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Tonsillopharyngitis +t@n-su-lO-+far-un-!jIt-us

(Tonsillitis; Pharyngitis)

By Clarence T. Sasaki, MD

Tonsillopharyngitis is an infection of the throat and/or tonsils and is more common among children than adults.

  • This infection is usually caused by a virus.

  • Symptoms include severe pain with swallowing and swollen, red tonsils.

  • The diagnosis is based on an examination of the throat.

  • If untreated, tonsillopharyngitis that is caused by bacteria may become a tonsillar abscess.

  • Pain is relieved with analgesics, and a streptococcal infection is treated with antibiotics.

  • Sometimes the tonsils have to be surgically removed.

The tonsils contain tissue that is part of the body's immune defense system. Thus, the tonsils and nearby throat tissue frequently become infected by organisms that enter the nose and throat. People who have had their tonsils removed can still get throat infections.


Tonsillopharyngitis is usually caused by a virus. Most often, it is one of the viruses that cause the common cold, such as rhinovirus, adenovirus, influenza virus, or respiratory syncytial virus. Less often, another virus is involved, such as the Epstein-Barr virus (which causes mononucleosis—see Infectious Mononucleosis) or HIV.

In less than one third of people, tonsillopharyngitis is caused by a bacterial infection. Group A streptococcus (strep throat) is the most common bacterial cause, and usually occurs in children between age 5 and age 15. Strep throat is rare in children under age 3 and in older adults. Untreated strep throat sometimes causes complications. Complications can include tonsillar cellulitis or abscess (see Tonsillar Cellulitis and Abscess), rheumatic fever (see Rheumatic Fever), and kidney inflammation (glomerulonephritis—see Glomerulonephritis (Nephritic Syndrome)). Rarely, bacterial infections such as gonorrhea and diphtheria cause tonsillopharyngitis.


People have severe pain with swallowing and usually speaking. The pain is sometimes also felt in the ears. Some people have fever, headache, and an upset stomach. The tonsils are red and swollen and sometimes have white patches on them. Lymph nodes in the neck may become swollen and tender.

In people who have frequent tonsil infections, the normal small pits in the tonsils sometimes become filled with white, hardened secretions that resemble tiny stones. These stones can trap odor-causing bacteria, causing chronic bad breath, and can predispose people to subsequent bouts of tonsillitis.

People with a cold virus infection often have a runny, congested nose and a cough. People with mononucleosis often feel extremely tired and have many swollen lymph nodes.


Doctors recognize tonsillopharyngitis by viewing the throat. However, because viral infections and bacterial infections often cause the same appearance in the throat, it is difficult for doctors to know whether the cause is a viral or bacterial infection just by looking at the throat. However, people with a runny nose and cough are more likely to have a viral infection. Because it is important to identify strep throat (which requires antibiotics), doctors sometimes swab the person's throat and do tests to identify streptococcus bacteria. Typically, doctors test most children but test only adults who meet certain criteria.


Analgesics given by mouth, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), often help reduce pain. Some doctors also give a single injection of a corticosteroid, dexamethasone, which helps shorten the duration of symptoms. Throat lozenges and sprays may briefly reduce pain but only for a few minutes. Gargling with warm salt water has often been recommended but has not been shown to help.

People with a strep infection are given an antibiotic, usually penicillin or amoxicillin. People who are allergic to penicillin may be given clindamycin.


People who have repeated streptococcal infections of their tonsils may need to have their tonsils removed (tonsillectomy). Typically, it is children who need tonsillectomy, including children who have had more than 6 infections in 1 year, more than 4 infections per year for 2 years, or more than 3 infections per year for 3 years. Doctors do not use these specific criteria for adults. However, doctors may do tonsillectomy in adults who have severe bad breath due to tonsillar stones.

There are numerous effective techniques for tonsillectomy. Doctors can use a scalpel, an electrocautery device, or destroy the tonsils using radio waves. Less than 2% of people have bleeding complications resulting from a tonsillectomy. Bleeding typically occurs within 24 hours of surgery or after about 7 days. People who have bleeding after a tonsillectomy should go to a hospital.

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