Chronic and Recurrent Tonsillitis: What to Know

Tonsillitis is a condition that consists of certain symptoms, including generalized swelling and inflammation of the pharyngeal tonsils and the back of the throat. Inflammation may also extend beyond the tonsils to include the adenoids and the lingual tonsils.

chronic tonsillitis symptoms
Illustration by Joshua Seong. © Verywell, 2018. 


Tonsillitis can be caused by infections such as viruses (ie. CMV, herpes simplex, Epstein-Barr) or bacteria such as strep throat. Tonsillitis occurs more commonly in children than in adults but does not typically affect children under the age of 2.

Tonsillitis is divided into three types, which is dependent upon frequency of times tonsillitis occurs and how long it lasts:

  1. Acute tonsillitis includes cases where symptoms last anywhere from three days to about two weeks.
  2. Recurrent tonsillitis occurs when a person suffers from multiple episodes of tonsillitis in a year.
  3. Chronic tonsillitis cases have symptoms which persist beyond two weeks.

Another condition, peritonsillar abscess, occurs when infection from the tonsils spreads to other tissues in the head and neck. While some sources include this condition as a type of tonsillitis, it is probably more accurately defined as a complication of inadequately treated tonsillitis. Peritonsillar abscess occurs more commonly in adolescents and adults than in children.

Recurrent Tonsillitis

Recurrent tonsillitis may be diagnosed if an individual has multiple bouts of tonsillitis in a year. Infections may respond to antibiotics initially but return on a frequent basis.

At least one study has shown a genetic predisposition to developing recurrent tonsillitis. Some research also suggests that while recurrent tonsillitis is more common in children, chronic tonsillitis is more common in adults.

In children, recurrent tonsillitis is most commonly caused by group A beta-hemolytic Streptococcus pyogenes (GABHS) infections, also known as strep throat, while other bacterium are more likely to be the cause of adult recurrent tonsillitis. Reasons for recurring strep throat include resistant strains of the bacteria, weakened immune systems, or the possibility that you or someone in your family is a strep carrier.

Chronic Tonsillitis

Chronic tonsillitis is more common in adolescents and adults. People who suffer from chronic tonsillitis tend to have chronic:

Both infections with bacterium, which are antibiotic resistant and alter immunologic function, likely play a role in the development of chronic tonsillitis. You may also have an increased risk of developing chronic tonsillitis if you have been exposed to radiation.

As with recurrent tonsillitis, sleep apnea is a serious complication of chronic tonsillitis and is often an indication for tonsil removal. Ultimately, the decision to remove the tonsils depends on multiple factors including your ability to attend work or school, your symptoms, and any complications of tonsillitis you may have.


Initial treatment for recurrent or chronic tonsillitis includes ensuring adequate hydration and pain control. Managing pain for a sore throat will allow you to keep yourself hydrated. If you have signs of dehydration, you should seek medical attention. For pain control, you can use over-the-counter medications like Tylenol, Ibuprofen, or throat lozenges or sprays.

Regardless of what is causing your recurrent or chronic tonsillitis, your doctor may also recommend having your tonsils removed. This will likely be the case if you are having five to seven episodes of tonsillitis in a year or you are having unresolved chronic tonsillitis.

Choosing to have a tonsillectomy can dramatically reduce the number of times you have a sore throat and need antibiotics in a year.

Improvement in quality of life has been identified as well, particularly if your tonsillitis is affecting work or school attendance.

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Article Sources

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  2. Gupta G, McDowell RH. Peritonsillar Abscess. StatPearls Publishing. Updated November 14, 2018.

  3. Regoli M, Chiappini E, Bonsignori F, Galli L, De martino M. Update on the management of acute pharyngitis in children. Ital J Pediatr. 2011;37:10. doi:10.1186/1824-7288-37-10

  4. Baker M, Scott B, Johnson RF, Mitchell RB. Predictors of Obstructive Sleep Apnea Severity in Adolescents. JAMA Otolaryngol Head Neck Surg. 2017;143(5):494-499. doi:10.1001/jamaoto.2016.4130

  5. Nikakhlagh S, Rahim F, Boostani H, Shirazi ST, Saki N. The effect of adenotonsillectomy on quality of life in adults and pediatric patients. Indian J Otolaryngol Head Neck Surg. 2012;64(2):181-3. doi:10.1007/s12070-011-0244-4

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