Tonsillitis is a common yet potentially serious condition involving inflammation of the tonsils — the soft tissue masses located at the back of the throat. In severe cases, an infection can progress to form a peritonsillar abscess, which may cause life-threatening airway obstruction if not treated promptly.
This guide covers pathophysiology, symptoms, complications, surgical treatment, and post-operative care for tonsillitis and related abscesses.
Pathophysiology
The tonsils are part of the immune system, acting as a first line of defense against inhaled or ingested pathogens. When bacteria or viruses infect the tonsils, they become swollen, red, and painful — a condition called tonsillitis.
If the infection spreads beyond the tonsil into the surrounding tissues, a peritonsillar abscess may form. This pus-filled pocket can push the tonsil toward the midline, narrowing the airway and making swallowing and breathing difficult.
Causes
- Bacterial infections – Streptococcus pyogenes (most common)
- Viral infections – Adenovirus, Epstein-Barr virus, influenza virus
- Poor oral hygiene
- Repeated throat infections
Key Signs & Symptoms
Tonsillitis
- Sore throat – especially when swallowing
- Red, swollen tonsils ± white patches or pus
- Fever
- Swollen lymph nodes in the neck
- Bad breath
Peritonsillar Abscess
- Severe sore throat (often one-sided)
- Difficulty opening the mouth (trismus)
- Muffled “hot potato” voice
- Painful swallowing (odynophagia)
- Swelling of the face or neck
Complications
If untreated, severe tonsillitis or abscess can cause:
- Airway obstruction
- Spread of infection to deep neck spaces
- Sepsis
- Rheumatic fever or post-streptococcal glomerulonephritis (if strep infection is untreated)
Treatment Options
Medical Management
- Antibiotics for bacterial tonsillitis (penicillin or amoxicillin as first choice)
- Antipyretics/analgesics – acetaminophen, ibuprofen
- Hydration and rest
- Abscess drainage – incision and drainage if peritonsillar abscess is present
Surgical Management – Tonsillectomy
Tonsillectomy is surgical removal of the tonsils and may be recommended for:
- Recurrent tonsillitis (≥7 episodes/year)
- Peritonsillar abscess not responding to drainage
- Obstructive sleep apnea caused by enlarged tonsils
Post-tonsillectomy bleeding is a major risk — careful post-op care is essential.
Patient Teaching After Tonsillectomy
Avoid:
- Coughing or blowing the nose
- Sharp foods (chips, nuts)
- Milk products (can thicken mucus)
- Hard brushing or gargling
Priority signs to report to healthcare provider (may indicate bleeding):
- Frequent swallowing
- Restlessness
- Persistent coughing
Quick Reference Table: Tonsillitis & Abscess
| Feature | Tonsillitis | Peritonsillar Abscess |
|---|---|---|
| Cause | Viral or bacterial infection | Spread of tonsillitis infection |
| Key Symptom | Sore throat, fever, swollen tonsils | Severe sore throat, trismus, muffled voice |
| Treatment | Antibiotics, analgesics | Drainage + antibiotics |
| Surgery | Tonsillectomy in recurrent cases | Tonsillectomy if recurrent |
| Major Risk Post-Surgery | Bleeding | Bleeding |
Frequently Asked Questions (FAQs)
1. Is tonsillitis contagious?
Yes — it can spread via respiratory droplets, especially if caused by bacteria or viruses.
2. How long is recovery after tonsillectomy?
Most people recover in 10–14 days, but throat discomfort may last longer.
3. Can adults get tonsillitis?
Yes — although more common in children, adults can also be affected.
4. What is the biggest danger after tonsillectomy?
Post-operative bleeding, especially within the first 24 hours or 5–10 days after surgery when scabs fall off.
5. When should I seek urgent care for tonsillitis?
If you have difficulty breathing, swallowing, or opening your mouth, or notice swelling in the neck/face.
