Why does tonsillitis cause ear pain?

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Sore throat and ear pain

Earaches and other disorders of the auditory system can cause intense pain and be debilitating. However, many people are unaware that issues in the throat, such as tonsillitis, or dental problems can also be contributing factors. These conditions can trigger otalgia, which is severe ear pain.

What is tonsillitis?

Tonsillitis is an acute inflammation of the tonsils, glands on the sides of the throat between the mouth and the pharynx, which are shaped like small almonds. In children, they help protect the respiratory tract, fighting off microorganisms and acting as a barrier against infections to prevent them from spreading through the body. As the years go by, the immune system strengthens and develops, and the role of the tonsils becomes less and less important; in fact, they gradually atrophy. 

There are two types of tonsillitis and they vary depending on the underlying cause: viral tonsillitis (the most common) and bacterial tonsillitis.

Viral tonsillitis

Viral tonsillitis is an acute inflammation of the tonsils, caused by pathogenic microorganisms that affect the body by finding a suitable habitat for their replication. Common cold viruses are the ones that normally cause this type of tonsillitis, characterised by a sore throat and fever, which normally does not exceed 39°.

If you are wondering how long viral tonsillitis lasts, it can be said that symptoms normally disappear spontaneously within 72 hours; paracetamol can help relieve sore throat and fever, the characteristic symptoms of this disorder. 

Particularly common in colder season, this condition is often transmitted in crowded places. However, it resolves after a few days.

Bacterial tonsillitis

Bacterial tonsillitis is caused by a bacterial infection that debilitates the organism and causes high fever (above 39°) and plaques on the tonsils. In adults, the main cause is the Streptococcus bacterium, while in children, it is Streptococcus beta-haemolyticus A. To treat it, antibiotic therapy is required, which should only be followed on doctor's instructions.

Glossopharyngeal neuralgia

Find out more about the relationship between ear, nose and throat.

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What are the causes of tonsillitis?

It is not always easy to understand the difference between viral and bacterial tonsillitis, because some symptoms are the same, but with different severity. 

  • The mainly causes of viral tonsillitis are cold viruses, Adenoviruses and Rhinoviruses, which find fertile ground in the body to replicate, causing acute inflammation of the tonsils, sore throat and fever, which usually does not exceed 39°. 
  • Bacterial tonsillitis, on the other hand, is caused by a bacterial infection: in children, Streptococcus beta-haemolyticus is the main cause. It manifests itself with high fever, which rises above 39°, debilitating the organism, and with plaques, sort of yellowish-white spots on the tonsils.

What are the symptoms of tonsillitis?

Sore throat

The main tonsillitis symptom is sore throat. Often the pain is so severe that it also extends to the pharynx (pharyngodynia) and makes swallowing, especially solid food, difficult. In severe cases, tonsillitis can also cause pain or burning in the back of the neck or sternum, also known as odinophagia.


Can tonsillitis cause ear infection

Yes, it can and one of the main symptoms of tonsillitis is earache. This is because the tonsils are located at the transition point between the mouth and pharynx, close to the ears. Therefore, when they become inflamed, the entire area may be affected by pain, including the ears. This type of earache is called reflex otalgia because it is not the auditory system that is attacked by the virus or bacteria, but rather the throat. When considering treatment, it is important to consult a doctor rather than relying on self-treatment.

Swollen lymph nodes behind the ear

Tonsillitis and enlarged lymph nodes are a fairly common combination. Tonsillitis, in fact, can cause reactive laterocervical lymphadenopathy, a scientific term for swollen lymph nodes in the neck. The lymph nodes, in general, swell because our body is responding to the presence of an infection and is, in fact, trying to get rid of it; a simple palpatory examination by the doctor is enough to diagnose them and indicate how to intervene to help the body eliminate the cause more quickly.

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How does tonsillitis affect the ear?

Tonsillitis can also manifest itself with pain in the ears, known as otalgia. Specifically, when the pain is caused not by a problem in the auditory system but by tonsillitis, it is called reflex otalgia. In severe cases, tonsillitis can also cause mastoiditis, which is inflammation of the cranial bone.

Reflex Otalgia

Otalgia refers to inflammation of the ear and is normally understood as an illness that is caused by inflammation of the outer, but often also the inner ear. There are two different types of otalgia: bilateral and reflex otalgia. 

  • Bilateral otalgia is pain that affects both ears: the cause is a disorder affecting the auditory system and can be of various kinds. 
  • Reflex otalgia, on the other hand, is an intense pain in the ear that has causes unrelated to ear infections, such as those caused by tonsillitis or, more generally, all infections of the oral cavity. The latter cause inflammation so severe that it also affects the areas where the cranial nerves that are responsible for the increased sensitivity of the outer and middle ear are located. The affected nerve is the 9th cranial nerve, glossopharyngeal.


If left untreated, tonsillitis can lead to more severe complications, including otitis. This is an acute inflammation of the ear that can cause severe pain, itching, and irritation in the ear canal, and in some cases, a feeling of pressure inside the ear canal. It is important to seek prompt treatment for tonsillitis to avoid such unpleasant repercussions on the body.


In severe cases of tonsillitis, the disorder can complicate and lead to mastoiditis, a bacterial infection that normally follows acute otitis. To treat it, antibiotic therapy is required, administered under medical indication. 

Mastoiditis is a very painful and debilitating disorder, so it is always a good idea to treat tonsillitis early and avoid unpleasant repercussions on the body in general.

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How to treat tonsillitis

The treatments for tonsillitis depend on the cause of the infection. When the cause is viral, it is important to support the immune system's natural defense mechanisms. This may involve measures such as maintaining a consistent temperature, staying hydrated with water or herbal teas, and incorporating medicinal herbs known for their disinfectant properties into the diet. It is crucial to refrain from smoking, as this can further irritate the oral mucosa. Before initiating any pharmacological treatment, it is recommended to consult with a physician to determine the most appropriate course of action.

Medications to treat tonsillitis

Medications for tonsillitis vary depending on the cause of the disorder. 

In the case of viral tonsillitis, treatment is based on paracetamol, in doses appropriate for fever and pain. Normally, however, after a peak in the first 72 hours, it regresses spontaneously and disappears in 7-10 days. In some cases, the doctor may also indicate taking NSAIDs (non-steroidal anti-inflammatory drugs), such as acetylsalicylic acid and ibuprofen. On the other hand, if the tonsillitis is viral, antibiotics must not be taken under any circumstances, whereas they are necessary in the case of bacterial tonsillitis. The antibiotics normally used are broad-spectrum ones. If close infections occur, the antibiogram will give a useful indication of the antibiotic to be used.

Home remedies to treat tonsillitis

If tonsillitis is viral, it is essential to help the immune system defend itself. This may involve implementing all the good practices used for fever and other viral infections, such as 

  • avoid temperature changes;
  • washing hands often;
  • ventilate rooms to avoid contagion of the virus;
  • drink small sips of water often to moisturise the tonsils, or infusions and herbal teas based on honey, lemon, ginger, mallow and echinacea; 
  • disinfect the throat by gargling with a mouthwash or with salt and bicarbonate.
  • Eating fresh food can also help soothe the pain.

Good practices can help, but it is always best to consult with a physician to evaluate the most effective  to treat the disorder.

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Tonsillectomy: when to do it and how is it work?

When an individual experiences recurring bouts of tonsillitis over an extended period, especially following significant infections such as tonsillar abscess, the option of undergoing a tonsillectomy (i.e., the surgical removal of the tonsils) may be considered. A tonsillectomy is a short operation, lasting 30 to 45 minutes, to be performed under general anaesthesia, in children and adults: the techniques are different and are evaluated by the surgeon on a case-by-case basis, based on his experience and what is best for the patient.

After the operation, it is normal to feel pain in the throat and in the ear: in adults it can last more than a week, while children generally have a faster recovery. To keep the pain under control, painkillers are prescribed.

Following a tonsillectomy, it is recommended to consume soft, semi-solid, and lukewarm-cold foods, as they are easier to swallow during the initial post-operative period. It is important to adhere to the dietary recommendations provided by the hospital and medical staff. Despite possible difficulties with swallowing, it is recommended to gradually reintroduce solid foods as instructed, as this can aid in expediting the recovery process.

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