Unobtrusive, but burning like fire

What is tonsillitis?

Tonsillitis, also known medically as tonsillitis or angina tonsillaris, is an inflammation of the palatine tonsils. These two lymphatic organs are located on either side at the back of the throat, just behind the uvula, and are usually easy to see when the mouth is widely open. They are part of the body's immune system and belong to the lymphatic pharyngeal ring, which helps prevent pathogens from entering via the mouth and nose.

With tonsillitis there is a immune response to invading microbes, which can cause marked swelling and redness of the tonsils. In some cases pus is visible, indicating a strong inflammatory reaction. The illness often starts suddenly and can vary in severity – from mild symptoms to pronounced inflammation with a significantly impaired general condition. One tonsil or both sides can be affected. A detailed medical assessment helps evaluate the likely course and plan further measures.

Are there different forms of tonsillitis?

Yes. There are different forms that vary in course, cause and frequency. Acute tonsillitis usually appears suddenly and is caused mostly by viruses and less often by bacteria. Children and adolescents are frequently affected because their immune systems are still developing. A weakened general condition can also increase risk. Typically, this form heals without sequelae within one to two weeks.

Purulent tonsillitis is a more severe form. A bacterial superinfection, often with streptococci, can lead to the formation of pus on the tonsils. This form can occur in connection with certain diseases such as scarlet fever or infectious mononucleosis and requires special attention.

If tonsillitis recurs several times within a year, it is called recurrent tonsillitis. Symptom-free intervals between acute phases are often short. One possible reason is that infections do not fully resolve and bacterial residues and dead cells accumulate in the tonsillar crypts, which can promote new infections.

In the past chronic tonsillitis was also described. Today this term is more often used to refer to permanently altered tonsil tissue after repeated infections. There is usually no active inflammation, but a persistent dysfunction of the tonsils that can cause swallowing difficulties or a general feeling of illness. In such cases surgical removal of the tonsils may be medically appropriate.

What symptoms are typical of tonsillitis?

Typical signs of tonsillitis appear mainly in the throat area. The most common complaints are severe sore throat and difficulty swallowing, caused by markedly enlarged and reddened palatine tonsils. These are often covered with whitish-yellow coatings, particularly in bacterial infections. In addition, the lymph nodes in the neck are often enlarged and tender to pressure.

A general feeling of illness with fatigue, headache and elevated body temperature, sometimes accompanied by chills, is common. Some people also experience changes in their voice. In some cases, throat pain radiates to the ears.

In children less typical symptoms may occur. For example, abdominal pain, nausea or vomiting may be prominent, which can make diagnosis more difficult. When viruses are the cause, cold symptoms such as cough, runny nose or hoarseness often appear simultaneously. An inflammation of the entire pharynx may also occur alongside tonsillitis.

What causes tonsillitis?

Tonsillitis can be caused by a variety of pathogens, with viral infections accounting for the majority of cases. They often occur as part of common respiratory infections caused by cold viruses such as rhinoviruses, adenoviruses or influenza viruses. The Epstein–Barr virus, which causes infectious mononucleosis, can also be a trigger. Viruses typically enter the body via droplets and infect the sensitive tissue of the palatine tonsils. As part of the immune system, the tonsils react quickly to invading pathogens.

In addition to viruses, bacteria can also be responsible for tonsillitis. Common causative agents include group A streptococci, notably Streptococcus pyogenes. Other bacteria such as pneumococci, Haemophilus influenzae or staphylococci are also possible. Such an infection often occurs when the body's defences are already weakened by a preceding viral infection. In some cases a so-called superinfection occurs, where a bacterial infection is superimposed on an existing viral inflammation.

Is tonsillitis contagious?

Yes, tonsillitis is contagious, especially in the acute phase of the illness. Transmission occurs primarily via droplets released when coughing, sneezing or speaking. These tiny saliva droplets may contain viruses or bacteria and can spread through the air to other people.

Direct physical contact, for example kissing, also significantly increases the risk of infection. Indirect transmission is possible via shared objects: pathogens are transferred by hands, door handles or other surfaces to the mouth, nose or eyes, reaching the mucous membranes.

The duration of infectivity depends greatly on the specific pathogen and the treatment. With viral tonsillitis the risk of contagion usually remains as long as symptoms such as cough or runny nose persist. An untreated bacterial form can remain infectious for several weeks. However, if an antibiotic is taken correctly, the person is generally considered non-contagious about 24 hours after starting treatment.

When should the tonsils be removed?

Surgical removal of the palatine tonsils is only considered when certain conditions are met, as the procedure is not without risk. In adults the question of surgery typically arises when infections occur very frequently and significantly impair quality of life.

As a rough guideline: if a bacterial tonsillitis occurs about seven times in one year, five times in two years or three times in three years, a tonsillectomy may be appropriate. It is essential that these are truly bacterial infections. A throat swab can be used to confirm this.

If repeated courses of antibiotics have been necessary and the symptoms are severely limiting, for example through frequent sick leave or considerable pain, surgery is considered more often. It must first be carefully checked whether other causes exist and whether there is an increased tendency to bleed, which would raise the procedural risk.

How is tonsillitis treated?

Treatment of tonsillitis is primarily determined by the underlying cause. For viral infections there is no causal drug therapy, as viruses cannot be treated with antibiotics. In these cases medical measures are limited to symptom control while the immune system fights off the pathogens.

If a bacterial infection is identified, for example by a throat swab, targeted treatment with antibiotics may be necessary. These medications help eliminate the inflammation, shorten the duration of illness and reduce the risk of possible complications. To ensure full effectiveness and to avoid resistance development, it is essential to take the prescribed antibiotics for the entire recommended duration.

In rare cases an abscess may form in the pharyngeal area as a result of tonsillitis. Drug treatment alone is then no longer sufficient and a surgical procedure to remove or drain the abscess is required. If tonsillitis recurs over a longer period, especially in childhood or adolescence, a surgical option for partial or complete removal of the palatine tonsils is considered under medical supervision.

Practical tips that help with tonsillitis

• Depending on how you feel, apply warm or cold compresses. For warm compresses, crush cooked potatoes, wrap them in a cloth and place the compress on the neck for 20 minutes. For cooling compresses, spread quark directly onto a cotton cloth, wrap it and apply the compress for 15 minutes for swelling.
• Also drink warm herbal teas regularly in small sips. Sage, chamomile or thyme are ideal. Pour one tablespoon of dried herbs over 250 millilitres of hot water, let the tea steep for ten minutes and drink it three to four times daily.
• Gargle two to three times a day with a lukewarm saline solution. Dissolve ½ teaspoon of sea salt in 200 ml of warm water. Gargle for about 30 seconds and then spit out the solution.
• Speak as little as possible to rest your voice. Use note paper or your phone's notes function to communicate if necessary. Avoid even whispering.
• Completely avoid smoking — including passive smoking. Stay away from smoky rooms, as even second‑hand smoke can further irritate inflamed tonsils.
• Humidify the indoor air with simple measures. For example, hang a damp towel over the radiator or place a bowl of water on the heater. This helps prevent drying of the mucous membranes.
• Avoid cold, carbonated or acidic drinks. Better choices are lukewarm water or unsweetened herbal tea. Also avoid orange juice, as its acidity can irritate the throat.
• Regularly suck sugar‑free lozenges containing soothing ingredients. Look for components such as Iceland moss or sage. Let the lozenge dissolve slowly, do not chew it.
• Prefer soft, lukewarm foods such as soups, porridge or soft vegetables. Avoid crusts, hard breads or very hot meals to prevent further throat irritation.
• Season meals mildly and avoid chilli, pepper and vinegar. Gentle spices such as turmeric or a pinch of ginger can be supportive.
• Inhale several times daily over a bowl of hot water. Add chamomile flowers or sage if desired. Lean over the bowl with a towel over your head and breathe deeply for ten minutes.

Tonsillitis is unpleasant but usually treatable. If the tonsils are noticeably swollen and fatigue or sore throat occurs, see a doctor. Home remedies such as neck compresses and gargles can usefully complement treatment.