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Treating tonsillitis Correctly

If your throat hurts, your tonsils are thick and swollen and there may even be small pus spots on them, you may have tonsillitis. This type of inflammation can be extremely painful - and is also highly contagious. Find out what can help and how you can protect yourself against it here. 

min read
Mar 2024
min read
Mar 2024

What is tonsillitis? 

If the tonsils are inflamed, doctors speak of tonsillitis or angina tonsillaris - these terms are derived from the Latin "tonsillae", which stands for palatine tonsils. Today, the palatine tonsils are referred to as tonsils. If only the tonsil on the right or left is affected, doctors refer to such unilateral inflammation as unilateral tonsillitis. 

Tonsillitis is usually caused by bacteria - predominantly streptococci. However, pneumococci, staphylococci or Haemophilus influenza can also be the culprits. Viruses are more rarely behind tonsillitis. In these cases, the affected person's immune system has already been attacked - for example by a viral cold or a viral sore throat, i.e. by cold viruses. If such viruses are behind the tonsillitis, patients can also suffer from a cough and runny nose - this is not usually the case with a bacterial inflammation. 

We get tonsillitis when we become infected with the pathogens mentioned above. This can happen via droplet or smear infection. Once the tonsils are infected, a sore throat and difficulty swallowing usually occur. These main symptoms are often accompanied by fever and a very pronounced feeling of illness. Children and young adults are particularly frequently affected by tonsillitis - but the disease can occur at any age. 

Tonsillitis - what does it look like? 

You can find many pictures on the internet of what tonsillitis can look like. However, you should not rely on this alone. The diagnosis should always be made by a doctor. In the case of acute tonsillitis, a glance into the patient's mouth is often enough for the doctor to recognise the illness at. In many patients, small yellowish-white spots appear on the tonsils, and the tonsils are often enlarged and reddened. In contrast, patients suffering from chronic tonsillitis often have less severe symptoms; for example, it can also run its course without fever. 

Tonsillitis or tonsil stones? 

Danger of confusion: Yellowish-white specks also appear on the tonsils in the case of so-called tonsil stones. However, these are not pus, but a solid to crumbly substance that is harmless, but can cause difficulty swallowing and a strong bad breath. People who often suffer from tonsillitis are more likely to develop tonsil stones than others. Skilled patients can remove tonsil stones themselves - special instruments such as snares and curettes are available on the market. Those who are wary of this and want to be on the safe side can also have their tonsil stones removed by an ENT specialist. 

Tonsillitis or scarlet fever?

It can be difficult for medical laypersons to diagnose their own illness. It is therefore always important to consult a doctor if you have symptoms. For example, tonsillitis and scarlet fever are similar, which means that they can also be confused. Scarlet fever also causes a sore throat and difficulty swallowing. The tonsils may also be red and enlarged. However, scarlet fever lacks the purulent spots on the tonsils. Instead, those affected suffer from a skin rash and the typical raspberry-red tongue. 

Tonsillitis: How long is it contagious?

Particularly in the first few days after the onset of acute tonsillitis, those affected are very contagious. Children should therefore not be sent to nursery or school. Of course, this is also because they are very likely to feel very ill. If patients receive adequate treatment, the risk of infection quickly decreases. After taking antibiotics, for example, you are usually no longer contagious after around 24 hours. 

Incubation period for tonsillitis

If you have had close contact with a person suffering from tonsillitis, there is a good chance that you have been infected. It is not possible to say exactly how much time will pass before you notice the first signs. If the inflammation is caused by a streptococcal infection, the incubation period is usually one to three days. 

Acute or chronic tonsillitis? 

Doctors differentiate between acute tonsillitis and a chronic infection, although nowadays the term chronic tonsillitis is only used colloquially. The correct medical term is recurrent acute tonsillitis (RAT). 

We explain the differences between the two processes here:

Acute tonsillitis - symptoms and progression

In the case of acute tonsillitis, the symptoms usually occur quite suddenly - both in adults and in babies and older children. The illness often begins with a fever, sometimes combined with chills. In addition, sufferers - regardless of age - may show the following symptoms: 

  • Very severe sore throat
  • Earache
  • Headache
  • Fatigue and general feeling of illness
  • Swollen throat, externally palpable, swollen tonsils and lymph nodes
  • Swallowing difficulties
  • A "lumpy" pronunciation due to the swallowing difficulties
  • Reddened tonsils
  • Pus formation on the tonsils, recognisable as white-yellowish pus spots/spots
  • Bad breath (Foetor ex ore)
  • Cough, Irritating cough or cold (in the case of viral tonsillitis)
  • Fever with sweating  or chills

Important to know: With a baby or a toddler, there is a risk that tonsillitis will initially be overlooked. Babies cannot express their symptoms. If they stop eating or have problems swallowing, you should definitely take your child to the paediatrician immediately. Small babies and children dehydrate quickly.

Duration of acute tonsillitis

If tonsillitis occurs acutely and is treated with the right medication, it usually heals within one or two weeks. Only rarely do complications occur that can prolong the course of the disease and, in the worst case, even become life-threatening.

Possible complications of acute tonsillitis

Only in rare cases can tonsillitis become dangerous. For example, if the tonsils become enlarged so that they obstruct breathing and the patient therefore suffers from shortness of breath. 

It is also rare for accumulations of pus to form in the tissue around the tonsils, so-called peritonsillar abscesses. In many affected patients, the fever rises again a few days after the acute infection. There may also be difficulty swallowing on one side and stinging in the mouth. An abscess also very often means that the mouth can no longer be opened properly. If you notice any of these symptoms, you should not hesitate for long. If you suspect you have an abscess, you should go to a doctor's surgery or the nearest emergency room immediately. This is because an abscess almost always needs to be treated surgically. If this is not done, it can have life-threatening consequences for you; for example, a narrowing of the airways, blood poisoning (septicaemia) or thrombosis. 

Good to know: 

Poor oral hygiene increases the risk of tonsillitis developing into an abscess. Therefore, even if you have a sore throat, make sure you clean your teeth and the entire oral cavity effectively. How does this work? Find out in our detailed guide. 

Instructions for brushing your teeth

Important to know: The risk of complications is greater during pregnancy. Pregnant women should therefore strictly adhere to their doctor's instructions. 

Diagnosis of acute tonsillitis 

Acute tonsillitis requires medical treatment. The right treatment depends on which pathogens caused the illness - was it viruses or bacteria? 

The challenge with the diagnosis: the ENT doctor cannot tell from your throat which pathogen has attacked your tonsils. To get closer to the answer, the scoring system with various criteria for patients aged
15 and over estimate how likely an infection with bacteria or viruses is. 

For example, if sufferers have a fever of more than 38 degrees, enlarged tonsils and swollen lymph nodes in the throat area, but no cough, it is more likely that bacteria are the culprit. Why is that the case? Because, as you have already learnt above, a cough is an indication of a viral cold, just like a headache, aching limbs or a cold, for example.


Bacterial tonsillitis: Treatment options

If bacteria are the culprit, the ENT doctor will prescribe an antibiotic such as Penicillin or amoxicillin, which patients usually have to take for between five and ten days - your doctor will provide you with detailed information on this. If the antibiotic works, you will feel an improvement relatively quickly. 

To alleviate accompanying symptoms such as fever and pain, you can take painkillers such as paracetamol or ibuprofen. As there is always a residual risk of your tonsillitis developing into an abscess, you should avoid taking aspirin. This medication has an anticoagulant effect, which can pose a problem in the event of a tonsillectomy. 

If you have bacterial tonsillitis, your doctor will certainly advise you to rest in bed. 


Viral tonsillitis: Treatment options

Is the antibiotic prescribed by your doctor not working? Then it may be that your acute tonsillitis is not caused by bacteria, but by viruses. In this case, taking the antibiotic is actually ineffective. The inflammation will then subside on its own with time and appropriate rest. In these cases, the main focus is on alleviating the symptoms - for example with painkillers. 


Treat yourself : Home remedies for acute tonsillitis

Even if tonsillitis is usually free of complications, you should always go to the doctor. It is often necessary to take an antibiotic. In addition to medical treatment, you can also try some home remedies to provide relief. For example, those affected find compresses around the throat or gargling with sage tea or salt water pleasant. Of course, you can also buy a throat spray, lozenges and sweets from the pharmacy or drugstore. However, they will not eliminate the cause of the illness, but will at least keep your throat moisturised. 

Many patients also ask themselves: Should I cool or warm my neck? It depends! The neck compresses described above are good for many people if they are cooled. However, the tea you drink can be very warm. 


Homeopathy for tonsillitis? Better not

Would you like to treat your tonsillitis with alternative remedies such as globules? As a supplement and for your own well-being, there is certainly nothing to be said against it. However, there is no evidence that homeopathy has any effect. You should therefore always rely on your doctor and take the medication he or she prescribes. As you have already experienced, dangerous complications can arise if you do not have tonsillitis treated or if you procrastinate. 

Chronic tonsillitis - symptoms and progression

It can happen that recurrent acute inflammation develops into chronic tonsillitis - the technical term for this is "recurrent acute tonsillitis" (RAT). In this case, there is a persistent bacterial inflammation. The risk of chronicity increases, for example, if tonsillitis is protracted or remains untreated. 

Chronic tonsillitis occurs when the bacteria and dead cells that cause it accumulate in the many grooves in the tonsil tissue and permanently fuel the inflammation. The body is then constantly on defence, which can even damage the kidneys, heart or joints in the long term. However, those affected do not usually suffer from constant discomfort - there are usually symptom-free periods without pain or other complaints, which are then followed by intervals with symptoms. 

The following symptoms are possible with chronic tonsillitis:

  • Slight swallowing difficulties
  • Scratchy throat
  • Unpleasant taste in the mouth
  • Bad breath

If the doctor looks in your mouth and you suffer from chronic tonsillitis, he may also see fissured tonsils. In addition, the tonsils can either be enlarged (hyperplasia) or small and atrophied (atrophy). 

Treating chronic tonsillitis - tonsillectomy

Your tonsillitis keeps coming back and you need an antibiotic against it at least six times a year? Then your doctor will probably consider surgically removing the tonsils (tonsillectomy). In this type of tonsillectomy, the ENT doctor removes both tonsils under general anaesthetic - the procedure is absolutely routine and one of the most frequently performed operations in the ENT field. It is usually performed on an inpatient basis. You therefore have to be prepared for several overnight stays in hospital. 

The time after the procedure is usually quite painful for patients, so those affected will be given a sick note for at least two weeks.  Pain medication can provide relief during this time, which you will be given in hospital and also for the time at home. 

Risks of a tonsillectomy

Tonsillectomy surgery is generally uncomplicated if patients follow the doctor's recommendations, especially during the first week. These are as follows:

  • Maintain strict bed rest to prevent secondary haemorrhaging
  • Drink a lot
  • Rinse mouth with sage and camomile tea
  • Brush teeth carefully with children's toothpaste and a soft toothbrush
  • Do not smoke
  • Avoid alcohol and caffeine
  • Do not take a hot shower
  • Avoid full baths and hair washing
  • Do not stay in direct sunlight
  • No sauna and solarium visits
  • Do not push hard during bowel movements
  • Do not lift heavy objects
  • Do not eat solid food

And one more important piece of information: as a general rule, you should not fly for at least two weeks after an operation, as there is an increased risk of bleeding. 

Good to know: 

Even if it is difficult and pinches your throat: After a tonsillectomy, you still need to pay a lot of attention to your oral hygiene. With the CS Surgical Mega Soft, you can clean your teeth particularly gently. It is ideal for times after a surgical procedure. 

Tonsillectomy: What to eat after the procedure?

The throat hurts, swallowing hurts - a tonsillectomy is no walk in the park. Nevertheless, patients naturally need to eat and drink something afterwards. The question is what! We have put together a list of recommended foods here and tell you what you should avoid for the time being.

These foods are ideal after a tonsillectomy: 

  • White bread (without crust)
  • Dairy products such as quark, cheese spread, yoghurt, dairy ice cream and milk
  • Honey
  • Spreadable sausage
  • Soups
  • Still water 


It's better to stay away from these foods for the time being: 

  • any solid food such as rolls and bread
  • Fruit juices and fruit
  • Carbonated drinks
  • Spicy and crunchy food (for example brittle or nuts)
  • Caffeine and alcohol
  • Hot dishes and drinks

Tonsillotomy: partial removal of the palatine tonsils

A complete removal of the palatine tonsils may also be considered in children if they suffer from chronically inflamed tonsils. However, as the time after the operation can be associated with severe pain, the doctor will certainly weigh up the decision very carefully before making such a recommendation. 

More common than a complete tonsillectomy in children between the ages of three and six is a partial tonsillectomy - the so-called tonsillotomy. The doctor does not remove the entire tonsils, but only part of them. This procedure is considered when children have enlarged tonsils that cause breathing and swallowing difficulties. Unfortunately, this procedure does not provide a remedy for chronic tonsillitis, as part of the inflamed organ remains in the body after a tonsillotomy and can continue to cause discomfort. 

Why is it often the case that only part of the tonsils are removed in children and not the entire palatine tonsils? There is a good reason for this: tonsils fulfil an important function, especially at a young age. They are part of the body's immune system and can ward off pathogens. In addition, the tonsils contain many white blood cells that can kill pathogens. 

How can tonsillitis be prevented?

Preventing tonsillitis is not so easy as it is highly contagious. The best protection is therefore to keep your distance from people who are ill and to wash your hands well after skin contact, such as shaking hands. Prophylaxis also includes the usual advice to keep any colds away from you - this includes, for example

  • Balanced diet
  • Get enough sleep
  • Sufficient exercise and sport in the fresh air
  • Avoiding stress
  • Drink enough 



Alfried Krupp Hospital: Removal of the palatine tonsils.

Charité: Recommendation on behaviour after tonsillectomy. 

Deximed - General practitioner knowledge online: Tonsillitis. 

ENT doctors on the net: Tonsillitis. 

HNO Biberach:Tonsillitis. 

Kantonsspital Baselland: tonsillectomies & tonsillitis. gangrene.

Mooci: tonsil stones (tonsil stones). 

MSD Manual: Peritonsillitis and tonsillar abscess.

Robert Koch Institute: Streptococcus pyogenes infections. 

All websites last accessed on 14/11/2023.