Tonsillitis - tonsillitis

Tonsillitis - tonsillitis

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We speak of tonsillitis (medical: tonsillitis, angina tonsillaris) when the tonsils become inflamed. This hurts especially when swallowing, is very contagious and mostly bacteria or viruses are responsible.

Tonsillitis - the most important facts

  • Occurrence: According to the Federal Statistical Office, chronic diseases of the tonsils and throat tonsils (with almost 55,000 cases in 2013) were the second most common cause of inpatient treatment in children between 0 and 15 years of age.
  • Background: The frequent occurrence of tonsillitis is no accident, because the tonsils and the entire pharynx ring act as a filter to stop germs before they reach vital organs inside the body.
  • Causes: Triggers are mostly viruses and bacteria, whereby a virus infection often precedes a bacterial attack.
  • Tonsillitis symptoms: Typical symptoms are swollen tonsils and swollen lymph nodes on the corner of the jaw, the swollen tonsils are red and, in the case of bacteria, covered with pus. Other symptoms include high fever and sore throat when swallowing.
  • What to do if you have tonsillitis? If you have tonsillitis, you should always see a doctor, especially to check whether it is a serious illness.
  • Treatment: Antibiotics help fight bacteria as the cause, for viruses only remedies that relieve symptoms.
  • Chronic course: We speak of a chronic tonsillitis if the tonsils ignite again and again. Here you have lost your protective function and should be removed surgically.

Palatine tonsils - structure and function

The tonsils are on both sides of the throat and, together with the other tonsils, form the pharynx ring. This pharynx ring is a kind of filter that stops pathogens from attacking the vital organs inside the body. That is why it consists of lymphoid tissue with a lot of white blood cells. The tonsils are biologically sensible because germs enter the body through the mouth and nose.

Acute inflammation of the tonsils

The tonsils become acute through droplet infection - i.e. through coughing, sneezing, kissing or speaking. Viruses and bacteria often take turns. In the beginning there is a viral infection and subsequently bacteria attack the tonsils weakened by viruses. Acute tonsillitis is widespread and is one of the 20 most common reasons to see a doctor.

Tonsillitis - symptoms

A sore throat is typical of tonsillitis, especially when swallowing. At the same time, swallowing is difficult - those affected can only eat solid food with difficulty. There is also a high fever and fatigue. The almonds turn red and swell. If there is an infection with bacteria, specks appear, i.e. pus, which consists of the whitish-yellow secretions of the bacteria.

With tonsillitis, lymph node swelling often occurs in the angle of the jaw, which can be felt from the outside. Another symptom is difficulty breathing, as the swollen tonsils press on the airways. In the case of a bacterial infection, sufferers often have a foul breath.

Similar symptoms - other diseases

The typical symptoms of acute tonsillitis occur similarly with scarlet fever, diphtheria and with Pfeiffer's glandular fever. All of these are far more serious diseases than “ordinary” tonsillitis. The differences are barely discernible to laypeople, so you should consult a doctor with inflamed tonsils to make such differential diagnoses.

Is tonsillitis contagious?

Acute inflammation of the tonsils is easily transmitted from person to person. For this reason alone, sick people are not allowed to go to school, go to kindergarten or work where they come into contact with people. Most of the time, those affected become infected by droplets. Germ reservoirs are also domestic and farm animals or objects of everyday use (especially toothbrushes).

Tonsillitis - duration

Acute tonsillitis is usually not a long-term illness. With bed rest and the right medication, she usually heals within two weeks. Without treatment, tonsillitis can lead to serious problems such as subsequent infections in other organs or chronic inflammation, in which the tonsils remain permanently at least latently inflamed. In the long run, this only helps to remove the tonsils by surgery.

Causes of tonsillitis

If the tonsils do not manage to fight invading germs, then corona, adeno, rhino or flu viruses attack, but also the Epstein-Barr virus and enteroviruses. The first triggers are viruses in 70 to 95 percent of cases, and up to 50 percent rhino or corona viruses in adults.

The bacteria that subsequently affect the tonsils include streptococci in particular, but also pneumococci. These now multiply in the lymphatic tissue of the pharynx ring. In Germany, the main causative agent of acute bacterial tonsillitis is the bacterium Streptococcus pyogenes. These creatures are responsible for approximately 15 to 50 percent of tonsillitis cases in children (estimates vary), and at least five to ten percent in adults. Other bacteria that cause acute tonsillitis are streptococci B and C, Haemophilus influenzae, nocardia, corynebacteria and Neisseria gonorrhoeae.

Putrid symbiosis

A symbiosis of Fusobacterium nucleatum and Borrelia vincentii occurs very rarely. The resulting disease is usually a one-sided tonsillitis with a typical foul smell and a gray-greenish coating. This inflammation causes little pain.

Determination of the pathogen

It is not always easy to determine the exact pathogen, because hundreds of viruses and bacteria are constantly present in the microflora of the throat and it is often difficult to tell which of them are part of the healthy body flora - and which are not. Greening streptococci and coagulase-negative as well as positive staphylococci are commensals, so like Moraxella and Neisseria they belong to the normal pharynx flora. This is why the special pathogen can only be detected in 50 to 75 percent of all people suffering from tonsillitis.

Immune suppression as a gateway

Affected people who take drugs that suppress the immune system can also be attacked by "opportunistic" pathogens, for example pseudomonas or candida fungi, which could ward off a stable immune system.

Caution diphtheria

Extremely rare in Germany today, but very dangerous if it occurs, is tonsillitis with the cause Corynebacterium diphtheriae - a diphtheria. Typical symptoms here are gray-white pseudomembranes, which form on the tonsils, suppositories and in the throat and bleed when they detach. This topping smells sweetly of acetone.

Very rare pathogens

The following pathogens very rarely ignite the tonsils:

  • Yersinia pestis (pest),
  • Corynebacterium ulcerans,
  • Francisella tularensis,
  • Arcanobacterium haemolyticum,
  • Treponema pallidum,
  • Mycoplasma pneumoniae,
  • Chlamydia pneumoniae
  • and Chlamydia psittaci.

Tonsillitis caused by herpes viruses are characterized by a burning pain.

Tonsillitis - diagnosis

It is easy to determine that the tonsils are inflamed - not only by the doctor, but also by those affected themselves. The region of the neck and the lymph nodes are enlarged, which can be seen and felt. A look with the lamp in the throat shows the tonsils red and / or suppurated. During the patient consultation, the doctor will find out typical symptoms such as severe sore throat, difficulty swallowing, fever and general feeling of illness. Then the mouth, throat, nose and ears are examined using optical tools.

If patients show these symptoms, a rapid test is required to find out bacteria as potential pathogens. From a medical point of view, without such a rapid test, clinical suspicions remain. The doctor makes a swab in the throat and can thus determine the bacteria present after a few minutes - streptococci, however, must prove a laboratory, which takes several days. Statutory health insurance companies only pay a quick test up to the age of 16.

Bacteria detection alone is not enough for people without a weakened immune system to identify them as pathogens, since bacteria are also part of the normal pharynx flora. Certainty first creates the intersection between patient discussion, clinical symptoms,
microbiological findings and existing antibodies. A blood test is only carried out by a doctor if there is a special suspicion, especially that of glandular fever.

Differential diagnosis scarlet fever

Symptoms of scarlet fever also include inflammation in the back of the throat. Scarlet fever is a general streptococcal infection, not just tonsillitis, and scarlet fever also breaks out without infecting the tonsils.

How can you distinguish tonsillitis from scarlet fever? Fever and inflamed tonsils also occur in scarlet fever, and swollen lymph nodes, swallowing problems and sore throats have inflammation of the tonsils and scarlet fever in common.

Typical for scarlet fever is the sudden onset, combined with chills and vomiting, all three signs are not common for other tonsillitis. A key symptom is scarlet red: Often, not always, the face turns intensely red, which is not the case with other tonsillitis. The scarlet enanthem (rash) is clearly visible on the palate, first light, then dark red. The tongue is white, then the raspberry-colored papillae emerge.

These differences from other tonsillitis occur in the early phase of scarlet fever. If the scarlet enanthem spreads later on the body and the skin flakes, there is no longer any risk of confusion.

Treatment for tonsillitis

If there is a viral infection, it cannot (!) Be combated with antibiotics. Therapy alleviates the symptoms here. A cold (flu infection) is, for example, such a viral disease. If this infection now spreads to the tonsils and causes inflammation, the doctor will administer pain-relieving medication, prescribe bed rest and advise you to keep the skin warm around the inflamed area.

Tonsillitis - antibiotics

If, on the other hand, there is a bacterial infection, antibiotics are the first choice to kill the bacteria.

Those affected should definitely take the antibiotics for the recommended length of therapy and in the correct dosage - even if the symptoms subside earlier. If the antibiotic is not taken long enough in the case of bacterial tonsillitis, there is a risk that the inflammation will flare up again and resistance will develop.

It is also important in this context that you keep the time intervals or take the medicine at about the same time. This is the only way to keep the concentration of the active ingredient in the blood sufficiently high and even. If your doctor's recommendation here is “once a day”, this means that the medication should be taken every 24 hours. Accordingly, “twice a day” or “three times a day” means taking about every twelve or eight hours.

Caution: Always read the leaflet carefully to find out about interactions with other medicines or the right way to take them (for example, only with water, etc.). If you have any further questions or anything is unclear, please ask your doctor or pharmacist.


A tonsillitis caused by bacteria that remains untreated can develop into an otitis media or an abscess on the tonsils. A rheumatic fever, i.e. inflammation of the heart and joints, is also possible. Almond abscesses are increasingly treated with antibiotics and often even have to be removed surgically.

Chronic tonsillitis

Some people keep getting tonsillitis, and these repeated illnesses increase from year to year. If the infection persists for more than three months, it is a chronic tonsillitis. The same applies if the tonsils ignite more than three times a year. One cause can be repeated acute inflammation that has "eaten" the tonsils.

Food leftovers and germs now get stuck in the furrowed almonds, and the filters, whose purpose is to prevent diseases, subsequently become their breeding ground. Instead of fighting invading germs at the gate entrance, so to speak, the unwanted guests nest in the "caves" of the scarred tonsils. As a result, they repeatedly trigger inflammation. Even more: the intruders can now infect other organs. The tonsils, as part of the immune system, now put a strain on the immune system itself.

Surgical removal of the tonsils

With scarred almonds, which become a gathering place for pathogens and force those affected to bed every three months, only surgical removal helps in the long run. Those affected should not delay this step, such tonsils are as superfluous as a goiter and as healthy as a perforated gallbladder full of gallstones.

Such tonsil removal is the most common surgical procedure under general anesthesia in children and adolescents. It is a routine operation in which complications rarely occur. Nevertheless, it should only be an option if the tonsils are permanently damaged and conservative therapies are unsuccessful.

If you have fewer than three tonsillitis per year, you should not have the tonsils removed. If you have three to five purulent inflammations of the tonsils per year with an increasing tendency, you should think about it. If you have six (or more) purulent tonsillitis a year, surgery is a clear option.

It also depends on the overall risk for those affected. If people suffer from heart disease, the tonsils should be removed in the event of repeated infections as there is a risk of the heart becoming infected.

The procedure takes place under general anesthesia and lasts up to half an hour. Every tenth patient has rebleeding. These must be recorded precisely, since they can cause death in extremely rare cases. Most of the time, the operated people stay in the hospital for three to four days because of such possible after effects.

It takes two to three weeks for the surgical wounds to heal. For those affected, the pain of wound healing feels like severe tonsillitis. But they will never get them for life.

Naturopathy and holistic medicine

In addition to the treatment methods mentioned so far, naturopathy and holistic medicine offer various other therapeutic options, which up to now have often lacked scientific proof of their effectiveness, but which should not go unmentioned.

Naturopathy works with natural means that are not synthetically produced. This includes herbal medicine / medicinal plants (phytotherapy), heat, cold, earth and minerals, as well as water, fire and air. This also includes forest and body therapy, which activates their self-healing powers - for example, hiking in the forest, moderate exercise and various movement therapies.

Holistic medicine / holistic health means including the various factors that affect health, the development of diseases and their cures: the body / person, the social environment (friends, acquaintances, community, society), the technical environment ( Science, technology) and the natural environment (climate, weather, humidity, heat, cold etc.).

In the case of tonsillitis, the first means of naturopathy is to keep the neck warm with a scarf, warm blankets, a turtleneck sweater or the like. A cherry stone pillow or heat pillow is also a good source of heat.

In the spirit of naturopathy, you can also gargle with salt water to fight the pathogens. By inhaling the vapors of hot water, you moisten and relieve the airways. You can also place vessels with water on the heater.

Drink a lot to wash away the germs. The ideal combination is with phytotherapy, i.e. drinking tea with sage, chamomile, ribwort and linden flowers. For the pain you can drink tea with meadowsweet.

In everyday parlance, treatments with Schüßler salts and homeopathy are often referred to as naturopathy; however, the mechanism of action imagined differs considerably from the effect of the active ingredients of medicinal plants and the scientific explanation of diseases.

Therapy with Schüßler salts assumes that functional disorders of organs are based on a deficiency of minerals and are treated by supplying these minerals to the affected person in dilutions in which they are not biochemically detectable. So they should stimulate the body as a stimulus to promote the absorption and utilization of the respective "salt".

Schuessler salts, which should help in this idea against tonsillitis, are initially Ferrum phosphoricum (salt No. 3) and potassium chloratum (No. 4), with pus formation Kalium sulfuricum (No. 6), with chronically recurring tonsillitis Silicea (No. 11 ) and in children who are susceptible to such inflammation, calcium phosphoricum (No. 2).

In homeopathy, from which the Schüßler salts are derived, the basic substances are also extremely diluted, so that the biochemical active ingredients are hardly available in low dilutions (low potencies) and are no longer present in strong dilutions (high potencies). According to the founder of homeopathy, Samuel Hahnemann, dilution (potentiation) is intended to carry on an energetic-spiritual essence of the basic substance, which is then to be found in the individual homeopathic remedies.

Homeopathic single remedies for tonsillitis are aconite, storm hat or Apis mellifica (honey bee). In the tradition of premodern analogy medicine / association formation, honeybee as an “energetic means” is considered to be effective, since the burning and stinging pain of tonsillitis is reminiscent of the stings of the honeybee and the like is treated with the like.

Other homeopathic remedies for tonsillitis include belladonna (dilutions of the deadly deadly poisonous deadly cherry), black mercury oxide, lime-like sulfur liver (a recipe from Hahnemann himself), lachesis (poison from the South American snake snake Lachesis muta) and pokeweed.

Tonsillitis - home remedies

With tonsillitis, you should always see a doctor, mainly because it could be dangerous diseases.

In addition, there are proven home remedies for tonsillitis to effectively fight the pathogen and relieve the pain. We have summarized these for you again below:

  • Tie a scarf around your neck to warm the infected area.
  • Gargle with a solution of salt and water to fight the pathogens.
  • Moisten the air in the room, for example by placing vessels with water on the heater. This will relieve the stressed airways.
  • Drink a lot, as this will flush away the pathogens. Teas with sage, chamomile, plantain or linden flowers have an antibacterial or antiseptic effect. Tea with meadowsweet helps against pain.
  • Avoid hot spices - no chili, no black, green or pink pepper, no garlic.
  • Only eat dishes that do not burden the almonds, i.e. soft dishes and soups: mashed potatoes, pudding, yoghurt, semolina porridge, rice pudding, asparagus soup, vegetable stew etc.
  • Hot vegetable broth is ideal for getting nutrients without processing hard foods. Avoid hard bread, firm meat, raw vegetables like carrots and hard fruits like apples.
  • Remedies such as ibuprofen or acetaminophen help against the sore throat.

(Dr. Utz Anhalt)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.


  • Arnold, Wolfgang; Ganzer, Uwe: Checklist Otorhinolaryngology, Thieme, 2011
  • Boenninghaus, Hans-Georg; Lenarz, Thomas: Otorhinolaryngology, Springer, 2012
  • German Society for Otorhinolaryngology, Head and Neck Surgery eV, German Professional Association of Otorhinolaryngologists, German Society for Pediatric and Adolescent Medicine and German Society for Pediatric Infectiology: Therapy of Inflammatory Diseases of the Palatine tonsils - tonsillitis, S2k guideline 017/024, 2015 (accessed: November 18, 2019), AWMF
  • Otolaryngologists on the Internet: tonsillitis (retrieval: November 18, 2019), Otolaryngologists online
  • Robert Koch Institute: Streptococcus pyogenes infections, RKI guide (accessed: November 18, 2019), RKI
  • Bakar, Muhamad Abu; McKimm, Judy et al .: Chronic tonsillitis and biofilms: a brief overview of treatment modalities, in: Journal of Inflammation Research, 11: 329-337, 2018., PMC

ICD codes for this disease: J03, J35ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.

Video: Tonsilitis (December 2022).