Tonsillitis in adults

Overview

Tonsillitis is an infection that makes the tonsils (the two soft pads at the back of your throat) red, swollen, and painful. It is usually caused by a virus, but bacteria can also cause it.

Yes, tonsillitis is very common, especially in children and young adults.

Adults of any age can get tonsillitis, but it is most common in people under 40. It often occurs in people who are in close contact with others, such as at school or work.

Symptoms

Common symptoms

• Sore throat that makes swallowing painful
• Red, swollen tonsils (sometimes with white or yellow patches)
• Fever (high body temperature)
• Swollen glands (lymph nodes) in your neck
• Ear pain or a feeling of pressure in your ears
• Headache
• Tiredness and general feeling of being unwell

Symptoms in children

• Nausea or vomiting
• Stomach ache
• Drooling more than usual (if very young)
• Refusing to eat or drink due to throat pain

Symptoms in older adults

• Fever may be milder or absent
• More likely to feel very weak or confused
• Throat soreness may be less intense but swallowing can still be difficult

Causes

Main causes

• Viral infections – most often from the same viruses that cause colds or flu
• Bacterial infections – most commonly group A streptococcus (strep throat)

Risk factors

• Being around someone with a sore throat or infections
• Weakened immune system (from illness, stress, or certain medicines)
• Smoking or exposure to secondhand smoke
• Seasonal changes when colds and flu are more common

When to see a doctor

See a doctor urgently if:

• If you have trouble breathing or swallowing
• If your fever stays high despite taking over-the-counter pain relievers
• If you see pus or white patches on your tonsils
• If your neck becomes very swollen or painful

Book a routine appointment if:

• If your sore throat lasts longer than 2–3 days
• If you have a fever that lasts more than 48 hours
• If you have repeated episodes of tonsillitis (several times a year)
• If home care does not help you feel better

Diagnosis

Your doctor will ask about your symptoms and examine your throat and neck. They will look for redness, swelling, and pus on your tonsils and feel for swollen glands.

Tests that may be done

• Throat swab – a cotton swab is rubbed gently on your tonsils to test for bacteria (strep throat)
• Rapid strep test – gives results in minutes, but may need a follow-up culture if negative
• Blood tests – rarely needed, but can help rule out other infections like mononucleosis (glandular fever)

What to expect at your appointment

The exam is quick and usually painless. The throat swab might cause a brief gagging feeling. Your doctor will explain the results and discuss treatment options based on the cause.

Treatment

Treatment depends on whether the cause is viral or bacterial. Viral tonsillitis does not need antibiotics – rest and home care are enough. Bacterial tonsillitis may be treated with antibiotics prescribed by your doctor.

Self-care at home

• Get plenty of rest to help your body fight the infection
• Drink cool fluids often (water, ice pops, clear soups) to stay hydrated
• Gargle with warm salty water (mix half a teaspoon of salt in a cup of warm water) several times a day
• Use a cool-mist humidifier or breathe steam to soothe your throat
• Take over-the-counter pain relievers as recommended by your pharmacist for fever and pain
• Avoid smoking and smoky environments

Medical treatments

If a bacterial infection is confirmed, your doctor may prescribe a course of antibiotics. These are usually taken for 10 days. It is important to finish the entire course even if you feel better. For severe or recurrent cases, your doctor might refer you to an ear, nose, and throat (ENT) specialist.

When is surgery considered?

Surgery (tonsillectomy – removal of the tonsils) may be considered if you have repeated infections (for example, 7 or more in a year, or 5 or more in each of 2 years) or if an infection leads to complications like an abscess (collection of pus behind the tonsil).

Living with this condition

During an episode, plan to take it easy. Stay home from work or school to avoid spreading the infection. Use tissues when you cough or sneeze, and wash your hands often. Keep your drinking cup separate from others.

Lifestyle tips

• Get enough sleep and eat well to support your immune system
• Avoid close contact with people who are sick
• Quit smoking if you smoke – smoking irritates the throat and makes infections worse
• Manage stress, as high stress can weaken your immune defenses

Diet and exercise

Eat soft, cool foods like yogurt, applesauce, and smoothies. Avoid spicy, acidic, or rough foods that can scratch your throat. You can return to normal exercise once you have no fever and feel better, but listen to your body and rest as needed.

Mental health and emotional wellbeing

Dealing with a painful throat and feeling unwell can be frustrating or worrying. Some people worry about missing work or getting sick again. If you feel anxious or depressed, talk to your doctor – they can offer support and advice.

Prevention

You cannot always prevent tonsillitis, but you can lower your risk. Practice good hand hygiene – wash your hands often with soap and water. Avoid sharing food, drinks, or toothbrushes with someone who has a sore throat. Cover your mouth when coughing or sneezing.

Vaccines

There is no vaccine specifically for tonsillitis. However, getting vaccinated against flu and COVID-19 can reduce your chances of getting viral infections that may trigger tonsillitis.

Screening programmes

There is no routine screening test for tonsillitis. See your doctor if you have symptoms, especially if they are severe or recurrent.

Complications

If left untreated

• Peritonsillar abscess (quinsy) – a painful collection of pus behind the tonsil that may need draining
• Spread of infection to nearby areas, such as the middle ear or sinuses
• Rheumatic fever – a rare but serious condition that can damage the heart valve (from untreated strep throat)
• Post-streptococcal glomerulonephritis – a rare kidney inflammation that can follow some strep infections

Long-term outlook

Most people recover fully from tonsillitis within a week with simple home care. If you need antibiotics, they work well. For those with frequent infections, surgery can provide long-term relief. With proper care, the outlook is very good.

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