Is it Tonsillitis?

The tonsils sit just behind the back teeth and are part of the body’s immune system. If they are infected you will typically get a sore throat, fever, headache and often, bad breath. However, the vast majority of sore throats are not tonsillitis but rather pharyngitis, which is an infection of the back of the throat and is almost always viral (and therefore not helped by antibiotics).

True tonsillitis may be due to a virus or bacteria and is more common in children. The throat is more acutely painful than in pharyngitis. Your doctor nearly always takes a look at the health of the tonsils when assessing a ‘sore throat’ and will be wary of group A Streptococcus infection (about 1 in 5 cases) which can cause complications like difficulty breathing, drooling, stiff neck, and neck swelling below the lower jaw. The same bacteria can cause acute rheumatic fever, particularly in children of Aboriginal, Maori, or Pacific Islander background.

When in doubt, your doctor may organise a swab to help sort it out.

The viral form of tonsillitis is treated with rest, fluids and pain relief. It will be painful to eat so don’t force it for children or adults. The less common bacterial form will need antibiotics – typically penicillin (unless there is allergy to this drug).

Complications, which are rare now, can include ear or sinus infection or an abscess (called Quinsy). Occasionally, an acute sore throat can be the beginning of a longer bout of glandular fever (Infectious Mononucleosis) or the more risky acute epiglottitis.

In previous generations, removing tonsils was common. Today they are only removed on good grounds including chronic or recurrent (more than four per year) infections or if the enlarged tonsils impact on breathing and contribute to things like sleep apnoea in the toddler.

There is generally no need to see your doctor with a mild sore throat. If it does not settle or you have a fever, or other concerns then always get it checked. Remember that most times antibiotics are not required and tonsils usually do not need to be removed.

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