Why only one side?
The throat is symmetrical, but infections and irritation often begin or stay on one side: one tonsil may be inflamed or hold debris, a gland may be swollen on one side, or an object may scratch one side as it is swallowed. Pain can also be referred: the throat, ear, teeth and jaw share nerves, so a problem in one can be felt in another on the same side. One-sided pain is not necessarily more serious than two-sided pain, but its causes differ and it deserves attention if it persists.
Infection and inflammation
- Tonsillitis and strep throat may begin on one side, with a red, swollen tonsil, white patches and fever. See strep throat and tonsillitis treatment.
- Viral pharyngitis, as with a cold, may feel worse on one side. See pharyngitis.
- Peritonsillar abscess (quinsy): a pocket of pus beside a tonsil, with severe one-sided pain, fever, trouble opening the mouth and a muffled voice; urgent.
- Tonsil stones trapped in the crypts. See tonsil stones.
- Swollen lymph nodes in the neck, tender under the jaw on one side.
- Dental infection or wisdom tooth problems.
- Ear infection, with pain referred to the throat.
Irritation and other causes
- Postnasal drip and chronic rhinitis. See postnasal drip.
- Acid reflux and LPR, sometimes felt more on one side. See laryngopharyngeal reflux.
- A foreign body or scratch: a fish bone, a hard crust or a sharp food fragment.
- Throat dryness from mouth breathing. See dry throat.
- Muscle strain after shouting, coughing or vomiting.
- TMJ disorders and neck problems referring pain.
- Eagle syndrome (an elongated styloid bone) and glossopharyngeal neuralgia, rare causes of sharp one-sided pain on swallowing.
- Thyroiditis, with tender pain at the front of the neck.
Less common but important causes
A persistent one-sided sore throat, particularly with ear pain on the same side, a lump in the neck, difficulty swallowing, hoarseness, weight loss or blood in the saliva, can be a sign of a tumour of the tonsil, tongue base, throat or voice box. Risk is higher in smokers, heavy drinkers and people infected with HPV, and in people over 45, although it can happen in younger people. These cancers are uncommon, and most one-sided sore throats are not cancer, but a throat symptom lasting more than 3 weeks should be examined. See lump in throat.
Home care
- Drink plenty of fluids; warm drinks with honey (not for babies under 1) soothe.
- Gargle with warm salt water several times a day.
- Use lozenges or throat sprays.
- Take paracetamol or ibuprofen if suitable.
- Rest your voice and avoid smoking and alcohol.
- Use a humidifier if the air is dry.
- Treat nasal congestion and reflux if they are present. See home remedies for heartburn.
- Avoid very hot, spicy or sharp-edged foods while it is sore.
Medical treatment
- Antibiotics for strep throat or confirmed bacterial infection.
- Drainage of a peritonsillar abscess, often with antibiotics and steroids.
- Removal of tonsil stones or a foreign body by a clinician.
- Treatment of reflux, allergies or sinus disease.
- Dental treatment for dental causes.
- Further tests (nasal endoscopy, scan or biopsy) for persistent or suspicious symptoms.
- Tonsillectomy for recurrent severe tonsillitis or abscess.
How long should it last?
A viral sore throat usually improves within 3–7 days. Strep throat improves 1–2 days after starting antibiotics. A sore throat that is getting worse after 3–4 days, or that persists beyond 1–2 weeks, needs assessment, and symptoms lasting more than 3 weeks need examination regardless of severity.
When to see a doctor
- One-sided throat pain with fever and trouble opening your mouth, drooling or a muffled voice: same-day urgent care.
- Pain lasting more than a week, or recurring on the same side.
- Difficulty swallowing, food sticking or pain on swallowing.
- A lump in the neck, hoarseness or voice change.
- Unexplained weight loss, night sweats or persistent fatigue.
- Blood in saliva or phlegm.
- Ear pain on the same side without ear disease.
- Smoker, heavy drinker or over 45 with persistent one-sided symptoms.
Three common situations
A teenager with a sore throat that is worse on the left with fever and white patches: consider strep throat; see a doctor for a test.
An adult with a one-sided throat pain, trouble opening the mouth and a muffled voice after 4 days of sore throat: possible quinsy; seek urgent care.
A 55-year-old smoker with a month of one-sided throat pain and ear pain: needs an ENT assessment.
Key points to remember
Most one-sided sore throats are infections or irritation that settle with simple care, but severe pain with fever and trouble opening the mouth is an emergency, and persistent one-sided pain, particularly with ear pain or a neck lump, needs an examination. Our ENT team can look at the throat and guide treatment.
This guide is for general information and does not replace an examination by your own doctor or ENT specialist.
Questions about a sore throat on one side
These answers are general information and do not replace an examination or individual medical advice.
Why does only one side of my throat hurt?
Often one tonsil is inflamed, a gland is swollen, there is irritation or the pain is referred from the ear, teeth or jaw.
Could a sore throat on one side be cancer?
Rarely; it is more likely if it lasts more than 3 weeks, with ear pain, a neck lump, weight loss or blood, particularly in smokers.
What is a peritonsillar abscess?
A collection of pus beside a tonsil causing severe one-sided pain, fever and trouble opening the mouth; it needs urgent treatment.
What helps a sore throat on one side?
Fluids, salt-water gargles, lozenges and pain relief; see a doctor if it is severe or persistent.
Can ear problems cause throat pain on one side?
Yes, nerves are shared, so ear infections can cause throat pain on the same side and vice versa.
How long before I should see a doctor?
Within days if severe or worsening, and by 2–3 weeks at the latest if it persists.
Sources
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.