Tonsillitis Symptoms: Signs, Causes & Warning Symptoms

Quick Glance: Common Tonsillitis Symptoms

Tonsillitis can cause throat symptoms along with signs of infection that affect the rest of the body. The most common tonsillitis symptoms include:

Sore throat
Pain or difficulty when swallowing
Red and swollen tonsils
Fever or high temperature
White spots or patches on the tonsils
Tender or swollen glands in the neck
Headache
Tiredness

Other symptoms, such as coughing, feeling sick, earache or bad breath, can also occur.

Tonsillitis Symptoms That Should Not Be Ignored

Most tonsillitis symptoms start to improve within a few days. However, symptoms that worsen, persist or repeatedly return should be assessed by a healthcare professional. The following table highlights tonsillitis symptoms that may need medical assessment and what they could indicate.

Symptom	What It May Indicate
Throat pain that continues to worsen	Increasing inflammation or another cause of severe throat pain
Sore throat that does not start improving after about a week	An infection that is not settling as expected or another cause of throat symptoms
Difficulty eating or drinking because of throat pain	More severe inflammation and an increased risk of dehydration
Repeated episodes of tonsillitis	Recurrent tonsillitis that may need further medical assessment
Increasing pain or swelling on one side of the throat	A possible complication such as quinsy, also called a peritonsillar abscess
Persistent swollen or painful glands in the neck	An ongoing infection or another cause of enlarged lymph nodes
White spots or patches with significant throat pain	Tonsillar inflammation that may need clinical assessment

White patches on the tonsils do not by themselves confirm bacterial tonsillitis. Viral infections can also cause similar changes. So, the overall symptoms and examination findings are considered when assessing the likely cause.

Why Do Tonsillitis Symptoms Occur?

The tonsils are areas of lymphoid tissue at the back of the throat that form part of the immune system. They can become inflamed when a virus or bacterium infects the throat and tonsils.

During an infection, the immune system sends infection-fighting cells to the affected area. This inflammatory response causes the tonsils to become red, swollen and painful, which can make swallowing uncomfortable.

The lymph nodes in the neck may also become enlarged and tender as they respond to the infection. Fever, headache and tiredness can occur as the body's immune response affects the whole body.

White spots or patches may appear when inflammatory material, including immune cells and fluid, collects on the tonsils. These patches can occur with both viral and bacterial infections, so their presence alone cannot determine the cause.

Tonsillitis Symptoms That Require Immediate Medical Attention

Most cases of tonsillitis are not emergencies. However, rapidly worsening symptoms or swelling in the throat can sometimes affect swallowing or breathing and require urgent medical attention.

Seek emergency medical care if you have:

Severe throat pain that is rapidly getting worse
Increasing swelling inside the mouth or throat
Difficulty breathing
Inability to swallow
Drooling because swallowing saliva is difficult
Difficulty speaking or a significant change in the voice
Difficulty opening the mouth
Rapidly increasing swelling or severe pain on one side of the throat

These symptoms can occur with quinsy, also known as a peritonsillar abscess. It is a collection of pus that develops beside a tonsil and can cause severe pain, swelling and difficulty swallowing or opening the mouth.

Symptoms of Tonsillitis Based on Type

The table below presents the symptoms of different types of tonsillitis:

Type	Typical Symptoms
Viral tonsillitis	Sore throat and swollen tonsils, which may be accompanied by cough, runny nose or a hoarse voice
Bacterial tonsillitis	Often causes a sudden sore throat, fever, painful swallowing and tender neck glands; white patches may also occur
Recurrent acute tonsillitis	Separate episodes of sore throat and inflamed tonsils that repeatedly return after periods of improvement

Tonsillitis Symptoms in Children

Children can develop the same symptoms of tonsillitis as adults, including a sore throat, painful swallowing, fever and swollen tonsils. However, younger children may not be able to describe throat pain clearly, so changes in eating, drinking or behaviour may be more noticeable.

Other tonsillitis symptoms in children may include:

Eating less or refusing food because swallowing hurts
Irritability
Fever
Nausea or vomiting
Headache
Abdominal pain, particularly with group A Streptococcus infection
Swollen or tender glands in the neck

Drooling, inability to swallow fluids or saliva, difficulty breathing or rapidly worsening symptoms require urgent medical attention.

Can You Have Tonsillitis Without Symptoms?

Tonsillitis usually causes symptoms such as a sore throat, painful swallowing, swollen tonsils or fever. However, symptoms can sometimes be mild and may go unnoticed, particularly in the early stages of an infection.

A person can also carry bacteria such as group A Streptococcus in the throat without feeling unwell. This is known as bacterial carriage and is different from having active bacterial tonsillitis.

When Can Tonsillitis Symptoms Become Life-Threatening?

Serious complications of tonsillitis are uncommon. They can become dangerous when an abscess or severe swelling affects the airway, or when an infection spreads into deeper tissues of the neck.

The following table explains serious complications that can make tonsillitis symptoms dangerous and require urgent medical assessment:

Emergency Condition	Why It Is Serious
Quinsy (peritonsillar abscess)	A collection of pus beside a tonsil can cause severe one-sided throat pain, swelling, difficulty swallowing and difficulty opening the mouth.
Severe airway swelling	Significant swelling in the throat can narrow the airway and make breathing difficult.
Deep neck infection	Infection can rarely spread into deeper tissues of the neck and cause serious complications.

Difficulty breathing, inability to swallow, drooling, or rapidly increasing swelling in the mouth or throat requires immediate emergency assessment.

How are Tonsillitis Symptoms Diagnosed?

A doctor usually diagnoses tonsillitis by reviewing the symptoms and examining the throat. Further assessment may be considered when the cause is unclear, symptoms are severe, or they do not improve as expected.

The following table summarises the main assessments and tests that may be used when evaluating tonsillitis symptoms:

Diagnostic Test or Assessment	Purpose
Symptom and medical history	Reviews symptoms such as sore throat, fever, swallowing difficulty, duration and previous episodes.
Throat examination	Checks the tonsils and throat for redness, swelling, white patches and other signs of inflammation.
Neck examination	Checks for enlarged or tender lymph nodes around the neck.
FeverPAIN score	Uses five clinical features to assess how likely an acute sore throat is to be caused by streptococcal bacteria.
Centor score	Uses clinical signs and symptoms to estimate the likelihood of a streptococcal throat infection.
Throat swab	May be used to test a throat sample for bacterial infection when further testing is considered appropriate.
Blood test for glandular fever	May be considered when symptoms are severe, persistent or suggest glandular fever.

FAQs

Q1. What are the first symptoms of tonsillitis?

Ans: A sore throat and pain when swallowing are common early symptoms of tonsillitis. The tonsils may become red and swollen, while fever, headache, tiredness or tender glands in the neck can develop.
Q2. Does tonsillitis always cause white patches on the tonsils?

Ans: No, tonsillitis does not always cause white patches. The tonsils may simply look red and swollen, while some people may develop white or pus-filled spots.
Q3. Can tonsillitis cause an earache?

Ans: Yes, tonsillitis can sometimes cause an earache. Pain from the inflamed throat can be felt in the ear because some of the nerves supplying the throat and ear share pathways.
Q4. How long do tonsillitis symptoms usually last?

Ans: Tonsillitis symptoms usually improve within a few days, although they can last longer. If tonsillitis symptoms have not improved within about a week, are getting worse or keep coming back, a medical assessment is advisable.
Q5. How can you tell viral and bacterial tonsillitis apart?

Ans: Symptoms alone cannot always distinguish viral from bacterial tonsillitis. Cough, runny nose and hoarseness are more commonly associated with viral infections, while fever, sudden throat pain and tender neck glands can occur with group A Streptococcus. A healthcare professional may use clinical assessment and, where appropriate, further testing to assess the likely cause.
Q6. Can tonsillitis keep coming back?

Ans: Yes, tonsillitis can keep coming back in some people. Repeated episodes may interfere with eating, drinking, sleep, school or work and may need further assessment by a healthcare professional.
Q7. Are tonsillitis symptoms different in children?

Ans: Children can experience the same tonsillitis symptoms as adults. However, younger children may have difficulty describing throat pain. They may instead become irritable, eat less, refuse food or develop symptoms such as nausea, vomiting or abdominal pain.
Q8. Which tonsillitis symptoms require emergency care?

Ans: Tonsillitis symptoms such as difficulty breathing, inability to swallow, drooling, rapidly increasing swelling in the mouth or throat, difficulty speaking or difficulty opening the mouth require urgent medical attention. These symptoms can occur with quinsy or with significant swelling that affects the airway.