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Why does tonsillitis cause ear pain?

Last update on Oct, 05, 2023

Did you know that the ears, nose and throat are interconnected? If you experience issues with one area, it can negatively affect another. Tonsillitis, for example, can lead to ear pain. Let’s look at what tonsillitis is, tonsillitis symptoms and how to treat this particular throat condition.

Sore throat and ear pain

When paired together, a painful throat and ears can be a sign of tonsillitis, mononucleosis and other throat-related conditions. The degree of pain in the ear and tonsils will differ by the type of illness, which will also determine the severity of hoarseness, redness and swelling within your throat and tonsils. Symptoms might manifest differently; as well, with some people feeling tonsil and ear pain on one side only, while others feel it on both sides. Some cases of painful tonsils and ears might require medical attention and treatment, while others can resolve on their own. 

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What is tonsillitis?

Tonsillitis is the inflammation of the tonsils, which are the two pads of tissues on the back of your throat. Because the tonsils fend off bacteria and viruses that might enter through the mouth, they are prone to infection or inflammation.

Tonsillitis most commonly affects children, and the tonsils become less important as you age. However, adult cases might arise because of the tonsils’ immune system function declines after puberty. All that said, if you’re wondering, “Is tonsillitis contagious?” the answer is “no”—but the causes of it (viruses and bacteria) most definitely are. 

Tonsillitis is classified as one of two types—viral or bacterial. So what is the difference between viral and bacterial tonsillitis? It all comes down to the tonsillitis’ root cause. 

The most common form of tonsillitis, viral tonsillitis, comes from a virus like the common cold and can benefit from at-home treatments.

Many bacterial tonsillitis cases are found in children ages 5 to 15. Bacterial tonsillitis comes from bacterial infection and will likely require medical intervention and potentially the removal of the infected tonsil tissue. 

What are tonsillitis symptoms?

How do you know if you might have tonsillitis? If you’re experiencing these symptoms, you should talk to a doctor about your treatment options.

One of the most noticeable tonsillitis symptoms—a sore throat—often stems from the swelling of the tonsils. Swollen tonsils might cause painful swallowing or breathing, as well as irritation within the throat.

If a sore throat doesn’t go away within 24 to 48 hours, visit a doctor. 

Earache is a very common tonsillitis symptom. In terms of ear pain or ache, you might experience it in one or both ears. The ear pain might feel subtle, sharp or burning, and it can also manifest in muffled hearing, fluid drainage, ear “popping,” or a feeling of fullness in the ear.

Likely the most defining tonsillitis symptom, you’ll notice that your lymph nodes behind the ear will start to swell. To check if you have this tonsillitis symptom, touch around that area and search for large bumps. Swollen lymph nodes indicate infection, which is exactly what tonsillitis is. These lymph nodes actually swell to create more antibodies that fight the infection.

To confirm that your lymph nodes are swollen, consult a doctor and have them do an examination.

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Tonsillitis vs. strep throat

You may notice that tonsillitis shares many of the same symptoms as strep throat: sore throat, large neck lymph nodes, pain while swallowing, headache, etc. That’s because strep throat is a kind of tonsillitis. They’re not the same thing, though—you can have tonsillitis without having strep throat. While tonsillitis can stem from both viruses and bacteria, strep throat is only caused by one group of bacteria known as A Streptococcus, which is where the word “strep” comes from. 

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How does tonsillitis affect your ear?

Because of the tonsils’ location close to the ear, tonsillitis can lead to simultaneous pain in ear and tonsils. It can also result in:

  • Otalgia: Ear pain
  • Otitis media: Bacterial or viral infection in the middle ear
  • Mastoiditis: Infection of the mastoid process, a large bone behind the ear

Ear pain (or otalgia) will commonly occur with tonsillitis. Often, this pain is a symptom of an underlying condition or an ear infection. To best treat this, a doctor will have to determine the cause—such as tonsillitis—and approach treatment accordingly. If the source of the ear pain is infection, leaving it untreated could lead it to worsen and require surgery.

A middle ear infection, also known as otitis media, is caused by a virus or bacteria (e.g. a cold or flu). This can have multiple effects, including congestion and swelling within the throat, nasal passages and eustachian tubes (which run from the ears to the throat). Since tonsillitis causes swelling and irritation within the throat, it increases the likelihood of a middle ear infection.

Symptoms of a middle ear infection include trouble hearing, ear pain and fluid drainage from the ear. A child might pull at their ears, act fussy, lose balance, develop a fever or have trouble sleeping.

If you suspect an ear infection in yourself or your child, visit a doctor to learn about your treatment options. When left untreated, people with ear infections can experience impaired hearing, spread of infection and tearing of the eardrum. Otitis media can also lead to mastoiditis.

Mastoiditis—the bacterial infection of the large bone behind the ear known as the mastoid process—often stems from an untreated middle ear infection. People  with severe tonsillitis may develop a middle ear infection that can progress into mastoiditis.

Once considered a serious illness, doctors can now treat mastoiditis with antibiotics and, in more extreme cases, surgery. Vaccinations have also helped limit the frequency of this infection. But if left untreated, mastoiditis can worsen and require surgery. Be sure to visit a doctor if you or your child start experiencing significant ear pain, blockage consisting of pus or thick fluid, hearing loss or ears sensitive to touch.

How to treat tonsillitis

Tonsillitis treatments will depend on the severity of your symptoms and the persistence of the infection. As previously mentioned, viral tonsillitis can benefit from at-home treatments, and bacterial tonsillitis will require a doctor’s care

For viral tonsillitis, doctors will likely recommend you take acetaminophen (Tylenol). With it, most symptoms will resolve in seven to 10 days after peaking within the first 72 hours (three days). As for bacterial tonsillitis, most doctors will first prescribe an antibiotic to fight off the bacteria causing the infection. They might also suggest NSAIDs, such as ibuprofen, to minimize pain and fever

To minimize irritation and soothe tonsillitis symptoms, you can try at-home remedies including:

  • Running a humidifier to alleviate dryness in your throat and nasal passageways
  • Drinking lots of water and gargling salt water to get rid of irritants getting stuck in your tonsils and throat
  • Eating popsicles and ice to cool the irritation in your throat
  • Sipping on herbal teas that have honey, lemon, ginger, mallow or echinacea
  • Trying throat lozenges or sore-throat spray to numb the tonsils on especially painful days


Be sure to practice good hygiene, such as washing your hands and disinfecting surfaces, to minimize the spread of infections. 

What causes throat and ear pain on one side?

Tonsillitis is just one of the potential causes of throat and ear pain on one side. Other illnesses or conditions that could spur throat and ear pain—in one or both ears—include:

Tonsillitis and an ear infection in one ear can cause ear pain on one side. TMJ disorders, which cause pain and dysfunction in the jaw joint, can also affect one ear more than the other, depending on which jaw joint is most affected.

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When to see a doctor

It’s especially important to address tonsillitis based on the severity of symptoms. Seek medical assistance immediately if you’re experiencing:

  • Difficulty breathing and swallowing
  • Inability to eat or drink due to sore throat
  • A severe sore throat lasting more than seven days
  • Swollen lymph nodes, even after sore throat resolves
  • Feeling of throat closing
  • Fever
  • Pus in the back of the throat
  • Body aches or joint pain
  • Ear ache
  • Rash
  • Blood in the mouth
  • Coughing up blood
  • Lump in the neck
  • Chronic sore throat
  • Hoarseness lasting over two weeks 

Tonsillectomy: What is it and when to do it

If you or your child experiences chronic infection and inflammation within the throat and tonsils, a medical professional might recommend a tonsillectomy, the removal of the tonsil tissue.

A tonsillectomy is a fairly simple and short procedure (30–45 minutes) that’s done under general anesthesia. However, tonsillectomies will always be done at the discretion of the doctor. They’re often only performed when someone experiences frequent tonsillitis and hasn’t had success treating it with other methods.

Tonsillectomy recovery can be difficult, but it’s easier for children, who have smaller tonsil tissue compared to adults. Recovery might take around a week for an adult and possibly less time for children. During this period, doctors will recommend soft, semi-solid and lukewarm or cold foods that will prevent throat irritation. As with any illness or recovery, drinking lots of fluids and getting plenty of rest are important.

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