Tonsillitis causes a sore throat, swollen tonsils, pain when swallowing, and often a fever above 38°C (100.4°F). Most cases are viral and resolve within a week, but bacterial tonsillitis tends to produce more intense symptoms and may need treatment with antibiotics.
The Main Symptoms
The hallmark of tonsillitis is a sore throat that comes on relatively fast. Your tonsils, the two oval-shaped pads at the back of your throat, become red, swollen, and sometimes coated with white or yellow patches of pus. Swallowing feels painful, and you may notice your voice sounds slightly muffled or scratchy.
Other common symptoms include:
- Fever, sometimes with chills
- Swollen, tender lymph nodes along the front of your neck, just below the jaw
- Headache
- Bad breath, caused by bacteria breaking down debris trapped in the inflamed tonsil tissue and releasing sulfur compounds
- Ear pain, even though the infection is in your throat. The throat and ears share nerve pathways, so inflammation in one area can produce pain in the other.
- Stomachache, especially in children
How Symptoms Differ by Cause
Viruses cause up to 70% of tonsillitis cases. Viral tonsillitis often arrives alongside other cold or flu symptoms: a runny nose, sneezing, cough, and a generally “under the weather” feeling. The sore throat is real but tends to be milder, and symptoms usually improve on their own within 7 to 10 days.
Bacterial tonsillitis, most commonly caused by Group A Streptococcus (strep throat), typically hits harder. The sore throat is more severe, the fever tends to be higher, and the tonsils are more likely to have visible white or yellow patches. One useful pattern: bacterial tonsillitis usually does not come with a cough or runny nose. Doctors use this distinction as one of the clues. The classic clinical checklist for estimating bacterial infection looks for four things: pus on the tonsils, tender swollen lymph nodes in the front of the neck, fever over 38°C, and the absence of a cough. The more of these you have, the more likely the cause is bacterial.
A rapid strep test or throat culture is the only reliable way to confirm whether bacteria are involved, since you can’t always tell just by looking.
Symptoms in Babies and Toddlers
Young children who can’t describe a sore throat show tonsillitis through their behavior instead. A toddler with tonsillitis may drool more than usual because swallowing is painful, refuse to eat or drink, or become unusually fussy and irritable. You might notice them pulling at their ears or just seeming “off” without an obvious cold. Fever and restless sleep are common. If a young child stops drinking fluids, that’s worth prompt attention because dehydration can develop quickly at that age.
Warning Signs of a Complication
Most tonsillitis clears up without problems, but occasionally the infection spreads to the tissue around the tonsil and forms a pocket of pus called a peritonsillar abscess. This is one of the more serious complications, and it has distinctive symptoms that set it apart from ordinary tonsillitis.
The red flags include a severe sore throat that’s noticeably worse on one side, difficulty opening your mouth (the jaw feels locked or stiff), and a voice that sounds like you’re trying to talk around a hot object in your mouth. If you look in the mirror, you may see the soft tissue at the roof of your mouth or the uvula pushed to one side. These symptoms develop over a day or two, usually after a tonsillitis episode that seemed to be getting better and then suddenly worsened. This needs same-day medical evaluation.
Other reasons to seek care sooner rather than later: a sore throat that lasts more than a couple of days without improving, difficulty breathing or swallowing liquids, inability to open your mouth, or a fever that keeps climbing despite rest and fluids.
What Recovery Looks Like
Viral tonsillitis typically peaks around days two through four and then gradually improves, with most people feeling mostly normal within a week to ten days. Bacterial tonsillitis treated with antibiotics usually starts improving within 48 to 72 hours of starting the medication, though you should finish the full course even after symptoms fade. The sore throat is often the last symptom to fully resolve, lingering a few days after the fever breaks and energy returns. Swollen lymph nodes in the neck can take a week or two to shrink back to normal size, which is not a sign of ongoing infection.
Recurring episodes, defined as multiple bouts per year over several years, may eventually lead to a conversation about surgical removal of the tonsils. This is typically considered only when infections are frequent enough to significantly disrupt daily life.