About Tonsillitis: Symptoms and Complications

The main symptom of tonsillitis is sore throat, but since the throat and ears share the same nerves, the pain is often referred to the ears. The pain is usually worse on swallowing. Very young children may not complain of a sore throat but may simply refuse to eat.

Other symptoms include:

  • headaches
  • vomiting
  • fever
  • general ill feeling

Symptoms can be fairly similar whatever the agent causing the disease, but there's a slight tendency for bacterial infections to be more painful and more visible if you look in the throat.

All forms of tonsillitis clear up on their own if left untreated. It takes a few days in bacterial or normal viral tonsillitis, but can take weeks if mononucleosis is the cause. Ninety-nine percent of the time that's as far as the infection goes, but there are small risks associated with bacterial tonsillitis. It's because of the risk of such complications that doctors commonly give antibiotics for sore throat.

The main complications they're trying to prevent are further infections - people with tonsillitis tend to be mildly infectious if it's a bacterium or Epstein-Barr virus, and very infectious if it's the cold or flu. People catching the bug may not develop tonsillitis, but get a cold or flu instead. Unfortunately, antibiotics only reduce the risk of bacterial transmission and do nothing to prevent the spread of viruses.

Another problem that can occur is peritonsillar abscesses (quinsy). These occur when a clump of streptococci are "walled off" by new tissue growth. The abscess is not in the tonsil itself but on one side of it. Unlike simple tonsillitis, quinsy tends to be felt on one side of the throat only, and sufferers can often be seen tilting their head to one side to reduce pain. Quinsy afflicts about one person in 3000 per year. It's most likely to appear in young adults with tonsillitis.

Other complications include:

  • otitis media, which is a common middle ear infection that's almost invariably caused by infection spreading from the throat, since infections can't penetrate the outer ear. The tubes through which the infection spreads are shorter in children, who make up the vast majority of victims. Otitis media is painful and can lead to complications of its own
  • rheumatic fever, which used to be common until doctors started treating tonsillitis and other bacterial mouth and throat infections with antibiotics. In rheumatic fever, group A strep spreads through the body and infects vital organs, especially the heart. This can cause permanent damage, resulting in fatal heart disease later in life. It's now extremely rare in Canada (a couple of cases a year), though still a major problem in some countries.

Learn more about Sore Throat