Blisters on the tonsils can be unsettling. Understanding their potential causes can alleviate concern and guide appropriate steps. This article provides general information about tonsil blisters.
Common Causes
Blisters on the tonsils frequently result from viral infections. Herpes Simplex Virus (HSV), associated with cold sores, can cause raw, blister-like lesions on the tonsils. Coxsackievirus is another common culprit, especially in children, leading to Hand, Foot, and Mouth Disease or Herpangina. Hand, Foot, and Mouth Disease causes painful sores in the mouth and throat, including the tonsils, often with a rash on hands and feet. Herpangina features red-ringed blisters and ulcers primarily on the tonsils and soft palate. Other viruses, such as Epstein-Barr virus (Infectious Mononucleosis), adenovirus, and measles, can also cause tonsil lesions.
Bacterial infections can also cause lesions on or near the tonsils. Severe bacterial tonsillitis (strep throat) can sometimes result in pus pockets or abscesses mistaken for blisters. A peritonsillar abscess, a pus-filled collection near a tonsil, is often a complication of untreated tonsillitis or strep throat. This abscess can appear as a swollen, whitish blister and typically causes significant pain.
Fungal infections include oral thrush (candidiasis), an overgrowth of Candida albicans. This manifests as creamy white patches, sometimes resembling cottage cheese, which can spread to the tonsils, especially in individuals with weakened immune systems.
Less common, non-infectious causes include aphthous ulcers (canker sores). These small, painful sores, not contagious like cold sores, have a distinct red border with a white, gray, or yellowish center and can develop on the tonsils. Triggers include food sensitivities, stress, minor mouth injuries, or nutritional deficiencies.
Accompanying Symptoms
Tonsil blisters are often accompanied by other symptoms that provide clues about the underlying cause. Common symptoms include a sore throat, often with pain or discomfort when swallowing, fever, headache, fatigue, and swollen, tender lymph nodes in the neck.
Specific symptoms help differentiate the cause. Hand, Foot, and Mouth Disease often presents with a characteristic rash on hands and feet and poor appetite. Oral thrush may cause a cottony sensation, loss of taste, or burning discomfort; white patches might bleed if scraped. Peritonsillar abscess symptoms include severe, often one-sided, throat pain, difficulty opening the mouth, a muffled voice, and drooling. Canker sores might be preceded by a tingling or burning sensation and can cause stinging pain when acidic foods are consumed.
When to Seek Medical Attention
While many tonsil blisters resolve on their own, certain symptoms warrant prompt medical evaluation. Seek medical attention if there is severe difficulty swallowing or breathing. A high fever (above 102°F/39°C) or worsening pain also warrants medical attention.
Other warning signs include rapidly spreading blisters, persistent blisters that do not heal within a few days to a week, or any pus or drainage around the sores. Inability to drink fluids due to pain or discomfort, leading to dehydration, also warrants attention. Individuals with compromised immune systems, infants, or young children should seek medical advice readily, as they are more vulnerable to complications.
Diagnosis and Management
Diagnosing the cause of a tonsil blister begins with a physical examination of the throat by a healthcare professional. This visual inspection identifies lesion characteristics and associated signs of inflammation or infection. Bacterial infections like strep throat are confirmed with a rapid strep test or throat swab. Viral causes may use a viral swab or blood tests. If a peritonsillar abscess is suspected, imaging (e.g., ultrasound or CT scan) and needle aspiration may confirm and drain pus.
Management strategies for tonsil blisters focus on relieving symptoms while the underlying cause is addressed. Over-the-counter pain relievers (e.g., acetaminophen or ibuprofen) manage discomfort and fever. Warm salt water gargles can soothe and promote healing. Staying well-hydrated with fluids (e.g., cold beverages or milk products) eases swallowing and prevents dehydration. Consuming soft foods also reduces tonsil irritation.
Specific treatments depend on the identified cause. Antibiotics are prescribed only for bacterial infections, such as strep throat or peritonsillar abscesses. Antiviral medications might be considered for severe viral infections, but most viral causes are self-limiting and resolve with supportive care. For fungal infections like oral thrush, antifungal medications are prescribed. If a peritonsillar abscess is present, drainage of pus is often necessary alongside antibiotic treatment.