Tonsillitis (Inflamed Tonsils & Sore Throat)
Tonsillitis — inflamed, infected tonsils — is one of the most common causes of a severe sore throat, especially in children. Most episodes settle within a week, but frequent, severe, or one-sided attacks deserve an ENT assessment.
Medically reviewed by Dr. Marwan Alhalalmeh, ENT Specialist · Last reviewed: 2026-06-16
Overview
Tonsillitis is inflammation of the tonsils, two pads of tissue at the back of the throat. It is usually caused by the same viruses that cause colds and flu (around seven in ten cases) and, less often, by bacteria such as group A streptococcus (strep throat). It differs from a general sore throat, where irritation is spread across the throat rather than focused on swollen tonsils. Viral and bacterial tonsillitis can look alike, so when a bacterial cause is likely an ENT specialist may take a quick throat swab — because antibiotics help a bacterial infection only, not a viral one. Most cases, whatever the cause, improve within a week. The reasons to see a specialist are attacks that are frequent, unusually severe, one-sided, or that interfere with breathing, swallowing, or sleep.
Symptoms
- A sore throat with painful or difficult swallowing
- Red, swollen tonsils, sometimes with white or yellow patches of pus
- Fever and feeling generally unwell
- Tender, swollen glands in the neck
- A muffled or husky voice
- Bad breath
- In young children: refusing food, drooling, or unusual irritability
When to see a doctor
- Difficulty breathing, or difficulty opening the mouth
- Severe pain on one side, or trouble swallowing saliva (a possible abscess, or quinsy)
- Symptoms that last longer than three to four days or keep worsening
- A very high fever, or a widespread rash
- Repeated attacks several times a year
Treatment options
- Confirming the likely cause — viral or bacterial — by examination, with a throat swab when needed
- Symptom relief for viral cases: rest, fluids, pain relief, and salt-water gargles
- A full course of antibiotics when a bacterial (strep) infection is confirmed or likely
- Prompt treatment of complications such as a peritonsillar abscess
- Discussing tonsil removal (tonsillectomy) when attacks are frequent, severe, or affect sleep
Common questions
Is tonsillitis contagious?
Yes. The viruses and bacteria that cause tonsillitis spread through coughs, sneezes, and close contact, and it is most contagious in the first few days. With bacterial tonsillitis, people are usually no longer infectious about 24 hours after starting antibiotics.
Do I need antibiotics for tonsillitis?
Only if it is bacterial. Around seven in ten cases are viral, and antibiotics do not help those — rest, fluids, and pain relief do. When a strep infection is likely, a throat swab guides whether antibiotics are needed.
How long does tonsillitis last?
Most cases settle within about a week. Symptoms that last longer than three to four days, keep worsening, or are severe and one-sided should be assessed by an ENT specialist.
What is the difference between tonsillitis and strep throat?
Strep throat is tonsillitis caused specifically by group A streptococcus bacteria. It tends to be more severe and is the type that benefits from antibiotics, which is why a throat swab is sometimes used to confirm it.
When should the tonsils be removed?
Surgery (tonsillectomy) is considered when attacks are frequent — as a guide, about seven in one year, five a year over two years, or three a year over three years — or when enlarged tonsils affect breathing and sleep.
Further reading
General information about this topic from an independent health authority:
ENThealth (AAO-HNS)If you or your child get frequent or severe sore throats, Dr. Marwan can find the cause and advise whether treatment or tonsil surgery is the right step.
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