Lacunar tonsillitis: symptoms and treatment

The tonsils have small natural folds called crypts. During tonsillitis, mucus, inflammatory material or debris can collect in these folds and look like patches. The appearance alone cannot show whether the cause is viral or bacterial. Sore throat, fever, swollen neck glands, painful swallowing and bad breath may occur; earache can be referred from the throat.

Strep throat is one possible bacterial cause, but many sore-throat illnesses are viral. A clinician may examine your throat and consider a swab or other assessment based on symptoms and local practice.

Rest, drink regularly, and choose soft or cool foods if swallowing hurts. Follow the label for suitable pain relief and avoid sharing cups, cutlery or toothbrushes while ill. Do not scrape the tonsil patches, because this can irritate tissue and cause bleeding.

Arrange a [GP Consultation](/treatments/consultations-and-assessment/gp-consultation/) if symptoms are severe, do not improve, or make drinking difficult. [Antibiotic Treatment](/treatments/medical-management/antibiotic-treatment/) is used only when a clinician considers a bacterial infection likely or confirms it; antibiotics do not treat viral illness.

Seek emergency care for difficulty breathing, inability to swallow saliva, drooling, a muffled voice, severe one-sided throat pain, trouble opening the mouth, neck swelling, confusion or marked dehydration. Prompt medical advice is also needed for persistent high fever, worsening pain, or symptoms that return after improving.

Ask whether the pattern suggests viral tonsillitis or strep throat, whether testing is needed, and which pain-relief options suit you. Ask how long to stay away from close contact and what change should prompt review.