Why do I Have Tonsils and What is Tonsillitis?

At a Glance:

  • The palatine tonsils are located at the back of the throat and are a part of the lymphatic system. They help guard against infections that enter the body through the mouth
  • Tonsillitis is a viral or bacterial infection of the tonsils. This causes them to become painfully inflamed
  • The majority of tonsillitis is due to a viral infection
  • 15% of tonsillitis is caused by bacterial infection. The responsible bacteria is usually streptococcus
  • Depending on the severity and frequency, tonsillitis is classified as either acute or chronic
  • In some cases a doctor may recommend the tonsils be removed. This is called a tonsillectomy

The tonsils are part of the lymphatic system, a collection of tiny drainage tubes and lymph nodes that help regulate the fluid balance of the body, react to infection, deal with cancer cells and more. Lymph nodes and other lymphatic structures including the spleen, thymus and tonsils contain special white blood cells known as lymphocytes that can grow and multiply very quickly in response to bacteria or a virus, helping to fight infection.

The palatine tonsils themselves are a pair of fleshy masses located at the rear of the pharynx (throat). Each of these masses is made from a similar material to lymph nodes and are intended to help fight both bacterial and viral infections. 

Palatine tonsils  act as a frontline defence against viral and bacterial infections that enter the body through the mouth, either fighting the infection in the mouth or trapping the infectious material in endents on the surface of the tonsils known as crypts. They can vary greatly in size from person to person and swell with infection. 

The two palatine tonsils are only part of the tonsillar ring, a system of tonsils that includes the two palatine tonsils, the adenoids on the roof of the pharynx, two tubal tonsils (also located on the roof of the pharynx) and two lingual tonsils located behind the tongue. When the palatine tonsils become infected, this is known as tonsillitis.

What is Tonsillitis?

Tonsillitis is the infection and swelling of the tonsils due to viral or bacterial infection. The majority of infections are due to viruses, with only about 15% of tonsillitis being caused by bacteria.

Tonsillitis can develop in people of any age but is more common in children, as the tonsils are usually less susceptible in adults with fully developed immune systems. 

The condition is usually classified in one of two ways; acute or chronic. Acute tonsillitis is the infection of the tonsils by a viral or bacterial agent. Chronic tonsillitis refers to ongoing or repeated infection of the tonsils, sometimes caused by repeated bouts of acute tonsillitis. Depending on whether the infection is acute or chronic, the symptoms of tonsillitis can vary. 

In addition to the swelling of the tonsils themselves, tonsillitis can lead to a number of complications or secondary infections, including:

  • Peritonsillar abscess: Also known as “quinsy”, a peritonsillar abscess can form if an infection spreads to the tissue surrounding the tonsil. An abscess in the throat can be extremely painful and cause trouble swallowing and in severe cases, even breathing.
  • Otitis media: More commonly known as “glue ear” is a condition that can affect children with tonsillitis. When the adenoids swell - usually as a result of an infection of the tonsils though it can happen independent of the tonsils - they can block the eustachian tubes. These tubes run from the middle ear to the back of the throat and control the pressure within the middle ear. Blocking these tubes for extended periods can lead to a buildup of sticky fluids that can affect hearing.
  • Secondary infections: Infections in the tonsils can spread to surrounding tissue to other areas such as the nose, sinuses or ears. In rare cases the infection can spread further to areas such as the kidneys or even the skin. 
  • Obstructive sleep apnea: Severe swelling of the tonsils can lead to difficulty breathing while sleeping and increases snoring.   

Symptoms of Tonsillitis

Depending on the severity of the condition and whether it is acute or chronic, tonsillitis can have a number of different symptoms, including:

  • Red, swollen tonsils - depending on the severity of the infection the tonsils may have grey or yellow spots of pus on them as well
  • Sore throat
  • Difficulty and pain when swallowing
  • Fever
  • Headache
  • Fatigue
  • Bad breath
  • Swollen glands (lymph nodes) - on the side of the neck below the jaw
  • Earache or ear pain - dulled hearing can also be a factor in children (glue ear)
  • Skin rash - if the infection is bacterial, a skin rash may also be present

What Causes Tonsillitis?

Any viral infection can potentially cause tonsillitis, making it difficult to immunise a person against tonsillitis. Viruses that cause the common cold or flu can also lead to tonsillitis, so in these cases the person with swollen tonsils may also have corresponding cold and flu symptoms.

The majority of bacterial tonsillitis is due to streptococcus bacterium. Without the presence of a skin rash it’s difficult to distinguish between viral and bacterial tonsillitis without a throat swab.

If your tonsils are inflamed and you need help, or you have a child with tonsillitis, the easiest way to find and book an appointment with a doctor is with MyHealth1st.

Do I Need to Have My Tonsils Removed?

Depending on the severity and frequency of the tonsillitis and any associated complications have their tonsils removed. This operation is known as a tonsillectomy and is performed by an ENT (ear, nose, throat) surgeon under general anaesthetic. The operation is generally quick and patients are usually able to go home the same day or the next morning.

 A tonsillectomy may be recommended due to a number of factors, including: 

  • Frequent and recurring instances of tonsillitis accompanied by acute pain
  • Frequent secondary infections due to tonsillitis
  • Chronic tonsillitis that is difficult to clear with normal treatment
  • Children that have frequent difficulty swallowing due to tonsillitis
  • Breathing difficulties or obstructive sleep apnea due to enlarged tonsils
  • Severe peritonsillar abscesses

While a tonsillectomy is generally safe, the tonsils have a substantial blood supply, so their excision has a risk of heavy bleeding. Removal of the tonsils doesn’t help reduce instances of viral or bacterial infection but eliminates the chance of the tonsils themselves becoming infected and inflamed.

Other Treatments for Tonsillitis

While there may be no way to immunise a person against tonsillitis, there are a number of ways to lower your chance of being infected.

  • Observe proper hand hygiene Wash your hands frequently when you have touched a shared surface, before and after preparing food, when you cough or sneeze and when you go to the bathroom.
  • Avoid people who are unwell As any virus can cause tonsillitis, avoiding close contact with people with viral infection is a good way to help avoid infecting yourself.
  • Don't share food and drink Avoid drinking out of a shared glass or bottle and don’t use the same set of cutlery as someone else.    

If your tonsillitis is caused by a bacterial infection, a doctor may prescribe a course of antibiotics to fight the infection. With viral tonsillitis, antibiotics will have no effect so any medications are purely to relieve symptoms.

Drinking plenty of fluids and getting ample rest are two of the best home treatments available for tonsillitis. Eating soft foods that are easy to swallow can help minimise pain while the infection runs its course. Gargling with salt water can also help ease pain and speed recovery. 

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