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When should you be worried about tonsillitis?

The condition is rarely life-threatening, but inflammation in the tonsils can cause more than just a sore throat.
“It’s important to know the different signs and symptoms caused by a virus versus those caused by bacterial infections in order to get proper treatment,” Dr. Alanna Levine told TODAY.TODAY illustration / Getty Images

While the mere mention of tonsillitis can trigger fear that a trip to the hospital is coming to remove those tonsils, the infection can actually mean many things.

But what is tonsillitis? Tonsillitis is an umbrella term for any inflammation of the tonsils caused by a bacterial infection or a virus. A lot of things can cause a sore throat — anything from a simple cold to the flu to strep throat, and even COVID-19.

“Strep throat is a common cause of tonsillitis, but it’s not the only cause,” Dr. Kara Meister, a head and neck surgeon with Stanford Children’s Health in Palo Alto, California, told TODAY. “There’s a misconception among parents that tonsillitis and strep throat are synonymous terms. This isn’t true.”

Streptococcus A is the bacterial cause of strep throat, according to the Centers for Disease Control and Prevention. The influenza virus leads to the flu, while rhinovirus causes colds. All could come with a diagnosis of tonsillitis because symptoms are likely redness, inflammation and pain in the back of the throat.

“You can have a sore throat in any season, but late fall and winter are when doctors see an uptick,” Dr. Alanna Levine, a pediatrician at Boston Children’s Health Physicians, told TODAY. “It’s important to know the different signs and symptoms caused by a virus versus those caused by bacterial infections in order to get proper treatment.”

What are symptoms of tonsillitis?

While viral causes are more common, bacterial infections can cause more complications.

Characteristics of a virus are wheezing, a runny nose and visibly red tissue on the tonsils, Meister said, and the virus just needs to run its course. Other tonsillitis symptoms may include a sore throat, swollen tonsils, trouble swallowing and tenderness in the lymph nodes on the sides of the neck. Ibuprofen and salt water gargles could reduce inflammation. Honey and lozenges can also help ease the swelling.

However, if children have a high fever and their throats hurt so much they can’t eat, swallow liquids or turn their necks because their lymph nodes are so swollen, it’s time to go to the doctor for a throat culture, Levine said.

How is tonsillitis treated?

The throat swab determines if the cause is a bacterial infection and whether it should be treated with antibiotics.

But if left untreated, such an infection can lead to serious health problems and may even require surgical intervention. For example, a pocket of puss called an abscess can form in the tonsils. The abscess must be drained before the infection worsens. Even when abscesses have been drained, complications can still arise. However, if you're concerned about whether tonsillitis can kill you, you can rest assured that life-threatening cases of tonsillitis tend to be rare.

“Typically, a child will have a sore throat for five or six days," Meister said. "They will start to feel better, but then start to feel much worse."

There are three consequences of untreated strep: rheumatic fever, post-streptoccoccal glomerulonephritis (PSGN) and pneumococcal disease.

According to the Mayo Clinic, rheumatic fever can cause damage to a child’s heart by compromising its pumping capacity. PSGN affects the kidney’s filtering system, resulting in bloody urine. Pneumococcal disease is a bacterial infection that targets the lungs, sinuses and can even lead to a deadly form of meningitis. But these conditions are extremely rare.

How to avoid tonsillitis

You may be wondering: Is tonsillitis contagious? The answer is yes — the germs that cause cases of viral and bacterial tonsillitis are contagious. Both Meister and Levine emphasize that viruses and bacteria are everywhere, so prevention is key. Don't share cups, water bottles or straws — and wash hands often to reduce the chances of getting sick. Wearing a mask and following COVID-19 safety protocols, including social distancing and frequent handwashing, can also help minimize the spread of such germs.

Meister also advises keeping the immune system strong through healthy eating, including a wide range of fruits and vegetables, staying hydrated and getting plenty of rest. That can be especially important for children.

“When kids are in school, they're being exposed to new friends and new viruses their bodies haven’t seen," she said. "The more equipped their immune system is to fight infections, the less likely they’ll get sick.”

Adults can teach children how to avoid spreading germs when they're sick and everyone should be vigilant about hygiene in their daily routines during the coronavirus pandemic, and beyond.

“Teachers can encourage good hand hygiene and encourage kids — if they're coughing or sneezing — to do it into their elbow and not in their hands. Also, if a child blows his or her nose into a tissue then make sure that child throws that tissue away instead of leaving it on a desk or another shared surface.”