Throat & Voice

Tonsillitis In Children & Adults: An ENT Specialist’s Guide

March 24, 2020

What are the tonsils, and how do you get tonsilitis

The tonsils are soft tissue masses located at the back of the throat that are composed of tissue similar to lymph nodes. As part of the lymphatic system, they help to fight infection.

Although it’s extremely common in young children, tonsilitis can occur in patients of any age. Symptoms include sore throat, swollen tonsils, and fever among others.

Symptoms Of Tonsillitis

Symptoms of tonsilitis may vary from person to person, but the following are the most commonly found symptoms:


  • Fever
  • Severe sore throat
  • Difficulty Swallowing
  • Swollen tonsils
  • Pain in the ears
  • Tiredness and body aches
  • How Is Tonsillitis Diagnosed

It’s advisable to see a General Practitioner (GP) or an ENT doctor in Singapore if you suspect that you have tonsillitis,

Tonsillitis is most often a clinical diagnosis, so your ENT doctor will start by asking you about your symptoms and giving you a physical exam. Your doctor will examine the back of your throat to check if the tonsils are red or inflamed, or have white patches or some pus.

To determine the cause of your infection, your ENT doctor may take a throat swab.

This is to collect fluids from the back of your throat, which may be used to either:

Perform a rapid strep test (this is to rule out strep throat as an underlying cause)
Be sent to a lab for a throat culture

Blood tests may also be taken to ascertain to determine the severity of your throat infection.

Is Tonsillitis Contagious

Tonsillitis itself is not contagious but the bacteria or virus (e.g. from a cold or flu) that causes it are. To reduce the risk of developing tonsillitis, you should practise good hygiene such as:

Frequent hand washing, especially after going to the toilet or before touching your face or mouth
Avoid sharing food, drinks and utensils with people who are unwell from a viral cold/flu

Causes Of Tonsillitis

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The tonsils trap germs that enter through the mouth and nose while producing white blood cells to protect the body against infection, making them vulnerable to infection.


Most often, tonsilitis is caused by viruses, such as the flu virus. In rare cases, other viruses may be the source of tonsilitis, such as:

  • Adenovirus
  • Rhinovirus
  • Epstein-Barr virus
  • Influenza virus
  • Parainfluenza virus
  • Herpes simplex virus

When a patient is suffering from viral tonsilitis, commonly associated symptoms include coughing and a runny nose.

It is therefore important for your tonsilitis to be diagnosed as accurately as possible, as antibiotics will not do anything to help viral tonsilitis.

Drinking lots of fluids and rest, along with some medication to ease the symptoms are the most common prescriptions.


Approximately 15-30% of tonsilitis cases are bacterial. Most of the time, it’s strep bacteria which causes bacterial tonsilitis, but other bacteria can also cause tonsillitis.

Your doctor will most likely prescribe antibiotics to treat your bacterial tonsillitis, such as amoxicillin or azithromycin.

Types Of Tonsilitis


Tonsilitis is considered acute when the symptoms last less than 2 weeks.


Chronic tonsillitis is considered chronic when the symptoms last beyond 2 weeks

Please see an ENT specialist if you suspect you have chronic tonsilitis.

Treatments for chronic tonsillitis include a tonsillectomy.


Tonsilitis may be diagnosed as recurrent if it meets the following criteria:

  • Occurs at least 7 times a year
  • Occurs at least 5 times in each of the previous 2 years
  • Occurs at least 3 times in each of the previous 3 years

As with chronic tonsilitis, your ENT specialist may recommend a tonsillectomy.

Chronic and recurrent tonsillitis both cause repeated occurrences of inflamed tonsils which have a significant impact on the quality of your life.

Research has also shown that biofilms (a collective of one or more types of microorganisms that can grow on and stick to different surfaces) are one of the causes of recurrent tonsillitis, as they have increased anti-microbial resistance.

How Can Tonsillitis Be Treated


Tonsillectomy is a surgical procedure in which both (palatine) tonsils are fully removed from the back of the throat. The procedure is mainly performed for recurrent throat infections and obstructive sleep apnea.

For more information about a tonsillectomy, please read our comprehensive guide.


Antibiotics such as amoxicillin or azithromycin may be prescribed for bacterial tonsilitis.

Home Remedies

Here are several home remedies that may ease your throat pain from tonsilitis:

  • Hydrating yourself
  • Getting an adequate amount of rest to allow your body to recover
  • Over the counter (OTC) medication such as ibuprofen to reduce pain and general inflammation as well as throat gargle and lozenges

How long does it take to recover from tonsilitis?

Most cases of viral tonsillitis resolve within 7-10 days.

For tonsilitis caused by strep throat, patients start to feel better within 24-48 hours after starting a course of antibiotics.

What’s The Difference Between Tonsillitis and Strep Throat

Both tonsilitis and strep throat are terms that are often used interchangeably, which is incorrect.

You can have tonsilitis which is caused by viruses, such as the flu virus without having strep throat.

Tonsilitis can also be caused by group A Streptococcus bacteria, which is the bacteria responsible for strep throat.

Complications Arising From Tonsillitis

For patients who have chronic or recurrent tonsilitis, it is important to get it treated as soon as possible.

Some of the complications that may arise from recurrent and chronic tonsilitis are:

  • Obstructive Sleep Apnoea. Typically caused by swelling airways which obstruct breathing while you’re sleeping.
  • Rheumatic fever. Normally occurs after tonsilitis caused by group A Streptococcus bacteria, and commonly affects the joints and heart

When Should You See An ENT Specialist

You should see either your primary care doctor or an ENT specialist if your symptoms become severe or last longer than four days without any noticeable improvement.


Medically reviewed by Dr Gan Eng Cern

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