Tonsillitis | Pokenga repe korokoro

Tonsillitis (pokenga repe korokoro) is when the tonsils at the back of your throat become red and swollen (inflamed).

On this page, you can find the following information:

Key points

  1. Tonsillitis is common in children over 2 years of age but teenagers and adults can get it too.
  2. Treatment for tonsillitis is usually rest and pain relief.
  3. Surgical removal of your tonsils (tonsillectomy) may be considered if you get tonsillitis often.
  4. Tonsilitis might actually be rheumatic fever which is a serious condition, so know when to seek urgent care.

What are tonsils and what do they do?

Tonsils are two small, rounded masses of tissue that can be seen in the back of the throat. They are made of tissue similar to the lymph glands and are part of the immune system. The tonsils are thought to help protect the body from infection during the first year of life but are not essential for immune function in later life.

Tonsillitis is the medical name for when your tonsils become red and swollen (inflamed). Tonsillitis can happen more than once.

What causes tonsillitis?

Viruses

Tonsillitis is usually caused by viruses, such as those related to colds. You can inhale the viruses through droplets in the air from people sneezing and coughing, or by contact with secretions from the nose or throat of people with the infection. Tonsillitis may be a symptom of the Epstein-Barr virus which causes glandular fever; this is more common in teenagers.

Bacteria

The main type of bacteria causing tonsillitis is Streptococcus, which causes a strep throat infection. If you have strep throat you need to take antibiotics. Untreated strep throat can lead to serious complications, such as rheumatic fever (which can cause permanent damage to your heart) or inflammation of your kidneys. Read more about rheumatic fever. 

What are the symptoms of tonsillitis?

Symptoms of tonsillitis
  • sore throat (often severe)
  • red and swollen tonsils
  • hoarse or no voice
  • a high temperature (fever) of 38°C or above
  • difficulty swallowing
  • headache
  • runny nose
  • congestion
  • swollen lymph nodes (glands) on either side of your neck
  • possibly pus on tonsils
  • possibly muscle aches and a feeling of being unwell
  • young children may say they have a tummy ache.

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When should I visit my doctor?

You should see your doctor urgently if you are in any of the groups below.

Risk of rheumatic fever

The bacteria that causes tonsillitis can cause rheumatic fever. This is a very serious condition that can lead to damage of the heart and kidney disease. It is important that you seek urgent medical advice if you have any signs of tonsillitis and have:

  • a personal, family, or household history of rheumatic fever, or
  • two or more of the following:
    • Māori or Pacific ethnicity
    • aged 3 to 35 years
    • living in crowded accommodation or a lower socio-economic area.

If you or your child:

  • have difficulty breathing
  • can't swallow saliva, which may cause dribbling
  • can't get enough fluids
  • have severe pain
  • have ongoing high fever
  • aren't improving after two days
  • have earache or joint pain.

If you are unsure what to do, phone Healthline on freephone 0800 611 116. Calls are free and are answered by registered nurses or other health professionals who can help you.

What tests would the doctor do?

Usually your doctor will only need to hear your symptoms and look at your throat. As tonsillitis may be a symptoms of another condition, they may do more tests.

If you are at risk of rheumatic fever or if you have a job where you are at risk of spreading an infection (such as teacher or being a student), you may have a swab taken from your throat to check for strep throat.

If your doctor thinks you might have glandular fever they will take a blood test.

How is tonsillitis treated?

Mild tonsillitis often doesn't need any treatment and symptoms get better in 2 or three days.

Self-care for tonsillitis

Rest

Children and adults need rest to recover from tonsillitis.

Fluids and food

Make sure the person with tonsillitis drinks plenty of fluids, mainly water, especially if there is fever. 

  • Offer cold drinks, sips of ice to suck or ice blocks. They may like some soft foods such as jelly, ice cream or custard.
  • Don’t worry if not much is eaten for a few days, as long as fluid intake is kept up. 
  • Children and older adults should be taken to the doctor if they have not managed to drink anything for 15 hours.
Medications

Pain relief medication such as paracetamol and ibuprofen eases pain. Gargling with salt water or sucking pain relief lozenges may help to soothe a sore throat. Antibiotics are not usually needed to treat tonsillitis because tonsillitis is mostly caused by viruses and antibiotics only work against bacteria. Read more about medications for tonsillitis.

Surgery to remove the tonsils

An operation to remove the tonsils (tonsillectomy) may be considered if you have frequent bouts of tonsillitis. Read more about tonsillectomy.

Preventing tonsillitis

Other children or family members should be kept away from the person with tonsillitis if possible. To prevent the spread of infection, use good hygiene measures including:

  • regularly washing hands
  • using a tissue or inside of the elbow to cover coughs and sneezes
  • not sharing eating utensils or drinking vessels
  • frequent cleaning of surfaces, particularly in the kitchen and bathroom
  • keeping your home warm and dry. See here for support.

Learn more

The following links provide further information about tonsillitis. Be aware that websites from other countries may have information that differs from Aotearoa New Zealand recommendations.    

Tonsillitis Southern Cross, NZ
Tonsillitis HealthInfo, NZ
Tonsillitis NHS, UK
Toi Te Ora Public Health: Hei Āwhina i te Taupātia o te Rūmātiki Pakakāāori – He take o te Korokoro Mama [Māori]. Helping to Prevent Rheumatic Fever: Sore Throats Matter [English]

References

  1. Heart Foundation. group A Streptococcal sore throat management  guideline. 2019 Heart Foundation, NZ, 2019
  2. The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd edition) 
  3. Sore throat  Ministry of Health, NZ 
  4. Tonsillitis and sore throat 3D HealthPathways, NZ. Subscription only

Information for healthcare providers

Heart Foundation. group A streptococcal sore throat management – guideline. 2019 Heart Foundation, NZ, 2019
The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd edition) 
Intervention review - Chinese medicinal herbs for sore throat The Cochrane Library, 2012

Credits: Health Navigator Editorial Team.