Pharyngitis & Tonsillitis

What Causes a Sore Throat?

Viral or bacterial infections cause most cases of pharyngitis and tonsillitis. Both are contagious. They spread through tiny droplets from coughing or sneezing or direct contact with an infected person, such as kissing or interacting at daycare.

Irritants such as allergens, dry air, smoke and mouth breathing at night can sometimes cause pharyngitis. These cases are not infectious.

Viral Causes 

About 50–80 percent of pharyngitis cases are viral, and viral infections are the most common cause of tonsillitis. Common viruses that cause sore throats include rhinovirus, adenovirus, coronavirus and parainfluenza. These viruses also cause the common cold. Mononucleosis (mono), caused by the Epstein-Barr virus, can also lead to pharyngitis and tonsillitis.

Bacterial Causes

The most common bacterial cause is Group A beta-hemolytic streptococcus, which causes strep throat. 

What Are the Symptoms of Tonsillitis? 

A sore throat is often the first and most noticeable symptom of tonsillitis. Other signs and symptoms may include:

• Bad breath 
• Changes in voice
• Difficulty swallowing
• Fatigue or lethargy
• Fever
• Red, swollen tonsils (sometimes with white patches or pus)
• Swollen lymph nodes in the neck
• Tonsil stones (These are small, often smelly, pebble-like formations that develop in the crevices of the tonsils. They are made up of debris, such as food particles and bacteria, that accumulate and harden over time.)

In more severe infections, your child may have a stiff neck or difficulty opening their mouth.

How Are Pharyngitis and Tonsillitis Diagnosed?

Diagnosis typically involves a combination of physical examination and laboratory tests. It begins with the pediatrician.

• Physical exam: Your pediatrician will examine your child’s throat, looking for redness, swelling and other signs of infection.
• Rapid strep test: They will then take a quick swab from the back of the throat to detect strep bacteria. This involves briefly rubbing a cotton swab against the back of your child’s throat.
• Throat culture: If the rapid strep test is negative but the pediatrician still suspects strep, they may perform a throat culture, which also involves a swab. These results can take 24-72 hours.
• Viral panel: Your pediatrician may conduct another swab test to identify common respiratory viruses.
• Monospot test: They may order this test to check for mono, another cause of tonsillitis. This test is unreliable in children under 4 years old.

When Should I See a Specialist for a Sore Throat? 

If your child has frequent infections, severe symptoms or complications such as trouble breathing, your pediatrician may refer them to an ear, nose and throat (ENT) specialist. 

How Is a Sore Throat Treated?

Treatment depends on the cause:

• Bacterial infections are treated with antibiotics, usually penicillin.
• Viral infections can be managed with supportive care, which includes rest, plenty of fluids and over-the-counter pain relievers as needed. 

Recurrent Tonsillitis

If tonsillitis is recurrent or severe, the ENT specialist may recommend removing your child’s tonsils — a tonsillectomy. Here are the general criteria for recurrent tonsillitis: 

• Seven episodes in one year
• Five episodes per year for two consecutive years
• Three episodes per year for three consecutive years

Your ENT may recommend a tonsillectomy if your child has severe complications like sleep apnea, recurrent tonsil abscesses, peritonsillar abscesses or impact to their quality of life.

What Are the Long-Term Effects of Tonsillitis?

Tonsillitis typically doesn’t cause long-term problems. But any untreated bacterial infection can result in serious complications. Untreated tonsillitis can lead to:

• Peritonsillar abscess: A collection of pus behind the tonsils that may require drainage.
• Deep neck infections: Infections spreading to the muscles in the neck.
• Quality-of-life issues: Recurrent infections can affect school attendance and even a parent’s ability to work outside the home. 

What Makes Lurie Children’s Approach to Tonsillitis and Other Sore Throats Special? 

Lurie Children's board-certified pediatric ENT team provides expert, compassionate care for both routine and complex cases. Our child-centered, team-based approach ensures your child receives personalized attention. Their care team includes experienced providers from several medical specialties. This collaborative care model allows you to see all the necessary specialists under one roof, often during a single visit.

Pediatric Otolaryngology at Lurie Children’s

Lurie Children’s provides expert, child-centered ear, nose and throat (ENT) care. Our specialists focus exclusively on pediatric conditions, ensuring comprehensive treatment for both routine and complex cases. With a strong commitment to family-centered care, Lurie Children’s ensures parents play an active role in their child’s treatment. 

Our physicians treat more children for ENT conditions than any other hospital in Illinois. As both a high-volume clinical center and a research leader, Lurie Children’s offers unparalleled expertise, specialized resources, and access to the newest treatments for its ENT patients.

Learn more about pediatric otolaryngology at Lurie Children’s.