Acute tonsillitis causes a sore throat, difficulty swallowing, fatigue, and fever. If tonsillitis recurs several times in quick succession, this can be very difficult for patients to endure and, in isolated cases, may also lead to complications.

At a glance

  • Tonsillitis is characterized by a sore throat, high temperature, and swelling of and appearance of a yellowish coating on the two palatine tonsils, which can be seen on either side of the back of the throat.
  • Typically, the infection clears up within one to two weeks.
  • The symptoms can be relieved with painkillers. Antibiotics may also be used to treat a bacterial infection.
  • Recurring tonsillitis can be very difficult to endure but complications are very rare.
  • Surgery may be considered if a tonsillitis recurs frequently.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

A woman clutching her throat

What is tonsillitis?

A sore throat is typically the result of a throat infection (pharyngitis) caused by a cold virus, which can also spread to the tonsils.

A bacterial infection of the palatine tonsils occurs less frequently. However, it is not easy to determine which pathogen caused the infection.

Tonsillitis occurs much more frequently in children and teens than in adults.

Tonsillitis typically appears suddenly. It usually subsides in one to two weeks. However, a person may experience inflamed tonsils multiple times a year. Recurrent infections can be difficult to endure. However, complications are rare.

It is important to distinguish between tonsillitis and persistent enlargement of the tonsils. These are two different conditions. Enlargement of the tonsils (tonsillar hyperplasia) can affect not only the palatine tonsils on either side of the back of the throat, but also the pharyngeal tonsils located at the opening of the nasal cavity into the throat.

What are the symptoms of tonsillitis?

The following symptoms are indicative of tonsillitis:

  • sore throat
  • difficulty swallowing
  • swollen and dark red tonsils with a yellow coating
  • body temperature above 38 degrees Celsius
  • headache
  • lethargy and fatigue
  • mouth odor
  • loss of appetite
  • swollen and painful cervical lymph nodes

If an infection is triggered by a virus, cold-like symptoms, such as coughing and sneezing, often appear.

Tonsillitis is typically the diagnosis if the infection mainly affects the tonsils. Pharyngitis (commonly called “sore throat”) is the diagnosis if an infection of the throat is also present.

In children in particular, tonsillitis may also be accompanied by atypical symptoms, such as abdominal pain, nausea, and vomiting.

What causes tonsillitis?

Most bacteria and viruses are spread by droplet infection. When people speak or sneeze, tiny droplets containing the disease-causing microbes are produced, travel through the air, and can be inhaled into the mucous membranes of other people’s airways.

The cause of bacterial tonsillitis is usually certain types of streptococci. However, not all people who carry these bacteria in their bodies become ill with tonsillitis.

Tonsillitis can also occur in connection with other illnesses, for example, with a bacterial scarlet fever infection or a viral infection such as glandular fever (also known as mononucleosis).

How does tonsillitis progress?

Typically, an acute case of tonsillitis subsides after one or two weeks. First, the fever will go down but the sore throat will remain. The swollen tonsils last the longest.

Acute tonsillitis usually clears up within 1 to 2 weeks.

Complications are rare. The most common complication is an accumulation of pus around the tonsils – this is known as a peritonsillar abscess. This may occur as part of bacterial tonsillitis and may clear up on its own. However, there is a risk that the inflammation could spread to the surrounding tissue in the neck and chest area or that sepsis (blood poisoning) could develop. This can lead to serious complications. It is therefore important for the abscess to be treated.

A peritonsillar abscess can cause symptoms such as pain on one side of the throat or in one ear and difficulties with swallowing and speaking.

How is tonsillitis diagnosed?

Doctors who examine patients with a sore throat want to answer the following questions:

  • Is an infection of the tonsils causing the symptoms?
  • How severely are the tonsils infected?
  • Is the infection bacterial?
  • Are antibiotics necessary or will the infection most likely subside quickly on its own?
  • Is the patient at an increased risk for complications?

The doctor will examine the throat and inquire about the patient’s symptoms. A bacterial infection of the tonsils is indicated by swollen and coated tonsils, fever, but no cough.

A rapid test can also be administered. Health insurance providers pay for this for children up to 16 years of age. The test involves taking a swab from the tonsils and testing it for a specific type of streptococci. The results are available within a few minutes, but the test is not always accurate. A more accurate test result is obtained if the swab is sent to a lab and analyzed there, which can take one to two days.

Blood is rarely drawn unless other illnesses must be ruled out, for instance.

How is tonsillitis treated?

The goal of treatment is to alleviate the symptoms and prevent complications.

The following medication is considered for acute tonsillitis:

  • pain-relieving and fever-reducing medication, for example, ibuprofen or paracetamol
  • antibiotics – if the infection is caused by bacteria

Antibiotics shorten the duration of the illness. Within 24 hours of taking the first dose of antibiotics, the patient is no longer contagious. Antibiotics reduce the risk of complications, although these rarely occur. As antibiotics do little to relieve the symptoms and can cause side effects, many prefer not to take them.

To alleviate the symptoms, many people use cough drops or home remedies, such as gargling with salt water or drinking tea. A throat compress can also be soothing.

Recurring tonsillitis is most often treated with pain medication or antibiotics. If symptoms occur frequently, the tonsils may be surgically removed.

Important: It may make sense to get a second opinion (i.e., consult a doctor in another practice or hospital) if an operation is recommended.

The decision aid for tonsillitis in children or the decision aid for tonsillitis in adults from may help you in reaching a decision for or against surgery.

  • Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin e.V. (DEGAM). Halsschmerzen. S3-Leitlinie. DEGAM-Leitlinie Nr. 14. AWMF-Registernummer 053-010. 2020.
  • Georgalas CC, Tolley NS, Narula PA. Tonsillitis. BMJ Clin Evid. 2014 Jul 22;2014:0503.
  • Kenealy T. Sore throat. BMJ Clin Evid. 2014 Mar 4;2014:1509.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG).

As at:
Did you find this article helpful?