Differentiating between viral pharyngitis and tonsillitis

There can be many different causes of sore throat – from allergies to heartburn, or even bacterial infection. Thus, it can sometimes be difficult to determine the cause of it. 

Here, we’ll share two common causes of sore throat in Singapore – viral pharyngitis and bacterial tonsillitis, as well as the symptoms. 

Both pharyngitis and tonsillitis are throat infections that cause inflammation. If your tonsils are mainly affected then you might be suffering from tonsillitis. On the other hand, if your pharynx (the area of the throat that is around the tonsils) is mainly affected then it is known as pharyngitis. These infections tend to spread through close contact with others.

What is pharyngitis?

Pharyngitis refers to inflammation of the back of your throat, also known as the pharynx. 

In general, viruses are the most common cause of sore throats, and this is known as viral pharyngitis. Viral pharyngitis is usually caused by the common cold, influenza, or mononucleosis. Antibiotics are not required and treatment is often targeted to relieve symptoms accompanying the condition. 

Less commonly, pharyngitis can be caused by a bacterial infection and will require a course of antibiotics to treat it. Frequent exposure to the common cold and flu can increase your risk of contracting pharyngitis. This also applies to people who have allergies and frequent sinus infections.

The incubation period for viral pharyngitis caused by the common cold is typically between two to five days, and these are some of the symptoms experienced by most people: 

• Fever 
• Hoarseness
• Body aches 
• Cough 
• Runny nose

What is tonsillitis?

Tonsils are two oval-shaped clusters of tissues located at the back of your throat. They are part of your immune system that protects you against infection and illness. 

Patients suffering from tonsillitis often have tonsils that are inflamed, and as such, they present with symptoms like swollen tonsils, sore throat, difficulty swallowing, and tender lymph nodes on the sides of the neck. 

Tonsillitis can be categorised into three types: 

1. Acute tonsillitis

In acute tonsillitis, symptoms will last around 10 days or less, and they tend to respond well to home treatments. In some cases, they may require other treatments such as antibiotics. 

2. Chronic tonsillitis 

The symptoms of chronic tonsillitis last longer, patients may experience symptoms such as sore throat, halitosis, and/or tender lymph nodes in the neck. Chronic tonsillitis may also be a result of tonsil stones that come loose on their own, or require a doctor to remove them. ENT Specialists may sometimes recommend a tonsillectomy to surgically remove your tonsils if this condition becomes problematic. 

3. Recurrent tonsillitis 

Recurrent tonsillitis is usually defined as: 

• Five to seven tonsil infections in the first year
• At least five tonsil infections a year, in two consecutive years 
• At least three tonsil infections a year, in three consecutive years

Similar to chronic tonsillitis, tonsillectomy is the ideal treatment option for patients suffering from recurrent tonsillitis.

How are viral pharyngitis and tonsillitis diagnosed? 

Most of the time, it is hard to tell the difference between viral pharyngitis and tonsillitis. An ENT Specialist in Singapore will rely on a combination of thorough clinical history and physical examination to determine if your sore throat is caused by pharyngitis or tonsillitis. In some cases, additional investigations such as a blood test and a throat swab may be required. 

Treatment 

Home care remedies can help relieve symptoms of viral pharyngitis, some of these include: 

• Drinking plenty of fluids to prevent dehydration 
• Gargling with warm salt water or with over-the-counter antibacterial throat gargle
• Good rest and sleep

For pain or fever relief, you can consider taking over-the-counter medications like Panadol or Ibuprofen. Throat lozenges are also helpful in soothing a painful and scratchy throat. If you have been diagnosed with acute tonsillitis, a course of antibiotics (usually 7-10 days) may be prescribed by your ENT Specialist. It is important to ensure that you complete  the course of the antibiotics to ensure complete eradication of the bacteria involved.

If you suffer from recurrent tonsillitis, an ENT Specialist in Singapore may recommend surgical removal of your tonsil, a procedure known as tonsillectomy. The surgery may also help relieve other symptoms associated with tonsillitis such as breathing problems or difficulty swallowing. While you may still get a sore throat from cold/flu, postnasal drip, and acid reflux throat infections after removing your tonsils, undergoing a tonsillectomy eliminates the risk of recurrent tonsillitis.  

Although most sore throats are usually not a cause for concern, some severe symptoms to take note of include difficulty in swallowing or breathing, dehydration, and neck swelling. Anyone experiencing one or more of these symptoms should see an ENT Specialist or their local general practitioner immediately for an assessment and treatment.

Reach out to Dr Gan, at his ENT clinic in Mt Elizabeth Novena Specialist Centre and find out more about the treatment options as well as tips to help you kick this habit. 

References

https://www.healthline.com/health/pharyngitis

https://www.hopkinsmedicine.org/health/conditions-and-diseases/pharyngitis-and-tonsillitis

https://www.sgh.com.sg/patient-care/conditions-treatments/acute-pharyngitis-tonsillitis/symptoms