Tonsillitis is an inflammation of the tonsils, which are part of the immune system and act as a first line of defence against microorganisms entering through the mouth and nose. The inflammation can be caused by viruses, bacteria, and, in rarer cases, fungi. The condition may be acute, with sudden onset and limited duration, or chronic, when episodes are recurrent and affect quality of life.
The most common causes of tonsillitis are viral, involving agents such as adenoviruses, rhinoviruses, influenza viruses, or mononucleosis. When caused by bacteria, the main culprit is Streptococcus pyogenes, also known as Group A streptococcus. Transmission occurs through respiratory droplets released when coughing, speaking, or sneezing, but can also happen through close contact or sharing personal items.
Clinically, tonsillitis presents with severe sore throat, difficulty swallowing, fever, chills, and visible inflammation of the throat, which may show white pus patches in bacterial cases. Cervical lymph node enlargement, bad breath, headache, and general malaise are also common. Diagnosis is usually clinical but can be confirmed by rapid tests or throat swab cultures.
Treatment depends on the cause of the infection. For viral tonsillitis, management includes rest, adequate fluid intake, warm salt-water gargles, and the use of analgesics or antipyretics to control pain and fever. In bacterial infections, antibiotics prescribed by a doctor—typically penicillin or amoxicillin—are essential, and it is important to complete the full course to prevent complications and resistance. In specific cases, corticosteroids may be used to reduce inflammation. When tonsillitis is recurrent or causes complications, surgical removal of the tonsils, known as a tonsillectomy, may be indicated.
Although tonsillitis is generally a benign condition, inadequate treatment can lead to complications such as peritonsillar abscess, rheumatic fever, or post-streptococcal glomerulonephritis, as well as infections in nearby organs, including the ears and paranasal sinuses. In children, tonsil hypertrophy may also be associated with sleep apnoea and breathing difficulties.
Prevention is straightforward and relies on hygiene measures, such as frequent handwashing, avoiding sharing personal items, and practising respiratory etiquette when coughing or sneezing. Regular oral hygiene also plays an important role.
Medical attention should be sought whenever sore throat and fever persist for more than two to three days, when there is significant difficulty swallowing or breathing, or in cases of recurrent episodes over time.
Tonsillitis is a very common condition and, with appropriate diagnosis and treatment, usually resolves favourably. Medical follow-up is essential to determine the correct approach, prevent complications, and ensure the patient’s well-being and quality of life.
3, October 2025
