Your tonsils (you know, those two blobs of tissue at the back of your throat) are there for you through every cough, sneeze, and sniffle, battening down the hatches every time an infection tries to invade your body. But every so often, they become swollen and sore, and you might find yourself wondering how to return the favor.
Swollen tonsils—better known as tonsillitis—aren’t as common in adults as they are children, but they do happen. “There are many causes of tonsil swelling,” says Craig Zalvan, MD, associate professor of clinical otolaryngology at New York Medical College. “It’s almost always a benign process related to some type of inflammation—viruses, infections, allergies—that can either fluctuate or resolve with treatment.”
Knowing when to ride it out and when to see a doctor can be tricky, but there are a few things to keep in mind: “Tonsil swelling that comes and goes or resolves is generally less worrisome than swelling that persists or gets worse over time,” says Dr. Zalvan.
It’s also important to take note of other symptoms that are happening at the same time, such as a fever, weight loss, or lumps in the neck or other parts of the body. And if your tonsils are only swollen on one side with no other symptoms, definitely score a consult with an ear, nose, and throat specialist to get to the bottom of what’s going on.
As for what might be causing your tonsils to inflate? It could be a number of things. Here, doctors reveal potential causes of swollen tonsils that adults can experience, and exactly what to do about them.
1. You’re fighting a virus.
Viral tonsil infections are very common, says Clare Morrison, MD, general practitioner and medical advisor at MedExpress. There are several different strains of virus that can affect the tonsils and trigger swelling—influenza, adenovirus, Epstein-Barr (mono), herpes simplex—and they tend to go hand-in-hand with cold symptoms. Think: fever, headache, runny nose, sore throat.
When tonsillitis is caused by a virus, it’ll usually go away once your body’s fought off the infection (on average, within 10 days). While your body’s in battle mode, the best thing you can do is soothe your throat with plenty of fluids, salt water gargles, and the occasional acetaminophen or ibuprofen tablet.
2. Strep throat is lurking.
Though it’s not as common in adults, strep throat is a bacterial infection that can cause swollen tonsils and inflammation, says Dr. Zalvan. Besides difficulty swallowing, you might also experience bad breath and have trouble opening your mouth.
Left untreated, bacterial tonsillitis can lead to a more complicated infection that causes pus to collect around the capsule of the tonsil. “This infection may require intravenous antibiotics and a drainage procedure to remove the abscess,” says Brad DeSilva, MD, otolaryngologist at The Ohio State University Wexner Medical Center.
Because strep is sometimes associated with sinusitis, ear infections, and pneumonia, it can be hard to tell if your swollen tonsils are the victim of a viral or bacterial infection. If symptoms persist, Dr. DeSilva recommends having your doc run a rapid strep test to determine if antibiotics are needed.
3. Your tonsils need a good cleaning.
If, in addition to swollen tonsils, you’re experiencing a sensation of fullness in your throat, you might have what experts call tonsilloliths, or tonsil stones.
These yellow-white spots are pebbles that have a cheese-like quality to them, and are typically a result of tiny food particles building up in the nooks and crannies of the tonsils, says Dr. DeSilva. This can cause bacteria to grow, leading to swelling and all-around discomfort.
The fix? “Gargling with salt water or using a water pick is helpful for removing tonsil stones,” says DeSilva. You can also gently dig out extra-stubborn ones with a cotton swab or the back of your toothbrush, followed by regularly brushing and flossing to prevent new stones from setting up shop.
4. Stomach acid isn’t staying put.
Reflux that affects the throat is called laryngopharyngeal reflux (phew), or LPR. “LPR is a very common problem in the U.S., mostly from poor diet,” says Dr. Zalvan. When stomach acid travels up and into the throat on the regular, the chronic burning and irritation can cause sore and swollen tonsils.
You might also feel the need to clear your throat a lot, have trouble swallowing, or get saddled with a cough that just won’t quit.
If you suspect LPR is what’s messing with your tonsils, “avoid aggravating factors, such as acidic or spicy foods and drinks, caffeine, and alcohol,” says Dr. Morrison, who also recommends sleeping with sufficient pillows to keep yourself propped up, popping antacids as needed, and steering clear of tight-fitting waistbands.
5. Your allergies are acting up.
Environmental irritants like allergens, dust, and pollution can cause throat irritation and inflammation, but typically doesn’t cause significant tonsil swelling on its own, says Dr. Zalvan. These irritants can ban together with a person’s allergies or sinusitis, however, and trigger inflammation in the upper airway, lungs, and esophagus, leading to swollen tonsils.
Another sucky side effect that can cause swollen tonsils is post-nasal drip (that icky feeling of mucus running down the back of your throat). The throat irritation it spurs can also cause tissues in the throat to swell, including the tonsils, according to the American Academy of Otolaryngology.
It can be tough to figure out exactly what’s flaring up your sinuses solo—you may need to get an ear, nose, and throat exam by a specialist to nail down the culprit and start the appropriate treatment.
6. It’s a symptom of certain STDs.
Both syphilis and gonorrhea can flare up in the throat area. Syphilis usually appears as sores in the early stages, called chancres, and can crop up at the back of your throat, swelling your tonsils in the process. Symptoms of gonorrhea are more subtle, and can include mouth soreness and burning in the throat.
Although both STDs have been increasing in prevalence, they’re still considered uncommon, says Dr. Zalvan. The sooner you catch them, the easier they are to treat. If you suspect an STD might be the cause of your swollen tonsils, your doc can do a throat swab to be sure—and if positive, prescribe antibiotics, according to the American Dental Association.
7. Your swollen tonsil could potentially be a sign of cancer.
“Cancer is always the most concerning, and what most people are afraid of,” says Dr. Zalvan. Tonsil cancers are almost always concentrated on one side, and can present with swelling and pain with no other symptoms. (Though, can also present with throat pain, ear pain, bleeding, and a lump on the neck.)
Chronic smoking and alcohol used to be the most common cause of tonsil cancer. Now, they’re more commonly caused by the human papilloma virus (HPV), which have a far better rate of cure, Dr. Zalvan adds. This type of cancer is now completely preventable by getting the HPV vaccine.
Lymphoma, a cancer of the immune system, can also present with swollen tonsils: “It can be on one or both sides, often with lumps or lymph nodes in the neck, armpits, or groin,” says Dr. Zalvan. Your doctor will complete a thorough exam to determine what’s causing your swollen tonsils and map out the best course of action.
Should you have your tonsils removed?
These days, it’s not as common for tonsils to be removed. “Removal will only be considered if there are frequent bouts of pustular tonsillitis that require antibiotics—say, five or more attacks in one year,” says Dr. Morrison, especially if the infections don’t get better with treatment or they’re getting in the way of daily activities. Your doctor may refer you to a specialist, who will ultimately make the final decision regarding surgery.
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