Tonsillitis – when swallowing hurts

Tonsillitis is a painful inflammation of the tonsils at the back of the throat which causes a scratchy throat and difficulty swallowing. It is a commonplace illness, being one of the 20 most common reasons for seeing a family doctor. Tonsillitis is a very contagious droplet infection that is passed from person to person via coughing, sneezing or simply through contact. Infection usually becomes apparent after two to five days. Those affected can remain contagious for up to two weeks if untreated.

How does tonsillitis develop and how is it diagnosed?

It all starts with viruses or bacteria that enter the body via the mouth and nose. Here, they break through the protective mucous barrier and infect the mucous membrane. The warm and moist environment here helps the pathogens to multiply and damage the tissue. They also pass by the tonsils, which are part of the body’s defence system, and cause inflammation and a red and sore throat. To find out whether bacteria or viruses are the trigger, your family doctor will do a throat swab, the rapid strep A test.

“With tonsillitis, I always also look at the nose and sinuses to determine where the infection is coming from,” says Dr Hans-Wolfgang Mahlo, a specialist in ear, nose and throat medicine. For example, the sinuses may be inflamed and the tonsils may become inflamed due to the discharge of nasal mucus. It may also be glandular fever, which is sometimes mistaken for tonsillitis. However, apart from swelling of the tonsils, the diseases have nothing in common. In any case, it is important to monitor the development and, especially in persistent cases, to have the progress monitored by a doctor.  

If you look in the mouth, the palatine tonsils are located on the left and right behind the uvula. They form part of Waldeyer’s tonsillar ring, which contains many leukocytes, i.e. white blood cells. Its job is to fend off germs that penetrate the throat. Two lesser-known siblings of the palatine tonsils are the pharyngeal tonsil (adenoid) and lingual tonsil. So we actually have four tonsils, not just two.

What are the symptoms of tonsillitis?

The classic symptoms of tonsillitis are:

• Difficulty swallowing
• Stinging sore throat
• Feeling of a dry throat
• Lump in the throat
• Swollen lymph nodes (can be seen from outside the throat)
• Fever

How is tonsillitis treated?

If it is caused by a virus, you have to let the body do its work and can only ease the symptoms, because antibiotics don’t work against viruses. “I usually sign patients off work for a week and tell them to rest. So, no sport, housework or gardening. They should stay in bed and give the body time to heal,” says Dr Mahlo. A sore throat usually goes away on its own within three to five days.

It is similar with a bacterial infection: the body needs rest. With a minor infection, the immune system can fight the pathogens itself. Pain-relieving, anti-inflammatory or decongestant preparations such as mouthwash, throat sprays or lozenges can help. Unlike in the past, antibiotics are used as little as possible today. This more cautious approach is intended to prevent the development of unnecessary resistance and possibly even the promotion of multi-resistant germs. However, bacterial tonsillitis is usually treated with antibiotics to prevent possible secondary diseases. The body often needs time to heal afterwards.

Can you prevent tonsillitis?

It isn’t easy to prevent tonsillitis, but a healthy immune system is a good start. It is important to eat a balanced diet rich in vitamins and few sweet treats, get enough sleep, exercise outdoors, dress appropriately for the weather, reduce stress, don’t smoke and drink plenty of water. Making sure the air inside your home isn’t too dry also helps the airways.

A stable body temperature also helps both when you’re healthy and during the recovery process. “Upper respiratory tract infections often occur when the body’s core temperature drops,” explains Dr Mahlo. For example, a 16-year-old leaves the house in light clothing in the early afternoon in spring when the weather is changeable. She returns home late in the evening. When it gets cool towards evening, her free arms, legs and neck cool down and her core temperature drops. When she wakes the next morning she has a sore throat.

Home remedies for tonsillitis

Six home remedies and tips to ease the symptoms of tonsillitis:

What is pharyngitis?

Pharyngitis is defined as an infection or irritation of the pharynx. It is more common in people who have had their tonsils removed. Symptoms are similar to those of classic angina: fever, a sore throat that can spread to the ear, pain when swallowing and a feeling of a lump in the throat. Pharyngitis usually clears up on its own, but antibiotics are needed in some cases.