Tonsillitis

Tonsillitis

with Dr Nile

Tonsillitis is a very common condition that can cause swelling at the back of the throat, soreness, pain on swallowing, fever and tender glands in the neck. It can also be associated with headache, tiredness, bad breath, earache, snoring and mouth breathing. It usually gets better without any treatment and lasts between 2 and 7 days. 

In most cases, up to 80% of the time, it is caused by a virus. This is important, because it means that it does not usually require treatment with antibiotics. Antibiotics can only help if there is a bacterial cause for the infection. It can be difficult to distinguish between viral and bacterial causes but there are things that give us clues. Bacterial infections are often sudden in onset, produce pus (or exudate) on the tonsils, fever, tender lymph nodes and no cough, whilst viruses often cause other symptoms such as a runny nose, nasal and sinus congestion, a hoarse voice, cough and conjunctivitis.

If you have symptoms that suggest you have a virus, you can take simple, over the counter pain relief. Ensure you get plenty of fluids and rest and you can even gargle with warm salty water. If you wish, you can also use lozenges and throat sprays which you can buy from the pharmacy to help relieve the pain in your throat. You can still be very unwell with a viral illness but it is your immune system that will have to clear the infection. 

If you feel that you may have a bacterial cause of tonsillitis, you will need to see a doctor who may prescribe a course of antibiotics. Antibiotics are not always necessary, even with a bacterial tonsillitis, as your symptoms should get better on their own after 3 or 4 days of your body mounting an immune response to fight the infection. If you are given antibiotics, it reduces the length of the illness by about 16 hours on average; this means that you may get well less than one day sooner than if you didn’t take any antibiotics. 

Some people are unlucky enough to suffer from recurrent episodes of tonsillitis that can cause them to take lots of sickness absence from school or work. If this occurs repeatedly, an Ear Nose and Throat specialist may consider surgically removing the tonsils to stop this from happening. Before surgery is agreed, there is usually a period of time for monitoring symptoms and a specific number of episodes per year needed to justify the procedure. The benefits always have to be weighed against the risks involved such as bleeding, infection and very rare complications of anaesthesia, like serious reactions and even death. 

If your infection follows the usual path, you can expect to feel much improved after a week. If this is not the case however, you will need to see a doctor. There are other conditions that can cause a sore throat; some result in mild symptoms from say a general cold, others can be more serious and require urgent or immediate assessment by a medical practitioner. It is important that you are aware of these so that you can decide if a medical review is needed. 

Sometimes the swelling and inflammation in the throat can be so severe that it can prevent you from swallowing anything at all. If you are not able to swallow fluids, you can become dangerously dehydrated and may need to be admitted to hospital for intravenous fluids. Some conditions such as a peritonsillar abscess or epiglottitis can cause difficulties in breathing, talking and opening your mouth. This is an emergency which needs immediate treatment. 

Sometimes you can have more unusual symptoms such as ulcers on your tonsils or in your mouth, one sided earache or sore throat, muscle aches, joint pains and lethargy. If you have any of these symptoms, have a very high temperature or your symptoms have lasted longer than you think they should, you must be assessed by your GP as a matter of urgency.