White Spots on the Tonsils
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Try one of these related symptoms.
White spots at the back of the throat
Cheese-like layers on tonsils
White streaks in throat
Tonsillar exudates
Cheese-like layers on side of the throat
Possible Causes
Generally, White spots on the tonsils can be related to:
- Acute Tonsillitis / Pharyngitis
Infection of the tonsils and pharynx (back of the mouth), either by viruses or bacteria.
Related Serious Diseases
Sometimes, White spots on the tonsils may be related to these serious diseases:
- Peritonsillar Abscess / Deep Neck Abscess
A bacterial infection of the areas around the tonsils and deep parts of the neck. Pus accumulates in these areas forming an abscess.
- Infectious Mononucleosis
Doctor's Diagnostic Questions
Your doctor may ask these questions to check for this symptom:
- Do you have white coating or film in the back of your throat?
- How long have you had white, cheese-like spots on your tonsils?
Reviewed By:
Eric A. Gantwerker, MD, MMSC (Otolaryngology (ENT))
Pediatric Otolaryngologist at Northwell Health and Associate Professor of Otolaryngology at Zucker School of Medicine at Hofstra/Northwell. He holds a Master of Medical Science (MMSc) in Medical Education with a special focus on educational technology, educational research, and game-based learning from Harvard Medical School and a Master of Science in Physiology and Biophysics from Georgetown University. He has a special interest in faculty development and has been a speaker or faculty at hundreds of local, national, and international courses and conferences. He is also an active blogger and podcaster for several organizations, including the Harvard Macy Institute (HMI), Harvard Medical School CME Online, and BackTable Innovations. He has been featured in the news and print for media outlets such as USA Today, Businesswire, The Washington Post, Nature Medicine, Fox News, and KevinMD. He was also the Vice President, Medical Director of a medical video game company, Level Ex from 2018 to 2023 that utilized game technology and psychology to create interactive experiences for healthcare professionals. | He is recognized as an expert on the implementation of educational technologies and gaming with a foundation in educational theory for health professions education. He was honored to be inducted as an Associate Member of the American College of Surgeons (ACS) Academy of Master Surgeon Educators and as an Associate Fellow of the Association for Medical Education in Europe (AMEE).
Yoshinori Abe, MD (Internal Medicine)
Dr. Abe graduated from The University of Tokyo School of Medicine in 2015. He completed his residency at the Tokyo Metropolitan Health and Longevity Medical Center. He co-founded Ubie, Inc. in May 2017, where he currently serves as CEO & product owner at Ubie. Since December 2019, he has been a member of the Special Committee for Activation of Research in Emergency AI of the Japanese Association for Acute Medicine. | | Dr. Abe has been elected in the 2020 Forbes 30 Under 30 Asia Healthcare & Science category.
Content updated on Feb 6, 2025
Following the Medical Content Editorial Policy
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FAQs
Q.
Tonsil Stones in Your 30s & 40s: Relief & Essential Next Steps
A.
Tonsil stones in your 30s and 40s are common and usually manageable with saltwater gargles, good hydration, and gentle oral hygiene, and if they keep coming back an ENT can remove them or consider laser cryptolysis or, rarely, tonsillectomy. There are several factors to consider, including dry mouth, allergies, and red flags like severe pain, high fever, trouble swallowing or breathing, bleeding, or one-sided swelling. See below for safe at-home steps to try, what not to do, prevention tips, and exactly when to see a doctor so you can choose the right next steps.
References:
* Stoodley, M. L., & Teoh, R. B. (2014). Tonsilloliths: A case series of 25 patients and review of the literature. *ORL; Journal for Oto-Rhino-Laryngology and its Related Specialties*, *76*(3), 119-123.
* Morita, M., Suzuki, H., Kitamura, S., Fujino, S., & Shioda, S. (2020). Tonsilloliths and oral malodor: a systematic review. *Journal of Oral Science*, *62*(1), 1-5.
* Cha, K. J., Cho, J. M., Kim, S. W., & Kim, M. G. (2019). Coblation tonsillectomy for chronic tonsilloliths causing halitosis: A single-institution study. *International Journal of Oral and Maxillofacial Surgery*, *48*(8), 1057-1061.
* Bains, A., & Chhabra, S. (2021). Management of Tonsilloliths: A Review of Literature. *Cureus*, *13*(7), e16361.
* Abdel-Aziz, M. (2018). Tonsilloliths: pathogenesis, clinical features and therapeutic management. *Egyptian Journal of Otolaryngology*, *34*(3), 223-228.
Q.
Only One Tonsil Is Swollen? Why Asymmetrical Throat Pain Isn't Always a Standard Cold
A.
One swollen tonsil with one-sided throat pain is often from localized tonsillitis, tonsil stones, irritation, or reactive lymph nodes, while a standard cold usually affects both sides; there are several factors to consider, so see below for details that can guide your next steps. Seek urgent care for severe one-sided pain, trouble swallowing or breathing, high or persistent fever, swelling lasting more than 1 to 2 weeks, recurrent episodes on the same side, or hard non tender neck nodes, as these can signal a peritonsillar abscess or other less common causes.
References:
* Schoem SR, Choi SS, Kim D. Unilateral tonsillar enlargement: a review of current literature and proposal of a management algorithm. J Laryngol Otol. 2017 Jul;131(7):590-596. doi: 10.1017/S002221511700109X. Epub 2017 Apr 13. PMID: 28407886.
* Galioto NJ. Peritonsillar Abscess: An Update on Diagnosis and Treatment. Am J Otolaryngol. 2021 May-Jun;42(3):102922. doi: 10.1016/j.amjoto.2021.102922. Epub 2021 Feb 2. PMID: 33549929.
* Hussain A, Iqbal M, Al-Attar S, Hussain A. Unilateral tonsillar enlargement in infectious mononucleosis. J Laryngol Otol. 2014 Mar;128(3):288-90. doi: 10.1017/S002221511300329X. Epub 2014 Feb 20. PMID: 24598284.
* Sharma T, Bhardwaj A, Raina A, Goel M. Primary tonsillar lymphoma: Clinical presentation, diagnosis, and management. Head Neck. 2019 Jul;41(7):2352-2358. doi: 10.1002/hed.25688. Epub 2019 Feb 14. PMID: 30734351.
* Lee WS, Kim JY. Lemierre's syndrome: A systematic review. Otolaryngol Head Neck Surg. 2014 Jul;151(1):6-16. doi: 10.1177/0194599814528721. Epub 2014 Apr 3. PMID: 24706596.
Q.
Is tonsillitis contagious?
A.
Yes—tonsillitis is contagious, whether viral or bacterial, spreading through respiratory droplets, close contact, and contaminated surfaces. It’s most contagious in the first 2–3 days; viral cases remain contagious until the fever resolves, and strep usually stops being contagious 24 hours after starting antibiotics. There are several factors to consider for prevention, testing, treatment, and when to seek care—see the complete guidance below to understand your next steps.
References:
Bisno AL. (2001). Acute pharyngitis. N Engl J Med, 11172189.
Walker MJ, Barnett TC, McArthur JD, et al. (2014). Disease manifestations and pathogenic mechanisms of group A Strep… Clin Microbiol Rev, 24520070.
D'Amico G, Garcia-Tsao G, Pagliaro L. (2006). Natural history and prognostic indicators of survival in cir… Journal of Hepatology, 16337704.
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Link to full study:
https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1References
Tonsil Stones - Cleveland Clinic
https://my.clevelandclinic.org/health/diseases/21505-tonsil-stonesPharyngitis - American Association of Family Physicians (AAFP)
https://www.aafp.org/pubs/afp/issues/2004/0315/p1465.htmlFlores AR, Caserta MT. Pharyngitis. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 2015:753–759.e2. doi: 10.1016/B978-1-4557-4801-3.00059-X. Epub 2014 Oct 31. PMCID: PMC7152369.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152369/#:~:text=Acute%20pharyngitis%20is%20typically%20described,ulcerations%20may%20also%20be%20present.Smith KL, Hughes R, Myrex P. Tonsillitis and Tonsilloliths: Diagnosis and Management. Am Fam Physician. 2023 Jan;107(1):35-41. PMID: 36689967.
https://pubmed.ncbi.nlm.nih.gov/36689967/