Tonsillitis is a medical condition causing inflammation (infection, swelling and redness) of the tonsils. 

What are tonsils?

Your tonsils are two small bean-shaped organs at the back of your throat. They function as lymph nodes that filter out dirt, bacteria, and viruses that enter through your nose or mouth. Your tonsils also contain white blood cells that fight off bacteria and viruses. 

Without them, these harmful substances would go straight into your lungs and digestive system, causing you to get sick from infections. The tonsils are important in early childhood, but has less importance in adults.

Even though your tonsils are responsible for preventing infection, they are quite vulnerable to getting infected too.

Tonsillitis: Causes and symptoms

Tonsillitis is usually caused by a viral or bacterial infection.

• "Majority of tonsillitis are caused by viruses (like Adenovirus, Influenzae viruses, Parainfluenzae virus, Respiratory Syncytial Virus etc) that can affect the upper respiratory tract, including the virus that causes infectious mononucleosis (the Epstein-Barr virus)," said Dr Adele Ng, Associate Consultant from the Department of Otorhinolaryngology - Head and Neck Surgery at Singapore General Hospital (SGH), a member of the SingHealth group. 

• "Tonsillitis caused by a specific type of bacteria called Streptococcus pyogenes (group A Streptococcus) is called strep throat. With strep throat, you may see yellowish streaks of pus on the tonsils," Dr Ng added.

Tonsillitis occurs more frequently in children aged 5 to 10 years old. It’s more common in children as they are frequently exposed to germs from others at childcare centres and preschools.

Symptoms of tonsillitis include:

• Sore throat (along with pain when swallowing)

• Fever

• Difficulty swallowing (due to pain and swelling)

• Feeling like there is something stuck in your throat (swollen tonsils)

• Voice change (due to swollen tonsils)

• Coughing

• Headache or ear pain

• Swollen neck lymph nodes

5 Tips to prevent tonsillitis

1) Maintain good personal and oral hygiene

Good oral and personal hygiene prevents tonsillitis-causing bacteria from entering your mouth. These tips help you keep your mouth clean:

• Wash your hands with soap and water before and after eating or using the toilet, and after sneezing or coughing.

• Brush and floss your teeth regularly to remove plaque and trapped food particles, as these cause bacteria to thrive in your mouth.

• Brush with antibacterial or fluoride toothpaste to kill bacteria in the food particles stuck between your teeth.

• Rinse with antibacterial prescription chlorhexidine or fluoride mouthwash to kill bacteria in your mouth.

• Replace your toothbrush every 3 months, as bacteria can build up over time on old toothbrush bristles.

• Visit the dentist regularly for teeth cleaning. 

2) Keep your immune system healthy

Bacterial and viral infections cause tonsillitis, so you should make sure your body’s immune system is strong enough to fight off any infections.

• Keep your immune system healthy by eating healthy food, resting well, and getting enough exercise.

• Eat foods that boost your immune system, like citrus fruits (oranges, lime, grapefruits), red bell peppers and broccoli, which are packed with Vitamin C.

• Get enough sleep. Your immune system releases infection-fighting proteins called cytokines when you sleep. Sleep deprivation can slow down production and lower the amount of these cytokines in your body, making you more vulnerable to infection.

• Get enough low-to-moderate intensity exercise. Exercise improves heart health and lowers blood pressure, which boosts your overall health and immune system.

3) Avoid or quit smoking

Smoking weakens your immune system. Tar and nicotine in cigarettes are immunosuppressive (suppressing or restricting your immune system) and affect your natural immune response.

Your immune system won’t be able to fight bacterial infections as quickly and efficiently. As such, you might get throat infections more easily. 

Need help with quitting smoking? Try NRT (nicotine replacement therapy) or participate in the local I Quit Programme. You can also get professional help from a counsellor by booking an appointment with the SGH Smoking Cessation Clinic.

4) Avoid sugary food

Sugary food provides an energy source for bacteria to thrive and grow in your mouth, which increases your risk of getting tonsillitis. It also increases the risk of dental caries.

5) Don’t share personal items

Tonsillitis-causing bacteria can spread around through saliva on personal items. For example, the Epstein-Barr virus is spread through saliva and can cause acute tonsillitis.

Don’t share cups, water bottles, oral cosmetics like lipstick, eating utensils (forks, spoons, chopsticks) and toothbrushes.

If you’re already having a case of tonsillitis, then prevention may be a little too late. Fortunately, you can still manage your symptoms well with tonsillitis treatment at home.

Tonsillitis treatment and home remedies

1) Take medication as instructed by your doctor

You might have seen a doctor already. If your tonsillitis is due to bacterial infection (like Strep throat), your doctor will prescribe antibiotics as a tonsillitis cure. Make sure you finish the full course of your antibiotic treatment, even if you feel better early.

If it’s due to a viral infection (like the Epstein-Barr virus), you won’t need antibiotics. Your doctor will give you painkillers, fever medicine (paracetamol), and medicine for sore throat (lozenges). Get plenty of rest at home, stay hydrated by drinking lots of water and take your medicine as instructed.

2) Gargling with warm salt water

Salt water is a natural disinfectant that kills tonsillitis-causing bacteria. It also helps dislodge and wash away tonsil stones (tonsil stones are lumps of hard minerals, food particles, and germs that build up as small white ‘pebbles’ on your tonsils).

How to prevent tonsil stones by gargling with warm salt water mouthwash:

3) Stay hydrated with warm fluids

Stay hydrated by drinking warm water or warm, clear fluids (clear broth or soup, herbal tea with honey). Warm fluids soothe your throat pain and reduce inflammation by encouraging more blood flow to the swollen tonsils.

4) Eat cold food to numb pain

Warm liquids can soothe pain, but cold foods can also relieve tonsillitis symptoms. Just like how you might put ice or a cold pack on an injury, cold food can also help with pain relief by numbing the area. Try eating fruity ice popsicles, drinking cold milkshakes, and sipping cold water.

5) Avoid straining your voice or irritating your throat

Tonsillitis causes sore throat and swelling that may change your voice or cause you to lose your voice. Straining your voice (singing, shouting) may irritate your throat more.

You should also avoid eating anything that irritates your throat. With tonsillitis, some foods to avoid are spicy and greasy food as well as food with harder consistency.

6) Take pain relief medication

If your tonsillitis is causing a severe sore throat and headache, take regular painkillers (such as Panadol). Your doctor may also prescribe stronger painkillers to help with the sore throat.

Your doctor may also give you throat lozenges, gargle or throat spray (Difflam) to help with the pain. You can also buy lozenges from a local pharmacy (Strepsils, Difflam).

Make sure you don’t take more than the amount recommended by your doctor or the manufacturer.

7) Increase indoor humidity

Dry air can irritate your sore throat and make the itch or pain worse, especially if you sit in an air-conditioned room all the time. A mist humidifier helps increase the room humidity, which makes the air more moist to soothe a sore throat. Just switch it on and put it near your bed or chair.

If you don’t have an indoor humidifier, try taking a warm shower or bath. Inhaling the hot steam from your shower has the same soothing effect on your painful throat. You can also use a bowl filled with hot water for the same purpose. Sit down and lean slightly over it to slowly inhale the steam.

8) Tonsillitis surgery

Some patients develop a peritonsillar abscess (a collection of pus that forms beside your tonsil and causes severe pain on the affected side). A simple surgery under local anaesthesia is performed to drain and remove the pus.

Your doctor may advise you to surgically remove your tonsils (tonsillectomy) if you have:

• Seven or more serious throat infections in one year

• Five or more serious throat infections every year over a two year period

• Three or more serious throat infections every year over a three-year period

• Chronic tonsillitis

The surgery is usually planned after the infection has resolved, and a complete recovery may take up to two weeks. Your doctor will tell you more about the surgical procedure and risks.

Tonsillitis can be prevented and treated at home. Take antibiotics for bacterial tonsillitis as prescribed by your doctor. If it’s a viral infection, get plenty of rest at home, stay hydrated and take pain relief medicine to manage symptoms.

Ref: G25

Related articles:

Allergic Rhinitis: Types, Symptoms and Treatments

Nasal Irrigation (Nasal Rinse): Does It Help Clear Sinuses?

Allergies and Sinusitis: What Is the Difference?

Snoring and Sleep Apnoea: What is the Link