Is it tonsillitis? How would you know?

You look into your throat at the bathroom mirror with your phone torch. Red, raw, with some ulcers on the tonsils. It's a throat infection.
Shall I call the doctor, or will they just say “it’s viral, take paracetamol”?
Well, based on statistics, the vast majority of throat infections are viral.

Let me give you an insider view on how the doctors think and what you are likely to hear from them.

Most doctors work by what is called the Centor criteria.

• Tonsillar exudate
• Tender anterior cervical lymphadenopathy or lymphadenitis
• History of fever (over 38 degrees Celsius)
• Absence of cough

Each of the Centor criteria score 1 point (maximum score of 4). A score of 0, 1 or 2 is thought to be associated with a 3 to 17% likelihood of isolating streptococcus. A score of 3 or 4 is thought to be associated with a 32 to 56% likelihood of isolating streptococcus.

It means that if you fulfil all the four criteria, in nearly half of the cases, you still have a viral sore throat. In this case, however, most GPs would offer antibiotic prescriptions as you are more likely to respond than not.
Studies have shown that use of antibiotics for bacterial (streptococcal) sore throat decreases symptom duration by less than 1 day.
However since the widespread use of antibiotics the more severe but rare complications of tonsillitis like rheumatic fever, kidney or joint inflammation are seldom seen in clinical practice.

In a child is that without any notice the child becomes unwell with high temperature, lethargic, not eating, not playing, just wants to sleep on the sofa. In young children aged 2-3 years, they often don't even complain of sore throat, the temperature on its own can be the only symptom.

In an older child or in a young adult the sore throat can be a prominent symptom with fever and voice change to what is called a “hot potato” voice, when it is audible that their throat is full.

When you then look into the throat you see the enlarged tonsils with exudate. Often the tonsils are not that red, they are more just pinkish.

On the other hand, if the illness starts with a runny and blocked nose, sneezing, coughing, croaky or lost voice and headache, together or later with a sore throat, that would be the story of a viral infection. In these cases the tonsils are most times enlarged, red, raw with some kind of craters or ulcers on them, but no real pus. The arches of the throat (called palatinal arches) and the dangly bit in the middle (called the uvula) also tend to be red, inflamed and swollen.

Instead you can gargle with salt and water, use throat lozenges like Strepsils or antiseptic spray like Difflam that are available without prescription.

Paracetmol and Ibuprofen could be taken for pain relief.

Children can return to nursery or school when the temperature is resolved (not when it is down with Calpol) or once they are on antibiotics for 24 hours.

Sore throat due to a viral or bacterial cause is a self-limiting condition which generally resolves within two weeks.

1. Immunosuppressed because of an underlying condition or treatment (like cancer treatment or Methotrexate, especially if you have a fever with the sore throat)
2. If you are dehydrated (minimum 2 urination per day, or 2 wet nappies a day for young children; less than 50% of fluid intake over 24 hours)
3. If you (or your child) was not immunised as a baby, so prone to serious throat infections like diphtheria, measles or epiglottitis
4. If the sore throat is not improving after a week and the temperature continues over 38 ℃ for longer than 5 days
5. If you develop breathing difficulty (not when you are coughing)
6. If you are unable to swallow your saliva, as this could be a sign of abscess in the throat, called quinsy. The nice double arch is gone and you see a big bulge on one side, usually with the uvula shifted from the middle to one side.

1. It is a good idea to have a look at your own or your child’s throat when there is no illness so you know how it looks when it is normal. This way you can appreciate the difference when a sore throat comes.
2. It is a good idea to have a working ear thermometer at home as feeling hot is not a reliable sign of a temperature
3. Please check this video to see how to take a good photo of your throat if you decide that you need to ask for advice from your doctor.
   https://youtu.be/_xZjv45eh2k
4. Recurrent bacterial tonsillitis might be treated with tonsillectomy, a surgery to remove the tonsils. The criteria for that is 7 or more tonsillitis episodes in a year, or 5 in each year in 2 consecutive years or 3 in each year for 3 consecutive years.

I hope that this helps you to decide whether you need to call the doctor or you might be safe treating yourself at home.

I hope you will get better soon.