It may come as a surprise but tonsillitis is actually one of the less common causes of sore throat.
Hi, I’m Dr Joe.
We tend to think of tonsils as soon as we think of a sore throat. In reality though over 25 years or so in medicine, for probably every 1 case of tonsillitis I see 80, 90, maybe 100 regular garden-variety sore throats.
The difference between a viral sore throat, often called a pharyngitis which affects the back of the throat, and a tonsillitis which affects the tonsils – there are quite a few of them and we’ll go through those.
As I said at the top, pharyngitis will be generally caused by a virus. You will have a sore throat, you might have some other cold symptoms with it, maybe a little bit of a low-grade temperature but not too much else. When we look at the throat it will look a little bit red but again you won’t see too much else. And for a viral throat illness of course you don’t need to take an antibiotic, it will be treated with what we call symptomatic measures: maybe some gargle, some paracetamol, something along those lines.
Now the tonsils are part of the lymphatic system so they’re part of the body’s immune or defence system. They sit behind the teeth so they’re not actually at the back of the throat. Some people when you look in their mouth you can hardly see their tonsils, they’re quite small, other people they’re like these almost big footballs coming out of the side, and in some cases although this is rarer they almost meet in the middle, you see these two little footballs come out and meet at the uvula, which is the part of the palate that dangles down.
Tonsils generally are bigger in children than in adults, relatively speaking, and it’s thought that that’s because the tonsils have a more important role in the immune system in children rather than adults. So they’re not just there for decoration. Up until 30 years ago it was very popular to remove the tonsils, it was almost done routinely and what was really discovered is that the tonsils are useful. If they’re not causing a problem you don’t want to remove them. It’s not major surgery but it is significant surgery particularly in children, and there are potential serious complications including haemorrhaging or bleeding. So it has been found that unless there are good reasons to remove the tonsils leave them alone.
Alrighty with tonsillitis, it is an infection of the tonsils per se. When we look into the throat we can see yellow muck or pus on the tonsils and that’s the hallmark of a tonsillitis. Some people will get a mild with a few yellow spots, some people may get the tonsils completely covered in pus or muck. The throat will generally be more painful than with a viral sore throat. Generally there will be a temperature with it and it may be quite high, not always, people might get a headache and feel quite unwell with tonsillitis. It is caused by a bacteria rather than a virus. To that extent it is the type of sore throat that actually does benefit from an antibiotic, and for people who aren’t allergic to penicillin you will be treated with penicillin, obviously in children in may be liquid, in adults you can take a capsule. For some people, if they have difficulty swallowing – and I don’t just mean it’s a little bit sore to swallow but they really can’t swallow – they may need penicillin injections. Now, whilst that might initially sound simple, if you do have a sore throat, penicillin injections are also fairly painful. So if you’re able to swallow, it is much, much better. Course of treatment may be 7 to 10 days.
Tonsillitis can be recurrent in some people and the current working rule of thumb as to when one should contemplate having tonsils removed is roughly 4 bouts of actual tonsillitis – again, actually the tonsils not just a sore throat – per year, over at least 2 years. It’s then felt that it’s justifiable to remove the tonsils because like we said before it’s not minor surgery.
There are a couple of other reasons why tonsils might be removed and that’s if they’re particularly large and almost obstructing the air passageway. Sometimes if people are having problems with snoring and the tonsils are involved with that again they might be removed. But there’s not – compared to 30 years ago – nearly as many people having their tonsils out and that’s a good thing, and particularly in children. Like with everything, if they’re causing more problems that they’re good for then talk to your doctor about whether you should be considering having them out in your child. If you get the occasional bout of tonsillitis then they can certainly stay there because they do have a role in the immune system.
Alright so to sum up, tonsillitis is not actually that common. The vast majority of the times you’ll get a sore throat it will not be tonsillitis. Where it is, you will get a sore throat, you can’t always tell it apart, a temperature usually and perhaps some of the other symptoms we mentioned. The hallmark will be, when your doctor has a look at your throat, there will be some pus or muck on the tonsils and it’s the one type of sore throat that will benefit from an antibiotic. For those who get frequent tonsillitis having the tonsils removed might be an option but that’s certainly not the majority of instances.
Tonsillitis is contagious but not highly so, you really need to be at kissing distance to pick up tonsillitis so it’s not highly contagious. Most of the time it will run a course of around about a week and you’ll need to be off school or off work for most of that time.
Once the soreness is settling, the temperature has gone down, you’re feeling reasonable good and you can swallow, you can generally go back to school or work. Apart from your antibiotics, simple things like throat gargle can be helpful, and again perhaps things like paracetamol or other measure for temperature or aches and pains can be taken as well.
So to sum up, tonsillitis is a bacterial infection and it will require treatment with an antibiotic. The symptoms will typically be a sore throat and as we mentioned possibly a headache and temperature. The hallmark is that there will be pus or muck that you actually see on the tonsils. It is quite treatable. For those people who have recurrent episodes, they may want to talk to their doctor about whether having their tonsils out is worthwhile for them, but compared to some years ago for most people you can stay with your tonsils for your entire life.

More information

A young girl is sick and having her temperature taken. For more information on the risk factors, symptoms and treatment, see Tonsillitis