Pharyngitis vs. Tonsillitis: What’s the Difference?

When your throat hurts, it can be hard to tell exactly what’s going on back there. Is it a regular sore throat? Strep? Tonsillitis? Something else?

Two of the most common culprits are pharyngitis and tonsillitis. They’re closely related conditions that can share many of the same symptoms. But they’re not exactly the same thing.

Pediatrician Kristin Barrett, MD, explains pharyngitis vs. tonsillitis: the differences between them, what symptoms to watch for and when it’s time to call a healthcare provider.

What are pharyngitis and tonsillitis?

Pharyngitis and tonsillitis can feel very similar — and sometimes they happen at the same time. The biggest difference is where the inflammation occurs: Pharyngitis affects the throat itself, while tonsillitis affects your tonsils.

“Pharyngitis happens when the tissue lining the middle of your neck, called your pharynx, becomes inflamed,” Dr. Barrett explains. “In simple terms, it’s what most people mean when they say they have a sore throat.”

Tonsillitis causes a sore throat, too, but the pain comes from inflamed tonsils. Your tonsils are the two oval-shaped lumps of tissue at the back of your throat, responsible for helping trap germs before they can get further into your body.

Now, here’s the tricky part: You can have pharyngitis and tonsillitis at the same time. You can even have both of them and another illness, like strep throat. It all comes down to what’s causing your symptoms.

Causes of each

Pharyngitis has a wide range of possible causes. But viral or bacterial infections can both cause pharyngitis and tonsillitis. They’re most commonly caused by viral infections, like:

• Common colds
• Flu
• COVID-19
• Other upper respiratory infections

Strep throat is the most common bacterial cause of pharyngitis and/or tonsillitis.

So, how can the conditions overlap? Let’s say, for example, that you come down with a viral cold, which gives you a sore throat. That same virus can also cause tonsillitis, which can make the throat pain even worse.

But sometimes, pharyngitis has causes that aren’t viral or bacterial. That means you can have a standalone sore throat that isn’t connected to an illness, but instead, stems from something like:

• Allergies
• Acid reflux
• Irritants, like smoking or spicy food
• Mouth breathing
• Overuse (like if you cheered really loudly at a game or a concert)

Pharyngitis vs. tonsillitis symptoms

Both pharyngitis and tonsillitis cause throat pain and swollen lymph nodes in your neck.

When it comes to additional symptoms, let’s start with the symptoms of pharyngitis, as it’s the more likely of the two conditions to stand on its own.

Pharyngitis commonly causes:

• A raw or scratchy feeling
• Painful swallowing
• Dryness
• Hoarseness
• Mild cough or cold symptoms

Tonsillitis tends to cause more visible swelling and symptoms that center around your tonsils, like:

• Red, swollen tonsils
• White or yellow patches on your tonsils
• Trouble swallowing
• Fever
• Stomachache
• Vomiting

In severe cases of tonsillitis, one tonsil may become much larger than the other.

“If only one of your tonsils is bigger than the other, that may be a sign of a pocket of pus called tonsillar abscess,” Dr. Barrett explains. “That’s a complication that requires urgent treatment.”

And remember: If a virus causes your case of pharyngitis and/or tonsillitis, you may also be dealing with cold and flu symptoms, like sneezing, coughing, runny nose and red or watery eyes.

“It’s not always easy to tell where the symptoms of each begin and end when you’re also sick with something like a cold, the flu or strep,” she adds.

When to see a doctor

Most sore throats improve on their own, but some symptoms deserve medical attention.

Dr. Barrett recommends contacting a provider if you:

• Also have a high fever
• Have trouble swallowing or breathing
• Notice that one tonsil is much larger than the other
• Aren’t getting better or your symptoms get worse
• Have symptoms that last longer than a week

Your healthcare provider may want to run certain tests if they suspect strep throat or another bacterial infection.

How they’re treated

How pharyngitis or tonsillitis is treated depends on what’s causing it.

“Antibiotics can be used to treat bacterial tonsillitis or pharyngitis,” Dr. Barrett says. “But if a virus is responsible, antibiotics won’t help.”

Viral forms of tonsillitis and pharyngitis often go away on their own, usually within a few days to a week. In the meantime, rest and drink plenty of clear fluids. It may also help to:

• Gargle with warm salt water
• Use throat lozenges
• Drink warm tea or broth
• Take an over-the-counter pain reliever like acetaminophen (Tylenol®) or ibuprofen (Advil®), if your doctor says it’s safe for you

If your symptoms linger, become severe or make it hard to swallow or breathe, it’s important to talk to a healthcare provider. But most sore throats improve with rest, fluids and time — so try to be patient, take it easy and give your body the time and support it needs to heal.