The condition associated with the repeated episodes of tonsillitis throughout the year is termed as chronic (or recurrent) tonsillitis, with the number of episodes being around five per year, whereas persistence of symptoms for a prolonged period of time may also be considered a chronic form of this infection [1]. The condition is more frequently encountered in children, but adults of any age may be affected. The clinical presentation initially focuses on symptoms such as cervical lymphadenopathy, presence of tonsillar exudates, fever and swallowing difficulties, which is considered a hallmark of tonsillitis [2] [3]. Additional signs may include odynophagia, airway obstruction, loss of appetite and the presence of cough that could indicate an infection of the respiratory tract. Constitutional symptoms like lethargy, fatigue, malaise and weakness are common in patients who develop a tonsillar infection. Symptoms of tonsillitis last approximately 1 week and they rarely last more [3], but the progression of acute tonsillitis into chronic over time results in a more frequent onset of symptoms and persistently enlarged cervical lymph nodes. Since chronic tonsillitis is more frequently encountered as a repeated onset of symptoms in a short period of time, the terms "chronic tonsillitis with acute exacerbation" or simply recurrent tonsillitis have been recommended by certain authors [1]. Regardless of the etiology (bacterial or viral), the clinical presentation is the same, which is why laboratory workup is oriented toward identifying the underlying cause; thus determining the optimal therapy.

• Pediatric Disease

  Scarlet fever responds very well to oral penicillin and can (as so often with pediatric diseases) range from a mild feeling of illness with sore throat to severe courses with fever, malaise, confinement to bed and exsiccosis [174]. [egms.de]

• Splenectomy

  This can lead to exposure to a variety of treatment regimens including immunosuppressants and splenectomy. [ncbi.nlm.nih.gov]

• Cervical Lymphadenopathy

  A physical exam can easily identify key findings of tonsillitis - cervical lymphadenopathy and hypertrophy of the tonsils with exudative content. [symptoma.com]

  The most common presentations are cervical lymphadenopathy, oro-oesophageal candidiasis and otitis media. Investigations It is recommended that throat swabs and rapid antigen tests should not be performed routinely. [patient.info]

  The most common presentations are cervical lymphadenopathy, oro-oesophageal candidiasis and otitis media. [cmc.ph]

  Symptoms may include sore throat, dysphagia, cervical lymphadenopathy, and fever. Diagnosis is clinical, supplemented by culture or rapid antigen test. [merck.com]

• Cough

  Cough with sputtering Worse with emotional turmoil or anger Difficult to cough up sputum Maybe Blood-streaked sputum The cough may drag on or may recur regularly Pain over the chest and hypochondrium During the coughing, the patient may get hot, flushed [americandragon.com]

  Additional signs may include odynophagia, airway obstruction, loss of appetite and the presence of cough that could indicate an infection of the respiratory tract. [symptoma.com]

  Runny nose; Cough; Nose and chest congestion; Watery eyes; Constant Inhaling steam is one of the most effectual ways to get rid of a stuffy nose. QUESTION 4 OF 10: period of 30 years between 1976. [cedag.eu]

  Chronic irritation in throat with cough. 3. Bad taste in mouth and foul breath (halitosis) due to pus in crypts. 4 Thick speech, difficulty in swallowing and choking spells at night (when tonsils are large and obstructive). Examination 1. [earnosethroatclinic.blogspot.com]

  If you have viral tonsillitis, your symptoms may include coughing or a stuffy nose. [healthline.com]

• Tonsillar Hypertrophy

  […] treatment of chronic tonsillitis and tonsillar hypertrophy. [ncbi.nlm.nih.gov]

• Halitosis

  Bad taste in mouth and foul breath (halitosis) due to pus in crypts. 4 Thick speech, difficulty in swallowing and choking spells at night (when tonsils are large and obstructive). Examination 1. Tonsils may show varying degree of enlargement. [earnosethroatclinic.blogspot.com]

  Chronic Tonsillitis Patients with chronic tonsillitis may experience a chronic sore throat, halitosis, tonsillitis, and tender cervical lymph nodes. [naenta.com]

  Symptoms include halitosis (bad breath), sore throat, enlarged tonsils and visualization of tonsilloliths within the tonsils. [bergerhenryent.com]

  Because of this, halitosis or bad breath is a frequent symptom. In addition, a chronically sore throat and enlarged or sore lymph nodes in the neck are usually present. [livestrong.com]

  नपुंसकता Menopause रजोनिवृत्ति Piles बवासीर Pregnancy गर्भावस्था Menstrual-Disorder मासिक-विकार Paralysis पक्षाघात Sciatica-Pain कटिस्नायुशूल-दर्द Rheumatism गठिया Fibromyalgia Fibromyalgia Arthritis गठिया Cholesterol कोलेस्ट्रॉल Leucoderma Leucoderma Halitosis [shinderaj.blogspot.com]

• Tonsillar Exudate

  The clinical presentation initially focuses on symptoms such as cervical lymphadenopathy, presence of tonsillar exudates, fever and swallowing difficulties, which is considered a hallmark of tonsillitis. [symptoma.com]

  Infectious mononucleosis is suggested by posterior cervical or generalized adenopathy, hepatosplenomegaly, fatigue, and malaise for 1 wk; a full neck with petechiae of the soft palate; and thick tonsillar exudates. [merck.com]

  Tonsillar exudates. No cough. Tender anterior cervical lymphadenopathy. Patients with one or none of these criteria are unlikely to have GABS. Consideration of antibiotic prescription should be limited to patients with three or four criteria [ 1 ]. [patient.info]

  There are four Centor Criteria that may be used: History of fever Tonsillar exudates No cough Tender anterior cervical lymphadenopathy Patients with one or none of these criteria are unlikely to have GABS. [cmc.ph]

  Tender, swollen cervical lymph nodes and tonsillar exudates may occur. The disease is normally self-limiting. [amboss.com]

Firstly, a detailed patient history regarding the onset and duration of symptoms should be performed, followed by a thorough physical examination of the head and neck area, with an emphasis on the throat. A physical exam can easily identify key findings of tonsillitis - cervical lymphadenopathy and hypertrophy of the tonsils with exudative content. Their confirmation can be sufficient for the diagnosis, but to identify the underlying cause and determine whether antibiotic therapy is necessary, microbiological studies should be performed. Throat cultures are rarely done, primarily due to a prolonged time to obtain viable results, which is why throat swabs and rapid antigen detection test (RADT) is recommended, as it can yield a positive result within an hour [4]. However, it is used exclusively for streptococcal infection [4] [5]. RADT carries a 98% specificity for streptococcal species, and the test should be repeated if the initial turns out to be negative [4]. RADT is positive in chronic asymptomatic carriers as well (approximately 10% of healthy children), but the absence of symptoms indicate that therapy is not necessary [4]. Evaluation of antistreptolysin O (ASO) antibodies through serology may also be a possibility, but its use in the setting of an active infection is minimal and establishing prior infection is the main purpose of this test [4]. A valid diagnostic tool to distinguish viral agents as the cause of tonsillitis is yet to be created, especially when having in mind that adenovirus and parainfluenza virus have been detected in > 95% of children with bacterial tonsillitis [4].

• Immunoglobulin A Decreased

  The post-operative levels for the three immunoglobulins were decreased; however, a significant reduction was observed for IgG only where the mean value was comparable with the control group. [ncbi.nlm.nih.gov]

1. Georgalas CC, Tolley NS, Narula PA. Tonsillitis. BMJ Clin Evid. 2014;2014:0503.
2. Pribuišienė R, Kuzminienė A, Sarauskas V, Saferis V, Pribuišis K, Rastenienė I. The most important throat-related symptoms suggestive of chronic tonsillitis as the main indication for adult tonsillectomy. Medicina (Kaunas). 2013;49(5):219-222.
3. Worrall G. Acute sore throat. Can Fam Physician. 2011;57(7):791-794.
4. Stelter K. Tonsillitis and sore throat in children. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2014;13:Doc07.
5. Johansson L, Månsson NO. Rapid test, throat culture and clinical assessment in the diagnosis of tonsillitis. Fam Pract. 2003;20(2):108-111.