Swollen tonsils are typically the result of an infection, known as tonsillitis. Your tonsils play a vital role in your immune system, acting as a defense against viruses and bacteria. You have two tonsils, located on either side of your throat at the back of your tongue. Tonsil tissue, also called lymphatic tissue, is filled with white blood cells known as lymphocytes.
When bacteria or viruses enter your body through your mouth or nose, a ring of lymphatic tissue helps trap them. This ring, known as Waldeyer’s ring, includes your adenoids at the back of your nose, your lingual tonsil at the base of your tongue, and your two faucial tonsils on either side of your throat.
Why are my tonsils swollen?
There are two common reasons why tonsils become swollen. The most frequent cause is a short-term infection called acute tonsillitis. Once the infection clears, the swelling subsides. However, if tonsils become frequently infected, they may remain swollen, a condition known as chronic tonsillitis. Although tonsillitis can occur at any age, it is most common between the ages of 5 and 15.
A much less common cause of swollen tonsils is tonsil cancer. Unlike tonsillitis, tonsil cancer usually affects only one side and may not initially be painful. Other common infection symptoms such as chills, fever, or congestion are typically absent. Tonsil cancer is more common in individuals over the age of 50.
What do swollen tonsils look like?
You can see your faucial tonsils by looking in a mirror and opening your mouth wide. Normally, they appear as small, lumpy structures behind the base of your tongue. When swollen, they may protrude further, narrowing the space at the back of your throat. If you have tonsillitis, your tonsils may appear deep red and may have white mucus patches. Chronic tonsillitis may cause the tonsils to remain enlarged with pits filled with mucus.
Tonsillitis
In most cases, tonsillitis is caused by a cold virus and resolves on its own. However, viral tonsillitis can be more severe if caused by the Epstein-Barr virus, which leads to mononucleosis (mono). Mono-related tonsillitis can cause extremely large, painful tonsils covered with a grayish mucus membrane. This condition can make swallowing difficult and, in severe cases, may require hospitalization for fluids and anti-inflammatory medication.
Bacterial infections are the second most common cause of tonsillitis. Unlike viral tonsillitis, bacterial tonsillitis may not resolve on its own and often requires antibiotic treatment. The most common bacterial cause is group A beta-hemolytic streptococcus, known as strep throat. In some cases, a bacterial infection can lead to a peritonsillar abscess, which usually affects only one side. This abscess is very painful, making swallowing difficult, and often requires drainage at a hospital.
Diagnosing tonsillitis
A doctor can diagnose tonsillitis by examining your tonsils, but determining whether it is viral or bacterial can be challenging. A throat culture may be necessary to identify the cause. In some cases, blood tests may be performed to rule out mononucleosis, and a complete blood count (CBC) can help assess white blood cell levels.
Symptoms of tonsillitis may include:
- Fever
- Sore throat
- Difficulty swallowing
- Muffled voice
- Ear pain
- Swollen lymph nodes in the neck
How to treat swollen tonsils
Treatment for swollen tonsils depends on the cause. Viral tonsillitis typically requires only supportive care, including over-the-counter pain relievers, rest, and adequate fluid intake. Bacterial tonsillitis, however, usually requires antibiotic treatment. In severe bacterial infections, hospitalization may be needed for intravenous antibiotics.
A tonsillectomy (surgical removal of the tonsils) may be recommended for chronic tonsillitis, particularly if an individual experiences five or more infections per year. Additionally, persistently swollen tonsils that interfere with swallowing or breathing may need to be removed.
How to treat swollen tonsils in adults
Tonsillitis treatment for adults is similar to that for children. However, adults are more likely to have swollen tonsils caused by conditions other than tonsillitis. If an adult has a single persistently swollen tonsil, a biopsy may be necessary to rule out tonsil cancer.
Another common cause of swollen tonsils in adults is sleep apnea, a condition characterized by loud snoring and interrupted breathing during sleep. In some cases, enlarged tonsils contribute to sleep apnea, and a tonsillectomy may be recommended as part of the treatment.
When to seek medical care for swollen tonsils
Seek immediate medical attention if swollen tonsils make it difficult to swallow or breathe. Consult a healthcare provider if you experience:
- A sore throat that does not improve
- Severe throat or ear pain
- Persistent swelling of the tonsils without a sore throat
- A swollen tonsil on one side that does not resolve
