Difference Between Viral and Bacterial Tonsillitis

Tonsils are lymphoid tissue. There is a ring of such tissue around the throat. They are called the Waldeyer’s tonsillar ring. It includes two tonsils at the back of the throat (pharyngeal tonsils), two tonsils on either side of the root of the tongue (lingual tonsils), two tonsils on either sides of the oropharynx behind the uvula (palatine tonsils) and two tonsils on the roof of the pharynx (tubal tonsils). People usually refer to the two palatine tonsils as tonsils. Tonsillitis is usually the inflammation of the two palatine tonsils. It presents as nasal speech, sore throat, painful swallowing and enlarged lymph node just below the angle of the jaw. On examination, reddened, swollen palatine tonsils are visible. There may be pus formation. If untreated, it can lead to peri-tonsillar abscess due to spread of infection into the deep tissue around the palatine tonsils. When palatine tonsils are inflamed and enlarged, they do not obstruct the airway but, in children, because the Eustachian tube is more horizontal, middle ear infections can accompany tonsillitis. Commonly tonsillitis is viral, but it also can be bacterial. Adenovirus, streptococcus, staphylococcus, heamophilus and well known culprits. Drinking warm water, steam inhalation and antibiotics can effectively cure tonsillitis, but it can recur. When cellular debris accumulates inside a tonsillar crypt, a small stone forms. This is called a tonsillolith. This presents as tonsillitis, bad breath, or tonsillar abscess. These stones mainly contain calcium salts. These can be removed under direct vision in the doctor’s office.

Viral Tonsillitis

Purely viral tonsillitis presents as sore throat, painful swallowing, enlarged lymph nodes, and nasal speech. Throat looks red on examination. Usually there is no pus formation. Viral tonsillitis is short lasting. It resolves in three to four days. It hardly requires treatment. Drinking warm water, anti-histamine drugs, and rest are all that is needed in most cases. Adenovirus is the usual culprit.

Bacterial Tonsillitis

Bacterial tonsillitis can start after a viral infection too. If tonsillitis is bacterial from the onset, it is a primary bacterial tonsillitis. If it comes on after a viral tonsillitis, it is a secondary bacterial tonsillitis. Both cases present with similar features. Sore throat, painful swallowing, enlarged lymph nodes and red swollen throat are the usual symptoms. Sometimes throat pain can be referred to the angle of the jaw, external ear canal, and there can be difficulty of opening the mouth. Pus forms due to severe inflammation. Peri tonsillar abscess is a known complication.  Drinking warm water, antibiotic mouth wash, systemic antibiotics, anti-fever drugs may be needed.

What is the difference between Viral and Bacterial Tonsillitis?

• Viral tonsillitis is usually milder than bacterial tonsillitis.

• Initially both conditions present similarly.

• Viral tonsillitis does not cause pus formation while bacterial tonsillitis does.

• Viral tonsillitis usually resolves on its own while bacterial tonsillitis does not.

• Viral tonsillitis does not need antibiotics while bacterial tonsillitis does.


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1. Difference Between Adenoids and Tonsils