Tonsillitis in older adults

Overview

Tonsillitis is an infection that causes swelling and redness of the tonsils — two small glands at the back of your throat. It is usually caused by viruses or bacteria. In older adults, it can be more serious because the immune system may be weaker, and other health problems can make recovery harder.

Tonsillitis is much more common in children and young people. In older adults, it is less frequent, but when it does occur, symptoms can be more severe and complications are more likely.

Tonsillitis can affect people of any age, but in older adults it often appears in those with weakened immune systems, chronic illnesses (like diabetes or heart disease), or who smoke or drink heavily. It is also more common in people who live in close-contact settings like care homes.

Symptoms

Common symptoms

• Sore throat
• Pain or difficulty when swallowing
• Red, swollen tonsils
• White or yellow patches on the tonsils
• Fever (high temperature)
• Swollen glands in the neck

Symptoms in children

• Similar symptoms as adults, but children may also have nausea, vomiting, or stomach pain.
• Young children may cry more, refuse to eat or drink, and drool because swallowing hurts.
• A high fever is more common in children.

Symptoms in older adults

• The sore throat may be less intense or even absent — instead, older adults might feel very tired, achy, and confused.
• They may have a high fever, but sometimes the temperature is low or normal.
• Difficulty swallowing can lead to dehydration, especially if they already have trouble eating or drinking.
• Swollen lymph nodes in the neck may be harder to feel in older adults.

Causes

Main causes

• Viruses — most cases are caused by cold viruses, flu virus, or the Epstein-Barr virus (which also causes glandular fever).
• Bacteria — Streptococcus bacteria (group A strep) are the most common bacterial cause.
• Less often, other bacteria like Staphylococcus aureus can cause tonsillitis.

Risk factors

• Having a weakened immune system (due to age, chronic illness, or medications that suppress immunity)
• Living in crowded places like care homes or hospitals
• Smoking or being around second-hand smoke
• Dry mouth or poor oral hygiene
• Recent exposure to someone with a sore throat or tonsillitis

When to see a doctor

See a doctor urgently if:

• If you have trouble breathing or swallowing, call your local emergency number (like 999 in the UK) immediately.
• If you cannot keep down fluids or signs of dehydration appear, seek urgent medical help.

Book a routine appointment if:

• If your sore throat lasts more than 2-3 days and is getting worse, or you have a fever that does not go away with paracetamol or ibuprofen (as directed on the package).
• If you have white patches on your tonsils or swollen glands that do not improve.

Diagnosis

A doctor will ask about your symptoms and look in your throat using a light. They will feel the sides of your neck for swollen glands. They might gently swab the back of your throat (throat swab) to test for bacteria.

Tests that may be done

• Throat swab — a cotton bud is rubbed over the back of the throat to collect a sample. It is sent to a lab or tested quickly (rapid strep test) to see if bacteria are present.
• Blood tests — sometimes done if the doctor suspects glandular fever (Epstein-Barr virus) or to check for infection markers.

What to expect at your appointment

The exam is quick and usually painless. The throat swab may cause a brief gagging sensation. If test results are needed, they may come back in a few days. Your doctor will explain what the results mean and whether you need antibiotics.

Treatment

Treatment depends on whether the cause is viral or bacterial. Viral tonsillitis cannot be cured with antibiotics — it gets better on its own. Bacterial tonsillitis may need antibiotics. The main goal is to relieve symptoms and prevent complications.

Self-care at home

• Rest — take time off from daily activities until fever and soreness improve.
• Drink plenty of fluids — water, warm tea with honey, or clear broths to stay hydrated.
• Eat soft, cool foods like yoghurt, ice cream, or soup to make swallowing easier.
• Gargle with warm salt water (half a teaspoon of salt in a glass of warm water) several times a day.
• Use a humidifier or breathe steam from a bowl of hot water to soothe the throat.

Medical treatments

Your doctor may recommend pain relief medicines such as paracetamol or ibuprofen (follow the label directions). If a throat swab shows bacteria, antibiotics (usually by mouth for 7-10 days) may be prescribed. It is important to take the full course even if you feel better. For severe cases, a short course of steroid medication might be used to reduce swelling, but this is not common. Do not take any leftover antibiotics or other people’s medicines.

When is surgery considered?

Surgery (tonsillectomy) to remove the tonsils is rarely needed in older adults. It might be considered if you have very frequent or severe episodes of tonsillitis, an abscess that does not drain, or if the infection causes breathing problems. Surgery is generally safe but recovery takes longer in older adults.

Living with this condition

During the infection, rest as much as possible. Drink regularly to avoid dehydration. If swallowing is painful, eat soft foods and avoid spicy or acidic foods. Keep your mouth clean by brushing gently and rinsing with warm salt water.

Lifestyle tips

• Stay away from tobacco smoke and other irritants that can worsen throat pain.
• Avoid close contact with others while you are still feeling ill to prevent spreading the infection.
• Keep your hands clean by washing them often, especially after coughing or sneezing.

Diet and exercise

While sick, avoid strenuous exercise. Gentle stretching or short walks may be okay if you feel up to it. As you recover, gradually return to your normal activity. Drink plenty of water and eat balanced meals to support your immune system.

Mental health and emotional wellbeing

Being unwell can make you feel down or irritable. The pain and trouble swallowing can affect your appetite and sleep. It is normal to feel frustrated. Let your family or carers know how you feel. Most people start to feel better within a week.

Prevention

You cannot always prevent tonsillitis, but you can reduce your risk. Practice good hand hygiene — wash hands with soap and water often. Avoid sharing cups, utensils, or toothbrushes with someone who is sick. Keep your immune system strong by eating well, staying active, and managing chronic conditions.

Vaccines

Vaccines can help prevent some infections that may lead to tonsillitis. For example, the flu vaccine and pneumonia vaccine are recommended for older adults. Talk to your healthcare provider about which vaccines are right for you.

Screening programmes

There is no routine screening test for tonsillitis. If you have frequent sore throats, your doctor may check for underlying conditions like sleep apnoea or GERD (acid reflux) that can mimic or trigger tonsillitis.

Complications

If left untreated

• Peritonsillar abscess — a collection of pus near the tonsil that can cause severe pain and trouble opening the mouth.
• Spread of infection to the neck or chest (deep neck infection or mediastinitis) — serious and requires hospital treatment.
• Rheumatic fever — a rare complication from untreated strep throat that can affect the heart, joints, and brain.
• Kidney inflammation (post-streptococcal glomerulonephritis) — also rare but can cause blood in urine and swelling.

Long-term outlook

For most older adults, tonsillitis resolves with proper care and does not lead to long-term problems. With rest, fluids, and medical attention when needed, recovery is usually complete. Even if complications occur, modern medicine can treat them effectively. The key is to seek help early if symptoms are severe or not improving.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.