Tonsillitis and Sore Throat

A sore throat is an extremely common complaint that affects people of all ages. It is often the first sign of a cold or another mild viral infection. However, when the pain is persistent, severe, or accompanied by other symptoms, it can be a sign of tonsillitis, a condition that deserves attention.

What Is Tonsillitis?

Tonsillitis is the inflammation of the tonsils, which are two masses of lymphoid tissue located at the back of the throat. They act as the first line of defense of our immune system against pathogens that enter through the mouth and nose. When the tonsils become overwhelmed by an infection, they become inflamed, causing pain and discomfort.

Common Symptoms of Sore Throat and Tonsillitis

Although a sore throat may be just a passing nuisance, tonsillitis usually presents a more robust set of symptoms, which may include:

  • Severe and persistent sore throat.
  • Difficulty or pain when swallowing.
  • Visibly red and swollen tonsils.
  • Presence of pus patches (white or yellowish spots) on the tonsils.
  • Fever and chills.
  • Swollen and tender lymph nodes (glands) in the neck.
  • Bad breath.
  • Headache and body aches.

In children, tonsillitis may also present with nausea, vomiting, or abdominal pain.

Main Causes: Viruses or Bacteria?

The vast majority of sore throats and tonsillitis are caused by viruses, the same ones responsible for colds and the flu. In these cases, the condition tends to resolve on its own within a few days, with rest and hydration.
However, a significant portion of tonsillitis cases, especially the more severe ones, are bacterial in origin. The most common bacterium is Streptococcus pyogenes, also known as group A streptococcus. Distinguishing the viral cause from the bacterial one is essential, as bacterial tonsillitis requires treatment with antibiotics to prevent complications.

Risks and Complications: What Can Happen?

Ignoring bacterial tonsillitis can lead to serious health problems. The complications can be local or systemic.

  • Peritonsillar Abscess: A collection of pus forms around the tonsil, causing excruciating pain, difficulty opening the mouth (trismus), and a “muffled” voice. It is a medical emergency that requires surgical drainage.
  • Rheumatic Fever: A rare but serious complication that can occur weeks after an untreated streptococcal infection. It affects the heart, joints, skin, and brain, and may leave permanent cardiac sequelae.
  • Post-Streptococcal Glomerulonephritis: An inflammation of the kidneys that can also arise after a streptococcal throat infection, leading to a decline in kidney function.

When to See an Otolaryngologist (ENT)?

Not every sore throat requires a visit to the doctor. However, it is crucial to see a specialist if you or your child experience:

  • A sore throat that lasts more than 48 hours without improvement.
  • Severe pain that makes swallowing, speaking, or breathing difficult.
  • High fever (above 38.5°C).
  • Presence of pus patches on the tonsils.
  • Significant swelling in the neck.
  • Skin rash.
  • Symptoms of dehydration, such as dry mouth and decreased urination.

Only a doctor can make the correct diagnosis, often with the help of a rapid throat swab test, to confirm the presence of the streptococcus bacterium.

Available Treatments

Treatment varies according to the cause of the tonsillitis.

  • Viral Tonsillitis: The focus is on relieving symptoms. Rest, fluid intake, analgesics, and anti-inflammatories are recommended. Antibiotics are ineffective and should not be used.
  • Bacterial Tonsillitis: Treatment is carried out with antibiotics prescribed by the doctor. It is essential to complete the entire course of the medication, even if symptoms improve beforehand, in order to eradicate the bacteria and prevent complications.
  • Recurrent Tonsillitis and Complications: For patients who suffer from recurrent episodes of bacterial tonsillitis (several episodes per year) or who have had complications such as an abscess, surgery to remove the tonsils (tonsillectomy) may be indicated.

Tonsillectomy is a safe and effective procedure to resolve the problem definitively, significantly improving the patient’s quality of life.

Take Care of Your Health

A sore throat can be simple, but it can also be the warning of something more serious. At our practice, we have the experience of more than 20 years of Dr. José Eduardo Marcondes and a qualified team to offer an accurate diagnosis and the most appropriate treatment for your case.

Do not neglect your health. If symptoms persist or are severe, schedule an appointment. We are ready to take care of you at the main medical centers in Faria Lima, Morumbi, and Alphaville.

Frequently asked questions about Tonsillitis and Sore Throat

What is tonsillitis?

Tonsillitis is the inflammation of the tonsils, structures located at the back of the throat that take part in the body’s defense. When inflamed, they can cause a sore throat, difficulty swallowing, fever, and malaise.

How can you tell viral tonsillitis from bacterial tonsillitis?

Most sore throats and cases of tonsillitis are caused by viruses, but some bacterial infections, such as those caused by streptococcus, require specific evaluation. Signs such as fever, patches on the tonsils, tender lymph nodes in the neck, and the absence of a cough can raise suspicion, but confirmation may require a medical examination and, in selected cases, a rapid test or culture.

When does a sore throat warrant medical evaluation?

Medical evaluation is important when the pain is severe, persists for several days, progressively worsens, or is accompanied by high fever, difficulty swallowing, changes in the voice, shortness of breath, dehydration, or significant enlargement of the neck lymph nodes. In children, persistent refusal to eat, listlessness, and difficulty drinking fluids deserve special attention.

What are the complications of untreated bacterial tonsillitis?

When not treated properly, bacterial tonsillitis can progress with local complications, such as a peritonsillar abscess, and in rarer situations with inflammatory complications, such as rheumatic fever and post-streptococcal glomerulonephritis. For this reason, when the use of an antibiotic is indicated, it must be taken correctly until the end.

When is surgery to remove the tonsils indicated in adults?

Tonsillectomy in adults may be indicated in cases of well-documented recurrent infections, recurrent peritonsillar abscesses, bad breath related to tonsil stones, or when the size of the tonsils contributes to snoring, sleep apnea, or breathing difficulty. The decision must be individualized according to the frequency of the episodes and the impact on quality of life.