What is tonsilitis and how do you know if you have it?

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Your child’s throat is sore and they’re coughing. Or maybe you have a fever and are having difficulty swallowing. These are common symptoms of a cold or the flu, but can they also be symptoms of tonsillitis?

Tonsillitis shares many of the symptoms (and causes) of other illnesses that affect your throat – which can make it hard to know if you have tonsillitis or something else.

Below, we answer all your questions about tonsillitis, including how tonsillitis differs from other illnesses. Read on to learn how to get the care you need when you need it.

First, what are tonsils?

Tonsils are two small masses of tissue located at the back of your throat. Tonsils are a part of your immune system and help prevent infection by trapping the germs that enter through your nose and mouth.

What is tonsillitis?

While tonsils do a great job of protecting you, sometimes the tonsils themselves can get infected. When tonsils get infected, swollen or inflamed, it’s called tonsillitis.

Symptoms of tonsillitis

The telltale sign of tonsillitis is tonsils that usually look red and swollen, and coated with yellow or white spots or patches. But tonsillitis also comes with a range of other symptoms.

  • A sore throat that doesn’t go away
  • Bad breath
  • Coughing
  • Swollen lymph nodes in your neck
  • Difficulty swallowing
  • Fever higher than 100.9 degrees Fahrenheit
  • Neck pain or stiffness
  • Headache
  • Voice changes

Symptoms of tonsillitis in young children

If your little one has tonsillitis, they may not be able to tell you how they feel. But it’s possible that they’ll be able tell you through their actions. The following behaviors may indicate that their throat is sore and it’s very difficult to swallow:

  • Fussiness
  • Drooling
  • Refusing to eat

Causes of tonsillitis

Most of the time tonsillitis is caused by viruses, such as the ones responsible for the common cold. If your tonsillitis is caused by a virus, you’re more likely to have mild symptoms that go away pretty quickly.

Tonsillitis can also be caused by bacteria, like the one that causes strep throat. If your tonsillitis is caused by bacteria, you’ll likely need antibiotics to help you get better.

Is tonsillitis contagious?

Tonsillitis is not contagious, but the bacteria and viruses that cause tonsillitis usually are. And these germs can cause colds and other illnesses. So if you or your child has tonsillitis, practice good hygiene to keep germs from spreading.

Who gets tonsilitis

Tonsillitis is very common, and most people will get it at least once. Anyone can get tonsillitis, but it’s most common in kids between the ages of 5-15 years old. It’s rare in children under 2 years old.

Risk factors for tonsillitis

You may be more likely to get tonsillitis if:

  • You are a child or elderly
  • You are frequently around viruses or bacteria – for example, at a school or daycare
  • You have been exposed to radiation
  • You have a weakened immune system
  • You live in a colder climate
  • You breathe high levels of airborne pollutants, such as smoke
  • You’re overweight or are living with diabetes or heart disease
  • You overuse corticosteroids

How long does tonsillitis last?

Tonsillitis can go away in a few days, or it can last for weeks. It can also go away and come back. The following are terms that your doctor may use when describing how long tonsillitis will last.

Acute tonsillitis

Acute tonsillitis is when the infection lasts between three days and two weeks. Acute tonsillitis is often caused by viruses and generally has more mild symptoms.

Chronic tonsillitis

Chronic tonsillitis is when symptoms last more than two weeks. People with chronic tonsillitis often have a sore throat, bad breath and enlarged lymph nodes that don’t go away.

Recurrent tonsillitis

Tonsillitis can also be recurrent, meaning that your tonsils get inflamed and infected multiple times in a year. Recurrent tonsillitis in kids is usually related to recurrent strep throat. In adults, recurrent tonsillitis is caused by different bacteria. Recurrent tonsillitis is more likely if:

  • The tonsillitis is caused by a strain of bacteria resistant to antibiotics. Recurrent tonsillitis can happen, even if earlier episodes responded to antibiotics
  • A person has a weakened immune system
  • Other family members had recurrent tonsillitis
  • A child is between 5-7 years old – younger kids have larger tonsils, and their immune system isn’t fully developed to fight against attention

Comparing tonsillitis and other illnesses

Tonsillitis is caused by viruses and bacteria that affect your nose and throat – often the very same ones that cause colds and influenza. So, it’s no wonder that tonsillitis is commonly mistaken for other conditions.

Strep throat vs. tonsillitis

Strep throat is an infection of the throat and tonsils caused by a certain type of bacteria – streptococcus pyogenes. So, strep throat is usually considered a specific type of tonsillitis.

Sore throat (pharyngitis) vs. tonsillitis

The big difference between these two conditions is that pharyngitis affects the pharynx, (which is another name for the throat), whereas tonsillitis affects the tonsils.

Both pharyngitis and tonsillitis can be the result of viral or bacterial infections. Pharyngitis can also be caused by fungal infections.

These conditions can have very similar symptoms, including sore throat, difficulty swallowing and fever. But if you have enlarged lymph nodes, it’s more likely that you have tonsillitis. And if you have pharyngitis caused by a fungal infection, you’ll have more severe symptoms.

Cold vs. tonsillitis

Both colds and tonsillitis can be caused by the same viruses. In fact, cold viruses are one of the most common causes of tonsillitis. So, how do you know if a cold has turned into viral tonsillitis? If it’s tonsillitis, the tonsils will be swollen and may have spots on them. If you’re suffering from only a common cold, you won’t have swollen or infected tonsils.

COVID-19 vs. tonsillitis

Symptoms of COVID-19 and tonsillitis can be similar – with both you can have a sore throat, fever and headache. But if it’s extremely difficult to swallow or you have swollen tonsils, enlarged lymph nodes, bad breath or a stiff neck, it’s more likely to be tonsillitis. If you’re not sure, test for COVID-19 using an at-home antigen text.

Tonsillitis complications

Complications of tonsillitis are pretty rare. Still, they do happen. Here’s what can happen if you don’t get treatment.

Spreading bacterial infection

If you don’t get treatment for bacterial tonsillitis, the bacterial infection could spread to other parts of the body, causing problems.

Tonsil stones

If you have chronic tonsillitis, you may be more likely to have tonsil stones which are white or yellow bumps that cover your tonsils. These bumps collect materials such as bacteria, fungi, food, dead cells and salvia.
Tonsil stones aren’t usually harmful, but they can cause really bad breath that lasts for years or even a lifetime. Tonsil stones are most common for people between the ages of 18-35 years old.

Tonsil stones can usually be treated at home. In some cases, your doctor may recommend a tonsillectomy to remove your tonsils.

Breathing problems and sleep apnea

Swollen tonsils can block your airway, making breathing more difficult during the day and at night.
Tonsillitis may contribute to obstructive sleep apnea, a nighttime breathing disorder that happens when a person’s airway is partially or completely blocked during sleep. In fact, enlarged tonsils are a main cause of obstructive sleep apnea in children.

If your child has symptoms of sleep apnea, your doctor may recommend a tonsillectomy to remove the tonsils.

Peritonsillar abscess

A rare complication from tonsillitis is a peritonsillar abscess. This is when a pocket of pus collects between the tonsils and the wall of the throat. This condition can cause swelling inside your mouth and throat, making it hard to breathe, swallow, speak or even open your mouth. Immediate medical attention is usually needed to drain the abscess.

A peritonsillar abscess is caused by the same bacteria responsible for strep throat and is more common in adolescents and adults.

Will tonsillitis go away on its own?

It depends. If tonsils are swollen but not painful, you typically don’t need to do anything. It’s likely the tonsillitis is caused by a viral infection and should go away within a couple of weeks with at-home treatments for tonsillitis.

But if the tonsillitis comes with a fever, doesn’t go away or keeps coming back, you or your child will probably need medical treatment to help the tonsillitis go away.

When to see a doctor for a sore throat and enlarged tonsils

In most cases, home treatment for tonsillitis will be all you need to help you get better. But there are times when you should get help from your doctor.

Make a primary care appointment if you or your child have:

  • A sore throat with a fever
  • A sore throat that doesn’t go away in a day or two
  • Pain when swallowing
  • Extreme fatigue

Head to the emergency room if you or your child have:

  • Difficulty breathing
  • A large amount of drool because it’s hard to swallow

During the appointment, your primary care doctor or clinician will look at your sore throat to see what might be causing your symptoms. They may also swab the back of the throat to collect a sample that can be tested for bacteria. If the test is positive, you’ll need antibiotics for a bacterial infection. If the test is negative, the tonsillitis is likely caused by a viral infection and should go away on its own.

If antibiotics don’t work or if the tonsillitis keeps coming back, your doctor will likely recommend you see an ear, nose and throat (ENT) doctor to determine if a tonsillectomy, a procedure to remove your tonsils, may be an option to stop recurrent infections.

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