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Recurrent Tonsillitis and Related Conditions

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Recurrent tonsillitis is repeated inflammation of tonsils, caused by bacteria, resulting in various symptoms. Read below to know more.

Medically reviewed by

Dr. Akshay. B. K.

Published At September 28, 2023
Reviewed AtSeptember 28, 2023


It is seen when the tonsils become infected, causing inflammation, swelling, and pain. Tonsils are the two oval-shaped pads of tissues situated in the back of the throat. This condition is also known as strep throat. Parents of growing children are very well aware of this condition.

Symptoms may include sore throat, fever, and swollen lymph nodes. In several children with recurrent tonsillitis, the bacteria that cause the disease gimmick immune cells into destroying each other instead of memorizing the bacterial origin. Streptococcus throat or tonsillitis can be treated with antibiotics, but some children repeatedly suffer from the condition (recurrent tonsillitis). Children who suffer from recurrent tonsillitis need to have the tonsils surgically removed. It is unclear why some children are more likely to get recurrent tonsillitis than others.

When people are exposed to streptococcus pyogenes, the immune system produces several antibodies, one of which identifies a toxic protein created by the bacteria known as SpeA. The SpeA caused the novel follicular helper T cells (TFH cells) to kill B cells rather than helping those B cells to make antibodies to neutralize or inactivate the SpeA toxin.

What Is Known as Recurrent Tonsillitis?

The tonsils are two masses back of the throat made of tissues. But sometimes, they get overpowered by bacteria or viruses. This results in swelling and inflammation of the tonsils. Tonsillitis is a condition common, specifically in children. Tonsillitis is not contagious or spreads through contact. When tonsillitis occurs repeatedly, the condition is known as recurrent tonsillitis.

Recurrent tonsillitis is described as a condition:

  • When there are more than seven episodes in one year.

  • When there are more than five episodes a year during a two-year period.

  • When there are more than three episodes during a three-year period.

T follicular helper (TFH) cells are a type of immune cell that usually helps another type of immune cell (B cells) create protective antibodies against bacteria and viruses. The researchers and scientists found that the tonsils of children with recurrent tonsillitis included relatively higher numbers of a novel T follicular helper cell type. The children suffering from recurrent tonsillitis also had a reduced number of B cells in their tonsils. Recurrent tonsillitis appears to have a genetic component. The researchers observed that several children in their study had a family history of recurrent tonsillitis.

What Is the Cause of Recurrent Tonsillitis?

If someone suffers from recurrent tonsillitis, that does not necessarily mean that the person's immune system is weak. Generally, tonsillitis is caused due to viruses rather than bacteria. Children are more prone to recurrent tonsillitis. One of the reasons behind this is the age factor. When we grow older, the tonsils shrink, and there is less incidence of tonsillitis infection. Recurrent tonsil infection is a common problem in adults also. When the person suffers from a sore throat repeatedly that lasts for weeks or can prolong for months, this usually happens due to a bacterial biofilm created by streptococcus. These biofilms are described as spider webs of bacteria.

It is not usually a problem, except when our immune system weakens. When this occurs, the biofilm can shed, and the person gets a bacterial infection. It can also lead to frequent visits to the healthcare facility. In the worst scenarios, an abscess can develop next to the tonsil, also known as a peritonsillar abscess, requiring surgical drainage. Common infections can tend to frequent use of antibiotics which may lead to problems such as resistance. Another bacteria in the mouth, known as Actinomyces, can also be a common problem in adults with frequent tonsil infections.

How Is Recurrent Tonsillitis Diagnosed?

The physician will do a physical exam. They will look at the tonsils to see if they are red or swollen or have pus in them. They’ll also check for a fever. They may look at the ears and nose for signs of infection and feel the sides of the neck for swelling and pain. The patient might need tests to find the cause of the tonsillitis. These tests include:

  • A Throat Swab: The physician will test the saliva and cells from the throat for streptococcus bacteria and run a cotton swab along the back of the throat. This might feel uncomfortable, but will not hurt. The results will be out in 10 or 15 minutes. Sometimes, the physician would also want a lab test that takes days to show results. When these tests come negative, a virus is behind recurrent tonsillitis.

  • Blood Test: The physician can call for a complete blood cell count. The numbers should be observed for high and low levels of blood cells to indicate whether a virus or bacteria is causing the condition of recurrent tonsillitis.

How to Take Care, Manage or Prevent Recurrent Tonsillitis?

It is stated that maintaining proper hygiene may prevent the incidence of recurrent tonsillitis. The guardian or parents should remind the children of the following:

  • Wash hands with hot water and soap, especially when people surrounding the person appear to be sick.

  • Do not share the toothbrush with anyone.

  • Do not share eating utensils.

  • Do not drink water or liquid from the same glass.

  • The mouth should be covered while coughing or sneezing, mostly using a tissue so germs do not get on the child’s hands.

  • Caregivers should carry disposable wipes and hand sanitizer to clean their hands and to wipe clean shopping carts or other items which are shared in public places.

  • Parents or caregivers should avoid smoking around the child.


Recurrent tonsillitis can be avoided by surgically removing the tonsils after a careful examination. Tonsillitis can be a painful and very uncomfortable condition. It is difficult for the person to comfortably live with this condition in day-to-day life as one has to struggle while doing daily activities like drinking water or swallowing food. Proper management of tonsillitis may avoid recurrent tonsillitis. Recurrent tonsillitis is common among children, but that does not mean it cannot occur in adults. The physician should be contacted if the symptoms, such as sore throat, swollen lymph nodes, painful swallowing, etc persist and there is an incidence of recurrent tonsillitis.

Dr. Akshay. B. K.
Dr. Akshay. B. K.

Otolaryngology (E.N.T)


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