Sore throat

Updated 24 February 2016

Symptoms of tonsilitis

Symptoms of tonsillitis may include ear pain when swallowing, snoring and fever. In severe cases children may experience sleep apnoea.

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Acute tonsillitis

The typical symptoms of acute tonsillitis are a very sore throat with bright red, swollen tonsils. The onset of pain may be rapid or gradual. These symptoms may be accompanied by any of the following:

  • A white or yellow coating or spots on the tonsils
  • Drooling and difficulty swallowing saliva
  • Ear pain when swallowing
  • Bad breath
  • Swollen and tender lymph nodes in the neck under the jaw
  • Fever
  • Headache
  • Repeated infection may cause the formation of small depressions, called crypts, on the surface of the tonsils.
  • hese crypts can harbour bacteria and may contain pus.
  • Sometimes small hard secretions called "tonsilloliths" develop in these crypts. These hard secretions may contain sulphur and give off a characteristic "rotten egg" smell when crushed. This contributes to the patient’s bad breath.
  • Tonsilloliths may also cause the unpleasant sensation of having something caught in the back of the throat.

Tonsillar abscess (Quinsy's abscess)

In addition to inflamed tonsils, a tonsillar abscess can result in:

  • Severe pain and tenderness around the area of the soft palate, at the roof of the mouth
  • Difficulty swallowing
  • Muffled speech caused by swelling from the abscess
  • Difficulty opening the mouth

Hypertrophic tonsils (enlarged tonsils)

Enlarged tonsils and adenoids can obstruct breathing. This can result in:

- Snoring 

- Disturbed sleep patterns, including:

  • Sleep apnoea (when the child stops breathing for brief periods while asleep)
  • Frequent awakening from sleep
  • Restless sleep
  • Nightmares
  • Bed wetting 

Such sleep-related problems can lead to the development of mood changes, excessive sleepiness, poor appetite and sometimes even heart problems.

  • Chronic mouth breathing. This may sometimes result in the teeth to becoming poorly aligned (malocclusion).
  • Chronic enlargement and infection of the tonsils, in combination with adenoidal infection, can cause infections in other nearby structures:
  • The air passages in the region of the nose may become infected (sinusitis) and problems with nasal drainage or obstruction can develop.
  • The Eustachian tubes of the ears may also be affected, resulting in chronic ear infections. 

Read more: 

What is tonsillitis? 

Diagnosing tonsillitis  

Causes of tonsillitis 

Reviewed by Prof Eugene Weinberg, Paediatrician Health24, February 2015.