Tonsillitis (Angina Tonsillaris)

Brief overview

  • Common symptoms: Sore throat, difficulty swallowing, reddened and clogged palatine tonsils, reddened pharyngeal wall, swollen lymph nodes, fever.
  • Treatment: Home remedies (throat compresses, gargling, lozenges, etc.), painkillers, antibiotics if necessary, surgery
  • Special form: Chronic tonsillitis (recurrent tonsillitis)
  • Infection:High risk of infection in the first few days, via droplet infection.
  • Possible complications: Otitis media, sinusitis, earache, peritonsillar abscess, rheumatic fever, “blood poisoning” (sepsis).

Symptoms: This is how tonsillitis manifests itself

Typical symptoms of tonsillitis are sore throat and difficulty swallowing. They usually develop within a few hours. The palatine tonsils on both sides of the uvula are clearly reddened, swollen and may have a whitish or yellowish coating.

Differences between viral and bacterial tonsillitis.

In most cases, it is viruses such as rhino, corona or adenoviruses that cause tonsillitis. Often, those affected then suffer from a cold in addition to tonsillitis. Patients with viral tonsillitis therefore often complain of

  • Rhinitis
  • Cough
  • headache and aching limbs
  • Fever over 38 degrees
  • no cough
  • swollen and painful throat lymph nodes
  • enlarged and occupied palatine tonsils

If all four symptoms are present in a tonsillitis, about 50 to 60 percent of the time it is a strep infection. If three of the above symptoms are present, the probability is still about 30 to 35 percent.

Tonsillitis as a symptom and special forms

Tonsillitis is not only a clinical picture. It can also be a symptom that accompanies other diseases. In addition, there are specific special forms. Examples are:

  • Pfeiffer’s glandular fever
  • Diphtheria
  • Scarlet fever
  • Herpangina
  • Angina Plaut-Vincent
  • Syphilis and gonorrhea
  • Tuberculosis
  • Soorangina in fungal infection

Tonsillitis – symptoms of diphtheria: Diphtheria is a dangerous bacterial infection, often accompanied by laryngitis or tonsillitis. The tonsils are then covered with a grayish-white coating. If one tries to remove the coating, it usually bleeds. Affected persons often have a foul-sweetish mouth odor, which is compared to fermenting apples.

Tonsillitis – symptoms of herpangina: In tonsillitis caused by Coxsackie A virus (herpangina), the tonsils are only slightly swollen. In addition, small blisters (aphthae) form on the mucous membranes of the palate and cheek, which leave flat, painful defects after bursting. Fever, difficulty swallowing and a distinct feeling of illness are further symptoms.

Also with gonorrhea – another venereal disease – tonsillitis can occur, among other things.

Tonsillitis – symptoms with fungal infection

Tonsillitis – symptoms in tuberculosis.

Tonsillitis in the context of tuberculosis is very rare. In this case, flat mucosal defects appear on the tonsils.

Tonsillitis: Treatment

If complications occur, such as a peritonsillar abscess (encapsulated pus focus), inpatient treatment in a hospital may be necessary. Here, too, doctors usually operate.

Self-help for tonsillitis: What to do at home?

  • Throat compress
  • Gargling (with solutions and tea)
  • Medicinal herbal teas (for example sage)
  • Inhalation
  • Bed rest
  • humid room air
  • drink enough (no acidic drinks, e.g. juice)
  • eat preferably soft, little spiced food

Home remedies have their limits. If the symptoms persist over a longer period of time, do not get better or even get worse, you should always consult a doctor.

Tonsillitis: When to see a doctor?

Pain is the most annoying symptom of tonsillitis, especially in the first few days. At first, you can try to relieve the pain with measures such as throat compresses or lozenges, special lozenges as well as sprays and antiseptic as well as locally anesthetic gargle solutions from the pharmacy.

If you are pregnant or chronically ill, for example with kidney, heart or liver problems, or have known stomach problems, allergies or blood clotting disorders, you should only take the medication after consulting a doctor! Paracetamol is also not advisable in cases of mononucleosis (EBV infection), as it puts additional strain on the liver.

Painkillers only relieve the discomfort, they do not fight the pathogens.

You should also seek medical attention for tonsillitis in the following situations:

  • abnormal breathing sounds
  • difficult breathing
  • severe pain on one side, especially when chewing, swallowing or opening the mouth
  • illness lasting more than three days without improvement
  • persistent increase of symptoms
  • acute rheumatic fever in the family
  • severe general illness
  • high fever, especially if it cannot be reduced with medication

If the doctor can detect streptococcal tonsillitis or if it is very likely, the doctor usually prescribes antibiotics, primarily of the penicillin V type. Those who cannot tolerate this agent are given other antibiotics (such as cefadroxil or erythromycin) that also work well against streptococci.

It is important to note that the antibiotics must be taken for as long as the treating physician has prescribed them. Do not discontinue the medication prematurely – even if the symptoms improve beforehand! There may still be some bacteria in the body, which can then trigger a new inflammation or build up resistance to the antibiotic.

Medical treatment for viral tonsillitis.

Antibiotics are effective only against bacteria, so they are not used for viral infections. Doctors use them for viral tonsillitis only if an additional bacterial infection has occurred on the diseased mucous membranes (superinfection).

Physical rest is particularly important in the case of infections. Even initially harmless illnesses can cause a potentially life-threatening myocarditis, for example, if excessive stress is applied.

In the case of glandular fever, internal organs (spleen, liver) can swell and there is a risk of rupture of the spleen. This complication is life-threatening and requires inpatient treatment in a hospital. Therefore, physical rest is also enormously important in this case.

You can learn more about symptoms and treatment of chronic tonsillitis in the article Chronic tonsillitis.

Tonsillitis: When to operate

In addition, there is also the possibility of a partial tonsillectomy (tonsillotomy). This is somewhat gentler than a complete tonsillectomy. However, it is not certain how effectively a tonsillotomy can prevent recurrent tonsillitis in the long term.

You can learn more about the procedure, benefits and risks of tonsillectomy in the article Tonsillectomy.

Tonsillitis: Treatment with homeopathy

Depending on the symptoms, the homeopathic remedies Aconitum, Belladonna, Apis or Pyrogenium, for example, are recommended for acute tonsillitis.

The concept of homeopathy and its specific effectiveness are controversial in science and not proven beyond doubt by studies.

Tonsillitis: Where it comes from

Most often, viruses are the causative agents of tonsillitis. More rarely, bacteria trigger tonsillitis, then mostly of the streptococcus type. The stipples or yellow-white coatings on the inflamed tonsils, which are typical of bacterial tonsillitis, consist of dead bacteria and dead cells of the immune system. Tonsillitis can be unilateral or bilateral.

Doctors speak of chronic tonsillitis when the inflammation persists for more than three months. The course of the disease can vary. Often the inflammation smolders in the tonsils, patients are symptom-free or have only mild tonsillitis symptoms. Now and then, an acute inflammatory event flares up on this ground.

Tonsillitis: Causes and risk factors

Tonsillitis can be triggered by various pathogens. These can easily settle on the fissured surface of the palatine tonsils. In principle, this is even good:

Bacterial tonsillitis – pathogens

In fact, in many cases tonsillitis is preceded by a viral infection (e.g., common cold), which may then be followed by a bacterial infection of the tonsils – usually with ß-hemolytic streptococci of Lancefield group A (Streptococcus pyogenes). The result is a bacterial (purulent) tonsillitis. Other pathogens that can be considered as causative agents of bacterial tonsillitis are:

  • Various strains of streptococci
  • Staphylococci
  • Corynebacteria
  • Nocardia
  • Neisseria gonorrhoeae

The special form Angina Plaut-Vincenti (Tonsillitis ulcerosa) is usually a mixed infection: screw bacteria (especially Treponema vincentii) and Fusobacteria (especially Fusobacterium nucleatum) cause tonsillitis.

Viral tonsillitis – pathogens

  • Coronaviruses
  • Adenoviruses
  • Influenza viruses and parainfluenza viruses
  • Epstein-Barr virus (causative agent of Pfeiffer’s glandular fever)
  • Enteroviruses such as Coxsackieviruses
  • RS virus especially of tonsillitis in children

Angina agranulocytotica

Tonsillectomy cannot be performed for angina agranulocytotica!

Is tonsillitis contagious?

The usual pathogens of tonsillitis can infect other people via germ-containing droplets. Doctors refer to this as droplet infection.

Since the risk of infection with tonsillitis is particularly high in the first few days, contact with other people should be avoided as far as possible during this time.

Unlike chickenpox, for example, you are not immune to re-infection after tonsillitis.

Tonsillitis: examinations and diagnosis

Severe sore throat and difficulty swallowing, fatigue and fever often lead those affected to the doctor. The doctor will first ask a few questions about the patient’s medical history. Possible questions include:

  • How long have the symptoms been present?
  • Does pain occur when chewing, swallowing or opening the mouth?
  • Is the tonsillitis new (acute tonsillitis) or is it a recurring problem (chronic tonsillitis)?

Physical examination

The doctor then checks whether there is any redness, swelling or coating on the throat and palatine tonsils. He also palpates the lymph nodes, especially at the back of the throat and head. They may be swollen in the case of tonsillitis.

Throat swab

Further examinations

In some cases, further examinations may be necessary. For example, if an encapsulated pus focus (abscess) is suspected, the doctor will perform an ultrasound examination. In some cases, blood tests may also be useful, for example to rule out other diseases.

Tonsillitis: course of the disease and prognosis

In acute tonsillitis, the symptoms usually decrease significantly after a few days. Within one to two weeks, the symptoms disappear completely. It can take somewhat longer for the swelling of the tonsils to go down.

In the case of bacterial tonsillitis, which is treated with antibiotics, the duration of the disease is shortened.

Complications of tonsillitis

Moreover, complications often arise if a bacterial, purulent tonsillitis was not treated at all or was treated too briefly with antibiotics. There is also an increased risk of complications during pregnancy.

Here is an overview of important complications of purulent tonsillitis:

Middle ear and sinusitis

Peritonsillar abscess

In tonsillitis with peritonsillar abscess, a focus of inflammation encapsulates between the tonsil and the surrounding connective tissue (peritonsillitis). In most cases, the pharyngeal wall then bulges significantly inward on the affected side. Affected persons also often have severe throat and swallowing pain and can only open their mouth minimally (lockjaw). Other symptoms are

  • slurred speech
  • increased salivation
  • “torticollis” with head tilted to one side
  • possibly shortness of breath with increasing swelling and thus narrowing of the airway

People who smoke during tonsillitis are more likely to develop an abscess. Another risk factor is poor oral hygiene.

Rheumatic fever

Acute rheumatic fever can also affect the nervous system and manifest as so-called “chorea minor”. This disorder manifests itself several weeks to months after the tonsillitis has subsided. Symptoms are lightning-like movements of the arms, throat and pharynx. These twitches occur suddenly and cannot be controlled.

Inflammation of the renal corpuscles (acute poststreptococcal glomerulonephritis).

  • Flank pain
  • Decreased urination due to less urine
  • High blood pressure (such as with headaches)
  • Edema
  • Feeling sick

About half of those affected have no symptoms, but in some cases still develop permanent kidney damage.

Streptococcal tonsillitis can also cause kidney inflammation in children. In severe cases, the kidney may even fail completely. However, children usually recover within a few days.

Sepsis