Spontaneous tonsillar hemorrhage (STH) is relatively rare in clinical practice. The etiology of STH is complex and insidious, the most common of which is local infection of the pharynx. Presently, there is no unified diagnostic criterion for STH, which is mainly based on clinical signs and laboratory tests for STH. Its treatment is mainly based on the different causes and bleeding conditions, including etiological treatment, supportive treatment, and hemostatic treatment. If the above treatments are ineffective, and coagulation system and hypertension and other diseases are ruled out, suture, tonsillectomy, external carotid artery ligation and selective arteriography and embolization should be decisively performed. This paper reviews the pathogenesis, diagnosis and treatment principles of STH, which will provide reference for the treatments of otolaryngology emergency.