What Causes Chronic Tonsillitis?

Why swollen tonsils may persist and how to treat it

woman touching sore throat

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Chronic tonsillitis is an infection of the tonsils—the two pieces of tissue at the back of your throat—that lasts longer than two weeks. Chronic tonsillitis can cause swelling and inflammation of the tonsils, as well as accompanying symptoms like sore throat, bad breath, and enlarged lymph nodes. 

This article explains the difference between chronic and recurrent tonsillitis. It also talks about chronic tonsillitis symptoms, treatment options, and when to see your healthcare provider.

chronic tonsillitis symptoms

Verywell / Joshua Seong

Why Chronic Tonsillitis Occurs

Tonsillitis can be caused by infections such as viruses (cytomegalovirus, herpes simplex, Epstein-Barr) or bacteria such as those that cause strep throat.

Tonsillitis occurs more commonly in children than in adults, but it does not usually affect children under the age of 2.

If you have an infection with antibiotic-resistant bacteria or an immune system that doesn't work correctly, you may develop chronic tonsillitis.

You may also have an increased risk of developing chronic tonsillitis if you have been exposed to radiation.

Symptoms of Chronic Tonsillitis

People who experience chronic tonsillitis tend to have ongoing:

While symptoms of acute tonsillitis typically last from three days to about two weeks, chronic tonsillitis symptoms last longer.

Chronic tonsillitis may also affect the adenoids, similar bundles of tissue higher up in the throat and back of nose, or the lingual tonsils, which are on the lower back part of the tongue.

A peritonsillar abscess occurs when infection from the tonsils spreads into the tissue of the throat behind the tonsil. This complication occurs more commonly in adolescents and adults than in children.

Chronic vs. Recurrent Tonsillitis

Whereas even one bout of tonsillitis that lasts more than two weeks is deemed chronic tonsillitis, recurrent tonsillitis is when someone has any case of tonsillitis multiple times in a year.

More specifically, recurrent tonsillitis is diagnosed when someone has more than seven bouts in a year, more than five a year during a two-year span, or more than three a year during a three-year span.

At first, the infections may respond well to antibiotics. But some people still experience frequent tonsil infections.

At least one study has shown that recurrent tonsillitis runs in families. In other words, if you have family members who have recurrent tonsillitis, you are more likely to have it too.

In children, recurrent tonsillitis is most commonly caused by group A beta-hemolytic Streptococcus pyogenes (GABHS) infections. It is also known as strep throat. Other bacteria are more likely to be the cause of adult recurrent tonsillitis.

Reasons for recurring strep throat include:

  • Strains of the bacteria that are resistant to antibiotics
  • Weakened immune system
  • The possibility that you or someone in your family is a strep carrier (who has no symptoms but can spread the bacteria)

Chronic Tonsillitis Treatment 

If a bacterial infection is the cause of your tonsillitis, your healthcare provider will prescribe an antibiotic. It's important to take the full course of medication as prescribed to reduce the chances the bacteria will become resistant or come back.

Since the bacteria may be resistant to antibiotics, it may be necessary to try another medication if the first prescription doesn't work.

For pain control, you can use over-the-counter medications such as:

When you first begin treatment for recurrent or chronic tonsillitis, you need to make sure you drink enough liquids. Treating your sore throat will make it easier to drink enough liquid to stay hydrated. If you have signs of dehydration, you should seek medical attention.


Regardless of what is causing your recurrent or chronic tonsillitis, your healthcare provider may also recommend having your tonsils removed. Ultimately, the decision to remove the tonsils depends on multiple factors, including:

  • If you've had five to seven episodes of tonsillitis in a year
  • If you have chronic tonsillitis that doesn't respond to medication
  • If your symptoms are severe
  • What complications of tonsillitis you may have
  • How the condition affects your ability to attend work or school

Choosing to have a tonsillectomy can dramatically reduce the number of times you have a sore throat and need antibiotics in a year. It will also improve your quality of life, especially if your tonsillitis is affecting work or school attendance.

When to See a Healthcare Provider

Tonsillitis is considered serious enough to see a healthcare provider when it persists longer than four days, or when you develop white spots on your tonsils.

Seek emergency care if you or your child have trouble breathing, excessive drooling, or if the pain interferes with your ability to eat or drink.


Chronic and recurrent tonsillitis is a medical condition that causes swelling of the pharyngeal tonsils and back of the throat. Sometimes the adenoids and the lingual tonsils swell as well.

Recurrent tonsillitis occurs when you have tonsillitis several times a year. Chronic tonsillitis happens when you have an ongoing sore throat, enlarged tonsils, bad breath, and enlarged lymph nodes. They can be treated with antibiotics, pain relievers, and sometimes surgery to remove the tonsils.

Frequently Asked Questions

  • What can tonsillitis turn into?

    Untreated tonsillitis can lead to a number of complications, such as:

    • Infection of the middle ear
    • Peritonsillar abscess
    • Sleep apnea

    Rarely, people who have a bacterial form of tonsillitis may develop rheumatic fever, scarlet fever, or an infection of the kidneys called glomerulonephritis.

  • Is tonsillitis more serious in adults?

    Tonsillitis isn't more serious in adults, but some adults may be more likely to develop it than others. Older adults and people who live or work with children, for example, are at greater risk.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Abu Bakar M, Mckimm J, Haque SZ, Majumder MAA, Haque M. Chronic tonsillitis and biofilms: A brief overview of treatment modalities. J Inflamm Res. 2018;11:329-337. doi:10.2147/JIR.S162486

  2. Galioto NJ. Peritonsillar abscessAm Fam Physician. 2017;95(8):501-506.

  3. Texas Children's Hospital. Recurrent Tonsillitis.

  4. Bager P, Corn G, Wohlfahrt J, Boyd HA, Feenstra B, Melbye M. Familial aggregation of tonsillectomy in early childhood and adolescenceClin Epidemiol. 2018;10:97-105. doi:10.2147/CLEP.S148575

  5. 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

  6. 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

Additional Reading

By Kristin Hayes, RN
Kristin Hayes, RN, is a registered nurse specializing in ear, nose, and throat disorders for both adults and children.