can then come into contact with other people‘s mucous membranes, where they start multiplying.

Bacterial tonsillitis is mostly caused by a specific type of streptococcus bacteria. But not everyone who has these bacteria in their body also ends up getting tonsillitis.

Sometimes tonisillitis occurs as a result of scarlet fever, which is also caused by bacteria. Viral infections like mononucleosis (also called “mono” or glandular fever) can lead to tonsillitis too.


Acute tonsillitis symptoms like sore throat and fever will usually go away within one to two weeks without any treatment. The fever goes away somewhat before the sore throat does. But it may take longer for the swelling of the tonsils to go down.


Complications are rare. The most common complication is a build-up of pus around the tonsils – known as a peritonsillar abscess or quinsy. This may develop if the tonsillitis is caused by bacteria, and can get better again without treatment. But there is a risk of the infection spreading to nearby tissue in the throat and chest area. This can lead to serious complications, so it is very important to get treatment.

The following symptoms may be signs of quinsy:

  • Very severe symptoms on only one side of the throat when swallowing
  • General physical weakness and fever
  • Earache
  • The feeling that there is a lump in your throat when speaking
  • Trouble opening your mouth

It is estimated that quinsy arises in no more than 1 to 10 out of 1,000 people who see a doctor because they have a sore throat.  It is just as rare for tonsillitis to lead to a middle ear infection.

Rheumatic fever is another possible complication of tonsillitis. This involves painful inflammations in several joints and in the heart muscle and valves. Rheumatic fever used to be much more common. Nowadays it is very rare, at least in industrialized countries. It is estimated that fewer than 1 out of every 100,000 children in Germany get rheumatic fever each year. Inflammation of the kidneys is also a very rare complication of tonsillitis – it is estimated that 6 out of 100,000 children are affected each year.


When you have a sore throat, a doctor can examine you to try to answer the following questions:

  • How severe is the inflammation?
  • Will it most likely go away quickly without treatment?
  • Is tonsillitis causing the symptoms?
  • Is it bacterial tonsillitis?
  • Is there a greater risk of complications, making treatment with antibiotics necessary?

The doctor usually examines your throat only, and asks about the exact symptoms. It is likely to be bacterial tonsillitis if your tonsils are swollen and coated, and you have a fever but you don’t have a cough.

A rapid test can be done too. In Germany, statutory health insurers cover the costs of these tests in children under the age of 16. The test involves using a throat swab to get a sample of secretions from your tonsils. The sample is checked for streptococcal bacteria. The results are available within just a few minutes. But they aren‘t very accurate. You can get more accurate results by sending a sample to a lab where it is checked for bacteria. But then you have to wait two or three days to get the results.

Blood tests are only rarely done, for instance in order to rule out other medical conditions.


The main goal of treatment is to relieve symptoms and prevent complications. The following medicines can be used to treat acute tonsillitis:

  • Medication for relieving pain and lowering fever, like ibuprofen or acetaminophen (paracetamol)
  • Antibiotics (for bacterial tonsillitis only)

Antibiotics can make the tonsillitis go away a little sooner. They can also lower the risk of developing complications. But they have side effects too.

Some people relieve their symptoms by sucking on throat lozenges, or using home remedies such as a neck wrap or gargling with salt water or tea.

Recurrent tonsillitis can also be treated with painkillers or antibiotics. The surgical removal of tonsils is a treatment option for people who frequently get tonsillitis.


  • Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin. Halsschmerzen. DEGAM; 2009.
  • Georgalas CC, Tolley NS, Narula A. Tonsillitis. BMJ Clin Evid 2009. [PubMed: 19454088]
  • Pichichero ME. Treatment and prevention of streptococcal tonsillopharyngitis. In: UpToDate. March 16, 2016.
  • Van Driel ML, De Sutter A, Deveugele M, Peersman W, Butler CC, De Meyere M et al. Are sore throat patients who hope for antibiotics actually asking for pain relief? Ann Fam Med 2006; 4(6): 494-499. [PMC free article: PMC1687169] [PubMed: 17148626]
  • IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

    Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

    Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

© IQWiG (Institute for Quality and Efficiency in Health Care)
Bookshelf ID: NBK401249


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