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. 

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. 

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.

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. 

Are tonsils connected to ears? 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.

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.

An earache after tonsils are removed​ is a common occurrence due to referred pain. This happens because the nerves in the throat and ears are closely connected. When the tonsils are removed, the irritation or healing process in the throat can cause discomfort that radiates to the ears, even though the ears themselves are not directly affected. This is known as referred otalgia.

The ear pain usually peaks a few days after surgery and can last for up to two weeks during the recovery period. It's often more noticeable when swallowing, which can also cause discomfort in the throat. To manage the pain, doctors typically recommend over-the-counter pain relievers, hydration, and soft foods that are easy to swallow. If the ear pain is severe or persists beyond the normal healing time, it's important to consult a healthcare provider to rule out complications.

Yes, tonsillitis can sometimes lead to an ear infection. This occurs because the throat, tonsils, and ears are connected through the Eustachian tubes, which help regulate pressure in the middle ear. When the tonsils become inflamed or infected, as in the case of tonsillitis, the infection can spread or cause blockage in the Eustachian tubes, leading to fluid buildup in the middle ear. This can result in a secondary ear infection, known as otitis media.

Tonsillitis and ear infection treatment 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. 

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:

• Allergies;
• Sinus infections;
• The common cold;
• Strep throat;
• Mono;
• TMJ and acid reflux.

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.

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.