Tonsillitis symptoms: What are the early signs of tonsillitis?

Tonsils—the two small lumps of soft tissue, one on each side, at the back of your throat—along with the adenoids, are part of your immune system. They trap germs that can make you ill. Tonsillitis, also called pharyngitis, is an inflammation of the tonsils. Either viruses or bacteria cause it. Common symptoms include a sore and scratchy throat, painful and difficult swallowing, swollen tonsils, and others. Tonsillitis caused by bacteria is treated with antibiotics. Tonsillitis caused by a virus is treated with supportive measures like over-the-counter pain relievers, lots of fluids, and lozenges. 

What are the signs of acute tonsillitis?

Symptoms of tonsillitis may vary based on the individual. The most common signs of tonsillitis include:

• A sore throat or throat pain that comes on suddenly

• Swollen, red tonsils, which may have white spots

• Blisters or sores on the throat

• Painful or difficult swallowing

• Snoring

• Bad breath

• Headache

• Appetite loss

• Fever or chills

• Fatigue

• Swollen lymph nodes around the neck or jaw

Tonsillitis complications

Viruses are a common cause of tonsillitis. In about 70% of cases, tonsillitis is caused by a virus, such as the Epstein-Barr virus (mononucleosis), the flu, or adenovirus. 

The other causes of tonsillitis are bacteria, such as Group A Streptococcus. Bacterial tonsillitis is commonly referred to as strep throat. Strep throat can occur in people without tonsils. Tonsillitis complications are more likely to happen when the infection is due to bacteria and may include:

Chronic tonsillitis

People who frequently have inflamed tonsils may have chronic tonsillitis. Symptoms may include a persistent sore throat, bad breath, tonsil stones (see below), and tender lymph nodes in the neck. Surgery (called a tonsillectomy) may be required to remove the tonsils in people who have tonsillitis:

• Seven times in one year, or

• Five episodes per year for two consecutive years, or

• Three episodes per year for three consecutive years

Tonsil stones

Tonsil stones are hard pieces of debris and bacteria that lodge in the tonsils. They might develop after you have had infected or inflamed tonsils for a long time. 

Scarlet fever

Strep throat can turn into scarlet fever. Symptoms include a red rash and fever. This uncommon complication occurs more in children than adults. 

Peritonsillar abscess

Severe cases of tonsillitis may lead to an abscess (a collection of pus) that forms around the tonsil(s). These abscesses are more common in adults and teenagers than children and require surgery to drain the abscesses. 

Rheumatic fever

Rheumatic fever can happen when you don’t treat bacterial strep throat or stop taking antibiotics before the prescribed length of time. Rheumatic fever is more common in children and can lead to permanent heart damage. 

Spread of infection

Left untreated, Streptococcal bacteria can migrate to the ear, sinuses, or even other parts of the body, which can lead to sinus infections, kidney damage (glomerulonephritis), and other complications. 

Types of tonsillitis: How can I tell which one I have?

Many people use strep throat and tonsillitis interchangeably, but even though they may cause a sore throat, they are not exactly the same. 

• Strep throat is an infection caused by Streptococcus bacteria. Strep throat can cause inflamed tonsils (tonsillitis). 

• Tonsillitis means that the tonsils are swollen or inflamed. Tonsillitis can be due to a virus or bacteria.

It is important to determine if your symptoms are due to a virus or bacteria (see next section). This is because bacterial infections require antibiotic treatment.

When to see a doctor for tonsillitis symptoms

You may wonder when—and what type of—healthcare provider you or your child should see for tonsillitis symptoms. You can see a primary care provider (or pediatrician), urgent care provider, or ear, nose, and throat (ENT) specialist, also known as an otolaryngologist. 

You should call a healthcare provider if you or your child have:

• A sore throat for more than two days

• Pain when swallowing

• Fever over 101 F

• Weakness or feeling very sick

• Any other concerning symptoms

The healthcare provider will ask about symptoms and medical history and examine the patient, checking the throat, lymph nodes, and ears. They will also likely check for strep throat by taking a throat swab. A rapid strep test provides results in several minutes. If the test is positive, the healthcare provider will prescribe antibiotics. Sometimes the test is negative, but there could still be a strep infection. So, the healthcare provider will send a sample to a lab. Results may take several days. If the culture is positive, antibiotics will be prescribed. If the culture is negative, the illness is thought to be viral and will not require antibiotics. 

If there is drooling, difficulty swallowing, or breathing, get emergency medical care. 

How to treat tonsillitis symptoms

For bacterial tonsillitis, an antibiotic will be prescribed. This helps clear the infection as well as prevent complications. Commonly prescribed antibiotics include a penicillin such as amoxicillin, a cephalosporin such as cephalexin, a macrolide such as azithromycin, or clindamycin. It’s important to finish the full course of antibiotics, even if you start to feel better. This ensures the infection clears and helps prevent antibiotic resistance. A free SingleCare card or coupon can help to save up to 80% off prescriptions. 

Viral tonsillitis does not require antibiotics. Antibiotics are not effective for viral infections. For viral tonsillitis, you can take measures to reduce symptoms. These measures can help those with bacterial tonsillitis (in combination with antibiotics). Some things you can try include:

• Taking over-the-counter pain relievers or fever reducers like Tylenol (acetaminophen) or Advil (ibuprofen). Children under 18 years old should not take aspirin. 

• Drinking plenty of fluids

• Gargling with warm salt water

• Eating soft foods to avoid throat irritation

• Sucking on throat lozenges (adults and children four years and older; very young children under four years old should not have cough drops due to the risk of choking)

• Getting plenty of rest

To try to prevent the infection from spreading:

• Keep children away from anyone with tonsillitis or a sore throat

• Wash hands frequently

• If an individual in the family has tonsillitis, keep their glasses and utensils separate and wash them in hot, soapy water. Ensure the person does not share food, drinks, towels, or napkins with others in the family.

In some cases, surgery may be required. Surgery called a tonsillectomy may be required for frequent tonsillitis episodes. A peritonsillar abscess requires surgical drainage. 

Signs bacterial tonsillitis is getting better

Once you start antibiotics, you should start to feel better by day two or three. Symptoms will start to lessen. Again, it’s still important to finish the course of antibiotics to make sure the infection goes away—and stays away. If symptoms worsen or do not start to improve by the second or third day, call your healthcare provider. 

If your child has strep throat, ask your healthcare provider for medical advice on how long they should remain home from daycare or school—most experts recommend staying home until the patient has been on antibiotics for at least 24 hours. Also, ask when and how often you should replace your toothbrush. 

FAQs about tonsillitis symptoms

Will tonsillitis go away on its own?

Viral tonsillitis will go away on its own. However, tonsillitis caused by bacteria will require treatment with antibiotics. See a healthcare provider if you have symptoms of tonsillitis. They can determine if your infection is viral or bacterial and whether it needs antibiotics. 

What gets rid of tonsillitis quickly?

A viral tonsillitis infection has to run its course, which may take a few days or even longer. There is no treatment to cure the infection—only measures to improve your symptoms, like pain and fever reducers. 

A bacterial infection is treated with antibiotics, which will help you feel better quickly. Just remember that even though you may feel better quickly, you still have to finish the full course of antibiotics.

What kind of doctor should I see for tonsillitis symptoms?

You can see your primary care provider (or pediatrician if that patient is a child), urgent care provider, or ENT. Individuals with difficulty breathing or swallowing or who are drooling should seek emergency care.

What’s next? Additional resources for people with tonsillitis symptoms

Test and diagnostics

• Tonsillitis and Tonsilloliths: Diagnosis and Management, American Family Physician

• Tonsillitis, Johns Hopkins Medicine

• Tonsillitis, StatPearls

Treatments

• Tonsillitis, American Academy of Otolaryngology-Head and Neck Surgery

• Tonsillitis, American Academy of Family Physicians

Scientific studies and clinical trials

• Antibiotics for sore throat, American Family Physician

More health information on related conditions

• Peritonsillar abscess, American Academy of Family Physicians

• Strep Throat, Sore Throat or Tonsillitis: What’s the Difference?, American Academy of Pediatrics

• Tonsillitis vs. strep: compare causes, symptoms, treatments, & more, SingleCare