Tonsils are the two soft tissue masses in the back of your throat. (1) They’re part of your lymphatic system, and they’re the body’s first line of defense in fighting off infection because they’re designed to protect you from germs that try to enter your system. Tonsillitis is when there is either inflammation or an infection of the tonsils, and it’s usually (but not always) caused by a virus.

RELATED: What Causes Tonsillitis

Most of the time tonsillitis will go away on its own in about five to seven days, explains James Clark, MBBCh, an assistant professor of otolaryngology at Johns Hopkins Medicine in Baltimore. Home remedies for managing tonsillitis symptoms include getting rest, staying hydrated, gargling with salt water, using a humidifier to eliminate dry air (which can further irritate a sore throat), and treating pain and fever with ibuprofen (Advil) or acetaminophen (Tylenol). (2)

If your sore throat seems to keep getting worse (or has not improved after about three days), you’re in a lot of pain when you eat or drink, or you have a fever of at least 101 degrees F, you’ll want to see your doctor to get it checked out, Dr. Clark says. Here’s what to expect.

Common Questions & Answers

What are tonsils and what is their purpose in the body?

Tonsils are soft tissue masses in the back of the throat that are part of the lymphatic system. They serve as the body's first line of defense against infection.

How long does tonsillitis typically last?

Tonsillitis usually goes away on its own within five to seven days.

When should someone see a doctor for tonsillitis?

It is recommended to see a doctor if the sore throat worsens after three days, if there is severe pain while eating or drinking, or if there is a fever of at least 101 degrees F.

How is tonsillitis diagnosed?

Tonsillitis is usually diagnosed based on signs and symptoms, along with a physical exam. A throat swab may also be done to test for strep throat.

How is tonsillitis treated?

Treatment depends on whether the tonsillitis is viral or bacterial. Viral tonsillitis usually resolves on its own without treatment. Antibiotics are usually prescribed for bacterial tonsillitis to reduce symptoms and prevent complications.

Doctors Diagnose Tonsillitis by Physical Exam and Usually Perform a Throat Swab, Too

Tonsillitis is most often a clinical diagnosis, which means it is usually diagnosed based on signs and symptoms of tonsillitis, so your doctor will start by asking you about your symptoms and giving you a physical exam, says Nicholas Rowan, MD, an associate professor of otolaryngology at John Hopkins Medicine in Baltimore.

“I make sure to look in the back of their throat to see if the tonsils are red or inflamed, and have white patches or some [pus],” Dr. Rowan says. “I look to see if one side is more swollen than the other and feel their neck to check for swollen lymph nodes.”

Your doctor will also likely do a throat swab, which, like it sounds, is when the doctor uses a cotton swab to collect a sample of fluids from the back of the throat. (3) The doctor can perform a rapid strep test on the sample in the office — looking for strep throat — and report the results to you within minutes. Your doctor may also send the sample to a lab for a more reliable and comprehensive throat culture (which can take one or two days, and can confirm or rule out strep and other infections).

Doctors want to rule out strep throat as an underlying cause when tonsillitis is suspected because strep throat does require treatment with antibiotics, since it is a bacterial infection. It’s important to make sure there aren’t any other underlying causes for throat pain that require other treatment, Clark says.

Diagnosing tonsillitis might also include these actions: (2)

Using a lighted instrument to look in the ears and nose for other signs of infection.
In children, checking for a rash known as scarlatina, which can be a symptom associated with strep throat.
Listening to breathing with a stethoscope.
Ordering a complete blood cell count, a blood test that can reveal whether the different types of blood cells are at normal levels (as abnormal blood cell levels can indicate infection).

Viral Tonsillitis and Bacterial Tonsillitis Can Cause Different Symptoms

Why does your doctor care so much about determining whether tonsillitis is viral or caused by a bacterial infection like strep throat? “These two types of infection can present a little differently, but there can also be a lot of overlap,” Clark explains. Importantly, strep requires treatment with an antibiotic, while such medication is futile if the infection is viral.

And it’s worth noting that if tonsillitis is caused by a bacterial infection, that infection is most often strep throat. (4) There are general guidelines that doctors use to distinguish between the two types of infections.

Viral tonsillitis features can include the following, Clark says:

Cough (often with fever and malaise)
Nasal congestion
Conjunctivitis (pink eye)
Coryza (inflammation of the nose that is not caused by allergies)
Oral ulcer
Viral exanthem (widespread rash)

Bacterial tonsillitis (which is caused by strep throat most of the time) can also bring on the following features, Clark adds:

Sudden-onset sore throat
Fever
Tonsillopharyngeal or uvular edema (swelling of the tonsils or uvula due to accumulation of fluid)
Patchy tonsillar exudates (pus in the tonsils)
Cervical lymphadenitis (swollen lymph nodes in the neck that are often tender and anterior)
Scarlatiniform skin rash or strawberry tongue (scarlet fever)

Treatment for Tonsillitis Depends on Whether a Virus or Bacterial Infection Is to Blame

The majority of patients who have viral tonsillitis or who test negative for strep can expect a full recovery within five to seven days without specific treatment, Clark says, adding that there is no indication for taking antibiotics in this situation. “If the person fails to recover during this period, then they should follow up with a healthcare provider for repeat evaluation,” he says.

If the tonsillitis tests positive for strep throat (a bacterial infection), then antibiotic treatment is usually recommended to reduce symptom severity and speed recovery, Clark explains. Without antibiotic therapy, strep throat symptoms will typically resolve on their own eventually, but the medication will help you feel better sooner and significantly reduces the risk of complications from the infection.

Once a person starts antibiotics for strep throat, they usually begin to feel better, often within 24 to 72 hours of starting the medicine, according to Clark. “Failure to improve within these time periods should raise suspicion for alternative diagnoses or complications,” he says, and the person should return to their healthcare provider.

Taking steroids to relieve the pain associated with an acute sore throat should be avoided, says Clark. “The use of glucocorticoids depends on the severity of the illness,” he says, adding that such treatment is usually restricted to an exceptional case in which the person has severe throat pain and can’t swallow.

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