Prevention/illnesses | 2.7.2026

Tonsillitis – An ENT specialist explains the causes, symptoms and treatment

Tonsillitis, an inflammation of the tonsils at the back of the throat, is a common condition, particularly during the colder months. Usually caused by a viral or bacterial infection, it is highly contagious. Typical symptoms include a severe sore throat, difficulty swallowing and a high temperature. To help manage the condition, ENT specialist Dr Grégory Schürmann explains how to recognise, treat and prevent tonsillitis early on.

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Tonsillitis (swollen tonsils): symptoms and treatment

Dr. med. Grégory SchürmannSpecialist in ear, nose and throat (ENT) medicine and cervicofacial surgery

What is tonsillitis?

Tonsillitis (sometimes called tonsillopharyngitis) is an acute inflammation of the palatine tonsils. It is one of the most common reasons for a medical consultation, accounting for around 2% of all outpatient visits, according to Dr Schürmann. In most cases, it is a viral infection that clears up within 5 to 7 days without specific treatment.

Is it viral or bacterial tonsillitis?

Viral tonsillitis is caused by common cold viruses such as rhinoviruses, adenoviruses or the Epstein-Barr virus (EBV). It usually clears up on its own within a few days and does not require antibiotics.

Bacterial tonsillitis is often caused by streptococcal bacteria. Antibiotic treatment (using penicillin for example) may be considered for treatment in this case, to prevent complications such as a throat abscess.

A note of caution, however: “Doctors are much less likely to prescribe antibiotics today than in the past,” advises Dr Schürmann. “As most cases of tonsillitis are straightforward and improve perfectly well without them.”

Which is more common, viral or bacterial tonsillitis?

Viral tonsillitis is much more common. It is usually milder and clears up faster. Bacterial tonsillitis carries a slightly higher risk of complications and should therefore be assessed by a doctor.

How is tonsillitis transmitted?

Tonsillitis is primarily spread through droplet infection from coughing, sneezing or talking, for example. Contact with contaminated surfaces can also lead to infection. Children are particularly susceptible because their immune systems are not yet fully developed.

In rare cases, tonsillitis can be caused by sexually transmitted infections (STIs) such as HIV, syphilis or gonorrhoea. In these instances, the infection usually spreads to the entire throat and may be accompanied by other symptoms, depending on the pathogen. A medical consultation is essential in this case.

Symptoms of tonsillitis

While swollen tonsils and a painful throat are the classic signs, symptoms can vary slightly by age.

Symptoms of tonsillitis in adults

In adults, the typical symptoms of tonsillitis include:

Severe sore throat
Difficulty swallowing
High temperature
General fatigue and malaise

Symptoms of tonsillitis in children

Children may additionally present with:

Abdominal pain
Nausea and vomiting
Irritability or uncharacteristic crying
Loss of appetite

When should you see a doctor?

“In most cases, tonsillitis can be treated with home remedies and over-the-counter pain relief, such as paracetamol or anti-inflammatory medications like ibuprofen,” says Dr Schürmann. “You don’t always need to see a doctor straight away. However, if symptoms do not improve or actively worsen during the following 48 to 72 hours, urgent medical attention should be sought.”

Warning signs: complications of tonsillitis

While a straightforward disease progression is the norm, the following symptoms can indicate complications:

Severe sore throat localised to just one side
Visible swelling of the neck
Trismus (painful or limited jaw movement)
Torticollis (a twisted neck in which the head is tipped to one side)
Changes in the voice
Shortness of breath or wheezing when breathing in
Excessive drooling
A high temperature above 39 °C lasting for over 48 hours
Signs of dehydration, especially in young children

Dr Schürmann warns: “Symptoms such as torticollis or trismus can indicate a peritonsillar abscess. This is a medical emergency that requires immediate evaluation, ideally at a hospital with an ENT specialist.”

Who should you contact if you suspect tonsillitis?

As a rule, your general practitioner (GP) is your first point of contact. They can assess your symptoms and whether a referral to an ENT specialist is necessary. In an emergency (such as severe difficulty breathing or swallowing), you should go to the nearest hospital emergency department (A&E).

How long does tonsillitis last?

The duration depends primarily on whether it is viral or bacterial.
Viral tonsillitis typically clears up on its own within 5 to 7 days. Bacterial tonsillitis, caused by streptococcal bacteria for instance, can last slightly longer (7 to 10 days). However, with antibiotic treatment, symptoms should start to improve within 48 hours.

“A typical illness involves a rapid spike in fever at the start, with the sore throat peaking on the second or third day. After that, symptoms begin to subside, provided there are no complications,” says the ENT specialist. “If you don’t feel better after a week, it is important to have a doctor check whether it is a straightforward case of tonsillitis or if there is another underlying cause.”

How is tonsillitis diagnosed?

A diagnosis is usually made by looking for classic symptoms: a red throat, swollen tonsils and sometimes white, pus-filled spots. However, these symptoms alone are often not enough to reliably distinguish between viral and bacterial infections.

In view of this, doctors frequently use the Centor Score: a simple point system that estimates the likelihood of a bacterial infection.

Throat swabs for lab cultures tend to be used only in exceptional cases because the results take 1 to 2 days. “In most straightforward cases, a clinical assessment and treatment of the symptoms are entirely sufficient,” says Dr Schürmann.

Note: tonsillitis is distinct from pharyngitis, which is a broader inflammation of the throat tissue rather than just the tonsils themselves.

Treatment of tonsillitis

Treatment depends on whether the cause is viral or bacterial.

Viral tonsillitis typically clears up on its own within a few days. In this case, treatment focuses purely on symptom relief.

Bacterial tonsillitis, usually caused by streptococcus, may require antibiotic treatment, especially if the case is severe or there is a high risk of complications.

“In most cases, symptom relief is all that is required. Antibiotics are only useful for specific bacterial infections that carry an increased risk of complications.”

Medications and home remedies

For tonsillitis, pain relief and fever-reducing medications such as paracetamol or ibuprofen help ease a sore throat, bring down a fever and reduce inflammation. Lozenges or throat sprays with analgesic (pain-relieving) or antiseptic properties can also provide relief. Note: corticosteroids (cortisone preparations) are not recommended for treating a sore throat.

Dr Schürmann recommends these proven home remedies to support recovery:

Gargling with salt water or chamomile tea.
Neck compresses: cold compresses (to reduce swelling and inflammation) or, as symptoms subside, warm compresses (to relax muscles and promote circulation).
Soft, cool foods, such as yoghurt, ice cream or lukewarm soup.
Staying hydrated by drinking plenty of water or herbal tea.
Not smoking or breathing in second-hand smoke.

Can you prevent tonsillitis?

There is no specific vaccine or preventive treatment for tonsillitis. However, you can significantly reduce your risk by following a healthy lifestyle and good hygiene practices. According to Dr Schürmann:

“A strong immune system is your best defence. This includes getting enough sleep, regular exercise and a balanced diet.”

What else helps prevent infection?

Hygiene: frequent hand washing and regularly airing out rooms
Avoiding contact: keeping your distance from people who have colds or are unwell.
Not smoking: avoiding smoking and second-hand tobacco smoke.
Oral health: practising good dental care and preventing periodontal disease.

According to Dr Schürmann, there is currently no evidence that antiseptic lozenges or throat sprays offer protection against catching an infection.

Dr. med. Grégory SchürmannSpecialist in ear, nose and throat (ENT) medicine and cervicofacial surgery

Dr Grégory Schürmann is a specialist in ear, nose and throat (ENT) medicine and cervicofacial surgery.

Tonsillitis – An ENT specialist explains the causes, symptoms and treatment

Tonsillitis – An ENT specialist explains the causes, symptoms and treatment