Duration

With antibiotic therapy, acute tonsillitis usually lasts no longer than two weeks. Under no circumstances should the antibiotic be discontinued, even if an improvement has already been seen after a few days. The bacteria are still abundant in the oral cavity and in the tonsils and must be combated with the antibiotic – longer than the symptoms are present. An early and arbitrary discontinuation of the antibiotic gives the germs another chance to make you sick again! Since the duration of tonsillitis depends on many other factors, such as the state of health, the immune system and the physical conditions, it is unfortunately not possible to determine the exact duration.

Complications

What complications can occur? – Peritonsillar abscess; paratonsillar abscess; retropharyngeal abscess If the tonsillitis does not heal completely and the inflammation starts again, bacterial colonisation of the surrounding tissue may have occurred (abscess formation). In this case, the symptoms such as difficulty swallowing and difficulty opening the mouth (lockjaw) are particularly severe.

The swallowing difficulties in peritonsillar abscesses are usually unilateral and only extend to one ear. The voice also sounds clumsy. – Rheumatic fever If the purulent tonsillitis does not heal quickly, the focus of infection on the tonsils can also reach other organs.

Heart, kidneys and joints are particularly at risk and can be severely damaged by an unhealed tonsillitis (endocarditis (inflammation of the heart valve) -> more information also under our topic Endocarditis, Myocarditis (inflammation of the heart muscle), Pericarditis (inflammation of the pericardium), heart valve defects, nephritis, glumerulonephritis, inflammation of the kidneys, arthritis, rheumatoid arthritis). If, after tonsillitis has taken place, symptoms of the heart (e.g. inability to exercise, shortness of breath), kidneys (blood when urinating, pain in the renal pelvis) or joints (pain, swelling, redness) occur, a doctor should be consulted as soon as possible! To make the diagnosis easier, remember tonsillitis and tell your doctor about it.

In the course of acute tonsillitis, or angina tonsillaris acuta, an abscess is the formation of an encapsulation filled with pus that forms in addition to the tonsillitis. The abscess in this case is called peritonsillar or parapharyngeal abscess, depending on its location either in the area of the tonsils, or if it lies in the throat (parapharyngeal). It is a frequent complication of acute tonsillitis and drastically aggravates the symptoms: on the one hand, it further narrows the already constricted throat, on the other hand, once it reaches a certain size it can no longer be treated with medication and must be surgically opened.

In medicine, the principle “ubi puus ibi evacua” applies: where there is pus, open it up. In this sense, the attending physician will cut or prick the abscess under local anesthesia, if necessary. The danger here is not so much from possible injuries to the tonsils, but rather from involuntary movements of the patient while the scalpel is in the throat.

In itself, however, this minimally invasive procedure can be performed very quickly and without complications. Antibiotics are given to support the treatment of acute tonsillitis. The abscess is – in contrast to the original infection – not caused by viral but bacterial pathogens.

A bacterial colonisation of a primarily viral inflammation (as is the case with tonsillitis in 50-80% of cases) is called a “superinfection“. An acute tonsillitis does not necessarily have to be accompanied by fever. Only in the later course of the disease, or in severe stages, do symptoms such as fever and heavy sweating normally appear.

In the early stages, symptoms such as difficulty swallowing, sore throat and fatigue still predominate. In the ideal case, one should go to the doctor already now to prevent a worsening (exacerbation). In addition to sweating and fever, headaches and severe weight loss also occur.

On the one hand, this is due to the difficult food intake as a result of swallowing difficulties, on the other hand because a lot of energy is needed to warm the body above the physiological body temperature of around 37 degrees. Although fever is unpleasant for the affected person, it is also a defence mechanism of the body to kill the pathogens. There is almost no better method for fighting pathogens, which is why fever should only be artificially lowered in extreme cases. But even an acute tonsillitis without fever is no less serious: It can be a chronic form, or as described above, the initial stage of a fully developed tonsillitis. In conclusion, of course, each patient is different and an acute tonsillitis without fever can occur, even if fever is a classic symptom.