Complications That Can Result From Tonsillitis

Your tonsils are the two lumps of lymphoid tissue located in the back of your throat that function as part of your immune system to keep germs and other foreign particles from slipping down your throat. (1) When the tonsils become inflamed and infected, the condition is known as tonsillitis. (2)

Tonsillitis can be caused by a viral infection or bacterial infection (like strep throat), and most of the time it goes away in a week or less.

Still, there can be complications from tonsillitis that require medical attention. And, rarely, there are cases in which a life-threatening illness can have some of the same symptoms as tonsillitis. If you have tonsillitis that doesn’t get better on its own with at-home management, or seems to keep coming back, be sure to consult your doctor or healthcare provider to see if you need other treatment.

The most notable risk of tonsillitis is that it can cause you to get sicker and sicker, says James Clark, MBBCh, assistant professor of otolaryngology at Johns Hopkins Medicine in Baltimore. “If you have a true bacterial infection in your tonsils, it works just like any other bacterial infection,” he says.

If bacterial infections do not go away on their own, they can continue to worsen and spread throughout the body. The risks of this are incredibly low, but it’s why you should see your doctor if tonsillitis does not clear up on its own in a week, Dr. Clark adds.

Here are a few other complications that can result from tonsillitis. Note that they are more common in people who have tonsillitis repeatedly or if it becomes chronic.

An estimated 2 to 4 percent of the adult population has obstructive sleep apnea, which is when the upper airway collapses repeatedly while a person is sleeping. This interruption leads to poor sleep quality and daytime tiredness, and is also associated with a significant cardiovascular morbidity and mortality. (3)

Sleep apnea can result from very enlarged tonsils that prevent normal breathing during sleep. Tonsillitis, which can cause the tonsils to become enlarged because of the infection and inflammation, is therefore a potential cause of sleep apnea (either temporarily or permanently, if tonsillitis is recurrent or causes lasting inflammation in the tonsils). (4)

“During an infection when tonsils are swollen, it can cause temporary sleep apnea,” Clark says. This complication can happen to both children and adults, Clark says. And particularly in children, removing the tonsils (tonsillectomy) may be recommended to cure the sleep apnea, which might otherwise turn into a chronic problem.

Another complication is that a tonsil infection can develop into a secondary infection of the middle ear. The tonsils that are visible behind your tongue when you open your mouth are just one part of a bigger collection of lymphoid tissue known as the Waldeyer’s tonsillar ring (including the palatine, adenoid, tubal, and lingual tonsils), Clark explains. (1) “When we get an episode of tonsillitis, all this tissue increases in size,” he explains.

The middle ear is a sealed cavity with only one opening, called the Eustachian tube. The adenoid tissue, or the highest part of your tonsils is located in the back of the nose and is next to the Eustachian tube.

When the adenoid tissue becomes swollen from an infection it can block the Eustachian tube and result in pressure buildup in the ear. “This can cause an effusion (or accumulation of fluid) in the ear, which can then get infected,” Clark explains.

If strep throat or tonsillitis does not go away (either on their own or with tonsillitis treatment), either type of infection can progress into an infection called tonsillar cellulitis. Tonsillar cellulitis can in some cases cause pus to accumulate around the tonsils, which is called peritonsillar abscess (sometimes referred to as quinsy). (5) “This abscess in the space behind the tonsil can cause compression of the airway, which is very painful,” Clark explains.

Symptoms of peritonsillar abscess include fever, throat pain, and even lockjaw. (6) “It’s typically associated with just one side, so we look for asymmetry,” explains Clark. “When this occurs, we have to drain it to help relieve the infection,” he adds.

If tonsillitis is caused by a strep throat infection, the bacteria can get into the blood system and cause a condition called rheumatic fever — an inflammatory disorder primarily found in children between the ages of 6 and 16. (7)

This condition can affect the heart, joints, and other tissues and sometimes causes permanent damage. Symptoms include sore throat, swollen and red tonsils, fever, headache, and muscle and joint aches. (8)

The damage to the heart valve, known as rheumatic heart disease, can affect you for the rest of your life, says Clark. “If your heart has been injured in this way, any type of surgery you undergo where there’s the potential for an infection or sepsis in the blood, you would have to be given antibiotics,” he says.

This step is to prevent bacteria from growing into the damaged heart valve, which would cause further damage and issues, Clark explains.

Post-streptococcal glomerulonephritis (PSGN) is an inflammatory disorder of the kidneys that can develop after a strep throat infection. Anyone can get it after recovering from strep throat, scarlet fever, or impetigo, but it’s more common in children than adults. (9) The disorder causes the kidneys to work less efficiently.

People with PSGN usually recover in a few weeks without any additional or lasting complications, though in very rare cases long-term kidney damage (or potentially kidney failure) can occur. (9)

While there is no link between tonsillitis and cancer, sometimes they may have similar symptoms. If an adult comes in complaining of tonsillitis that doesn’t seem to go away or has a chronic sore throat, those symptoms may be a sign of something more serious, such as cancer.

Adults don’t commonly get tonsillitis, so there is a concern that when it does appear, the symptoms may actually be something else masquerading as tonsillitis, says Nicholas Rowan, MD, associate professor of otolaryngology at John Hopkins Medicine in Baltimore.

“If a middle-aged man comes in complaining of tonsillitis or reoccurring tonsillitis, I want to be certain that their symptoms improve to ensure that he doesn’t have an underlying problem, such as throat or tonsil cancer,” says Dr. Rowan — adding that in general the symptoms do not end up being cancer.

But he says that even if the chances are small, it is important to rule out those more serious complications if tonsillitis symptoms do not go away or the infections appears to keep recurring.

The Takeaway

Tonsillitis, which occurs when the tonsils become inflamed, can potentially lead to complications like sleep apnea, ear infections, and even more severe issues like a peritonsillar abscess. Most of the time, tonsillitis resolves on its own within a week, but persistent or recurring symptoms may require medical attention. If you notice your symptoms aren’t improving, reach out to your healthcare provider for further guidance.

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