What Your Tonsils Can Tell You About a Sore Throat

What Your Tonsils Do

The two pink, bumpy mounds at the back of your throat are your tonsils. Healthy tonsils look a little rough up close. Their surface is dotted with small pits, the openings of deep pockets called crypts that fold down into the tissue. Tonsil size varies, and both large and small tonsils can be healthy.

Your tonsils are made of lymphatic tissue, which also makes up the lymph nodes in your neck. They sit right where the air you breathe and the food you swallow enter your body. Their job is to sample germs as they come in, so your immune system can learn to recognize them.

Most of that sampling happens in the crypts. Cells lining the crypts take in tiny samples of the germs and other particles that pass over them and deliver them to immune cells beneath the surface. Those immune cells make antibodies against each germ and remember it for next time.

When a coworker coughs across the conference table, you breathe in some of the virus, and part of it lands on your tonsils. Your immune system starts building antibodies against that virus, and if it reaches you again, your body can respond faster. If you’ve had your tonsils removed, other lymphatic tissue, including tissue at the back of your nose and along the lining of your gut, does this same work.

What Happens When Your Tonsils are Fighting Infection

When your tonsils are fighting an infection, inflammation can make them look very different from healthy tonsils. Your body uses this same response anywhere it’s injured or infected. Blood vessels in the area widen to bring in more blood and immune cells, so the tissue turns red and feels warm. Fluid also leaks from those vessels into the surrounding tissue and causes swelling. Chemicals released during inflammation make nearby nerves more sensitive to pain.

In your tonsils, inflammation shows up as red, puffy tissue that can look much larger than usual. Every swallow presses on the swollen tonsils and causes pain. Your tonsils also drain into the lymph nodes in your neck, and those nodes often swell as they filter germs from the infection. You may feel them as tender lumps just under your jaw. White or yellow patches form on your tonsils when immune cells, dead cells, and fluid collect on their surface and inside the crypts.

If your tonsils are red and swollen with white or yellow patches, you most likely have tonsillitis. Viral and bacterial tonsillitis look the same, so you can’t tell which one you have by appearance alone. If white spots appear while you feel well, they may be tonsil stones instead.

Your doctor can identify the cause with a quick test, usually a throat swab for strep, the most common bacterial cause of tonsillitis. If the test is positive, your doctor will treat the infection with antibiotics. If it’s negative, another type of bacteria could still be responsible, but a virus is more likely. Antibiotics only work against bacteria, so viral tonsillitis clears up on its own as your immune system fights off the infection.

Frequently Asked Questions about Tonsils

Doctors hear a lot of questions about tonsils, both during a sore throat and after it clears up.

What are tonsil stones?

Tonsil stones are small white or yellow lumps that form when dead cells, mucus, bits of food, and bacteria collect in the crypts of your tonsils and harden. They’re common and usually harmless, and they tend to show up while you feel well, without a fever or other signs of illness. Bacteria in the stones give off sulfur compounds with a rotten-egg smell, so tonsil stones often cause bad breath. Small stones often work loose on their own, and scraping or poking at them can injure your tonsils. If stones keep coming back or start to bother you, talk with your primary care doctor.

Is tonsillitis contagious?

The viruses and bacteria that cause tonsillitis spread from person to person. They travel in droplets from coughs and sneezes and on shared objects. While you’re sick, you can protect the people around you by washing your hands often and covering your coughs and sneezes with a tissue or your elbow. Keep your cups, utensils, and toothbrush to yourself, and stay home from work until you’re feeling better.

Can you get strep if your tonsils have been removed?

Yes. Strep bacteria and the viruses behind most sore throats can still infect the lining of your throat after tonsil removal. Your doctor tests for and treats strep the same way whether or not you have tonsils.

Can large tonsils cause you to snore?

Yes, large tonsils are one of many possible causes of snoring. They narrow the airway at the back of your throat, and when your throat muscles relax during sleep, air moving through that tighter space makes the tissue vibrate. Large tonsils can also contribute to obstructive sleep apnea, a condition where the airway repeatedly narrows or closes during sleep and interrupts your breathing. If you snore loudly or wake up tired even after a full night in bed, talk with your primary care provider.

When to See Your Doctor About Your Tonsils

Where you go for tonsil trouble depends on what you’re noticing and how quickly it’s changing.

Your Primary Care Doctor

Your primary care doctor is the place to start for tonsil problems that keep coming back. Repeated bouts of tonsillitis or a steady return of tonsil stones form a pattern your doctor can track over time, and your doctor may refer you to an ear, nose, and throat specialist to talk through longer-term options. If a sore throat or swollen tonsils linger long after a cold has passed, schedule a visit.

Tonsils can differ a bit in size from side to side. If one tonsil looks noticeably larger than the other, especially with a lump in your neck or symptoms that stick around, let your primary care provider take a look. If anything about your tonsils worries you, your primary care doctor is glad to check it out.

An Urgent Care Clinic

Visit an urgent care doctor when tonsil symptoms come on quickly, such as a sore throat with fever, swollen tonsils, or white patches. A quick strep test can show whether you need antibiotics.

Go to urgent care the same day if you have severe pain on one side of your throat, trouble opening your mouth, or a muffled voice, as long as you can still swallow your saliva and breathe comfortably. These symptoms can point to swelling or a pocket of infection deep beside the tonsil. A muffled voice sounds thick and rounded, as if you’re talking around a mouthful of hot food. Swelling at the back of your throat causes that change, and it sounds different from the raspy voice that often comes with a cold.

If you don’t have a primary care doctor, an urgent care doctor can also help with tonsil problems that linger or keep coming back.

The Emergency Room

Go to the emergency room if you’re drooling or can’t swallow your own saliva, if you have trouble breathing or noisy breathing, or if your sore throat is getting worse quickly. Saliva is the easiest thing your throat handles, so swelling severe enough to block it can also narrow the space air passes through.

Some throat infections happen below the tonsils, where you can’t see them. If your throat hurts so much you can barely swallow, seek care right away, even if your tonsils look normal.

Whether your tonsils are red and swollen or you keep finding tonsil stones, MedHelp providers can help you figure out what’s going on. Our urgent care clinics across the Birmingham area welcome walk-ins seven days a week, so you can get a strep test without waiting for an appointment.

For tonsil problems that keep coming back, our primary care doctors are accepting new patients and can follow your care over time. Wherever you start, you’ll find compassionate providers who take the time to explain what’s happening and help you feel better.