Etiology of chronic tonsillitis

Written by Deng Bang Yu
Otolaryngology
Updated on June 11, 2025
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Chronic tonsillitis is a chronic inflammatory disease of the tonsils, which can arise from two sources. One is due to the repeated occurrences of acute inflammation of the tonsils, incomplete healing, poor physical constitution of the patient, or strong infectiousness of bacteria, resulting in unresolved, lingering chronic inflammation. In this case, the tonsils undergo recurrent acute flares on the basis of chronic inflammation, leading to the chronicity of the inflammation that cannot be cured. Another possible scenario for the onset of this tonsillitis is that it begins as a chronic inflammation. This is mainly due to a bacterial infection that is either not severe or a chronic latent infection. Therefore, the inflammation of the tonsils does not show obvious acute inflammatory signs but exhibits signs typical of chronic inflammation, primarily due to these two reasons.

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What are the symptoms of chronic tonsillitis?

The symptoms of chronic tonsillitis during the non-acute phase vary from person to person. Some individuals may not exhibit clear symptoms, while others may display more typical ones. The most common symptoms include recurrent sore throat, and sensations of dryness, itchiness, the presence of a foreign body, and discomfort in swallowing or coughing. Another common symptom is persistent cough, which can be irritating, with some individuals frequently clearing their throat. Bad breath may also occur, such as when stone-like substances form on the tonsils and are expelled, carrying a foul odor. If the tonsils are excessively enlarged, they can interfere with breathing, cause snoring during sleep, and even lead to breath-holding, resulting in unclear speech, as if speaking with a mouthful. These are commonly seen in clinical settings. Additionally, some systemic reactions may occur, including fever, fatigue, low-grade fever, and headaches.

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Does chronic tonsillitis hurt?

Chronic tonsillitis can lead to throat pain. Chronic tonsillitis typically results from repeated bouts of acute tonsillitis or persistent, unresolved inflammation, leading to chronic inflammation of the tonsils. It can cause continuous dryness, itching, pain, a sensation of a foreign body, obstruction, and burning in the throat area. In severe cases, it may lead to hoarseness and irritative cough. Upon examination, both tonsils are seen to be swollen and congested, with visible crypts on the surface, and yellowish-white abnormal secretions may be expressed from these crypts when the tonsils are compressed. In terms of treatment, if the tonsils are repeatedly inflamed and accompanied by fever, the patient may need to undergo a bilateral tonsillectomy. The surgery requires hospitalization, general anesthesia, and postoperative use of antibiotics to prevent local infection. Recovery and hospital discharge can typically occur about a week after the procedure. (Medication should be used under the guidance of a professional doctor.)

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Is chronic tonsillitis serious?

Chronic tonsillitis is primarily caused by repeated acute tonsillitis attacks or due to poor drainage in the tonsillar crypts, where bacteria and viruses breed and infect, leading to chronic inflammation. It is mainly divided into three types: hyperplastic, fibrous, and cryptic. Clinically, it mainly manifests as sore throat, susceptibility to colds, and a history of acute tonsillitis attacks. Usually, there are few self-perceived symptoms, which may include dry throat, itching, foreign body sensation, and mild symptoms such as irritative cough. If cheesy decayed material or a large number of anaerobic bacteria accumulate in the tonsillar crypts, bad breath may occur. Excessive enlargement of the tonsils in children can lead to respiratory distress, snoring, or swallowing and speech function disorders, requiring surgical treatment. If chronic tonsillitis frequently inflames, accompanied by acute fever more than five times a year, or affects swallowing and breathing, surgical treatment is necessary; otherwise, it may lead to severe diseases such as rheumatic heart disease or nephritis.

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Does chronic tonsillitis cause headaches?

Chronic tonsillitis generally does not cause headaches, as the main cause of chronic tonsillitis is repeated inflammation of the tonsils. The primary symptoms are sore throat and a sensation of a foreign body in the throat. Some people may also experience snoring and breathing through the mouth while sleeping, but overall, the main manifestations of this disease are in the throat area, so the clinical symptoms are primarily those related to the throat. Generally, it does not lead to headaches. If there is a cold, sinusitis, or rhinitis accompanying it, headaches may occur. However, the specific causes of the condition should be assessed by visiting an otolaryngology department to determine and apply the correct treatment.

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How long to receive IV therapy for acute tonsillitis?

Acute tonsillitis is an acute infectious inflammation of the tonsils, primarily caused by bacterial infection. Therefore, intravenous therapy is required for acute tonsillitis, which indicates that the symptoms of the tonsillitis are severe, often being suppurative tonsillitis. The duration of intravenous treatment generally lasts about three to five days, but it specifically depends on the patient's condition, and can even last longer. After the infection is controlled and symptoms are alleviated, treatment can switch to oral medications for anti-infection. Overall, there is no specific time rule for how long the infusion should last; it is often determined based on the specific condition of the patient.