Tonsillitis

Tonsillitis is an inflammation of the palatine tonsils, usually caused by viruses and less often by bacteria. It typically presents with a sore throat, difficulty swallowing and fever. In a video consultation, the likelihood of a bacterial infection can be assessed using the Centor score and a camera-based inspection of the throat.

Medically reviewed by Adi Zoabi, Approbation als Arzt.
Last reviewed on August 31, 2026. Updated as clinical guidelines change.

Overview

Tonsillitis is an inflammation of the palatine tonsils, usually caused by viruses and less often by bacteria such as group A streptococci. Typical symptoms are a sore throat, difficulty swallowing, fever and swollen lymph nodes in the neck. Most cases of tonsillitis resolve on their own within one to two weeks. In the OpenClinic24 video consultation, the doctor takes a structured medical history and uses, among other tools, the Centor score, an established scoring system that estimates the likelihood of a streptococcal infection based on fever, tonsillar exudate, swollen cervical lymph nodes and the absence of cough. In addition, the throat can be inspected via the camera. On this basis, the next steps are discussed with you. Based on the doctor's assessment, a private prescription under the German GOÄ fee schedule may be issued, for example for pain-relieving agents or, if a bacterial infection is reasonably suspected, for an antibiotic. If you are unable to work, a sick note can also be issued.

Common causes

The most common cause of acute tonsillitis is viral, including common cold and influenza viruses as well as the Epstein-Barr virus, which causes glandular fever (infectious mononucleosis). Only a proportion of cases are caused by bacteria; the most relevant are group A beta-haemolytic streptococci. Transmission occurs mainly via droplets when coughing, sneezing or speaking, and through close contact. Contributing factors include a weakened immune system, dry mucous membranes, smoking and close contact with infected people, for example in schools or communal facilities. Children and young adults are particularly frequently affected. Recurrent tonsillitis may indicate chronic tonsillitis, which requires further in-person evaluation by an ENT specialist. Distinguishing between viral and bacterial causes is important, as antibiotics are only useful for bacterial infections.

When to see a doctor

You should seek medical advice if severe throat pain lasts longer than three days, if fever rises above 39 °C, or if your symptoms worsen despite self-care. Warning signs of complications such as a peritonsillar abscess include severe pain concentrated on one side of the throat, muffled speech, difficulty opening the mouth (trismus), increasing inability to swallow with drooling, and a pronounced feeling of illness. In these cases, prompt presentation at an ENT practice or emergency department is required, as a video consultation is not sufficient. If you experience shortness of breath, a wheezing or whistling sound when breathing, a feeling of choking, or can no longer swallow any liquids at all, call the emergency number 112 immediately. An in-person medical examination is also advisable if scarlet fever is suspected in children, if you have a known immune deficiency, or if symptoms do not subside after a course of antibiotics.

Symptoms & Indications

Sore throat, often radiating to the ears Pain when swallowing Red, swollen tonsils, sometimes with whitish coating Fever and chills Swollen, tender lymph nodes in the neck Bad breath Muffled, thick-sounding speech Fatigue and headache

Treatment Options

Physical rest and adequate fluid intake
Over-the-counter pain and fever medication such as non-steroidal anti-inflammatory drugs, after consulting a doctor
Locally numbing lozenges or gargle solutions
Soft, cool foods and throat compresses
Based on the doctor's assessment: an antibiotic if a streptococcal infection is reasonably suspected
Based on the doctor's assessment: a sick note (AU) in case of incapacity for work

Important Notes

A video inspection of the throat cannot fully replace a physical examination with a throat swab. If the findings are unclear, you will be advised to visit a practice in person.
Warning signs such as severe one-sided throat pain, difficulty opening the mouth, muffled speech or increasing inability to swallow may indicate a peritonsillar abscess and require prompt in-person examination.
If you experience shortness of breath, a feeling of choking, or can no longer swallow any liquids, call the emergency number 112 immediately.

HOW IT WORKS

How OpenClinic24 works

STEP 01

Complete the questionnaire

Brief details about your symptoms

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STEP 02

Doctor connects with you

Video consultation within minutes

STEP 03

Receive your documents

Prescription, sick note or referral, digitally

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Online consultation

Video consultation with licensed doctors.

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Medical notice: Not a substitute for an in-person medical examination. The information on this page is intended for general guidance only. In an emergency, please call 112.

Frequently Asked Questions

Can tonsillitis be assessed in a video consultation?

In many cases, yes. The doctor takes a structured medical history based on the Centor score and inspects your throat via the camera. With good lighting, redness, swelling and coating of the tonsils can often be assessed sufficiently. If the findings are unclear or warning signs are present, you will be advised to have an in-person examination.

Will I be prescribed an antibiotic?

That depends on the doctor's assessment. Most cases of tonsillitis are caused by viruses, against which antibiotics are not effective. If the Centor score and the examination findings suggest a bacterial streptococcal infection, a private prescription for an antibiotic may be issued based on the doctor's assessment. There is no entitlement to a specific prescription.

Can I get a sick note for tonsillitis?

Yes, this is possible. If the doctor determines during the video consultation that you are unable to work, a sick note (AU certificate) can be issued and provided to you digitally. Its duration depends on the course of the illness and the doctor's assessment.

What does the treatment cost and will my insurance cover it?

Billing is done as a private medical service according to the German fee schedule for physicians (GOÄ). Privately insured patients can usually submit the invoice to their health insurer; reimbursement depends on the individual plan. Patients with statutory insurance can use the service as self-payers. You will see the costs transparently before booking.

How long does tonsillitis last and how long am I contagious?

Acute tonsillitis usually subsides within one to two weeks. As long as symptoms such as fever and sore throat persist, you should avoid close contact with others and practise good hand and cough hygiene. If symptoms persist or keep recurring, further evaluation by an ENT specialist is advisable.