A sore on the tonsil, appearing as a white spot, ulcer, or raised lesion, can be alarming. The palatine tonsils are two masses of lymphoid tissue located on either side of the throat that function as part of the body’s immune defense. While many lesions result from common, temporary conditions, they represent a wide spectrum of potential causes. Determining the origin depends on the sore’s specific appearance, accompanying symptoms, and duration.
Infectious Agents That Cause Tonsil Sores
The most frequent causes of tonsil lesions are contagious infections, involving viruses or bacteria. Viral infections account for a majority of tonsil inflammation. The Epstein-Barr Virus (EBV), which causes infectious mononucleosis, can lead to severe throat pain and swollen tonsils covered in a gray-white coating or patches. Mononucleosis is characterized by prolonged fatigue and notably swollen lymph nodes, which helps distinguish it.
Bacterial infections, most commonly Streptococcus pyogenes (Group A Strep), often present with red, swollen tonsils featuring white patches or streaks of pus. Unlike viral infections, Strep throat typically has a sudden onset and high fever, lacking the cough and nasal congestion of a common cold. The Herpes Simplex Virus (HSV) causes painful vesicles that quickly rupture, leaving shallow, gray-yellow ulcers on the tonsils and surrounding throat tissues. These infectious causes are accompanied by systemic symptoms like fever and body aches.
Non-Infectious Causes of Tonsil Lesions
Sores can arise from localized inflammation or trauma without a transmissible pathogen. Aphthous ulcers, commonly known as canker sores, are non-contagious lesions that occasionally develop on the tonsils or soft palate. These lesions typically appear as a small, single sore with a white or yellowish center and a distinct red border, often causing intense pain when swallowing. They are often triggered by stress, minor injury, or certain food sensitivities.
Another localized issue is the formation of tonsil stones, or tonsilloliths, which are calcified accumulations of trapped debris, bacteria, and dead cells within the tonsil crypts. These stones are usually white or yellow and can protrude from the tonsil tissue, mimicking a raised lesion. Mechanical irritation, such as scraping the throat with sharp food items or intense coughing, can create a temporary ulceration. Laryngopharyngeal Reflux (LPR), where stomach acid travels up the throat, can cause chronic irritation and inflammation, contributing to lesion development over time.
Warning Signs Indicating Serious Conditions
While most tonsil sores are benign, certain characteristics warrant immediate medical attention to rule out serious underlying conditions, such as malignancy. A lesion that persists for more than two weeks without healing is a primary warning signal. This persistence, combined with a sore that is firm, raised, or fixed to the underlying tissue, should prompt an evaluation for oral or tonsil cancer.
The presentation of a sore or significant swelling on only one tonsil, known as unilateral enlargement, is concerning and requires urgent investigation. Other associated symptoms that signal a need for consultation include unexplained weight loss, difficulty or pain when swallowing (dysphagia or odynophagia), or persistent one-sided ear pain. Although tonsil cancer, including types related to the Human Papillomavirus (HPV), is rare, prognosis is better with early detection.
Seeking Diagnosis and Treatment
A healthcare provider begins diagnosis with a thorough physical examination of the mouth and throat, often including palpation of the neck for swollen lymph nodes. To determine the cause of an infectious lesion, a rapid strep test or a throat culture may be performed by swabbing the tonsil surface. For complex or persistent lesions, a complete blood count (CBC) can help determine if the infection is bacterial or viral, and a biopsy may be necessary to examine the tissue cells microscopically.
Treatment depends directly on the underlying cause identified during diagnosis. If a bacterial infection like Strep is confirmed, a course of antibiotics, such as penicillin, is prescribed, and completing the entire course is necessary to prevent complications. Viral infections, the most common cause, do not respond to antibiotics and are managed with supportive care. This includes rest, hydration, and over-the-counter pain relievers like acetaminophen or ibuprofen. For non-infectious causes like trauma or canker sores, symptomatic relief with saltwater gargles and avoiding irritants is effective.