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.


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.