Tonsils- what do they do? and what problems can they cause?

Tonsils- what do they do? and what problems can they cause?

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Tonsils- what do they do? and what problems can they cause?

Authored by Dr Aifric Boylan on 14.05.2018
Medically Reviewed by Dr John Phillips
Last updated on 11.10.2018
Tonsil stones
Enlarged tonsils

What are tonsils?

The tonsils are two clumps of immune tissue located in the throat. They contain cells that fight infection and help defend the body from germs which enter the mouth and nose. Tonsils vary a lot in size- in some people they can be very small- so small in fact it may be hard to see them, while others may have quite large tonsils.

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What problems can you get with your tonsils?


Tonsillitis is when the tonsils become inflamed. This is most commonly due to a virus (80-90% of cases), but bacterial infection is to blame in about 10-20% of cases.

Symptoms of tonsillitis include

  • Pain, especially when swallowing
  • Tender and enlarged glands (lymph nodes) in the neck
  • Fever
  • Bad breath (halitosis)
  • Soreness in the neck

On examination, the throat and tonsils usually look red, enlarged and there may be white or yellowish spots or pus on them. Sometimes the tonsils may be so big they touch in the middle of the throat.

Because most cases are viral, antibiotics are not usually recommended.

If it is bacterial tonsillitis, the symptoms may be a bit more severe, and your doctor may be able to confirm the diagnosis with a throat swab. Some special throat swabs can give you a result on the spot- indicating whether it’s a viral or bacterial infection. This is useful, as it may help to avoid an unnecessary course of antibiotics.

If it is bacterial, the bug is almost always Streptococcus (that’s why people call it a “strep throat”), and a 10 day course of Penicillin is the standard treatment. Erythromycin is a common alternative if someone has a penicillin allergy.

Tonsillar abscess (Quinsy)

  • Tonsillar abscess (also known as “Quinsy” ) is a possible complication of tonsillitis.
  • An abscess containing pus forms near the infected tonsil, often leading to severe pain and swelling, as well as fevers and chills.
  • The pain will usually be worse on one side of the throat. Quinsy can be so painful that a person cannot swallow their own saliva, which can lead to drooling.
  • It may be hard to open the mouth and quite difficult to speak.
  • It’s a serious condition and usually requires treatment in hospital, which may involve intravenous antibiotics and surgical drainage of the abscess.

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Tonsil stones  (Tonsilloliths)

  • Also known as tonsilloliths, these are small hard white or yellow deposits that occur on the tonsils.
  • They can be formed from a build up of food particles, mucus, calcium and dead cells- and tend to build up in the natural hollow on the surface of the tonsil.
  • Quite often they cause no problems and may just be noticed when looking into the mouth.
  • Sometimes they lead to bad breath (halitosis) or discomfort.
  • They may be prevented by good oral and dental hygiene, not smoking, and staying well hydrated.
  • It’s not recommended to remove stones yourself- if you’re having a lot of trouble with them, it may be worth speaking to your doctor.

Tonsillar Hypertrophy (enlarged tonsils)

  • Tonsillar Hypertrophy means persistently enlarged tonsils.
  • Some people have naturally large tonsils, and it causes no symptoms or complications. For others, large tonsils can be a sign of infection, irritation or allergy.
  • Tonsillar Hypertrophy is very common in children, but most of the time there is no need to do anything about it as the problem often goes away over time.
  • However, if there is recurrent tonsillitis, mouth breathing, bad snoring, sleep apnoea or glue ear, sometimes a tonsillectomy may be considered.
  • Obviously if there are any underlying triggers such allergies, these should be addressed first.

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If you have concerns about enlarged tonsils, recurrent tonsillitis or other problems, speak to your doctor.

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About the Author:

Aifric Boylan
Dr Aifric Boylan is an experienced GP based in Melbourne. She completed medical school at Trinity College Dublin, Ireland, and undertook specialist training as a General Practitioner. She has 10 years experience working in General Practice and currently works as a full time family doctor in Melbourne, with a special interest in women’s health and paediatrics. She is a medical writer, covering common health issues in General Practice, as well as publications and opinion pieces in the medical press.

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