Chronic tonsillitis is defined as more than five attacks of typical throat infection related symptoms per year accompanied by hypertrophy of the tonsils, most frequently caused by bacterial pathogens. The diagnosis can be made by physical examination and microbiological studies.
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 . 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  . 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 , 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 . 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.
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 . However, it is used exclusively for streptococcal infection  . RADT carries a 98% specificity for streptococcal species, and the test should be repeated if the initial turns out to be negative . 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 . 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 . 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 .