Acute tonsillitis

Synonyms in a broader sense

  • Acute tonsillitis
  • purulent tonsillitis

Medical: tonsillar angina


Acute tonsillitis is an infection of the tonsils. It can occur at any age and at any time of the year. Viruses can cause inflammation in children and bacteria in adults.
Mostly it is streptococci, in older patients also pneumococci or the germ Haemophilus influenza (HiB). Acute tonsillitis can be treated well with medication and usually heal without consequences.
In some cases, however, the inflammation lasts longer than three months. In these cases, the tonsils are chronically inflamed (chronic tonsillitis) and require more complex therapy. The germs that are responsible for the infection of the tonsils can rarely infect other organs in our body and cause complications.


What causes tonsillitis (tonsillitis)?

Acute tonsillitis is usually triggered by pathogenic germs (pathogenic bacteria). These germs either occur in small quantities in our oral flora and were able to multiply or they were brought in from the outside (droplet infection).
The bacteria that are already present have a great chance of multiplying when the general condition of our body is weakened.

  • Colds / runny nose
  • emotional, psychological and physical stress
  • Immunodeficiency (e.g. AIDS) and
  • Cancer

promote infection of the tonsils.

Especially in the first years of life ("immunological learning phase"), the tonsils have a lot to do, since every foreign substance in the oral cavity is initially regarded as an "enemy". Diseases of the tonsils are therefore very common in early childhood.

Read more on the topic: Pus on tonsils


The acute tonsillitis is highly contagious. By simple Droplet infections are for example at to cough or sneezing finely misted Water droplets including pathogens released from the throat to the environment. Another way to be contagious is the indirect way via contaminated objects, the classic being the touched contaminated door handle is to be called.
The pathogen can be picked up by other people multiply in the respiratory tract and throat and thus act contagious. So it is understandable that that too Kissing contagious is just like that Share a common drinking bottle. In order to reduce the risk of infection, the above should be avoided.
Obligation for those suffering from acute tonsillitis is to cough and sneeze Hand to mouth to hold and wash if necessary. It is also useful to larger crowds like in school or in the office too avoid, since the people around you are exposed to an unnecessary risk of infection.

How long one contagious is difficult to say. However, it should not be assumed that with Symptoms subside how Sore throat and difficulty swallowing that contagious potential disappeared is. Even if the tonsils look puffy and healthy still infectious agents be proven in the person. If you got infected, it amounts to incubation period until the first symptoms appear about 2-4 days. What is important is an immediate one Doctor visit and the Taking antibiotics. On the one hand, this not only combats or prevents the disease, but especially the rare but severe complications of acute tonsillitis. On the other hand, people are usually 24 hours after starting therapy no longer contagious in case it is bacterial Pathogen acts.

Risk of contagion

Acute tonsillitis develops in 50-80% of cases on the basis of a viral infection. One of these is the colloquially as "cold"designated Respiratory infection, but also one Rhinitis or Pharyngitis can develop into acute tonsillitis.
Typical viral pathogens are Influenza viruses, the Parainfluenza viruses, and the Coronavirus. In the remaining 20-30% of the cases there is an infection by means of bacteria before, significantly the Streptococci, and to a lesser extent Staphylococci and Pneumococci.
The viruses and bacteria mentioned are mainly transmitted through the air, by means of Droplet infection. That means that a "Cough up"The pathogen from another person, with subsequent inhalation, is in principle enough to become infected. Now you see someone all the time, especially on public transport to cough, and still very rarely has acute tonsillitis. How can that happen?
On the one hand, of course, is one certain amount of pathogens necessaryto actually infect the organism. On the other hand, we usually have a very strong one immune systemwhich makes life difficult for viruses or bacteria as soon as they enter the body. However, our immune system is at it chronic diseases, certain Medication, or plain stress impaired in their function and can do their job less well. So you feel already anyway posted and is perhaps also under physical or emotional stress, the pathogens are particularly dangerous for the body.
Physical exertion also includes excessive exertion when doing Sports with one: If you are excessively spent has, is that immune system within the next four hours after exercising demonstrably weakened. Therefore, in such situations, it is also meticulous to have enough warmth, Vitamins, and physical rest to pay attention.

Infection through droplet infection

Droplet infection in school

The acute tonsillitis is highly contagious and is about the so-called Droplet infection transfer.

Droplet infection is understood as the Spread of a pathogen through tiny droplets from the patient's mouth and throat, for example when sneezing. These droplets, which contain the contagious bacteria, either get there straight through the air or via the detour via skin contact to the mucous membranes of another person and lead to an infection here.

After this First contact with the pathogen it takes between two and four daysuntil acute tonsillitis breaks out. This period is also known as incubation period.
Even before the onset of the disease, a infection respectively.

About 24 hours after starting antibiotic therapy There is no longer any risk of infection with tonsillitis caused by streptococci, although the symptoms of acute tonsillitis still there are. With other pathogens of acute tonsillitis, there is a risk of infection multiple days be. Due to the high risk of infection Group facilities such as kindergartens and schools or the place of work for adults Be avoided.

Figure tonsillitis

Figure tonsillitis

A - tonsillitis - Tonsilitis
B - Simple catharrhal angina -
Angina catarrhalis
C - throat findings in diphtheria
D - ulcers in bacterial
Forms of angina

  1. Palatine almond bay -
    Tonsillar fossa
  2. Hard palate -
    Palatum durum
  3. Posterior palatal arch -
    Arcus palatopharyngeus
  4. Anterior palatal arch -
    Arcus palatoglossus
  5. Palatine almond -
    Palatine tonsil
  6. Back of tongue -
    Dorsum linguae
  7. Uvula + soft palate
    (Soft palate) -
    Uvula palatina + palatum molle
  8. Meandering -
    Isthmus faucium
  9. Throat (back wall) -

You can find an overview of all Dr-Gumpert images at: medical illustrations


What are the symptoms of tonsillitis?

The acute tonsillitis causes increasing difficulty swallowing. In acute tonsillitis, it is precisely the difficulty swallowing that stresses us the most, as an increased flow of saliva forces us to swallow a lot and often. In particularly severe cases, even trying to open your mouth can cause severe tonsil pain. When swallowing, there may be uncomfortable pricks in the ear. Smaller neck movements can also be painful, as the neck lymph nodes are swollen. In addition to a general feeling of illness with headache and exhaustion, there is also a fever. In children, the fever is usually higher than in adults.

Read more on the topic: Symptoms of tonsillitis

Difficulty swallowing in acute tonsillitis

The tonsils, which are located at the transition from the oral cavity to the pharynx between the anterior and posterior palatal arch (mucosal folds) on both sides, belong to the so-called Waldeyer pharynx ring - a body's defense system against bacteria and viruses.

Pathogens ingested with the air, saliva or food first pass these important guard stations and are recognized and fought by the numerous immune cells in the tonsils.

The surface of the palatine tonsil is heavily grooved, so that on the one hand the surface is enlarged and many immune cells can settle there, and on the other hand pathogens can easily get “caught” in this grooved surface.

So if there is a defense reaction, the almonds swell reactively and they turn inflammatory red - it is a sign that the immune system has been activated.

Depending on how much the tonsils swell, the limited spatial capacity in the mouth and throat area can lead to characteristic symptoms:
these include difficulty swallowing, a sore throat, impaired breathing through the nose and lumpy language.

Course of acute tonsillitis

The acute tonsillitis usually begins with sudden severe sore throat to that into the Ears and des entire head area can radiate, and is part of it fever and partially chills accompanied.
There is also one severe tiredness and fatigue.

The pharynx swells within a very short timewhich is not only very uncomfortable, but also too Swallowing and language problems can lead. The swelling can be very pronounced even impede breathing. In the further course this can Swelling will increasewhat in connection with the severe pain especially in children to a Adjusting food intake leads.

Typical of acute tonsillitis is a bad smelling bad breath, which often increases in the course of the disease.

If the tonsillitis is treated properly, it occurs A significant improvement after just a few days of the complaints. To about one to a maximum of two weeks the acute tonsillitis is healed. If symptoms persist after more than three weeks, this is the case Risk of chronic tonsillitis.


What do we recognize in our tonsils when we suspect tonsillitis?

If we look in the mirror ourselves, stick our tongue out and say "A" for a long time, we can with one Tonsillitis one red throat and possibly recognize thickened almonds behind the palatal arch.Even the tongue could show a whitish coating, especially in the rear area, which seems rather unusual to us.
If, in addition to reddening and swelling, the tonsils are also covered with whitish or small white specks are on the tonsils must in any case of the Family doctor to be visited. Now is a treatment with one antibiotic required!

Physical examination

The GP is with the Treatment of tonsillitis familiar. There is therefore no need to go to a specialist in ENT.

The family doctor will first want to know how long the symptoms have existed. He will then take a close look at the throat and tonsils, mirror the ears and hers Lymph nodes palpate in the neck area.
To distinguish it from a very similar disease (Pfeiffer glandular fever, Epstein-Barr virus infection, Mononucleosis), which, however, requires a different therapy, he will also spleen and liver scan. If the tonsils suggest a rare bacterial colonization, the doctor will take a swab from the throat and almond mucosa. A cotton swab is held against your throat for a brief moment. The stick is then sent to a laboratory in a tube.
A Blood test is usually not carried out.


You can treat some symptoms yourself.

What can you do yourself to relieve symptoms?

Against the pain and that fever the antibiotic itself does not help. Antipyretic and pain relieving medication (e.g. Paracetamol) that the doctor may prescribe for you. Against a high fever, old measures such as Calf wrap which, by the way, show great success with children.

The neck should always be kept warm. Neck scarves at home and shawls outside should be worn for at least five days.

Difficulty swallowing can be alleviated by pureeing the food and generally avoiding acidic foods and juices. Cold drinks and ice cream have a beneficial effect and ease swallowing difficulties.

Generally should much liquid (at least two liters) in the form of tea. Disinfecting teas (e.g. Sage tea, more information also under our topic sage) have an additional effect against the bacteria in our oral cavity. Camomile tea (more information also under our topic chamomile), on the other hand, has an anti-inflammatory effect.

The pharmacy has a whole range of over-the-counter products Lozenges and gargle remedies for the difficulty swallowing are available. An additional application keeps the throat moist, disinfected and relieved Sore throat.

Cigarette smoke hinders healing and also increases swallowing difficulties! As a smoker, you should therefore absolutely rely on the Smoke dispense.

How is acute tonsillitis treated?

If the typical findings of tonsillitis are present, the doctor will advise them antibiotic prescribe. It is imperative to take the drug as instructed by the doctor! With those prescribed today Antibiotics are very well tolerated drugs (penicillin, Amoxycillin), which bring about a rapid improvement. Also because of the consequential damage

  • heart
  • Joints and
  • kidney (Rheumatic fever)

If you have a purulent tonsillitis, you shouldn't do without an antibiotic. If you have a allergy is known to contain penicillin, be sure to let your doctor know. He will give you an equally effective replacement preparation (macrolide, Clarithromycin) prescribe.

Antibiotic therapy for acute tonsillitis

Usually standard antibiotics are used.

If the cause of acute tonsillitis is an infection with bacteria that either come from your own mouth and throat or were transmitted by droplet infection, the disease is treated with antibiotics.

Antibiotic treatment is not possible in the event of infection with viruses, which in addition to the bacteria also trigger acute tonsillitis.

The standard drug for the treatment of acute tonsillitis is penicillin V. This drug works by preventing the bacteria from multiplying from building up the cell wall so that they cannot multiply any further. Penicillin must be taken for 10 days, even if the symptoms have already subsided or have subsided.
If the tablet intake is stopped prematurely, resistant bacterial strains can develop. This means that these strains develop mechanisms that make the antibiotic ineffective.

A noticeable improvement occurs about 24-48 hours after the first penicillin intake. If the drug does not have any effect after this time, it is possible that the drug has no effect. Therapy failure occurs.
The proportion of therapy failures continues to rise and is currently around 20-30% of those treated. Nevertheless, penicillin is an effective antibiotic in acute tonsillitis and is used by default.

If the standard drug penicillin is unsuccessful, an alternative antibiotic must be administered (see also: Fever despite antibiotics - what to do?). The antibiotics cephalosporin, amoxicillin in combination with clavulanic acid or macrolides such as clarithromycin are available.
These three substitute medications can also be used if you have a penicillin allergy. If this occurs, it usually manifests itself initially with reddening of the skin and can lead to an allergic shock, which is life-threatening.
The advantage of the cephalosporins and the amoxicillins in combination with clavulanic acid lies in their shorter intake duration. Both antibiotics only need to be taken for five days and have the same effect as taking penicillin for 10 days.

Treatment with antibiotics is used for both acute tonsillitis and chronic tonsillitis. The aim of this antibiotic treatment is to combat tonsillitis itself and prevent the two main side effects, post-streptococcal glomerulonephritis (kidney damage with bloody urine) and rheumatic fever.

Read more on the topic: Antibiotics for tonsillitis

Homeopathy for acute tonsillitis

There are many different approaches one acute tonsillitis (angina) treat homeopathically. We have dedicated a completely separate page to this topic.

Home remedies for acute tonsillitis

Some teas are suitable for treatment.

The use of home remedies is one thing for acute tonsillitis sensible addition to antibiotic therapyto increase your own well-being and reduce pain. It should be during the illness drank a lot become. In particular Sage tea is suitable here because he has both disinfectant acts as well through the Warm the blood circulation promotes in the throat area, which in turn accelerates the healing process.

They work in the same way warm neck wrap from that with either warm, damp cloths or one warm onion wrap can be carried out. Warm neck wraps should be around one half a hour created so that they can develop their effect.

May also be cold compresses used as it is through cooling decongestant work and that Facilitate swallowing. However, the lower blood flow also ensures a worse healingso that you have to weigh up between warm and cold compresses depending on the symptoms.

The same goes for that Sucking ice cubes. Your decongestant effect should only be used if that Swallowing severely restricted is. Are better suited Sage dropsbecause they have the salivation stimulate so that the mucous membranes are moistened and the bacteria through those contained in the saliva Immune components can be attacked.


With a antibiotic therapy Acute tonsillitis does not usually last longer than two weeks. Under no circumstances should the antibiotic be discontinued, even if it has improved after a few days. The bacteria are still abundantly present in the oral cavity and in the tonsils and must be fought with antibiotics for longer than the symptoms have been present.

If the antibiotic is discontinued early and without authorization, the germs have another chance to make you sick again!

Since the duration of tonsillitis depends on many other factors, such as the state of health, the immune system and the physical conditions, unfortunately, the duration cannot be determined exactly.


What complications can arise?

  • Peritonsillar abscess; Paratonsillar abscess; Retropharyngeal abscess
    If the tonsillitis does not completely heal and the inflammation starts again, bacterial settling into the surrounding tissue could have taken place (abscess formation).
    In this case, symptoms such as difficulty swallowing and difficulty opening the mouth (jaw clamp) are particularly severe. The difficulty swallowing in the peritonsillar abscess is usually one-sided and only affects one ear. The voice also sounds lumpy.
  • Rheumatic fever
    If the purulent tonsillitis does not heal quickly, the focus of infection on the tonsils can also reach other organs. Heart, kidneys and joints are particularly at risk and can be seriously damaged by tonsillitis that has not healed (endocarditis (heart valve inflammation) -> more information also under our topic endocarditis, myocarditis (inflammation of the heart muscles), pericarditis (inflammation of the pericardium), heart valve defects, nephritis, glumerulonephritis, kidney inflammation , Arthritis, rheumatoid arthritis).
    If, after a previous tonsillitis, symptoms occur in the heart (e.g. inability to exercise, difficulty breathing), in the kidneys (blood when urinating, pelvic pain) or in the joints (pain, swelling, redness), a doctor should be consulted as soon as possible! To make diagnosis easier, remember about tonsillitis and tell your doctor about it.
    Read more on the topic: Rheumatic fever

Abscess formation in acute tonsillitis

As abscess is called in the course of acute Tonsillitis, or angina tonsillaris acuta the formation of a with pus filled enclosure that is additionally to the tonsillitis forms.
The abscess will be in this case Peritonsillar- or Parapharyngeal abscess called, according to its location either in the area of Tonsils, or if he's in throat (parapharyngeal). He is one common complication acute tonsillitis and worsen the symptoms drastically:
On the one hand narrowed he continues the already constricted throat, on the other hand he is from a certain size no longer medication treatable, and have to surgically to be opened.
In medicine, the principle applies "ubi puus ibi evacua“Where there is pus, there open it.
In this sense, the attending physician will, if necessary, take local anesthesia cut or prick the abscessed pus. The danger here comes less from any injuries to the tonsil but more from involuntary injuries Movements of the patientwhile the scalpel is in the throat.
In itself this is minimally invasive surgery however very much fast and without any complications perform. Can be used to treat acute tonsillitis Antibiotics given. The abscess is - unlike the original infection - not open viral, rather bacterial pathogens traced back. A bacterial colonization of a primarily viral inflammation (such as tonsillitis in 50-80% of cases) is called "Superinfection" designated.

Course without fever

Acute tonsillitis must not necessarily with a fever accompanied. Only in later disease course, or in severe stages Usually symptoms such as fever and heavy sweating added. In the initial stages, symptoms such as difficulties swallowing, Sore throat and Exhaustion. Ideally, you should go to the doctor now to see if it is getting worse (Exacerbation) to prevent.
In addition to sweating and fever, this also occurs a headache and stronger Weight loss on. On the one hand, this is due to the difficult food intake as a result of the difficulty swallowing, on the other hand, there a lot of energy is neededto heat the body above the physiological body temperature of around 37 degrees. True, there is a fever for the affected unpleasant, on the other hand it is a Defense Mechanism of the body to the Kill pathogens. There is almost no better method for combating pathogens, which is why fever should only be artificially lowered in extreme cases.
But there is also acute tonsillitis without a fever not to be taken less seriously: It can be a chronic form act, or as described above that Initial stage a fully developed tonsillitis. In conclusion, it remains to be said that every patient is of course different, and acute tonsillitis can occur without a fever, even if fever in itself to the classic symptoms counts.

Smoking during acute tonsillitis

The patient suffering from acute tonsillitis may wonder whether smoking makes one additionally damaging or healing effect on the course of the disease. This question must be answered with "Yes". Smoking disrupts the natural healing processes and can worsen symptoms such as a sore throat. In addition, the Mucous membranes already strongly irritated by the inflammation, so that the stimulus caused by smoking lengthen the illness greatly lengthen can. It takes about one to two weeks for acute tonsillitis to heal completely. During this time should stop smoking cigarettes completely waived become.

Acute tonsillitis in pregnancy

Tonsillitis in pregnancy

The pregnancy means one for the organism of the prospective mother special burden. Therefore, women in pregnancy are not uncommon for symptoms of acute tonsillitis such as Sore throat, Difficulty swallowing and fever affected. The increased susceptibility to infection is explained by the increased stress on the bodyto feed another growing organism. If acute tonsillitis is diagnosed, it usually heals just as it does in other people problem-free out. Treatment with Antibiotics and antipyretic agents however, should be carefully checked and discussed with a doctor, as some of the active ingredients harmful to the unborn child could be.

During pregnancy, women should always be on Do without pain relievers such as aspirin or ibuprofen. These are often used against pain and fever in acute tonsillitis, but they contain this in high doses Risk of serious complications. During the first two thirds of pregnancy with a doctor's consultation on these funds low dose can be used, there is one in the last third absolute contraindicationas there is bleeding that Labor be delayed and develop a heart defect in the child (premature closure of the Ductus arteriosus) can develop.
In addition, one is often required during acute tonsillitis Antibiotic therapy. This can be problematic during pregnancy because the wrong ingredients are used the most serious consequence of malformations in the child can stay behind. Well researched and usually against it during pregnancy Penicillins are unproblematic, which also play the main role in the treatment of acute tonsillitis.
Read more about the topic here: Antibiotics in Pregnancy

Is it a uncomplicated acute tonsillitis are known home remedies like Gargle with sage tea, leg compresses and plenty of drinking preferable to drug therapy.However, persistent tonsillitis may have to be treated with antibiotics due to the possible complications, although it cannot be sufficiently pointed out that the use of medication during pregnancy such as e.g. in acute tonsillitis only in consultation with a doctor should happen.

Acute tonsillitis in young children

Acute tonsillitis is a common condition especially with children. Especially toddlers, i.e. children in preschool age up to approx. 6 years often suffer from the unpleasant sore throat and difficulty swallowing that come with a fever. With children in particular, it is important to pay attention to some important measures.
The toddler should drink a lot despite the pain, Water, or tea are best. Also lightly numbing lozenges are useful against pain. It makes sense to see a pediatrician to avoid complications of untreated acute tonsillitis. In the worst case it comes to Heart and kidney damage as well as for rheumatic fever. Antibiotic therapy must be initiated. It is important to ensure that the infant is taking the drug takes even after the symptoms have subsidedto prevent reactivation.

When treating acute tonsillitis are also available antipyretic measures in focus. For one, stand Home remedies to disposal: cold calf compresses, wet towels for the head. If this is not enough, there are medications that can lower the fever. Here it must be remembered that on the toddler special needs enter into. Because of the danger of Reye's syndrome, should Aspirin in no case to children under 12 years of age are given. Alternatively, the active ingredient is available Ibuprofen to disposal. At Paracetamol must be limited to the limit dose of max. 60mg active ingredient per kg of body weight should be observed. Higher doses damage the liver.


A targeted prevention tonsillitis not possible.

However, you can try Risk factors for a disease to eliminate. A strong one immune system is always a basic requirement for a Avoid infection.
Influences like stress, lack of sleep and Smoke weaken the immune system and makes it prone to contagion.

In contrast, a vitamin-rich diet and lots of movement for a strong immune system. It is especially important in the throat area local defense of the mucous membranes to support. This is possible by refrains from alcohol and cigarette consumption and instead ensures that the mucous membranes are well moistened. Usually one is enough high humidity off, heating air, however, dries out the mucous membranes.
Is a adequate moisture retention of the mucous membranes due to an illness or after one chemotherapy not possible, can Lollipops and special spraysthat can replace the saliva provide relief. In the Naturopathy Oil pulls are also recommended as a preventive measure. This is done with a spoon Edible oil in the throat Gargled to reduce the bacterial density in the throat.