Tonsillitis, also known as angina tonsillaris, is an inflammation of the tonsils in the back of the throat accompanied by pain. There are both acute and chronic forms and different triggers. The most common cause of tonsillitis is a viral infection – but bacteria can also trigger tonsillitis.

Different treatments are indicated depending on the severity and cause. If you suspect tonsillitis, you should consult an experienced doctor who can identify the cause.

What tonsils are there?

There are a total of four tonsils in the throat:

  1. The two palatine tonsils, which are inflamed in classic tonsillitis
  2. The pharyngeal tonsil, which causes pharyngitis
  3. The lingual tonsil, which cases lingual tonsillitis
  4. The lateral tonsils, which show inflammation in the surrounding lymphatic tissue and are known as lateral tonsillitis.

The symptoms depend on which tonsils are inflamed. Clarification of the exact localisation of the inflammation in the throat is a prerequisite for correct treatment.

Tonsillitis symptoms and signs

The classic sign of tonsillitis is a foreign body sensation caused by swelling of the tonsils. Swollen, thick tonsils feel uncomfortable and can lead to difficulty swallowing.

Reddened tonsils with a whitish coating and pus

Reddened tonsils with a whitish or yellowish coating and pus are mainly caused by a bacterial infection. The tonsils can be colonised by oral bacteria and become inflamed, particularly in the case of immunodeficiency. Those affected also complain of pronounced swallowing difficulties and possibly fever.

This is a clear indication to consult a doctor so that prompt treatment can be initiated and the spread to other structures can be prevented.

Fissured tonsils

Fissured tonsils can have deep cuts and bumps on the surface and can develop during the course of a chronic infection due to scarring.

The problem with these irregularities is that food debris and bacteria can accumulate in the grooves, increasing the likelihood of a chronic infection.

Tonsil stones

Tonsil stones are small, hard deposits that can form in the recesses of the tonsils. They consist of food debris, bacteria and dead cells.

In most cases, they are harmless and can be easily removed by rinsing.
Nevertheless, they cause unpleasant accompanying symptoms such as bad breath, a foreign body sensation or a sore throat.

Fever with tonsillitis

Fever is a common symptom of tonsillitis. The body’s reaction to invading pathogens is completely natural and helpful. Mild tonsillitis usually does not require any treatment at all.

However, if the fever is unusually high and accompanied by other severe symptoms, you should consult a doctor.

Bad breath

Bad breath is also a common and unpleasant symptom of tonsillitis. It can also be caused by tonsil stones, but usually occurs in conjunction with coated, inflamed tonsils.

A biofilm of bacteria and food residue forms, which emits unpleasant odours.


Earache is a rather rare symptom of angina tonsillaris. Typical signs are pain, a feeling of pressure or hearing problems.
They can occur if the infection spreads towards the ear canals or if structures for pressure equalisation are swollen.

If earache occurs in conjunction with the symptoms of tonsillitis, it is important to get a precise diagnosis.

Important types of tonsillitis

Tonsillitis can be categorised according to duration and intensity (acute or chronic). However, the presence of pus should also be mentioned, as there may be a risk of it spreading.

Acute tonsillitis

Acute tonsillitis is the most common form of tonsillitis. It is usually triggered by a viral or bacterial infection and usually subsides within one to two weeks. The acute form is characterised by pronounced symptoms with pain, swelling and discomfort.

Chronic tonsillitis

Chronic tonsillitis is an inflammation of the tonsils that lasts for a long period of time (months or years). In many cases, it is accompanied by structural changes in the tonsils, which further exacerbate the chronicity.

If left untreated, chronic tonsillitis places a permanent strain on the body and can cause a variety of physical problems in the long term.

Chronic tonsillitis can be treated effectively by restoring the immune system and general bodily functions to an improved state.

Purulent tonsillitis

Purulent tonsillitis is a classic indication of bacterial infection of the tonsils. It is characterised by severe pain and a tendency to spread. However, the spread to surrounding structures should be avoided at all costs.

If you suspect you have tonsillitis, you should consult a doctor as soon as possible.
This is usually treated with antibiotics.

Unilateral tonsillitis

In unilateral tonsillitis, the symptoms only occur on one side. Those affected therefore complain of a sore throat on one side. Such symptoms can occur, for example, with the onset of angina.
Here, it is also worth seeking medical advice in order to recover quickly and avoid an infection on the other side.

How long does tonsillitis last?

Classic acute tonsillitis usually heals within one to two weeks. With mild symptoms and a healthy immune system, complete healing is possible without any treatment at all.

The chronic form can drag on for months and years and cause considerable suffering for those affected. In the case of chronic tonsillitis, the underlying immunological causes should be investigated.

Possible complications of tonsillitis

Tonsillitis can also lead to serious complications if it does not heal and the immune system is additionally weakened.

One possible complication is a peritonsillar abscess (also known as a tonsillar abscess), an encapsulation of pus in the area surrounding the tonsils, which must be opened and drained through an incision. If the abscess remains untreated, the infection can spread and, in the worst case, lead to septicaemia or in short ‘sepsis’ (blood poisoning or bloodstream infection). Sepsis poses a significant risk of death and should be treated professionally.

Causes of tonsillitis

In most cases, tonsillitis is caused by viral or bacterial infections. However, fungal infections or anatomical variations can also be a possible trigger. Other important aspects in this context are the immune system, the condition of the intestines (e.g. leaky gut, intestinal dysbiosis), intolerances (e.g. lactose intolerance) and possible deficiencies in vital substances.

For a precise clarification, you should consult an experienced doctor and have possible pathogens and the condition of your general health checked if they occur repeatedly.

Viral tonsillitis

Viral tonsillitis is often triggered by adenoviruses, influenza viruses, EBV or CMV. Treatment is aimed at alleviating the symptoms.

Symptomatically, the fever can be reduced, the body can be provided with sufficient rest and fluids and painkillers can alleviate the symptoms.

Viral tonsillitis usually subsides on its own in one to two weeks with the above measures, but if symptoms persist, a visit to the doctor may be advisable to rule out other causes.

Bacterial tonsillitis

Bacterial tonsillitis is usually caused by streptococci, pneumococci or staphylococci. An infection occurs when the body’s own immune defence fails and the physiological oral flora causes an infection.

To diagnose bacterial angina tonsillaris, a throat swab is taken to identify the pathogen and an appropriate antibiotic is administered. It is important to adhere to the doctor’s treatment plan in order to prevent the development of resistance and more serious complications such as abscess formation.

If you suffer from bacterial tonsillitis, it is advisable to stay at home until appropriate treatment is initiated, as you may be highly contagious.

Tonsillitis caused by a fungal infection

Tonsillitis can be caused by oral thrush, where the yeast Candida infects the tonsils and causes an infection. White patches are recognisable on the reddish tonsils and the coating is difficult to remove.

Such a fungal infection can occur after a course of antibiotics or in patients with a defective immune system.

Tonsillitis due to allergies

An allergic reaction can cause the throat to become inflamed and swollen. The inflammation is also noticeable in the tonsils. Tonsillitis caused by an allergic reaction is rather rare and requires a completely different therapeutic approach. The triggering allergens should be found and the immune system balanced.

Tonsillitis with an immune disorder

In the case of an immune disorder, the immune system may be weakened or excessively aggressive. In both cases, tonsillitis can occur more frequently. The immune disorder should be confirmed by a full diagnosis and treated in a cause-oriented manner. Immune disorders can often be a cause of chronic tonsillitis in particular. Deficiencies in vital substances and intestinal health play a decisive role here.

Lactose intolerance

People with lactose intolerance are more likely to suffer from tonsillitis. Lactose intolerance affects the intestines and unbalances the immune system. Precise clarification using special laboratory parameters provides the therapist with valuable information for targeted therapy.

Is tonsillitis contagious?

Yes, tonsillitis can be contagious, with transmission usually occurring through droplet infection when coughing, sneezing or speaking. Viral and bacterial tonsillitis in particular harbour the risk of infection.

It is important to note that the likelihood of transmission depends not only on contact with infected persons, but also on your own immune status. If you already feel somewhat weakened or if you know people who are ill in your immediate environment, it is all the more important to ensure appropriate hand hygiene and social distancing.

Risk factors for tonsillitis

There are a number of risk factors that favour tonsillitis. These include immune disorders, poor oral flora, fissured tonsils and smoking.

To optimise the immune system, you should ensure that you lead a healthy lifestyle with a wholesome diet, sufficient exercise and enough time in the fresh air. Causative factors that compress the immune system should be identified and eliminated.

Poor oral flora can also be a possible risk factor for tonsillitis. It is therefore advisable to build up the oral flora and keep it stable in the long term.

If tonsillitis occurs frequently despite a healthy lifestyle, a precise diagnosis is worthwhile in order to uncover underlying causes.

Tonsillitis, what to do? - Treatments for tonsillitis

Tonsillitis should always be treated depending on the causes. Consequently, a correct, cause-oriented diagnosis is crucial before treatment.
If severe symptoms are present or there is a risk of complications, medication may be necessary.

Antibiotics for tonsillitis

If bacterial tonsillitis is present, it is usually treated with antibiotics. A swab is taken by the doctor to determine the pathogen so that the appropriate antibiotic can then be prescribed. This diagnostic procedure is known as an antibiogram and is recommended if treatment is not possible without antibiotics.

The antibiogram provides information about the individually effective antibiotic. A penicillin (e.g. amoxicillin) is often used here.

Due to the side effects of antibiotics, antibiotics should be avoided if possible. Tonsillitis can often be treated without antibiotics using natural alternatives and strengthening measures.

Painkillers for tonsillitis

As a sore throat is a common symptom of tonsillitis and causes discomfort, especially when eating and swallowing, many patients resort to painkillers such as ibuprofen or paracetamol.
Taking painkillers can also have a toxic effect, which is why the dosage should be strictly adhered to and should not be overused.
It is important to consult your doctor before taking painkillers.


Lozenges can be an option to make tonsillitis more bearable.
There are lozenges with herbs that have a soothing and decongestant effect and variants with painkillers that have a pain-relieving effect.

Nevertheless, they are no substitute for conventional therapy and should not be consumed in excess.

Tonsillectomy - removal of the tonsils

Tonsillectomy is often the last resort in cases of recurrent and chronic tonsillitis.
The tonsils are surgically removed under general anaesthetic. The procedure is completed in less than an hour and heals, usually without complications, within one to two weeks.

Before considering a tonsillectomy, it is important to clarify all causative factors in order to find an atraumatic solution. In most cases, the affected person can be helped by treating the causes completely.

Herbal remedies and measures

The healing power of plants has been used for thousands of years to combat inflammation, heal wounds and strengthen the body.

Herbs such as camomile and sage are also very helpful for tonsillitis, as they have an antimicrobial and anti-inflammatory effect.

In addition, the bee product propolis is a popular remedy that can provide effective relief, especially for mild inflammation.

Angocin, a herbal medicine made from the roots of nasturtium, has antibiotic effects and can be taken in tablet form to promote the recovery process.

Even with herbal remedies, it is important that an experienced doctor supervises the therapy in order to avoid imbalances and overdoses.

Homeopathic globules for tonsillitis

Even if the effectiveness of homeopathy for tonsillitis is difficult to study in an experiment and thus not considered evidence based, there are many patients who have experienced good results with homeopathy.

In order to find the right remedy, it is important that the therapist knows the patient’s medical history and background.

Classic remedies are belladonna (deadly nightshade), phytolacca (pokeweed) and Apis mellifica (honey bee), which are said to have an anti-inflammatory effect.

Other complementary medicine treatments

Nowadays, there are a variety of complementary medical approaches that have been proven to provide therapeutic help for tonsillitis. Procedures such as ozone therapy, hyperthermia, sanum therapy, infusion therapy and intestinal rehabilitation offer valuable support for long-term recovery. Moreover, acupuncture and cupping have also shown success with tonsillitis.

It is always important that the methods support each other and are embedded in a complete therapy concept.

Home remedies for tonsillitis

There are many home remedies for tonsillitis. Before resorting to chemical substances, it is always advisable to support the body with natural measures. Throat compresses, soothing teas and gargling with salt water are some home remedies that have proven effective for tonsillitis.

Throat compress

A throat compress is a popular home remedy to promote blood circulation, loosen mucus and stimulate healing. Take a cloth soaked in warm water and wrap it around the irritated throat.

Sage tea

Sage tea has an anti-inflammatory effect and stimulates blood circulation. With plenty of rest and sleep, it can help to relieve symptoms quickly.

Camomile tea

Chamomile tea is also excellent for tonsillitis due to its antimicrobial effect. Its additional calming, sleep-promoting effect can improve regeneration.

Honey or Manuka honey

Honey or Manuka honey has a number of anti-inflammatory components and is considered effective for sore throats and tonsillitis.

Either dissolve the honey in tea or consume it directly.

Lemon juice

Lemon juice can relieve pain, loosen mucus and fight inflammation. It is therefore a very popular home remedy for mild tonsillitis and can speed up recovery. Always use lemon juice from freshly squeezed lemons and add it to tea with honey.

Gargling with salt water

Salt water can kill bacteria, loosen plaque and support healthy oral flora.
To do this, use a solution with sea salt and gargle for a few seconds or even minutes.

Tonsillitis and eating ice cream - is it helpful?

Ice is often recommended as a home remedy for tonsillitis as it can provide mild pain relief and make swallowing less painful. A little ice is generally unproblematic.

However, increased consumption of ice is counterproductive for a quick recovery, as cold reduces blood circulation and lymphatic drainage and, as a result, the removal of waste products is reduced.

In addition, icing of the tissue leads to a downregulation of the immune response, as immune cells work less effectively at low temperatures. As a result, the immune system is weakened.

How can tonsillitis be prevented?

To prevent (prophylaxis) tonsillitis, the immune system, intestinal health and vital substance supply are of central importance. Possible dysregulations and imbalances should be identified and eliminated by an experienced therapist. Such an approach offers long-term and sustainable prevention of sore throats and tonsillitis.

Dr. med. Karsten Ostermann M.A.

Chronic tonsillitis can disrupt the immune system and put a great strain on your health. An integrative approach that also takes the cause into account can relieve the symptoms and help avoid tonsillectomies.

Dr. Karsten Ostermann

Frequently asked questions and answers about tonsillitis

Tonsillitis is a common health problem these days. Many questions arise among those affected, which we would like to answer in this section of the article.

Tonsillitis is usually characterised by a sore throat, difficulty swallowing and a foreign body sensation in the throat. The tonsils are reddened and swollen, and there may also be a whitish coating.

In general, it is advisable to see a doctor when the symptoms become more noticeable. Severe sore throat, high fever and fatigue are indications of an acute event. Complications such as peritonsillar abscess and the development of septicaemia should be avoided at all costs.

The incubation period is the time between the invasion of the pathogen and the first symptoms being noticed. This period varies from person to person and depending on the type of pathogen. Generally, an incubation period of one to five days is assumed.

It is important to know that it is also possible to infect other people during the incubation period.

In the case of viral tonsillitis, the person affected can still be contagious one to two weeks after the first symptoms.

If bacterial tonsillitis is treated with antibiotics, it is usually no longer contagious after 24 hours. If left untreated, it can be contagious for up to two weeks after the first symptoms.

As a general rule, rest, plenty of sleep and drinking enough are the most important measures for a speedy recovery.
The use of painkillers can be considered to provide quick relief from the pain.

However, in order to be able to make a precise statement, a cause-oriented medical examination is required.

Tonsillitis should be treated depending on the cause.

Viral infections are treated symptomatically. A painkiller can make the sore throat more bearable and antipyretic medication can reduce the discomfort.

If a bacterial infection is present, the use of antibiotics may be indicated.

The pathogen plays a key role in choosing the right antibiotic. After taking a swab, an antibiogram is prepared in the laboratory, which provides information on which antibiotics are effective and which are resistant.

The doctor can then choose the antibiotic that will eliminate the pathogen to be treated as specifically as possible while minimising side effects.

In the case of tonsillitis, an improvement in symptoms should normally be noticeable within the first one to three days after starting antibiotic therapy. The sore throat should gradually decrease, the fever should subside and other symptoms, such as difficulty swallowing and headaches, should improve.

If there is no improvement, it is advisable to consult your doctor so that the treatment can be adjusted.

There are a number of reasons for recurrent infections, including resistance to antibiotics, too short and incorrect treatment, fissured tonsils or an immune disorder.

If tonsillitis recurs despite antibiotics, a thorough diagnosis should be carried out to identify all the individual causes.

Try to eat foods that are easy to swallow. Soups, yoghurt, porridge and nutrient-rich foods are recommended.

Avoid spicy, acidic and rough foods as they can make the sore throat worse.

Warm drinks such as tea, broth or warm milk with honey can loosen mucus and relieve inflammation.

Although cold drinks can have a temporary pain-relieving effect, they also suppress the blood circulation and immune response, which tends to delay the healing process.

Symptoms of protracted tonsillitis can include chronic pain, general fatigue, abscesses, bad breath and structural changes to the tonsils.
The aim should be to bring the inflammation under control as quickly as possible, not only to alleviate the unpleasant symptoms, but also to avoid chronicity and dangerous secondary diseases.

If your tonsils are swollen but not painful, this may indicate irritation caused by dry air or allergies. However, viral and bacterial tonsillitis can also be painless under certain circumstances and should therefore not be forgotten.

A precise diagnosis by an experienced doctor is crucial to find out the cause of the swollen but painless tonsils.

Pus in the throat always indicates a prevailing infection. Bacterial tonsillitis, for example, can often be characterised by a whitish, stippled appearance.

An abscess can also open up and release pus into the throat.

In principle, all inflammations accompanied by pus should be treated under the supervision of a doctor to prevent the infection from spreading.

When the tonsils secrete pus, this is known as stippling. This is a clear sign of bacterial tonsillitis. In most cases, this is treated with antibiotics and requires medical attention.

No, under no circumstances should you squeeze out your tonsils on your own!

This could spread the infection in the mouth or cause small injuries through which the germs could enter the bloodstream.

If you have purulent tonsillitis, you should always consult a doctor and receive appropriate treatment to avoid serious complications.

Reddened tonsils can have a variety of causes. These include allergies, bacterial or viral infection, mechanical irritation and many more.

Pay attention to the duration of the redness and accompanying symptoms, such as pain and difficulty swallowing, to narrow down the causes.
If the symptoms persist, you should consult a doctor.

This depends on the cause and how you feel.
Viral and bacterial tonsillitis are contagious for one to two weeks. From the point of view of infection, you should stay at home during this period and avoid socialising.

You should also pay attention to your regeneration. Exerting yourself physically and mentally too early can further delay the healing process.

Mild tonsillitis usually goes away on its own within one to two weeks if left untreated.

However, if you suffer from severe symptoms or the inflammation lasts longer, you should consult an experienced doctor.

Recurrent tonsillitis can be very annoying and restrict your quality of life. Triggers include fissured tonsils, which provide bacteria with an ideal breeding ground for growth, a weakened immune system or poor oral and intestinal flora.

In order to determine the exact triggers, a cause-orientated diagnosis should be carried out.

Yes, most tonsillitis heals on its own, without treatment or antibiotics.

If the cause of the problem has been identified and treated, tonsillitis can usually be cured without surgery. Surgery may only be indicated in severe or very chronic cases that do not improve.

As a general rule, you should not exercise during an active infection, as this deprives your body of regenerative abilities and prolongs the healing period.
In the worst case scenario, you can prolong the tonsillitis and cause serious long-term damage.

However, light exercise such as walking in the fresh air can promote healing and is welcome. Listen to your body and try to avoid strenuous exercise.

You should not go to the sauna if you have acute tonsillitis. The body needs rest and capacity to fight the infection. A sauna not only places an additional burden on the immune system, but can also quickly lead to dehydration and thus delay healing.

Further information

The information listed contains relevant topics and serves to improve understanding.