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.

• Cervical Lymphadenopathy

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

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

• Pediatric Disease

  Incidence of bleeding complications in pediatric patients with type 1 von Willebrand disease undergoing adenotonsillar procedures. J Pediatr. 2009 Jul;155(1):68-72. DOI: 10.1016/j.jpeds.2009.01.051 246. [egms.de]

• Splenectomy

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

• 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]

  Recent data from the BEACH (Bettering the Evaluation and Care of Health) project show that 4% of all symptomatic presentations to general practitioners were for throat complaints, second only to cough at 7%. 1 Sore throat is also one of the most common [mja.com.au]

  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]

  Tonsillitis is spread through the air in droplets when an infected person breathes, coughs, or sneezes. [uwhealth.org]

• Tonsillar Hypertrophy

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

• Halitosis

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

  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]

  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]

  The association of caseous with other two symptoms is the most frequent one and was distributed as follows: · tonsillitis sensation of foreign body (7 patients), · tonsillitis and halitosis (5 patients) and, · halitosis and sensation of foreign body [oldfiles.bjorl.org]

  Odonophagia - painful swallowing Fever - chills/rigors Constitutional symptoms - malaise, lethargy Earache which is either referred or acute otitis media Abdominal pain due to mesenteric lymphadenitis Redness of tonsils, soft palate, pillars and uvula Halitosis [youtube.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]

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

  Patients may present with a variety of symptoms including painful throat (may be unilateral), dysphagia, fevers, tender cervical lymphadenopathy and/or tonsillar exudate. Ear pain and trismus can also occur 1. [radiopaedia.org]

  […] criteria that must be present for tonsillitis comprise sore throat in conjunction with erythema and/or tonsillar exudate, which may or may not be accompanied by a scarlatiniform rash. [pharmacytimes.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].

Although it is usually short-lived, some cases persist and are unresponsive to treatment. This can lead to exposure to a variety of treatment regimens including immunosuppressants and splenectomy. [ncbi.nlm.nih.gov]

Estimations of the serum immunoglobulin, or simply of IgA, may help us to select those candidates for adeno-tonsillectomy who will have a good prognosis, or at least to exclude those with an underlying sub-clinical immunodeficiency disease. [ncbi.nlm.nih.gov]

Prognosis of Tonsillitis Tonsillitis is a self-limiting disease. [healthengine.com.au]

In general, the prognosis for tonsillitis is excellent, and most people recover without any complications or long-term problems. Most cases of viral tonsillitis resolve within 7-10 days with watchful waiting. [emedicinehealth.com]

Meanwhile, the prognosis for patients who develop serious complications, such as obstructive sleep apnoea, is dependent on the extent and severity of the complication. References: Fact sheet: Tonsils and adenoids. [docdoc.com.sg]

TY - JOUR T1 - [Chronic tonsillitis, etiological and pathogenetic aspects of the development of metatonsillar complications]. [unboundmedicine.com]

Abstract Group A Streptococcus has been identified as a possible etiologic agent in psoriasis in epidemiologic, immunologic, immunopathologic, medical, and surgical studies. [ncbi.nlm.nih.gov]

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. [symptoma.com]

Particularly useful for detecting prior infections in patients presenting with complications (e.g., rheumatic fever) Not recommended for diagnosing acute infection [7] Differential diagnoses Disease Etiology Clinical features Pharyngitis See Etiology [amboss.com]

Follicular tonsilitis is due to bacterial etiology. The tonsils will have white spots all over the tonsils due to pus being expelled from the crypts of the tonsils. [youtube.com]

Abstract Group A Streptococcus has been identified as a possible etiologic agent in psoriasis in epidemiologic, immunologic, immunopathologic, medical, and surgical studies. [ncbi.nlm.nih.gov]

Epidemiology Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

Epidemiologic observations made decades earlier indicated that some outbreaks of streptococcal pharyngitis in rheumatic fever hospitals or wards were followed closely by recurrent ARF, whereas other outbreaks failed to trigger such recurrences, even in [doi.org]

"The epidemiology of peritonsillar abscess disease in Northern Ireland". J. Infect. 52 (4): 247–53. doi:10.1016/j.jinf.2005.07.002. PMID 16125782. ^ Ehlers Klug T, Rusan M, Fuursted K, Ovesen T (November 2009). [en.wikipedia.org]

Presence of MDA and SOD in tonsillar tissue reinforce involvement of oxidative stress in pathophysiology of chronic tonsillitis. [ncbi.nlm.nih.gov]

Neuralgia of the glossopharyngeal nerve in a patient with posttonsillectomy scarring: recovery after local infiltration of procaine-case report and pathophysiologic discussion. Case Rep Neurol Med 2015;560546:1–5. [5]. [journals.lww.com]

Therefore, understanding the microbiology and pathophysiology of such diseases represent an important step in the management of biofilm-related infections. [hindawi.com]

Postsurgical care is aimed at prevention of hemorrhage, prevention of aspiration of drainage, and control of pain. The child is positioned on side until fully alert to facilitate drainage of secretions and prevent aspiration. [medical-dictionary.thefreedictionary.com]

[…] of secondary cases; and prevention of acute rheumatic fever. 26 There is no definitive evidence that antibiotic treatment of GAS pharyngitis prevents acute post-streptococcal glomerulonephritis. 27 An important consideration is the need to minimise potential [mja.com.au]

How can it be prevented? Tonsillectomy can prevent tonsillitis, but is only recommended in select circumstances. Because most types are spread by droplet transmission, droplet precautions can be effective means of prevention. [drgreene.com]

CONCLUSION: The neutrophil-to-lymphocyte ratio measurement can be used in chronic tonsillitis patients as an effective auxiliary method for determining the necessity and timing of tonsillectomy and post-operative follow up, thereby helping prevent complications [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.