Chronic Tonsillitis: Definition, Causes, Symptoms, Treatment, Outlook and Prevention

The tonsils are the two small masses of lymphatic tissue found on each side of the uvula.

The uvula is a “little tongue” of the soft palate, which, together with the adenoids, form part of a ring of glandular tissue at the back of the throat.

Healthy tonsils are small, pink bumps of tissue, almost the same color as the surrounding area. The two tonsils are usually about the same size.

The popular belief that the tonsils “filter” bacteria is a myth, But doctors believe that the tonsils can help defend the body against bacteria and viruses by helping form antibodies.

However, this help can only be significant during the first year of life, and there is no evidence that the tonsils play an essential role in immunity.

Studies show that children with tonsils and adenoids removed do not subsequently suffer from compromised immunity.

When viruses or bacteria infect the tonsils, they become red and inflamed and can develop white or yellow spots. This condition is called tonsillitis. Persistent or recurrent infection of the tonsils is called chronic tonsillitis.


Tonsillitis is a condition that consists of specific symptoms, such as generalized swelling and inflammation of the pharyngeal tonsils and the back of the throat.

The inflammation can extend beyond the tonsils, including adenoids and lingual tonsils.

Tonsillitis is most common in early childhood. This is probably when the tonsils are most involved in fighting disease.

As one ages, the tonsils get smaller, and people are less prone to tonsil infections.

Infection and chronic allergy can cause the tonsils and adenoids to become very large. This can obstruct breathing, causing snoring and disturbed sleep patterns.

Secondary ear infections from associated adenoid problems can also occur with chronic tonsillitis.

Chronic tonsillitis

Chronic tonsillitis in adults occurs when persistent tonsil infection causes symptoms lasting more than two weeks.

This condition, seen more often in teens and adults, repeated infections can lead to the development of bags on the tonsils that can store smelly and bacteria-filled stones, similar to kidney stones.

Because of this, halitosis or bad breath is a frequent symptom. In addition, there are often enlarged tonsils, a chronic sore throat, and enlarged or sore lymph nodes in the neck.

Complications of tonsillitis

Complications resulting from tonsillitis are rare, but some of the problems that can occur are described below:

Middle ear infection

A middle ear infection is also known as otitis media, a collection of mucus in the middle ear between the eardrum and the inner ear. In most cases, the infection goes away on its own.

Quincy abscess

Quincy abscesses are a rare condition that sometimes develops when the infection spreads from an inflamed tonsil to the surrounding area, causing an abscess in the throat.

Abscesses can be easily treated with antibiotics, although sometimes a minor operation may be necessary to drain the pus.

If this tonsillar abscess develops, the inflammation may be severe enough to obstruct breathing.

A peritonsillar or tonsillar abscess develops when pus collects behind the tonsils. This can push a tonsil towards the uvula.

This condition can be excruciating and make it difficult for the patient to open their mouth. If left untreated, the infection can spread deeper into the neck, obstructing the airway. Complications from this abscess can be life-threatening.


Swelling of the face and neck, although rare, can block the airway and prevent a person from breathing.

Chronic tonsillitis can cause obstructive sleep apnea, which prevents some of the oxygen from reaching your brain and can lead to disturbed sleep patterns.


Blood poisoning, or septicemia, can occur if bacteria enter the bloodstream and multiply. Bacteria can be killed using antibiotics.


Glomerulonephritis is very rare and is the inflammation of the filters in the kidneys caused by streptococcal bacteria.

Rheumatic fever

Rheumatic fever is a rare condition that causes widespread inflammation (swelling) throughout the body.

Lemierre syndrome

Lemierre’s syndrome is rare in spreading bacteria from the throat to the central veins in the patient’s neck. Small “clumps” of bacteria travel through the bloodstream to the lungs, joints, and bones.

Lemierre’s syndrome can be easily treated with antibiotics, but it can be fatal if not diagnosed quickly.

Causes of tonsillitis

There are two causes of tonsillitis in adults: bacteria and viruses.

Bacterial tonsillitis

Streptococcus pyogenes is the bacteria that causes bacterial tonsillitis and is the same bacteria that causes strep throat.

Viral tonsillitis

Viral tonsillitis is seen much more frequently and is usually caused by infections such as herpes simplex, Epstein-Barr, and the virus that causes the common cold.

Although the causes of tonsillitis can vary, the treatments are very similar.

Symptoms of tonsillitis

While the specific symptoms and their severity may vary depending on the general health of the infected person, there are some key indicators that you may have tonsillitis, such as:

  • Red or swollen tonsils.
  • White spots on the tonsils (usually an indicator of a bacterial infection).
  • Firm, swollen lymph nodes (the tissue on both sides of the neck, just below the jaw).
  • Throat pain.
  • Difficulty or pain when swallowing.
  • Mild to severe laryngitis.

If laryngitis develops, you may notice a raspy voice or a complete loss of voice in more severe cases.

Minimizing the use of your voice can help reduce your risk of laryngitis or relieve tonsillitis.

Because an infection or a virus can cause tonsillitis, many patients experience flu-like symptoms, including:

  • General pain in the body.
  • Headaches.
  • Earache.
  • Fever.
  • Cold symptoms.

Strep throat and tonsillitis

Despite being commonly confused, strep throat and tonsillitis are not the same.

Strep throat refers to a throat infection caused by strep bacteria.

Tonsillitis, on the other hand, occurs when the tonsillar glands become infected.

Because strep bacteria can cause large amounts of inflammation in the back of the throat, tonsillitis is a common side effect, and the two conditions are often seen together.


When the condition is chronic or recurrent, a surgical procedure is often recommended to remove the tonsils.

Regardless of what is causing your chronic tonsillitis, your doctor may recommend surgery.

The surgical procedure to remove the tonsils is called a tonsillectomy.

Removing the tonsils does not appear to have any adverse effect on children. There is no evidence that tonsillectomy reduces a person’s immunity.

Tonsillectomy procedure

A patient who undergoes a tonsillectomy must be hospitalized for up to 24 hours.

Tonsillectomy is performed under general anesthesia. The surgeon performs the intervention through the person’s mouth, and the tonsils are held with special instruments.

The glandular tissue is contained within a skin lining that the surgeon cuts using a scalpel, scissors, laser, or an electrical current (electrocautery).

The surgeon then removes the tonsils from the lining and then sutures. Each tonsil pad has a significant blood supply, so electrocautery is often used to fuse blood vessels and reduce the risk of bleeding.

After the operation in which the tonsils have been removed, it is observed that the throat acquires a whitish color. The new throat lining is formed under this white lining.

As the throat heals, the white coating gradually disappears. This takes about two weeks.

On average, cold steel surgery has the shortest recovery time (between five and seven days). And you will feel a slight discomfort up to two weeks after the operation.

Children with tonsillectomy must be kept out of school for two weeks. This is to reduce the chance that they will get an infection from another child.

Swallowing may be difficult after a tonsillectomy, but eating solid foods is essential as this will help your throat heal more quickly.

It would help if you drink plenty of fluids but avoid acidic drinks, such as orange juice, as they can bother causing itching when it passes down the throat.

Teeth must be cleaned regularly, and oral antiseptics are used as this helps fight infections in the mouth.

The pain usually worsens during the first week after the operation and gradually improves during the second week. Earache is common when having a tonsillotomy and is not a cause for concern.

After the tonsillotomy, the patient is placed on their side to prevent choking if there is any bleeding from the tonsil pad.

The doctor can prescribe medications to relieve pain if necessary.

It is essential to regularly check your pulse, blood pressure, breathing rate, and throat for signs of bleeding.

During the first four hours after the operation, you will probably not allow yourself to consume any food or liquids.

You may find it difficult to eat or drink food, but once your doctor orders it, the more often you use your throat, the better.

The pain may be relieved within about two days, but it may return six days after the operation.

There may be excessive bleeding (hemorrhage) in the tonsil pads. In most cases, bleeding occurs within a week after surgery.

Scabs that form on wounds can give a sour taste to your mouth.

Self-care after tonsillectomy

Although it is a simple intervention, it is necessary to follow the doctor’s recommendations on how to care for yourself at home, but general suggestions include:

  • No Smoking.
  • Avoid vigorous exercise after the operation and wait for your doctor to authorize it.
  • Generally, it would help if you rested at home for a week before returning to work or school.
  • Avoid visiting closed and crowded areas for at least a week to reduce the risk of infection.
  • Follow a diet of soft foods, gelatin, ice cream, and cold drinks.
  • A sore throat can last two to three weeks, but try to return to your regular diet as soon as possible.
  • Some foods can cause irritation and pain – avoid acidic beverages (such as citrus fruit juices), spicy foods, and rough-textured foods for about ten days.
  • Avoid taking aspirin, as this medicine, used to relieve pain, can also cause bleeding. Only take medications recommended by your doctor or surgeon.

Long-term outlook after a tonsillotomy

A tonsillotomy will not reduce the risk or frequency of problems such as upper respiratory infections (the common cold), chest infections, laryngitis, middle ear infections, sinusitis, or nasal allergies.

However, it will stop chronic tonsillitis. You will probably lose your lousy breath if that were a problem.

In the past, tonsils and adenoids were frequently removed during childhood as a preventive measure. However, doctors are generally only willing to recommend surgery in severe cases.


Tonsillitis, caused by a bacterial or viral infection, is contagious.

Practicing good hygiene is the easiest way to prevent the disease from spreading.

If someone is around someone with tonsillitis, wash their hands frequently and avoid sharing toys or utensils with them.

It is also necessary to replace the toothbrush when a person has contracted the condition, as this can lead to the appearance of infections.

One of the best ways to avoid infecting others is to stay home and not go to work or school until your doctor indicates that you are no longer contagious.