Tonsillitis is inflammation of the tonsils. (See also sore throat.)

Causes, incidence, and risk factors
The tonsils are Lymph nodes in the back of the mouth and top of the throat. They normally help to filter out bacteria and other microorganisms to prevent infection in the body. They may become so overwhelmed by bacterial or viral infection that they swell and become inflamed, causing tonsillitis.

The infection may also be present in the throat and surrounding areas, causing pharyngitis.

Tonsillitis is extremely common, particularly in children.


  • Sore throat       o Persisting longer than 48 hours       o Possibly severe  
  • Difficulty swallowing  
  • headache  
  • Fever, chills  
  • Tenderness of the jaw and throat  
  • Voice changes, loss of voice

Signs and tests
The health care provider will look in the mouth and throat for enlarged, visible tonsils. They are usually reddened and may have white spots on them. The Lymph nodes of the jaw and neck may be enlarged and tender to the touch.

A culture of the tonsils may show bacterial infection. A culture for the streptococcus bacteria (strep) may be taken because it is the most common and most dangerous form of tonsillitis. A rapid strep test may also be performed by your physician by taking a throat swab for a quick diagnosis.


If the cause of the tonsillitis is bacteria such as strep, antibiotics are given to cure the infection. The antibiotics may be given as a one-time injection, or by a 10-day course of antibiotic pills.

If antibiotic pills are used, they must be taken for the full course. They must not be stopped just because the discomfort stops, or the infection will NOT be cured. Some health care providers will treat all tonsillitis with antibiotics to prevent the chance of strep-related complications. Others treat only known bacterial and strep infections to minimize the chance of reaction to the antibiotic.

Rest to allow the body to heal. Fluids, especially warm (not hot), bland fluids or very cold fluids may soothe the throat. Gargle with warm salt water or suck on lozenges (containing benzocaine or similar ingredients) to reduce pain.

Over-the-counter medications may be used to reduce pain and fever. Do NOT use aspirin in children if the infection could be viral, because this may be associated with Reye’s syndrome.

Surgery to remove the tonsils (tonsillectomy) may be necessary for some people.

Expectations (prognosis)
Tonsillitis symptoms usually lessen in 2 or 3 days after treatment starts. The infection usually is cured by then, but may require more than one course of antibiotics. Complications of untreated strep tonsillitis may be severe. A tonsillectomy may be recommended if tonsillitis is severe, comes back, or does not respond to antibiotics.


  • Pharyngitis - bacterial  
  • Pharyngitis - viral  
  • Dehydration from difficulty swallowing fluids  
  • Blocked airway from enlarged tonsils  
  • Peritonsillar abscess or abscess in other parts of the throat  
  • Rheumatic fever and subsequent cardiovascular disorders  
  • Kidney failure  
  • Post-streptococcal glomerulonephritis

Calling your health care provider
Call your health care provider if a sore throat persists longer than 48 hours, is accompanied by other symptoms of tonsillitis, if symptoms worsen, or new symptoms develop.

Avoid people with known tonsillitis or bacterial sore throats, if susceptible to tonsillitis.

Johns Hopkins patient information

Last revised: December 4, 2012
by Amalia K. Gagarina, M.S., R.D.

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