Tonsillitis (Inflamed Tonsils) in Singapore: Diagnosing and Managing Throat Infections Effectively

What is Tonsillitis?

Tonsillitis is a medical condition where the tonsils, two small glands at the back of your throat, become swollen. These glands are crucial in trapping and fighting off harmful germs, particularly during childhood. Keep reading to learn more about effective treatments and tips for preventing tonsillitis in your daily life.

Feeling that scratchy tickle in your throat? If it hurts to swallow when you wake up, it might be tonsillitis. It’s a good idea to see your healthcare provider. Don’t worry: a little rest and the right medication can have you back to normal quickly.

What Causes Tonsillitis?

Most tonsillitis cases are due to viruses, including:

Adenovirus: A group of DNA viruses causing respiratory infections, conjunctivitis (inflammation of the eye’s membranes, causing redness and irritation), and other illnesses. Common in children.
Enterovirus: A group of RNA viruses that can cause mild to severe illnesses such as respiratory infections, hand, foot, and mouth disease (infection causing sores and rashes), and viral meningitis (inflammation of the membranes covering the brain and spinal cord). Highly contagious, they spread through direct contact with infected secretions or faeces. Symptoms vary but may include fever, sore throat, and rash.
HIV: Can weaken the immune system, making individuals more susceptible to infections like tonsillitis. Those with HIV may have more frequent and severe tonsillitis episodes. HIV spreads through contact with infected body fluids like blood and semen and is managed with antiretroviral therapy (treatment using medications).
Rhinovirus: An RNA virus responsible for the common cold. It leads to symptoms like runny nose and sneezing.
Influenza: Contagious respiratory illness caused by influenza viruses. Symptoms include fever, chills, headache, and muscle pain. It can lead to serious complications.
Respiratory syncytial virus (RSV): Contagious virus affecting the respiratory tract, especially in infants. Can cause bronchiolitis (inflammation of the small airways in the lungs, primarily in infants) and pneumonia (infection causing inflammation of the air sacs in one or both lungs).
Coronavirus subtypes: Includes SARS-CoV (causing SARS) and SARS-CoV-2 (causing COVID-19). Both impact the respiratory system.
Epstein-Barr virus (EBV): Common virus that spreads through saliva and body fluids. It can cause infectious mononucleosis (glandular fever, a viral infection causing fatigue, sore throat, fever) and is associated with conditions like swollen lymph nodes, sore throat, and fatigue.
Herpes simplex virus (HSV): A viral infection causing oral herpes (cold sores) or genital herpes. It spreads through direct contact and can lead to blisters, itching, and pain.
Cytomegalovirus (CMV): A common virus that usually causes mild or no symptoms. Severe infections can occur in infants, pregnant women, and people with weakened immune systems. It spreads through bodily fluids.

Viral tonsillitis often presents with milder symptoms.

Bacterial Infections

While less common, bacteria can also cause tonsillitis, notably:

Streptococcus pyogenes: Bacterium causing strep throat, skin infections, and other diseases. Commonly known as group A streptococcus.
Staphylococcus aureus: Gram-positive bacterium commonly found on the skin and in the upper respiratory tract. It can cause skin infections, abscesses (pockets of pus that form due to bacterial infections), and food poisoning.
Mycoplasma pneumonia: A type of bacteria causing atypical pneumonia with symptoms like cough, fever, and fatigue.
Chlamydia pneumonia: A bacterium causing respiratory infections, often mild or asymptomatic.
Bordetella pertussis: The bacterium responsible for whooping cough (pertussis), characterised by severe coughing fits.
Fusobacterium: A group of bacteria found in the mouth and throat, associated with various infections.
Neisseria gonorrhoeae: The bacterium causing gonorrhea, a sexually transmitted infection with symptoms like discharge and pain.

Bacterial tonsillitis, especially strep throat, generally results in more severe symptoms.

Types of Tonsillitis

Generally, tonsillitis is caused by infections with viruses, like the common cold or flu, or bacteria, such as Streptococcus. These pathogens (microorganisms such as bacteria, viruses, fungi, or parasites that cause disease in their hosts) lead to inflammation and swelling of the tonsils. Here’s a brief overview of the different types:

Type	Cause	Symptoms	Treatment
Viral Tonsillitis	Viruses like cold or flu	Sore throat, swollen tonsils, fever, difficulty swallowing	Rest, hydration, over-the-counter pain relievers
Bacterial Tonsillitis (Strep Throat)	Streptococcus bacteria	Severe sore throat, white/yellow tonsil patches, fever	Antibiotics, pain relief, rest
Acute Tonsillitis	Viral or bacterial infection	Intense, sudden symptoms	Symptom relief, resolves within a week
Recurrent Tonsillitis	Multiple acute episodes yearly	Similar to acute symptoms, frequent episodes	Medical evaluation, possibly surgery
Chronic Tonsillitis	Long-term inflammation	Chronic sore throat, bad breath, swollen lymph nodes	Hygiene, diet changes, potentially surgery

Tonsillitis Treatment Options

Medications

Viral Tonsillitis:

Typically managed with home remedies to relieve symptoms.

Bacterial Tonsillitis:

Antibiotics such as Amoxicillin or Penicillin are commonly prescribed. It is crucial to complete the full course of antibiotics to prevent recurrence of the infection.
Pain relievers like Paracetamol or Ibuprofen can help ease throat pain and fever.
Throat lozenges may be used to soothe the throat.
In cases of severe symptoms, such as difficulty swallowing, antibiotics might be administered via injection.
If someone tests positive for strep throat, they should complete at least 24 hours of antibiotic treatment before returning to school or work.

Additional Treatments:

Steroid medications might be used to reduce swelling of the tonsils.

Tonsillectomy

If you:

Often get tonsillitis
Have difficulty breathing
Keep getting strep throat (bacterial infection characterised by a sore, painful throat and swollen tonsils)
Have severe bad breath that smells like rotten eggs
Experience sleep apnea (disorder where breathing repeatedly stops and starts during sleep)
Have cancer in the tonsil area

You might need a tonsillectomy. This surgery removes your tonsils and is done under general anaesthesia, meaning you’ll be asleep and won’t feel pain. It takes about 30 to 45 minutes. After removing your tonsils, you’re likely to get fewer throat infections and feel better overall.

Tonsillectomy may be recommended for children experiencing:

More than six severe throat infections in one year
More than four severe throat infections per year over two years
More than two severe throat infections per year over three years

Tonsillectomy may be recommended for adults experiencing:

More than seven severe throat infections in one year
More than five severe throat infections per year over two years
Persistent sore throats that result in significant missed work or social engagements
Antibiotic therapy that is not effective in treating recurring throat infections
Complications from enlarged tonsils, such as breathing difficulties or sleep apnea

Tonsillitis Treatment Procedure

Before the Procedure

Consultation with an ENT Surgeon: Assess the frequency and severity of symptoms to determine the necessity of surgery after other treatments.
Pre-Surgical Instructions:
- Maintain good hygiene to prevent infections.
- Avoid sharing drinking glasses to minimise germ transmission.
- Discuss current medications, any history of bleeding disorders, and allergies or adverse reactions to anaesthesia.
Preparation for Surgery:
- Adjust or stop certain medications several days before surgery.
- Fast from midnight before the scheduled surgery day.
- Arrange transportation for post-surgery return home.
- Plan for a recovery period of 10 – 14 days or more.
Additional Pre-Surgical Evaluations:
- Possibly undergo a sleep study to address conditions like obstructive sleep apnea.
- Perform a complete blood cell count to identify the cause of infection and other necessary blood tests.
Final Recommendations: Based on test results, the doctor will recommend the best treatment approach tailored to your specific needs.

During the Procedure

A tonsillectomy is a quick surgery typically done under general anesthesia, so you won’t feel any pain. The procedure usually lasts between 30 to 45 minutes.
During surgery, a small cut is made in your throat to access and remove the tonsils.
The surgical team uses tools like a microscope and cautery (a tool used in surgery to burn tissue to stop bleeding) to minimise bleeding and carefully monitors your vital signs throughout the procedure.

After the Procedure

Post-Surgery Care:

Manage Pain: Use prescribed medications to manage pain effectively.
Diet and Hydration: Stick to a soft diet and stay hydrated to ease swallowing. Suitable foods include soups, smoothies, and yogurt.
Avoid Certain Foods: Avoid hot, spicy, or rough-textured foods like chips and nuts, as they can irritate your throat.

Recovery Tips:

Rest: Get plenty of rest and avoid strenuous activities to help speed up recovery.
Watch for Complications: Be alert for signs of infection, excessive bleeding, or dehydration.
Avoid Irritants: Stay away from smoke and allergens to keep throat irritation to a minimum.

Communication with Healthcare Provider:

Stay in Touch: Keep regular contact with your healthcare provider, especially if you encounter any issues during recovery.

Most patients recover within 1 to 2 weeks, experiencing some throat and ear pain during this time. Following these guidelines can help ensure a smoother recovery process.

Tonsillitis Symptoms

Common Symptoms Include:

Ulcers or painful blisters on your throat
Sore throat and painful swallowing (dysphagia)
Red, swollen tonsils, often with white or yellow spots or pus
Fever, cough, and headaches
Loss of appetite
Swollen neck glands (enlarged lymph nodes – small, bean-shaped glands that filter lymph fluid and help the body fight infections by trapping harmful pathogens)
Bad breath due to infection or tonsil stones
Earache and a scratchy or muffled voice
Difficulty swallowing, which may lead to drooling in very young children

Symptoms Specific to Children:

High fever and restlessness
Stomach issues like vomiting, diarrhoea, and abdominal pain
Stiff neck, possibly to avoid pain when swallowing
Increased irritability and excessive drooling, especially in very young children

Severe Symptoms:

Trouble breathing, potentially a serious complication from swollen tonsils
Stridor, a harsh, grating sound when breathing, often heard without a stethoscope.

Tonsillitis Risk Factors

Age-Related Susceptibility:

Children, especially those aged 5 to 15, are most at risk due to their developing immune systems and frequent germ exposure at schools or camps.
Very young children commonly get viral tonsillitis, while bacterial tonsillitis is more prevalent among children ages 5 to 15.
Elderly adults also face a higher risk of tonsillitis.

Exposure to Germs:

Children in school settings and adults working in close contact with children, like teachers, are more susceptible due to increased exposure to germs.

Environmental Factors:

Hot weather and high levels of smog may increase the risk of tonsillitis, although humidity seems to have no significant effect.

Immune System Variability:

- Some individuals are more prone to recurring bacterial tonsillitis due to the specific balance of immune cells their bodies produce.

Diagnosing Tonsillitis

During a physical examination, your doctor will check for throat redness, swelling, and tender lymph nodes to identify signs of infection.
The rapid strep test checks for Streptococcus bacteria, commonly linked to tonsillitis. During the test, the doctor swabs the back of the throat and tests the swab for these specific bacteria. Results are usually available within minutes.
A throat swab will be taken to detect bacterial infections like group A streptococcus, helping to determine the appropriate antibiotic treatment.
Additional tests, such as a Complete Blood Count (CBC), help differentiate between viral and bacterial tonsillitis; a rise in lymphocytes (key components of the immune system, involved in targeting specific pathogens) suggests a viral infection, while increased neutrophils (white blood cells that act as the first line of defence against infections) indicate a bacterial infection.

Centor Criteria is a 4-point scoring system that helps them figure out how likely it is that someone has streptococcal pharyngitis, a type of throat infection.
- Fever ≥ 38 °C
- Absence of cough
- Swollen anterior cervical lymph nodes (group of nodes found at the front of the neck)
- Tonsillar exudates (fluid secreted by the tonsils in response to infection or inflammation) or swelling
For severe cases, specific blood tests may be conducted to identify particular bacteria or pathogens. Rapid tests can quickly identify infections like influenza (highly contagious viral infection that affects the respiratory system) and RSV (common virus that causes respiratory infections, especially in children), or Streptococcus A, aiding in selecting the proper treatment, including antiviral medications.
These tests guide the management and treatment of tonsillitis effectively.

Tonsillitis Risks

Severe Infections: Acute tonsillitis, especially from streptococcal bacteria, is severe and requires prompt treatment to prevent escalation.
High Contagion Level: Tonsillitis is highly contagious, primarily affecting children, which necessitates frequent medical attention.
Immediate Symptoms: Common immediate symptoms include severe sore throat and significant difficulty swallowing, which can quickly reduce quality of life.
Potential for Worsening Conditions: If not treated early, there’s a risk of developing more complex conditions like poststreptococcal reactive arthritis ( inflammation of one or more joints, which leads to pain, swelling, stiffness, and limited movement, occuring after a streptococcal infection).
Necessity for Swift Action: Quick and accurate diagnosis and treatment are crucial to manage symptoms and prevent further complications such as the spread of infection or the development of abscesses.

Tonsillitis Complications

Rheumatic Fever: Can develop in children aged 5 to 15, potentially leading to heart disease. It is a serious condition that can also affect the joints, nervous system, and skin.
Scarlet Fever and Reactive Arthritis: Untreated streptococcal tonsillitis (bacterial infection causing sore throat, red tonsils, and possibly fever) can lead to scarlet fever (bacterial illness that causes a distinctive red rash, sore throat, and fever), and poststreptococcal reactive arthritis, causing joint pain and swelling within 10 days of a strep infection.
Spread of Infection: The infection may spread to the chest, causing pneumonia, or to the neck, leading to a deep neck space infection (serious infection occurring in the potential spaces and tissues of the neck, often requiring prompt medical attention) like tonsillar cellulitis (bacterial infection of the tissues around the tonsils, causing redness and swelling).
Peritonsillar Abscess (Quinsy): A severe buildup of pus near the tonsils, affecting swallowing and breathing, often accompanied by fever, neck pain, and difficulty opening the mouth.
Obstructive Sleep Apnea: Disrupted breathing during sleep caused by inflamed or swollen tonsils.
Kidney Inflammation: Rare complication such as poststreptococcal glomerulonephritis (kidney inflammation following a strep infection, potentially leading to urine changes and swelling), where the filtering mechanisms of the kidneys swell.
Middle Ear Infection: Commonly occurs as a complication of tonsillitis, especially in cases of bacterial infections.
Tonsil Stones: Small lumps that form on the tonsils, which can cause bad breath.

Comparison of Tonsillitis with Pharyngitis, Strep Throat and Sore Throat

Feature	Tonsillitis	Pharyngitis	Strep Throat	Sore Throat
Location	Tonsils (back of the throat)	Pharynx (throat area behind the mouth)	Throat and tonsils	Throat
Causes	Viral or bacterial infections	Mostly viral infections, sometimes bacterial	Bacterial infection (Streptococcus)	Viral infections, allergies, dry air, irritants
Symptoms	Sore throat, swollen tonsils, fever, swollen glands	Sore throat, redness, fever, swollen glands Does not involve swollen tonsils, typically featuring pain	Severe sore throat, fever, swollen lymph nodes in the neck, white patches on tonsils	Mild to moderate sore throat, cough, sneezing
Appearance	Red, swollen tonsils with white or yellow spots	Red, inflamed throat, no specific spots	Red throat with white or yellow spots	Red and swollen throat without spots
Treatment	Rest, hydration, pain relief, antibiotics if bacterial	Rest, hydration, pain relief, antibiotics if bacterial	Antibiotics, rest, hydration	Hydration, lozenges, over-the-counter pain relievers
Complications	May lead to breathing difficulties, sleep apnea	Less likely to cause severe complications	Rheumatic fever, kidney inflammation	Usually none; may lead to sinusitis (inflammation of the sinus linings, often causing congestion, pain, and nasal discharge) or ear infections if prolonged

When is Tonsillitis An Emergency?

Visit a doctor for your child’s first instance of tonsillitis. Recurrent tonsillitis that typically resolves at home may not always require a doctor’s visit.

For both children and adults, seek medical advice if:

Fever exceeds 38°C.
Pain increases despite using pain relievers.
Any other concerning symptoms arise.

Immediate medical attention is necessary for:

Difficulty breathing, swallowing saliva, or speaking.
Excessive drooling or severe throat pain.
Persistent sore throat lasting more than 24 hours.
Severe pain that interferes with eating or drinking.
Swelling in the mouth that complicates breathing or swallowing.
Extreme weakness or fever lasting more than four days.
Throat pain that worsens or is one-sided.
Visible pus near the tonsils, indicating a possible bacterial infection.
Accompanying symptoms like fever, earache, or neck pain.

Don’t hesitate to seek urgent care, as tonsillitis can lead to severe complications like sepsis or breathing difficulties.

Cost of Tonsillitis Treatment in Singapore

In Singapore, tonsillectomy costs between SGD 3,000 to SGD 6,000.
Medication for tonsillitis costs between SGD 5 to SGD 20 for a course of treatment.
Subsidies are available in public hospitals under MediSave and Integrated Shield Plan.
Prices vary for private clinics, so it’s best to check with the specific clinic directly.
Your insurance provider may cover part of the cost.

Are There Subsidies For Tonsillitis Treatment in Singapore?

Singapore Citizens and Permanent Residents diagnosed with tonsillitis can benefit from a flat subsidised rate of SGD 10 for consultation and treatment at polyclinics and Primary Care Network (PHPC) clinics.

Why Choose Nuffield ENT For Tonsillitis Treatment?

Established brand: Nuffield ENT has been providing our services to people in Singapore since 2008.
Expertise: Our ENT specialists have extensive experience in managing tonsillitis and related conditions.
Comprehensive Care: Nuffield offers a holistic approach, addressing pain relief, antibiotics (if needed), and post-operative recovery.
Convenient Locations: Located centrally in Orchard, Wheelock Place, Nuffield provides accessible care for patients of all ages.

Tonsillitis Treatment Before and After

Tonsillitis might seem intimidating, but we’re here to guide you through every step. Our collection of before and after photos showcases the transformations our patients have experienced. Book an appointment with us at +65 6950 2869 today 🙂

Preventing Tonsillitis

Practice Good Hygiene: Wash hands regularly, avoid sharing personal items like glasses or toothbrushes, and minimise exposure to environmental irritants such as tobacco smoke.
Stay Current with Vaccinations: Updated vaccines can prevent the viral infections that often lead to tonsillitis.
Maintain a Healthy Diet and Stay Hydrated: Eating well and drinking plenty of fluids bolster the immune system and help keep the throat moist, reducing the risk and discomfort of tonsil inflammation. Opt for warm, caffeine-free beverages to soothe the throat.
Use Simple Home Remedies: Rest, gargle with saltwater, and use humidifiers or steam to relieve throat discomfort.
Special Considerations for Children: Ensure children practice frequent handwashing and keep them away from sick peers. Avoid sharing their food, drinks, or utensils, and change their toothbrushes post-recovery. Teach them to sneeze or cough into their elbow and keep them home when ill, consulting a doctor about the appropriate time to return to school.

FAQs

1. How Long Does Tonsillitis Last?

Tonsillitis typically lasts about 7 to 10 days. It can be shorter with antibiotics if caused by bacteria. Rest, fluids, and pain relief can help recovery.

2. How to Cure Tonsillitis in 4 Hours?

Unfortunately, it’s not possible to cure tonsillitis in just 4 hours. However, to ease symptoms quickly, gargle warm salt water, stay hydrated, rest, and suck on throat lozenges. If symptoms worsen, see a doctor.

3. Can Tonsillitis Go Away On Its Own?

Yes, most cases of viral tonsillitis resolve without specific treatments, though supportive care like hydration and rest helps. If your symptoms persist, we recommend seeing a doctor.

4. Is Tonsillitis Contagious?

Yes, tonsillitis is contagious and can spread through droplets in the air or by sharing food and drinks.

5. Can I Kiss Someone if I Have Tonsillitis?

No, kissing should be avoided because tonsillitis can be spread through saliva.

6. What Happens If You Leave Tonsillitis Untreated?

If left untreated, tonsillitis can lead to complications like abscess formation, swollen lymph nodes, and spreading infection.

7. How to Remove Tonsils at Home?

Tonsils should never be removed at home; surgical removal is done by medical professionals under sterile conditions to prevent complications.

8. How Do I Know if My Tonsillitis is Viral or Bacterial?

Diagnosis between viral and bacterial tonsillitis requires medical evaluation, including symptoms assessment and possibly a throat swab.

9. Can You Get Tonsillitis From Oral Sex?

Yes, tonsillitis can be transmitted through oral contact, including oral sex, if pathogens are present.

Medical References

Norton, Laura, and Angela Myers. “The Treatment of Streptococcal Tonsillitis/Pharyngitis in Young Children.” World Journal of Otorhinolaryngology-head and Neck Surgery, vol. 7, no. 3, July 2021, pp. 161–65, doi:10.1016/j.wjorl.2021.05.005.

Tzelnick, Sharon, et al. “Long‐term Outcomes of Tonsillectomy for Recurrent Tonsillitis in Adults.”The Laryngoscope, vol. 130, no. 2, Mar. 2019, pp. 328–31, doi:10.1002/lary.27928.

Vuralkan, F. Başkan, Nuray Bayar Muluk, and T. Sih. “Tonsillitis.” Airway Diseases, edited by Cemal Cingi et al., Springer, Cham, 2023. doi:10.1007/978-3-031-22483-6_33-1.