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.