Tonsillitis*The information on this website is not intended to diagnose, treat, cure or prevent any disease.
What is Tonsillitis?
Tonsillitis is inflammation of the tonsils, which are a lymphoid tissue located in the back of the throat (also called the pharynx). Tonsils function similarly to lymph nodes, allowing white blood cells to traffic around the body, and helping them develop appropriately in order to respond to infections and inflammation. The most common reason the tonsils become inflamed is due to infection, which most often viral, but sometimes bacterial in origin.
Usually, tonsillitis tends to be a self-limiting infection, and most people will recover on their own, however it can occasionally become more complicated. Tonsils can become abscessed, or become so swollen that it becomes difficult to eat, drink, or speak. In these cases, hospitalization may be required in order to provide IV fluid therapy and liquid or semi-liquid nourishment. In the most severe cases, infections of the tonsils can spread to the rest of the body through the nearby blood vessels. This is a very specific and rare condition called Lemierre’s syndrome, in which a branch of the jugular vein becomes infected from the tonsils, potentially leading to sepsis.
Tonsillitis most commonly occurs in children, particularly during cold and flu season, but can also occur in adults.
The most common symptoms of tonsillitis are:
- Swollen tonsils
- Sore throat
- Difficulty or pain when swallowing
- General tiredness or malaise
- Swollen lymph nodes on neck
- Loss of appetite
- Voice changes
- White specks on tonsils
A simple oral examination can easily identify swollen tonsils and result in a diagnosis of tonsillitis, however further diagnostics are often required in order to definitively identify a cause of the inflammation and guide treatment options. Diagnostics which may need to be done include:
- Bacterial culture: This usually involves swabbing the affected tonsils and plating the swab on a plate designed to easily grow bacteria. Depending on what type of plate the bacteria grows, a specific diagnosis can sometimes be made. This can also help determine what antibiotics are likely to be effective if they are needed.
- PCR: This can sometimes be an alternative, faster option to culture by using DNA to identify bacteria. It may not always provide information about antibiotic resistance, however.
- Virus isolation: As some cases of tonsillitis are caused by viral infections, sometimes this test is performed in order to identify which specific type of virus is involved.
- Other infectious disease panels: Sometimes, inflamed tonsils can be a sign of more systemic disease processes, such as tick-borne disease (include Lyme disease).
Tonsillitis usually responds well to treatment, and does not always require medication. However, in some cases, there are options to treat infection or help alleviate the symptoms.
Pharmaceuticals and Medical Procedures:
- Antibiotics: If the tonsillitis is found to be bacterial in nature, antibiotics can help speed recovery and prevent other secondary conditions like Lemierre’s syndrome.
- Somnoplasty: This is a method which utilizes radio waves to reduce the size of tonsils, rather than surgically removing them. It may be an alternative to tonsillectomy in some patients.
- Tonsillectomy: This is surgical removal of the tonsils, which may be performed in situations where the tonsils are severely inflamed resulting in difficulty eating/drinking/sleeping, or if they become abscessed. In some cases, they are removed due to recurrent infections (for example, more than seven episodes in one year). As the tonsils are known to be important for immune function, this is now considered a procedure of last-resort.
- Anti-inflammatory medications: Over-the-counter anti-inflammatory medications such as ibuprofen (Advil) or naproxen (Aleve) can help reduce swelling and discomfort associated with tonsillitis.
- Analgesics: Acetaminophen (Tylenol) is another over-the-counter medication which can help relieve pain associated with tonsillitis. It is also an effective fever-reducing medication.
- Menthol Throat Lozenges: Throat lozenges can help provide temporary topical relief by temporarily numbing the back of the throat with menthol.
There are many non-pharmaceutical therapies for tonsillitis which may be beneficial in some people.
- Salt-water Gargle: One teaspoon of salt mixed in 8 oz of warm water is an effective way to temporarily relieve pain and discomfort associated with tonsillitis.
- Humidifier: Keeping the air humid can help prevent the throat from drying out, which can cause more discomfort to an irritated throat.
- Tea with Honey: Warm beverages sooth the throat and the addition of honey may provide a coating texture. Honey also has antibacterial properties itself, which may be beneficial in tonsillitis. Ginger and fennel teas are good options because they contain lots of antioxidants.
- Aromatherapy: Aromatherapy can be useful by relieving stress and minimizing focus on the pain and discomfort associated with tonsillitis.
- Turmeric: The potent anti-inflammatory properties may help provide some relief during tonsillitis.
- Holy Basil: Another natural herb with anti-inflammatory properties. Holy basil can be made into a tea by boiling the leaves.
- Cinnamon: Cinnamon is antibacterial and may be helpful when added to teas or consumed mixed in water. Consider combining with honey for added effect.
- Fenugreek: This herb has both anti-inflammatory and antimicrobial properties. This herb should be made into a gargle by simmering the seeds in water – it should be gargled and spit out.
- Apple Cider Vinegar: Apple cider vinegar has many anti-bacterial properties which make it a good option as a gargle when diluted in water.
- Echinacea: This is a traditional herbal remedy for many different infections. Echinacea can be made into a drink or taken as a pill/capsule.
- Ginger: Ginger also has anti-bacterial and anti-inflammatory properties which work well in tonsillitis. Ginger can easily be added to a tea to provide relief.
- Garlic: Garlic is known for its anti-bacterial properties. It can be taken as a supplement or added to food for its benefits.
- Licorice Root: Licorice root is very anti-inflammatory and can be boiled into a tea for relief from tonsillitis pain.
- Chamomile Tea: Chamomile is well-known to have anti-inflammatory properties and can help relieve throat pain which often accompanies tonsillitis.
- Peppermint: Peppermint oils and peppermint tea can help relieve pain through the natural menthol found in the plant.
- Capsaicin: Capsaicin is the hot compound found in many peppers such as cayenne. This is a natural pain reliever which induces the body to release its own opioids and blocking the pain response. A little goes a long way, but it can be added to teas or gargles to help relieve throat pain.
- Marshmallow Root: Marshmallow root contains a thick substance which helps coat the throat and protect the inflamed membranes.
- Slippery Elm: This is another plant with thick, mucus-like compounds in it which coat the throat and tonsils. Slippery elm has a long history of use for sore throats.
Preventing tonsillitis usually starts with maintaining good hygiene and living a healthy lifestyle, which will help maintain a strong immune system. As most cases of tonsillitis are caused by infections spread from person to person, it is important to wash your hands regularly and use hand sanitizers. Additionally, good oral hygiene can help reduce the chance of some infections caused by a yeast organism, Candida albicans.
It is important to support your immune system by eating a diet rich in fruits and vegetables while at the same time minimizing processed foods and refined sugars. Adding in a multivitamin which has vitamin C and B vitamins can also help boost the immune system, although if you have a healthy diet, your probably don’t need these.
Getting enough sleep is also key to keeping your immune response healthy and strong. Tired, fatigued, and stressed people are much more likely to develop infections. Getting a full 8 hours and keeping a regular sleep-wake cycle will help ensure your body is equipped for anything that comes your way.
Discontinuing unhealthy habits like smoking and excessive drinking will also help reduce your susceptibility to infection. These habits suppress the immune system, disturb sleep, and are generally unhealthy habits.
Most cases of tonsillitis are caused by viral infections. Many different viruses are known to infect the tonsils, including the common cold virus, influenza, coronavirus, adenovirus, herpes simplex viruses, cytomegalovirus, respiratory syncytial virus, and HIV. Part of the tonsils susceptibility to these infections is due to their nature as guardians of the immune system, helping filter out bacteria and viruses which are taken up by white blood cells. These viruses take advantage of their location in the tonsils and set up an infection.
Bacterial infections are also extremely common causes of tonsillitis, although not quite as common as viral infections. There are a wide range of bacteria capable of causing infection, with the most significant being streptococcal species which cause strep throat. These bacteria are known as Group A beta-hemolytic streptococcal species. There are other bacterial species capable of causing tonsillitis as well, however, including the bacterium responsible for whooping cough (Bordetella pertussis), Staphylococcus aureus, Mycoplasma pneumoniae, Corynebacterium diphtheriae, Chlamydia pneumoniae, Neisseria gonorrhoeae, and Treponema pallidum (also known as syphilis). The bacterium responsible for Lyme disease, Borrelia burgdorferi, has also been found to cause tonsillitis in some cases.
Some fungal diseases are also capable causing tonsillitis, such as Candida albicans, a type of yeast. Infection with Candida is often due to a weakened immune system, as is found in infants, the elderly, or in people with conditions such as HIV or taking immunosuppressives.
It is also important to note that the tonsils can become enlarged or inflamed for more serious reasons, such as cancer. As the tonsils are part of the immune system, certain cancers may spread to the tonsils, or even arise there.
Clinics for Management of Tonsillitis
Most primary care facilities will be able to diagnose and manage tonsillitis. Look for a doctor near you. Below, some examples of hospitals which
University of Washington (Offers Somnoplasty)
Dr. Linda Dahl, MD