Tonsillitis - Treating tonsillitis

There's no specific treatment for tonsillitis and most cases get better without treatment within a week.

While waiting for the infection to clear up, there are a number of things you can do to help relieve your symptoms (see below).

If your child has tonsillitis, make sure they have plenty to eat and drink, even if they find it painful to swallow. Being hungry and dehydrated can make other symptoms, such as headaches and tiredness, worse.

Self-help

Over-the-counter painkillers, such as paracetamol and ibuprofen, can help relieve painful symptoms such as a sore throat.

If treating your children with painkillers, it's important that you use the correct type and dosage. Younger children only need small dosages. Your pharmacist will be able to advise you about this.

Children under 16 years of age shouldn't be given aspirin.

Over-the-counter treatments that can soothe a sore throat, such as lozenges and oral sprays, are also available. Some people find that gargling with a mild antiseptic solution can also help relieve a sore throat.

Alternatively, you could try gargling with warm, salty water. Mix half a teaspoon of salt (2.5g) with a quarter of a litre (eight ounces) of water. It's important not to swallow the water so this method may not be suitable for younger children.

Antibiotics

Antibiotics may not be prescribed even if tests confirm that your tonsillitis is caused by a bacterial infection. The two main reasons for this are:

in most cases, antibiotics won't speed up the recovery but they can cause unpleasant side effects, such as stomach pain and feeling sick
the more an antibiotic is used to treat a non-serious infection, the greater the chance it won't be effective in treating more serious infections; this is known as antibiotic resistance

However, exceptions are usually made if:

symptoms are severe
symptoms show no sign of easing
you or your child has a weakened immune system

In these circumstances, a 10-day course of penicillin is usually recommended. If you or your child is known to be allergic to penicillin, an alternative antibiotic, such as erythromycin, can be used.

Hospital treatment may be required for particularly severe or persistent cases of bacterial tonsillitis that don't respond to oral antibiotics. In these cases, intravenous antibiotics that are given directly into a vein may be needed.

Antibiotics sometimes cause mild side effects, such as an upset stomach, diarrhoea or rash.

Surgery

Surgery to remove the tonsils is known as a tonsillectomy.

For children with mild sore throats, watchful waiting is recommended rather than a tonsillectomy.

A tonsillectomy will only be considered for a recurrent sore throat in both children and adults if certain criteria are met. You must have:

a sore throat caused by tonsillitis
episodes of sore throat that are disabling and stop you functioning normally
seven or more well documented, clinically significant, adequately treated sore throats in the preceding year or
five or more such episodes in each of the preceding two years or
three or more such episodes in each of the preceding three years

Tonsillectomies are carried out under general anaesthetic, which means you'll be asleep during the procedure. Your mouth will be held open to allow the surgeon to see your tonsils and no cuts will be made in your skin.

The operation can be carried out in a number of ways as described below.

Cold steel surgery – this is the most common method, where a surgical blade is used to cut the tonsils out. Bleeding is controlled by applying pressure or the blood vessels may be sealed using heat generated by diathermy.
Diathermy – a diathermy probe is used to destroy the tissue around the tonsils and to remove the tonsils. At the same time, the heat seals the blood vessels to stop any bleeding.
Coblation (or cold ablation) – this method works in a similar way to diathermy but uses a lower temperature (60C). It's considered less painful than diathermy.
Lasers – high energy laser beams are used to cut away the tonsils and seal the underlying blood vessels shut.
Ultrasound – high energy ultrasound waves are used in a similar way to lasers.

Each of these techniques is relatively similar in terms of safety, results and recovery so the type of surgery used will depend on the expertise and training of the surgeon.

You'll usually be able to leave hospital on the same day as you have surgery or the day after.

After surgery

After surgery it's likely you'll experience some pain at the site of the operation. This can last for up to a week. Painkillers can help relieve the pain.

Children who have had a tonsillectomy should be kept off school for two weeks. This is to reduce their risk of picking up an infection from another child that will make them feel more uncomfortable.

Swallowing will probably be difficult after having a tonsillectomy. However, it's important to eat solid foods because it will help your throat to heal more quickly. Drink plenty of fluids but avoid acidic drinks, such as orange juice, because they will sting.

Ensuring good oral hygiene by regularly brushing your teeth and using mouthwash can help prevent infection in the mouth.

The pain usually gets worse during the first week after having a tonsillectomy before gradually improving during the second week. Earache is common with tonsillectomies but isn't a cause for concern.

Post-operative bleeding

Bleeding at the site where the tonsils were removed is a fairly common complication of a tonsillectomy. This can occur during the first 24 hours following surgery or up to 10 days afterwards.

It's estimated that around one in 100 children and one in 30 adults will experience post-operative bleeding after having a tonsillectomy.

Minor bleeding isn't usually a cause for concern because in most cases it resolves by itself. Gargling with cold water can often help stem the bleeding because the cold helps to contract the blood vessels.

Occasionally, the bleeding can be more severe, causing people to cough up blood. Seek immediate medical advice if this happens. You should be given an emergency contact number before you're discharged from hospital. Alternatively, you can call NHS 111.

Extensive bleeding may need to be treated with surgery or a blood transfusion.

Anaesthetic: Anaesthetic is a drug used either to numb a part of the body (local) or to put a patient to sleep (general) during surgery.
Antibiotic: Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. Examples of antibiotics include amoxicillin, streptomycin and erythromycin.
Bacteria: Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and others are good for you.
Painkillers: Analgesics are medicines that relieve pain. Examples include paracetamol, aspirin and ibuprofen.