Tonsillitis A-to-Z Guide: Overview, Diagnosis, Treatment & Prevention

Introduction to tonsillitis:

If you look into your child’s throat, you might see what look like small, dimpled, pink golf balls on either side of the throat. These are the tonsils.

The tonsils are the visible part of the immune system’s ring of protection that surrounds the back of the throat. This immune tissue stands guard to protect your child’s lungs and intestines from foreign invaders. The adenoids, the other famous part of this ring, are hidden out of site above.

Tonsils are normally large during childhood, but they can cause trouble when they become infected or grow too large.

What is tonsillitis?

Tonsillitis is the name given to swollen, red, and tender tonsils. This is usually caused by an infection of the tonsils. The most common causes of tonsillitis are viral infections. Many of the viruses are the same as those that cause the common cold.

Coxsackievirus can cause painful tonsillitis with a high fever and decreased appetite, sometimes with a rash as well. Mononucleosis can also cause severe tonsillitis.

Bacterial infections are important causes of tonsillitis, even though they are less common. Streptococcus is the most common type of bacteria involved.

Tonsillitis overlaps with strep throat and other sore throats. When a child has a sore throat, either the tonsils may be red and swollen, or other parts of the throat may be red and swollen – or both.

Who gets tonsillitis?

Tonsillitis is not common before the first birthday. It tends to peak in the years surrounding kindergarten, but can occur throughout childhood and even in adult life.

What are the symptoms of tonsillitis?

Generally, children with tonsillitis have a sore throat and pain with swallowing. Babies and toddlers may simply refuse to eat or drink because of the throat pain. There may also be some difficulty with swallowing or breathing. You might notice snoring or mouth breathing, accompanied by a dry mouth and mouth odor. Sleep disturbances sometimes result in bed-wetting (enuresis). Decreased appetite, fatigue, and swollen glands in the neck are also common.

The specific symptoms of tonsillitis will depend largely on the underlying cause. Tonsillitis caused by an upper respiratory virus, for instance, may start gradually and be accompanied by nasal congestion. On the other hand, tonsillitis caused by strep might start suddenly with a high fever.

Is tonsillitis contagious?

Most forms of tonsillitis are contagious and are spread by droplet transmission.

How long does tonsillitis last?

The length of tonsillitis depends largely on the underlying cause. Most viral tonsillitis tends to last a matter of days; strep tonsillitis for up to a couple of weeks, and tonsillitis caused by mononucleosis commonly lasts for weeks or months.

Sometimes bacterial tonsillitis will last for months, even with appropriate antibacterial therapy.

How is tonsillitis diagnosed?

Tonsillitis can be diagnosed with a history and physical exam. A throat culture and/or rapid strep test are important to identify the cause, especially if antibiotics are being considered. A mono test, and other specific blood tests, may be indicated if the cause is not clear.

How is tonsillitis treated?

Taking out the tonsils for tonsillitis used to be common. Today, most cases of viral tonsillitis are managed by watching and waiting (while treating the pain and fever). Tonsillitis will be treated with antibiotics if bacteria appear to be the cause. The longer that tonsillitis lasts, the more likely that it will require stronger treatment. In some circumstances, steroids are used to reduce tonsil swelling.

The American Academy of Pediatrics recommends removing the tonsils under some conditions:

  • Tonsil or adenoid swelling that makes normal breathing difficult (this may or may not include sleep apnea).
  • Tonsils that are so swollen that your child has problems swallowing.
  • An enlarged adenoid that makes breathing uncomfortable, severely alters speech, and possibly affects normal growth of the face. In this case, surgery to remove only the adenoid may be recommended.
  • Your child has repeated ear or sinus infections despite treatment. In this case, surgery to remove only the adenoid may be recommended.
  • Your child has an excessive number of severe sore throats each year.
  • Your child’s lymph nodes beneath the lower jaw are swollen or tender for at least six months, even with antibiotic treatment.

How can tonsillitis be prevented?

Tonsillectomy can prevent tonsillitis, but is only recommended in select circumstances.

Because most types of tonsillitis are spread by droplet transmission, droplet precautions can be effective means of prevention. Some tonsillitis, such as the kind caused by mono, is spread by body fluid transmission. Body fluid precautions are needed to prevent this type of tonsillitis

Related A-to-Z Information:

Adenovirus, Allergies (Allergic Rhinitis), Body-Fluid Transmission, CMV (Cytomegalovirus), Common Cold, Coxsackievirus, Diphtheria, Droplet Transmission, Enteroviruses, Enuresis (Bedwetting), Fomites, Hand-Foot-Mouth Disease, Mononucleosis (Mono), Scarlet Fever, Sleep Apnea, Strep Throat, Streptococcus (Strep)

Dr. Alan Greene

Dr. Greene is the founder of (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.