Tonsillitis Treatment in Sydney

Tonsillitis is inflammation and infection of the palatine tonsils: the two oval-shaped pads of tissue at the back of the throat that form part of the body's immune defence. It is one of the most common reasons for GP visits and ENT referrals in Australia, particularly in children and young adults. While most episodes resolve with conservative treatment, recurrent or chronic tonsillitis may require surgical removal of the tonsils (tonsillectomy).

Symptoms of Tonsillitis

Tonsillitis symptoms range from mild to severe and typically develop over one to two days:

Sore throat: often severe, making swallowing painful
Red, swollen tonsils, sometimes with white or yellow patches (exudate) or pus
Fever, often above 38 degrees Celsius
Painful, swollen lymph nodes (glands) in the neck
Difficulty swallowing solids and sometimes liquids
Muffled or "hot potato" voice
Headache, earache (referred pain from the throat), and general malaise
Bad breath (halitosis)
In young children: drooling, refusal to eat, and irritability

Types of Tonsillitis

Tonsillitis is classified by its pattern and duration:

Acute tonsillitis: a single episode of tonsil infection, usually viral or bacterial, lasting 7 to 10 days
Recurrent tonsillitis: multiple episodes of acute tonsillitis per year, significantly disrupting school, work and quality of life
Chronic tonsillitis: persistent low-grade tonsil inflammation with symptoms such as chronic sore throat, bad breath, tonsil stones (tonsilloliths) and persistent tender neck lymph nodes

Causes

Tonsillitis is caused by viral or bacterial infections:

Viral causes: the majority of cases are viral, including rhinovirus, adenovirus, influenza, parainfluenza, and Epstein-Barr virus (which causes glandular fever/infectious mononucleosis)
Bacterial causes: Group A Streptococcus (GAS) is the most important bacterial cause, responsible for approximately 15 to 30 percent of tonsillitis in children and 5 to 15 percent in adults. Streptococcal tonsillitis is important to identify and treat because of the small risk of rheumatic fever and post-streptococcal glomerulonephritis

The tonsils are exposed to a constant stream of pathogens entering through the mouth and nose. While they play a role in immune defence in early childhood, this role diminishes with age, and removing them does not significantly impair the immune system.

Diagnosis

At Central Sydney ENT, diagnosis of tonsillitis is based on:

Clinical examination: Direct inspection of the throat reveals red, swollen tonsils, often with exudate. Your ENT surgeon will assess for signs of complications such as peritonsillar abscess (quinsy), where one tonsil is significantly more swollen and pushed towards the midline with trismus (difficulty opening the mouth).

Throat swab and rapid antigen testing: A throat swab can identify Group A Streptococcus, guiding the decision to prescribe antibiotics. Rapid antigen detection tests provide results within minutes, while culture takes 24 to 48 hours.

Blood tests: A full blood count and monospot test may be requested if glandular fever (Epstein-Barr virus) is suspected, particularly in teenagers and young adults with prolonged symptoms, significant fatigue and enlarged tonsils.

Documentation of episodes: For patients being considered for tonsillectomy, a record of the frequency and severity of tonsillitis episodes over the preceding 12 to 36 months is important. Your GP can help document this history.

Treatment Options

Conservative Management

Most episodes of acute tonsillitis are managed conservatively with rest, adequate fluid intake, regular paracetamol and ibuprofen for pain and fever, and throat lozenges or gargles for symptomatic relief. Viral tonsillitis does not require antibiotics.

Antibiotics

Antibiotics are prescribed when bacterial tonsillitis is confirmed or strongly suspected. Phenoxymethylpenicillin (penicillin V) is the first-line antibiotic for streptococcal tonsillitis in Australia. A full 10-day course is important to eradicate the infection and reduce the risk of complications. Amoxicillin should be avoided if glandular fever is suspected, as it can cause a widespread rash.

Tonsillectomy

Tonsillectomy, surgical removal of the tonsils, is the definitive treatment for recurrent and chronic tonsillitis. The widely accepted indications (Paradise criteria) include:

Seven or more documented episodes of tonsillitis in the past year
Five or more episodes per year for two consecutive years
Three or more episodes per year for three consecutive years
Peritonsillar abscess (quinsy)
Tonsil enlargement causing obstructive sleep apnoea or significant swallowing difficulty
Suspected tonsil malignancy (asymmetric enlargement)

The operation is performed under general anaesthesia as a day procedure. Techniques include cold steel dissection, bipolar electrocautery, and coblation. Recovery takes approximately 10 to 14 days, with throat pain being most significant in the first week.

Our ENT surgeons, including Dr Alexander Zhang, Dr Jareen Ebenezer, Dr Arjuna Ananda and Dr Sam Hwang, perform tonsillectomy for both children and adults across seven Sydney locations.

When to See an ENT Specialist

You should seek a referral to an ENT specialist if:

You or your child experience frequent episodes of tonsillitis (more than three per year)
Tonsillitis episodes are causing significant time off school or work
You have had a peritonsillar abscess (quinsy)
Your tonsils are significantly enlarged and affecting breathing or swallowing
You have chronic symptoms of sore throat, bad breath or tonsil stones that do not resolve
One tonsil is noticeably larger than the other

Related Conditions

Tonsillitis is closely linked to several other conditions treated at Central Sydney ENT:

Adenoid Hypertrophy: enlarged adenoids often coexist with tonsil problems, particularly in children, and may be removed at the same time as tonsillectomy
Peritonsillar Abscess (Quinsy): a complication of tonsillitis where pus collects beside the tonsil, requiring drainage
Snoring and Sleep Apnoea: enlarged tonsils are a common cause of snoring and obstructive sleep apnoea in children

Common Questions

Tonsillitis FAQ

When should tonsils be removed? +

Tonsillectomy is generally recommended when a patient experiences seven or more documented episodes of tonsillitis in one year, five or more per year for two consecutive years, or three or more per year for three consecutive years (the Paradise criteria). It is also recommended for peritonsillar abscess, significant tonsil asymmetry requiring biopsy, or tonsils so large they obstruct breathing or swallowing.

Is tonsillitis caused by bacteria or a virus? +

Both. Most cases of acute tonsillitis are caused by viruses such as rhinovirus, adenovirus, influenza, or Epstein-Barr virus. Bacterial tonsillitis accounts for about 15 to 30 percent of cases in children and 5 to 15 percent in adults, with Group A Streptococcus (Strep throat) being the most common bacterial cause. A throat swab can help distinguish bacterial from viral tonsillitis.

How long does tonsillitis last? +

Acute viral tonsillitis typically resolves within 7 to 10 days with supportive care. Bacterial tonsillitis treated with appropriate antibiotics usually improves within 2 to 3 days, though the full course of antibiotics should be completed. Chronic tonsillitis may cause persistent low-grade symptoms including sore throat, bad breath, and tonsil stones that do not fully resolve between episodes.

What is recovery like after tonsillectomy? +

Recovery from tonsillectomy typically takes 10 to 14 days. Throat pain is worst in the first week and often temporarily worsens around days 5 to 7 as the scabs in the throat begin to separate. Adequate pain relief, plenty of fluids, soft foods, and rest are important during recovery. Most adults take two weeks off work. Children usually recover faster than adults.

Can adults have their tonsils removed? +

Yes. While tonsillectomy is more commonly performed in children, adults with recurrent or chronic tonsillitis, peritonsillar abscess, or obstructive tonsil enlargement benefit from the procedure. Recovery tends to be more uncomfortable and slightly longer in adults compared to children, but the operation is safe and effective at any age.