Sore throat and tonsillitis: causes, self-care and warning signs

A sore throat is a common reason to see a pharmacist or doctor. Most are mild, but a few need medical care, and some signs are emergencies. This review uses information from the NHS, the US CDC and MedlinePlus.

1. Introduction

The NHS says sore throats are common and usually minor, and normally get better by themselves within a week ^[1]. The technical name for the throat is the pharynx, and a sore throat is also called pharyngitis ^[4]. Tonsillitis is infection of the tonsils, at the sides of the throat. It is common in children but teenagers and adults can get it too ^[2].

2. Signs and symptoms

For a sore throat, the NHS lists pain when swallowing, a dry or scratchy throat, redness at the back of the mouth, bad breath, a mild cough and swollen neck glands. Children may also have a high temperature and seem less active ^[1].

For tonsillitis, the NHS lists sore throat, difficulty swallowing, fever, cough, headache, feeling sick, earache and tiredness, with red, swollen tonsils. More severe signs include painful swollen neck glands, pus-filled spots or white patches on the tonsils, and bad breath. Symptoms usually clear within 3 to 4 days but may last longer ^[2].

3. Causes and risk factors

Most sore throats are caused by viruses such as those behind colds and flu, or by smoking. Bacteria are an occasional cause ^[1]. MedlinePlus also names allergies, mononucleosis (glandular fever), strep throat and tonsillitis ^[4].

Strep throat is a bacterial infection of the throat and tonsils caused by group A streptococcus. The CDC says viruses cause most sore throats, and that roughly 1 in 10 adults and 3 in 10 children with a sore throat have strep. It spreads through close contact, especially in households, schools and other crowded places, and affects children aged 5 to 15 most often ^[3]. A cough, runny nose, hoarseness or pink eye points more towards a virus ^[3].

The NHS notes that tonsillitis itself is not contagious, but the viruses that cause it can spread, so covering coughs, disposing of tissues, washing hands and staying home when unwell help ^[2].

4. Diagnosis and tests

The NHS says a doctor usually diagnoses tonsillitis from symptoms and an examination of the throat. A throat swab may be taken to look for bacteria and, if symptoms are severe or last long, a blood test for glandular fever ^[2]. The CDC says providers can run a quick test for strep, and that some people carry group A strep without symptoms ^[3]. MedlinePlus lists a strep A lab test and a throat swab culture ^[4].

5. Treatment and management

Self-care. The NHS suggests these steps for a sore throat ^{[1, 2]}:

• Rest and drink plenty of fluids, and eat cool or soft foods.
• Gargle with warm salt water and spit it out. Young children should not gargle.
• Avoid smoke and smoky places.
• The NHS says paracetamol or ibuprofen can ease pain, and children under 16 should not be given aspirin.
• Ask a pharmacist about lozenges, noting that evidence for throat sprays used alone is limited.

Antibiotics. The NHS says antibiotics are not normally needed, because they usually do not ease symptoms or speed recovery, and a pharmacist or doctor gives them only if a bacterial infection is possible ^[1]. Viral tonsillitis usually clears on its own, while bacterial tonsillitis may be treated with antibiotics ^[2]. The CDC says antibiotics for strep throat help people feel better faster ^[3].

Tonsil removal. The NHS says tonsillectomy is very rarely needed and is only considered for severe tonsillitis that keeps returning ^[2].

6. Prevention and self-care

The CDC advises washing hands often with soap and water, not sharing cups, utensils or food with a sick person, covering coughs and sneezes, and seeing a provider if you suspect strep ^[3]. The NHS adds avoiding smoking and smoky places ^[1].

7. Special groups and complications

The NHS advises that a child under 5 with a sore throat should be seen by a doctor, and that people with a weakened immune system, for example from diabetes or chemotherapy, should seek urgent help ^[1]. A rare complication of tonsillitis is quinsy, an abscess (a pus-filled swelling) between the tonsils and the wall of the throat, which needs emergency care ^[2]. The CDC says strep can sometimes lead to abscesses, ear or sinus infections, kidney disease or rheumatic fever ^[3].

8. When to see a doctor

See a doctor if symptoms have not improved after a week, if you often get sore throats, or if you have a lump in the mouth or neck or a mouth ulcer lasting more than 3 weeks ^[1]. Ask for urgent help if you have a very high temperature, signs of dehydration such as passing less urine, or a throat so painful that eating or drinking is difficult ^{[1, 2]}.

The NHS says to treat these as emergencies: difficulty breathing or swallowing, drooling, a high-pitched breathing sound, swelling inside the mouth or throat, trouble opening the mouth, or severe symptoms getting worse quickly ^{[1, 2]}. Do not drive yourself.

In an emergency, call your local emergency number (112 in India, 911 in the United States).

9. Conclusion

Most sore throats and cases of tonsillitis are caused by viruses and settle with rest and simple care. Tests help find strep throat, which needs a doctor's decision about antibiotics. Knowing the warning signs helps people get urgent help when it matters.