How Do You Get Tonsillitis?

Tonsillitis itself is not contagious, but the viral and bacterial causes of tonsillitis are contagious.

Tonsillitis is inflammation of the tonsils. The tonsils are masses of lymph tissue located in the back of the throat. They are part of the body’s immune system that helps the body fight off infection. 

Tonsillitis may occur suddenly (acute), or it may be persistent (chronic). Tonsillitis often occurs in children, but is rare in children under two years.

Symptoms of acute tonsillitis include:

• Tonsil swelling
• Tonsil redness
• White or yellow coating on the tonsils
• Hoarseness
• Laryngitis (loss of voice)
• Sore throat 
• Ear pain
• Difficult or painful swallowing
• Swollen or tender lymph nodes in the neck
• Fever
• Bad breath
• Decreased appetite
• Headaches
• Dehydration
• Mouth breathing
• Snoring
• Tiredness
• Lethargy
• Feeling unwell (malaise)

Symptoms of chronic tonsillitis include:

• Chronic sore throat
• Bad breath
• Tonsil stones (clusters of calcifications, or stones, that develop in the tonsil’s craters)
• Persistent tender lymph nodes in the neck
• Obstructive sleep apnea

Symptoms of peritonsillar abscess (severe tonsillitis) include:

• Fever
• Severe throat pain
• Drooling
• Difficulty opening the mouth 
• Voice sounds mufled
• One tonsil is larger than the other

The most common causes of acute tonsillitis are viruses, such as adenoviruses, influenza viruses, parainfluenza viruses, enteroviruses, and Mycoplasma. Other viruses that may cause tonsillitis include the Epstein-Barr virus (EBV) (the virus that causes mononucleosis), herpes simplex virus (HSV), cytomegalovirus, and the measles virus. Viruses account for about 70% of all cases of tonsillitis.

About 15 to 30 percent of tonsillitis cases are caused by bacteria such as group A beta-hemolytic streptococcus (GABHS), which causes strep throat.

Tonsillitis itself is not contagious, but the viral and bacterial causes of tonsillitis are contagious. Strep throat, for example, is spread through airborne droplets when an infected person coughs or sneezes. Patients are most infectious early in the course of the illness.

For tonsillitis caused by viruses, patients may be contagious until symptoms go away. For tonsillitis caused by bacteria, patients are generally considered no longer contagious after 24 hours of antibiotic therapy.

Tonsillitis is diagnosed with a physical examination of the patient’s throat. Tests used to diagnose the cause of the tonsillitis include: 

• Rapid strep testing
• Throat culture 
• Blood tests (for example, to check for mononucleosis)

Bacterial tonsillitis is usually treated with antibiotics such as penicillins, cephalosporins, macrolides, and clindamycin.

Surgery is used to treat tonsillitis in severe cases: 

• Removal the tonsils (tonsillectomy) may be indicated in some cases, such as children who have seven episodes of tonsillitis in one year, or five episodes per year for two consecutive years, or three episodes per year for three consecutive years
• In severe cases of tonsillitis (peritonsillar abscess), the abscesses may need to be surgically drained 

Viral tonsillitis usually goes away on its own without treatment. Treatment is aimed at relieving symptoms and may include: 

• Hydration 
• Pain control 
• Hospitalization in severe cases, such as when a patient becomes dehydrated or has an airway obstruction

Home remedies to relieve symptoms of tonsillitis such as pain and swelling include: 

• Drink plenty of fluids
  • Warm liquids such as soup, or tea with honey and lemon can be soothing
• Eat soft foods if it hurts to swallow
• Gargle with warm salt water (1/4 teaspoon of salt in 8 ounces of warm water)
• Over-the-counter (OTC) pain relievers for pain and fever
  • Acetaminophen (Tylenol) 
  • Ibuprofen (Advil, Motrin)
  • Children under 18 years of age should not take aspirin due to the risk of a serious illness called Reye’s syndrome
• Suck throat lozenges or hard candies (lozenges are not recommended for young children; they can be a choking hazard)  
• Use a cool-mist humidifier to moisten the air

Complications of tonsillitis are uncommon but may include: 

• Peritonsillar abscess 
• Middle ear infection (otitis media)    
• Swelling of the face and neck that can potentially block the airways and cause breathing problems (rare)
• Scarlet fever (from group A strep)
• Obstructive sleep apnea (due to chronic tonsillitis)   
• Blood poisoning by bacteria (septicemia)    
• Inflammation of the filters in the kidneys (glomerulonephritis) (very rare) caused by streptococcal bacteria
• Rheumatic fever (rare)
• Lemierre's syndrome (rare)