recurrenttonsillitis

Recurrent tonsillitis refers to repeated episodes of acute inflammation of the palatine tonsils, usually due to infection. It is most common in children but can occur in adults as well. An acute episode typically includes sore throat, fever, tonsillar exudate, tender cervical lymph nodes, and throat pain with swallowing. By convention, recurrent tonsillitis is defined by frequency, with common thresholds used by clinicians being seven or more episodes in a year, five or more per year for two consecutive years, or three or more per year for three consecutive years.

Causes include both viral and bacterial infections. Most episodes are viral, but group A Streptococcus is a frequent bacterial cause. Risk factors include close contact in schools or crowded living conditions, exposure to tobacco smoke, allergic rhinitis, and, rarely, underlying immune defects. The condition often shows seasonal variation, occurring more in winter and early spring.

Diagnosis is based on history and examination. A rapid antigen detection test or throat culture may be used to identify group A Streptococcus when indicated. Evaluation should consider complications such as peritonsillar abscess and, in children, assessment for sleep-disordered breathing if episodes are frequent or associated with snoring or daytime symptoms.

Management focuses on treating acute episodes and reducing burden. Analgesics and hydration are standard; antibiotics are reserved for episodes confirmed or highly suspected to be bacterial, typically penicillin V or amoxicillin. Continuous antibiotics are not routinely recommended for recurrent disease. Tonsillectomy may be considered for carefully selected patients who meet established frequency criteria and have significant symptom burden or sleep-related breathing problems, after discussion with an ear, nose, and throat specialist.

Prognosis is generally favorable, with recurrences often declining with age. Prevention centers on good hygiene, vaccination against influenza, avoiding tobacco smoke, and prompt treatment of infections. Tonsillectomy can reduce future episodes in those who qualify.