From the Research
Swollen tonsils after mononucleosis typically resolve on their own within 4-6 weeks, but persistent swelling should be evaluated by a healthcare provider. Rest, adequate hydration, and over-the-counter pain relievers like acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or ibuprofen (400-600mg every 6-8 hours with food) can help manage discomfort, as suggested by a study on postoperative pain control following tonsillectomy, which found that ibuprofen with acetaminophen is a safe and acceptable analgesic alternative 1. Gargling with warm salt water (1/2 teaspoon salt in 8 ounces warm water) several times daily may provide relief. If swelling persists beyond 6-8 weeks, causes severe difficulty breathing or swallowing, or is accompanied by high fever, you should seek medical attention promptly. This persistent swelling could indicate complications like a peritonsillar abscess or chronic EBV infection. Occasionally, if tonsils remain significantly enlarged after recovery and cause ongoing problems with breathing or swallowing, a tonsillectomy might be considered, as supported by a study on the management of severe infectious mononucleosis tonsillitis and upper airway obstruction, which found that acute tonsillectomy is an appropriate treatment option for patients with severe disease 2. The lingering swelling occurs because the Epstein-Barr virus that causes mono can remain in the lymphatic tissue of the tonsils even after acute symptoms resolve, causing prolonged inflammation, as discussed in a review of infectious mononucleosis 3. It's also important to note that bacterial superinfection of the pharynx in infectious mononucleosis is rare, and there is no indication for routine use of antibiotics when infectious mononucleosis is diagnosed, as found in a study on the incidence and management of bacterial superinfection in infectious mononucleosis 4.