Overview

Swollen tonsils, medically referred to as tonsillitis, occur when the tonsils become inflamed due to infection or other irritants. The tonsils are two oval-shaped lymphoid tissues located at the back of the throat, playing a role in the body’s immune defense by trapping bacteria and viruses. While tonsillitis is common in children, it can affect individuals of all ages. The condition can be acute (short-term) or chronic (long-term), causing sore throat, difficulty swallowing, and other symptoms. Most cases resolve with simple treatments, but recurrent or severe infections may require more intensive care.

Causes

Swollen tonsils are most frequently caused by infections, although other factors can contribute:

• Viral infections: The most common cause, including viruses like adenovirus, rhinovirus (common cold), influenza, Epstein-Barr virus (mononucleosis), and coronavirus.
• Bacterial infections: Streptococcus pyogenes (group A streptococcus) causes strep throat, a frequent bacterial cause of tonsillitis.
• Chronic irritation: Smoking, pollution, or chronic post-nasal drip can irritate and enlarge tonsils.
• Allergies: Seasonal or environmental allergies may lead to recurrent tonsil swelling.
• Immune disorders: People with weakened immune systems may experience more frequent tonsil infections.

Symptoms

The symptoms of swollen tonsils can vary based on the underlying cause but commonly include:

• Enlarged, red tonsils: With or without visible white or yellow patches (exudates).
• Sore throat: Persistent pain, especially when swallowing.
• Fever and chills: Often present, particularly in bacterial tonsillitis.
• Bad breath: Foul-smelling breath due to infection.
• Swollen lymph nodes: Particularly in the neck or jaw area.
• Hoarseness or muffled voice: Due to throat swelling.
• Ear pain: Referred pain from throat to ears.
• Fatigue and general malaise: Common during infections.

Diagnosis

Diagnosing swollen tonsils typically involves a clinical assessment by a healthcare provider:

• Physical examination: The doctor examines the throat, tonsils, and lymph nodes.
• Throat swab: A rapid strep test or throat culture is performed to identify bacterial infections, particularly strep throat.
• Blood tests: In cases of suspected mononucleosis, a complete blood count (CBC) or Monospot test may be recommended.
• Medical history: Reviewing the frequency of sore throats, duration of symptoms, and any underlying health conditions.

Treatment

Treatment for swollen tonsils depends on whether the cause is viral or bacterial:

• Viral tonsillitis:
  • Self-care measures including rest, hydration, and over-the-counter pain relievers (acetaminophen or ibuprofen).
  • Saltwater gargles and throat lozenges to ease throat discomfort.
  • Symptoms usually resolve within 7-10 days without antibiotics.
• Bacterial tonsillitis (Strep throat):
  • Antibiotics such as penicillin or amoxicillin are prescribed to eliminate the infection and prevent complications like rheumatic fever.
• Chronic or recurrent tonsillitis:
  • Tonsillectomy (surgical removal of tonsils) may be recommended if infections are frequent or causing significant health issues.
• Supportive care: Adequate rest, warm teas, soft foods, and cool mist humidifiers can help ease symptoms during recovery.

Prognosis

The prognosis for swollen tonsils is generally excellent with proper care. Viral tonsillitis usually resolves on its own without long-term consequences. Bacterial infections respond well to antibiotic treatment, and symptoms typically improve within a few days of starting medication.

In some individuals, especially children, recurrent tonsillitis may lead to sleep disturbances, difficulty swallowing, or chronic discomfort, warranting a tonsillectomy. After surgery, most patients experience significant relief from symptoms. Overall, with appropriate treatment, most people recover fully from tonsillitis without lasting problems.