When should I see a doctor for tonsillitis?

Seek medical attention if you have very severe throat pain, trouble breathing or swallowing, persistent high fever, swelling in the mouth or neck, or cannot open your mouth.

Tonsillitis

"Surgery is indicated when episodes of tonsillitis are so frequent or severe that they affect the child's general health".

DR. FRANCISCO JAVIER CERVERA PAZ
SPECIALIST. OTORHINOLARYNGOLOGY DEPARTMENT

What is tonsillitis?

Tonsillitis, also known as acute pharyngotonsillitis (APT), is the inflammation of the tonsils, two small masses of tissue located on each side at the back of the throat. It is an inflammatory process that usually lasts less than seven days and is often accompanied by sore throat, fever, difficulty swallowing, and general discomfort. This condition is very common, especially in children and adolescents, and it may be caused by viruses (the most frequent cause) or by bacteria.

The tonsils are part of the immune system and act as a first line of defense against germs that enter through the mouth. Their role is to trap bacteria and viruses to prevent them from causing illness. Because of this “filter” function, they are particularly vulnerable to infection and inflammation. When this happens, the tissue swells as a natural response of the body, leading to the characteristic symptoms of the disease. After puberty, the immune function of the tonsils tends to decrease, which explains why adults experience fewer episodes of tonsillitis than children.

At the Clinica Universidad de Navarra, our Department of Otolaryngology specializes in the diagnosis and treatment of this and other conditions of the throat, ear, and nose. We have a team of experts and advanced technology that allow us to provide a personalized approach for each patient, ensuring medical care of excellence and trust.

Imagen del icono de la consulta de Segunda Opinión. Clínica Universidad de Navarra

Do you need us to help you?

REQUEST AN APPOINTMENT

I want to request more information

What are the symptoms of tonsillitis?

Tonsillitis presents with a set of characteristic signs and symptoms, although their intensity may vary depending on the cause (viral or bacterial) and the patient’s age. Symptoms usually appear suddenly and, in most cases, last about 3 to 4 days. It is important to note that it is not possible to reliably distinguish whether the cause is viral or bacterial based solely on clinical symptoms, since they often overlap.

Common symptoms

The most frequent ones, in both children and adults, include:

Sore throat, ranging from mild discomfort to severe pain.
Fever, usually higher than 100.4 °F (38 °C).
Difficulty or pain when swallowing (odynophagia/dysphagia).
Red and swollen tonsils, sometimes with whitish or yellowish patches.
Swollen and tender lymph nodes in the neck.
Other general symptoms such as fatigue, headache, bad breath, or ear pain.

Symptoms in children and adults

Although most manifestations are similar, there are some differences:

In children:

Greater likelihood of digestive symptoms such as stomach pain, nausea, or vomiting.
In very young children, signs may include refusal to eat, irritability, or excessive drooling.

In adults:

When caused by a virus, it often appears along with cold-like symptoms such as cough or nasal congestion.
In rare cases, it may be complicated by a peritonsillar abscess, leading to severe one-sided pain, difficulty opening the mouth, and a muffled voice.

Warning signs that require immediate medical attention

In most cases, tonsillitis resolves without complications, but you should seek urgent medical care if you or your child experience:

Difficulty breathing or swallowing.
Excessive drooling, especially in children.
Severe sore throat that prevents eating or drinking.
Inability to open the mouth (trismus).
Visible swelling in the mouth or neck.
Muffled or “hot potato” voice.

These signs may indicate serious complications, such as a peritonsillar abscess or a deep neck infection, which require urgent medical treatment.

Do you have any of these symptoms?

If you suspect you are suffering from any of the above symptoms,
you should consult a medical specialist for diagnosis

Request an appointment with our specialists

Causes of tonsillitis

Tonsillitis is an infection of the tonsils caused by viruses or bacteria. These germs are contagious and can spread easily through coughing, sneezing, talking, kissing, sharing food or drinks, or touching contaminated surfaces and then putting your hands to your mouth or nose.

Viral infections are the most common cause, especially in young children. They are often associated with cold-like symptoms such as cough, nasal congestion, low-grade fever, or muscle aches. The most common viruses include adenoviruses (which can cause “pharyngoconjunctival fever”), the Epstein-Barr virus (infectious mononucleosis in teenagers), as well as rhinoviruses, influenza viruses, respiratory syncytial virus, and Coxsackie A virus.

Bacterial infections, although less frequent, usually cause a more sudden onset with high fever, severe throat pain, and white patches on the tonsils. The main bacterial agent is Streptococcus pyogenes, commonly known as “strep throat.” Proper diagnosis and treatment are essential to prevent complications such as rheumatic fever. Other bacteria may also cause tonsillitis, although less frequently.

Types of tonsillitis

Tonsillitis can be classified according to the frequency and duration of episodes. Identifying the type is important to guide the most appropriate treatment.

Acute tonsillitis

This is the most common form. It lasts less than a week and usually appears suddenly. It may be caused by viruses (the majority of cases) or by bacteria, such as Streptococcus pyogenes. Symptoms include sore throat, fever, difficulty swallowing, swollen tonsils, and in some cases, vomiting in children. Treatment depends on the cause: supportive care and rest for viral infections, and antibiotics for bacterial cases.

Chronic tonsillitis

This type is characterized by persistent inflammation of the tonsils, which can lead to ongoing discomfort, repeated infections, or problems such as sleep apnea. In severe cases, a tonsillectomy (surgery to remove the tonsils) may be recommended.

Recurrent tonsillitis

This is defined as repeated episodes of acute tonsillitis, separated by symptom-free periods. If the episodes are very frequent and significantly affect quality of life, the specialist may recommend a tonsillectomy. This procedure aims to reduce recurrences and improve the patient’s overall well-being.

How is tonsillitis diagnosed?

The diagnosis of tonsillitis aims to determine whether the cause is viral or bacterial, since treatment is different. To do this, the doctor relies on a clinical examination and, when necessary, on specific tests.

Clinical examination

The doctor examines the throat to look for redness, patches, or swelling of the tonsils, palpates the neck to check for swollen lymph nodes, and assesses other associated symptoms. The absence of cough, for example, may suggest a bacterial cause.

Rapid strep tests

The so-called Strep A test is performed using a throat swab and provides results within a few minutes. A positive result confirms bacterial infection and allows safe initiation of antibiotics.

Throat culture

This is the reference test and involves analyzing a throat swab sample in the laboratory. Its main advantage is its high accuracy, although results typically take 24 to 48 hours.

Differential diagnosis

Some symptoms may overlap with other conditions, such as infectious mononucleosis, peritonsillar abscess, or viral illnesses like the flu or herpangina. For this reason, additional tests may be ordered in cases of uncertainty.

How is tonsillitis treated?

The therapeutic approach depends directly on the cause of the infection, whether viral or bacterial.

Treatment of viral tonsillitis

Most cases of tonsillitis are caused by viruses (up to 70%). In these situations, antibiotics are not effective, and treatment focuses on relieving symptoms. Viral tonsillitis usually improves on its own within 7 to 10 days.

Symptomatic management includes:

Pain relievers and anti-inflammatory medications: To help control sore throat and fever.
Rest: Supports the body’s recovery.
Hydration: Drinking plenty of water and fluids to keep the throat moist and prevent dehydration.
Supportive care: Drinking warm liquids, eating cold foods, gargling with salt water (for those able to do so), and using humidifiers to ease throat irritation.

Antibiotics should not be prescribed if the cause is suspected to be viral.

Treatment of bacterial tonsillitis (antibiotics)

When tonsillitis is caused by a bacterial infection, mainly by Streptococcus pyogenes (group A streptococcus), the treatment of choice is antibiotics. The indication is based on clinical evaluation using the Centor or McIsaac criteria (score of 3 or higher) and, preferably, confirmation with a rapid antigen detection test (Strep A test). If the test is not available, treatment may be started based on the clinical score alone.

Recommended antibiotics include:

First choice: Penicillin is the reference treatment due to its effectiveness, low cost, and because streptococcus remains universally sensitive to it. Amoxicillin is an equally recommended alternative, especially in children, since it has a better taste in suspension form and allows once- or twice-daily dosing.
Duration: A full course of 10 days with penicillin or amoxicillin is recommended to ensure complete eradication of the bacteria and prevent complications such as rheumatic fever.
Alternatives for penicillin allergy: In mild, delayed reactions, first-generation cephalosporins (such as cefadroxil) may be used. In severe or immediate allergic reactions, non-beta-lactam antibiotics are recommended, such as macrolides (josamycin, clarithromycin, azithromycin) or clindamycin.

It is essential to complete the full course of antibiotics, even if symptoms improve earlier, to avoid relapses, complications, or the spread of the infection.

General home care

In addition to the medical treatment prescribed by the doctor, there are several supportive home measures that can help relieve the symptoms of tonsillitis and promote recovery:

Rest: Getting enough sleep and avoiding physical exertion is essential to allow the body to recover.
Hydration: Drinking plenty of fluids, especially water, caffeine-free teas, or warm broths, helps keep the throat moist and reduces irritation.
Saltwater gargles: For adults and older children who can do it safely, gargling with warm salt water may help ease throat pain.
Lozenges and throat sprays: Some lozenges with local anesthetics or anti-inflammatory agents can provide temporary relief from pain and inflammation.
Humidifying the air: Using a cool-mist humidifier or inhaling steam in a closed bathroom may help reduce dryness and throat irritation.
Avoid irritants: It is important to avoid cigarette smoke and exposure to chemical cleaning products that may worsen throat irritation.

Surgery: tonsillectomy (indications and recovery)

Tonsillectomy is the surgical removal of the tonsils. It is not a first-line treatment and is only recommended in specific cases where other treatments have not been effective. When indicated, it is a highly effective option to prevent further episodes and improve the patient’s quality of life.

Indications for tonsillectomy

Recurrent tonsillitis: This is the most common reason for surgery. The Paradise criteria are widely used:
- Seven or more episodes in the past year.
- Five or more episodes per year for two consecutive years.
- Three or more episodes per year for three consecutive years.
Complications: Surgery may also be considered when tonsillitis causes difficult-to-manage problems, such as:
- Obstructive sleep apnea.
- Difficulty breathing or swallowing.
- Peritonsillar abscess that recurs or does not improve with antibiotics.
- Repeated febrile seizures associated with infection.

Recovery

Tonsillectomy is usually performed on an outpatient basis, meaning the patient can return home the same day. Full recovery typically takes 7 to 14 days. During this period, effective pain management is essential, as it is considered one of the most painful procedures in otolaryngology. Good hydration, rest, and following the doctor’s instructions are key to a safe recovery.

Request more information about the treatment

Where do we treat it?

IN NAVARRE AND MADRID

The Department of Otolaryngology
of the Clínica Universidad de Navarra

The Department of Otorhinolaryngology of the University of Navarra Clinic is a national and world reference in numerous highly specialized surgical procedures.

We have the latest technology and we perform all diagnostic tests in less than 48 hours in order to offer our patients the best solution in the shortest time possible.

We were one of the first centers in Spain to use robotic surgery in the surgical treatment with the Da Vinci® System.

Organized in specialized units: