Adam Johnson scored his first league goal of the season to put the Black Cats ahead on 37 minutes at the Stadium of Light after a blunder by Spurs keeper Hugo Lloris.
But Paulinho drew the visitors level just six minutes later from close range after Nacer Chadli made a great header back across goal from a free-kick.
Spurs then took the lead five minutes after the re-start through a John O'Shea own goal after a strong run into the box by Mousa Dembele.
Jermain Defoe twice struck the woodwork and Sunderland had a penalty shout turned down after Sebastian Larsson's corner hit substitute Sandro on the arm as Spurs - fresh from their midweek win at Fulham - held on to hand Andre Villas-Boas a second successive victory.
The loss leaves the Black Cats deep in trouble at the foot of the table. It was the fifth time this season a Sunderland player had put through his own goal, more than any man in red and white has achieved at the other end.
Gus Poyet opted to start with both Jozy Altidore and Steven Fletcher, although he asked the United States international to play in a slightly withdrawn role in front of a narrow midfield trio.
However, that simply served to congest the midfield and playmaker Ki Sung-yueng found himself pinned back inside his own half with little scope to open up the visitors.
After a tepid opening to the game, Paulinho eventually injected some excitement with a dipping, swerving 13th-minute shot which flew just over.
Vito Mannone turned Lewis Holtby's curling effort around the post before he had another close-range attempt blocked by Wes Brown after he had run on to Defoe's clever pass.
In the meantime, Jack Colback had wasted good work by Fletcher and Altidore by firing high and wide, and the Black Cats might have been made to pay as Chadli and Defoe both went close within seconds.
However, it was the home side who took the lead with eight minutes of the half remaining when Lloris made a mess of collecting Ondrej Celustka's cross and Johnson controlled the loose ball before blasting it into the roof of the net.
But the lead lasted just six minutes, Paulinho stabbing home the equaliser after Chadli had headed a deep free-kick back across the six-yard box.
Celustka tested Lloris from distance on the stroke of half-time but this time the Frenchman was equal to the task.
Tottenham needed just five minutes of the second half to get their noses in front, although they did so with a touch of good fortune.
Dembele's powerful run took him past Colback's ineffectual challenge and his cross cannoned off O'Shea and past the unfortunate Mannone.
Johnson's last-gasp intervention denied Holtby a 53rd-minute tap-in and Brown blocked a goal-bound effort from the same man three minutes later with Spurs going for the kill.
But the visitors were unfortunate not to extend their lead with 57 minutes gone when Chadli played Aaron Lennon in and Defoe headed his cross against the post.
Paulinho passed up a glorious opportunity to make it 3-1 on the hour when he missed his kick after Lennon had drilled the ball across the face of goal, and Defoe was just as profligate after being played in by Holtby six minutes later.
Fletcher sent an ambitious 71st-minute header wide as Sunderland tried to respond and he and his team-mates were left appealing in vain for a penalty four minutes later after Larsson's corner hit Sandro's arm.
Defoe struck the upright for a second time with 11 minutes remaining and substitute Fabio Borini fired straight at Lloris at the other end three minutes later.
Fellow substitute Andros Townsend then drew a fine save from Mannone in injury time as Spurs held on for another valuable victory.