Open your mouth and say "aaah" - when you do, the tonsils can be seen at the back of the throat and will be clearly red and inflamed.
There's a tendency for viruses and bacteria to cause different types of inflammation. The Epstein-Barr virus, for example, often causes tiny red spots on the soft palate due to miniature internal bleeds. Bacteria may leave a thin white membrane on the tonsils themselves that peels off easily.
None of these symptoms, however, are reliable enough to diagnose the cause of tonsillitis from appearance alone, so a throat swab is needed. Traditionally, such swabs are then cultured to see what bacteria are present, but there are also rapid smear tests that can give results in minutes or hours.
Finding group A streptococcus on the tonsils doesn't prove it's causing the inflammation, since so many people carry this bug with no ill effects. A person could be a healthy group A streptococcus carrier, whose tonsillitis is due to a virus.
Blood tests are usually required to diagnose infectious mononucleosis.
If you have tonsillitis, you should rest and stay well hydrated. You can take acetaminophen* or ibuprofen to ease symptoms, but acetylsalicylic acid (ASA) should be avoided by children with viral infections, as it can lead to Reye's syndrome, a very dangerous condition that affects many organs, particularly the brain and liver.
When bacteria are causing the infection, your doctor will prescribe an antibiotic. Most doctors will not prescribe antibiotics until tests confirm that bacteria are the cause. However, people with 3 out of following 4 characteristics are usually treated with antibiotics "up-front" (before culture results are known): fever, discharge from the tonsils, no cough, and tender lymph nodes.
Few children get chronic or recurring infections. When a child has recurring tonsillitis, family members may be tested to see if they're asymptomatic (without symptoms) carriers of group A streptococcus. If so, they may be given antibiotics to ensure that the whole family is streptococcus-free, and to protect the child from reinfection.
If children don't respond to antibiotics, tonsillectomy may be necessary.
Quinsy is usually treated by draining the abscess and antibiotics. Sometimes removing the tonsils is needed to treat quinsy.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.
This condition and disease information is written and reviewed by the MedBroadcast Clinical Team.