Tonsillitis/Pharyngitis

Have you ever wondered what’s in the back of your throat? Besides your uvula (the piece of tissue that hangs down in the middle and looks like a tiny punching bag), you have 2 lumps of tissue on either side of your throat, called tonsils. Their job is to fight germs such as bacteria and viruses. Tonsils can get infected and become red and swollen. This condition is called tonsillitis/pharyngitis.

What causes tonsillitis?

Tonsils can be infected by viruses and bacteria. Viruses are more common than bacteria. The most common bacteria is group A strep. A common virus in teenagers is the Epstein –Barr virus (EBV) which causes mono. Other rarer causes include other strep, gonorrhea, and acute HIV infections.

What are symptoms of tonsillitis?

The symptoms of tonsillitis can vary depending on the germ (type of bacteria or virus) that caused the infection, but most people complain of a sore throat. Symptoms can come on slowly or quickly and they can range from being mild to severe.

Common symptoms include:

• Sore throat
• Trouble swallowing
• Hoarse voice
• Swelling of the glands in your neck
• Red throat
• White or yellow patches or pus on the tonsils
• Fever
• Loss of appetite (you’re not as hungry as you normally are)
• Nausea (feeling like you need to throw up)
• Vomiting (throwing up)
• Pains in your stomach

What should I tell my health care provider (HCP)?

Tell your HCP if you’ve had a sore throat or if you’ve had a recent cold, cough, or fever, and how long you’ve had symptoms. It’s also important to let your HCP know if you’ve been exposed to anyone with strep or mono, or COVID, or if you’ve had oral sex with anyone who may have had a sexually transmitted infection (STI).

You are much less likely to have a strep infection and more likely to have a viral infection if you have a runny nose, cough or hoarseness.

What will my health care provider (HCP) do?

1. Your health care provider (HCP) will take your temperature and ask you to tell him/her about your symptoms; how long you’ve had them and how bad they are.
2. Next, your HCP will ask you to open your mouth wide to look at your throat and also feel the lymph nodes (glands) in your neck. If your HCP thinks you might have strep, they will probably do a Rapid Strep Test. This involves having you open your mouth wide again-while your HCP holds down your tongue with a flat wooden stick called a tongue depressor with one hand, they will take a cotton swab with the other hand and gently (and quickly) wipe your tonsils and throat. It’s natural to gag when this test is done but it’s over before you know it.
3. Lastly, your HCP will place the cotton swab in a special tube. It takes about 15 minutes to get the results. If the results are positive, you will be told that you have strep throat and you will receive a prescription for an antibiotic. If the Rapid Strep Test is negative, the sample will be sent to the lab for further testing.

What is the treatment for tonsillitis?

Treatment for tonsillitis depends on whether the infection is caused by group A strep bacteria or other bacteria, or a virus.

If the infection is caused by group A strep bacteria:

• It’s very important that you take the antibiotic as ordered by your health care provider and finish all of your medicine even if you feel better.

If the infection is caused by a virus:

• You probably won’t need to take an antibiotic. Your body will naturally fight off the viral Your health care provider will likely suggest comfort measures to treat your sore throat.

I have tonsillitis – is there anything I can do to feel better?

Yes. You can do the following to feel better:

• Drink lots of fluids
• Eat soft foods (soup, ice cream, milkshakes)
• Gargle with salt water (Mix 1/4 – 1/2 teaspoon of salt with 8 ounces of warm water)
• Try throat lozenges or hard candy
• Get enough sleep (teens need about 8-9 hours of sleep every night)
• Take over-the-counter pain medicine for pain such as “acetaminophen”
• Take all the antibiotic medications (if your HCP has prescribed), even if you start to feel better.

Can I prevent tonsillitis?

You can lower your chance of getting germs that cause tonsillitis.

Here’s how:

• Wash your hands often
• Don’t share cups, toothbrushes, water bottles, forks, spoons etc. with others, especially if they’re sick
• Don’t kiss anyone on the lips if they are sick with a cold or sore throat
• See your health care provider if you have a sore throat, fever, or swollen glands

For a small number of teens, your HCP may suggest that you see an “ORL” doctor (otolaryngologist), also called ENT doctor (someone who specializes in caring for people’s ears, nose and throat.) The ORL doctor may suggest having your tonsils removed (tonsillectomy) if:

• Your tonsils are so big that it may be hard to breathe
• You have many strep infections in one year and miss a lot of school
• You have a hard time eating and/or chewing foods or swallowing because your throat is sore
• You don’t sleep well and may snore because your tonsils are swollen or you have sleep apnea (short periods where you don’t breathe normally while you are sleeping)

What is a tonsillectomy?

A “tawn-sill-eck-toe-me” is the surgical removal of the tonsils. The operation is done under general anesthesia (you’re asleep), in an operating room. The surgery takes about 20-30 minutes. You will need to stay in the post-op area for a few more hours until you are wide awake and can sip on fluids. Unless your doctor wants to observe you overnight, you’ll probably go home the same day. You may have pain and discomfort after the surgery and it can take up to 1-2 weeks (or possibly longer) before you recover completely.

When should I call my health care provider (HCP)?

It’s a good idea to call your HCP if you have symptoms such as a sore throat that doesn’t go away, fever, trouble swallowing, etc.

Our health guides are developed through a systematic, rigorous process to ensure accuracy, reliability, and trustworthiness. Written and reviewed by experienced healthcare clinicians from Boston Children's Hospital, a Harvard Medical School teaching hospital and consistently ranked as a top hospital by Newsweek and U.S. News & World Report, these guides combine clinical expertise, specialized knowledge, and evidence-based medicine. We also incorporate research and best practices from authoritative sources such as the CDC, NIH, PubMed, top medical journals, and UpToDate.com. Clinical specialists and subject matter experts review and edit each guide, reinforcing our commitment to high-quality, factual, scientifically accurate health information for young people.