Acute tonsillitis causes a sore throat, difficulty swallowing, fatigue, and fever. Recurring tonsillitis in short intervals can be very strenuous and also lead to complications in some cases.

At a glance

  • Tonsillitis appears suddenly.
  • Typically, it goes away in one to two weeks.
  • However, sometimes a person suffers from tonsillitis multiple times a year.
  • Recurring tonsillitis can be very strenuous, yet complications occur very seldom.
  • If symptoms are severe, an operation can be performed to remove the tonsils.

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

Tonsilitis: woman clutching her throat, grimacing and squinting.

What is tonsillitis?

A sore throat is typically the result of pharyngitis, caused by a cold virus, which can also infect the tonsils. A bacterial infection of the palatal tonsils occurs less frequently. However, it is not easy to determine which pathogen caused the infection. Tonsillitis is much more common in children and teens than it is in adults.

Tonsillitis typically appears suddenly. It usually subsides in one to two weeks. However, it is possible for a person to suffer from tonsillitis multiple times a year. Recurrent infections can be strenuous. However, complications are not common.

It is important to differentiate between tonsillitis and persistent enlargement of the tonsils. These are two different illnesses. Enlargement of the tonsils (tonsillar hyperplasia) can affect not only the palatal tonsils, but also the pharyngeal tonsils.

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°C
  • headache
  • lassitude and fatigue
  • mouth odor
  • loss of appetite
  • swollen and painful cervical lymph nodes

What causes tonsillitis?

Bacteria and viruses are most often transmitted via respiratory droplets. Tiny droplets are formed when a person speaks or sneezes. They reach the mucous membranes of others via the air and multiply there.

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 occur in connection with other illnesses, for example with a bacterial scarlet fever infection or a viral infection such 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.

Eine akute Mandelentzündung heilt normalerweise innerhalb von 1 – 2 Wochen aus.

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 a greater risk for complications? 

The doctor will examine the throat and inquire about the patient’s symptoms. Swollen and coated tonsils, fever, but no cough indicate a bacterial infection of the tonsils.

Furthermore, a rapid test can be administered. Health insurance providers pay for this for children up to 16 years of age. The tonsils are swabbed and tested for streptococci. The results are available within a few minutes, but the test is not always accurate.

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 prescribed for acute tonsillitis:

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

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  • Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC). Therapie entzündlicher Erkrankungen der Gaumenmandeln – Tonsillitis (S2k-Leitlinie). AWMF-Registernummer: 017-024. 08.2015. Aufgerufen am 01.06.2020.
  • Georgalas CC, Tolley NS, Narula PA Tonsillitis. BMJ Clin Evid 2014: pii: 0503. Aufgerufen am 01.06.2020.
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In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG).

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