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Chronic tonsillitis - Information Review

Medical expert of the article

Abdominal surgeon
, medical expert
Last reviewed: 12.07.2025

Chronic tonsillitis is an active chronic inflammatory focus of infection in the palatine tonsils with periodic exacerbations and a general infectious-allergic reaction. The infectious-allergic reaction is caused by constant intoxication from the tonsillar focus of infection, and intensifies during exacerbation of the process. It disrupts the normal functioning of the entire body and aggravates the course of general diseases, and often itself becomes the cause of many general diseases, such as rheumatism, joint diseases, kidney diseases, etc.

Chronic tonsillitis can rightfully be called the "disease of the 20th century", which "successfully" crossed the threshold of the 21st century and still constitutes one of the main problems not only of otolaryngology, but also of many other clinical disciplines, in the pathogenesis of which the main role is played by allergy, focal infection and deficiency states of local and systemic immunity. However, the basic factor of particular importance in the occurrence of this disease, according to many authors, is the genetic regulation of the immune response of the palatine tonsils to the effects of specific antigens. On average, according to the data of a survey of different population groups, in the USSR in the second quarter of the 20th century the incidence of chronic tonsillitis fluctuated within 4-10%, and already in the third quarter of the said century, from the report of I.B. Soldatov at the VII Congress of Otolaryngologists of the USSR (Tbilisi, 1975) it followed that this indicator, depending on the region of the country, rose to 15.8-31.1%. According to V.R. Gofman et al. (1984), 5-6% of adults and 10-12% of children suffer from chronic tonsillitis.

ICD-10 code

J35.0 Chronic tonsillitis.

Epidemiology of chronic tonsillitis

According to domestic and foreign authors, the prevalence of chronic tonsillitis among the population fluctuates widely: in adults it is from 5-6 to 37%, in children - from 15 to 63%. It should be borne in mind that between exacerbations, as well as in the non-anginal form of chronic tonsillitis, the symptoms of the disease are largely familiar and little or not at all bother the patient, which significantly underestimates the actual prevalence of the disease. Often, chronic tonsillitis is detected only in connection with the examination of the patient for some other disease, in the development of which chronic tonsillitis plays a large role. In many cases, chronic tonsillitis, remaining unrecognized, has all the negative factors of tonsillar focal infection, weakens human health, worsens the quality of life.

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Causes of chronic tonsillitis

The cause of chronic tonsillitis is the pathological transformation (development of chronic inflammation) of the physiological process of immunity formation in the tissue of the palatine tonsils, where the normally limited inflammation process stimulates the production of antibodies.

The palatine tonsils are part of the immune system, which consists of three barriers: lympho-blood (bone marrow), lympho-interstitial (lymph nodes) and lympho-elitelial (lymphoid clusters, including tonsils, in the mucous membrane of various organs: pharynx, larynx, trachea and bronchi, intestines). The mass of the palatine tonsils is an insignificant part (about 0.01) of the lymphoid apparatus of the immune system.

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Symptoms of chronic tonsillitis

One of the most reliable signs of chronic tonsillitis is the presence of tonsillitis in the anamnesis. In this case, it is necessary to find out from the patient what kind of increase in body temperature is accompanied by sore throat and for what period of time. Sore throats in chronic tonsillitis can be pronounced (severe sore throat when swallowing, significant hyperemia of the mucous membrane of the pharynx, with purulent attributes on the tonsils according to the forms, febrile body temperature, etc.), but in adults, such classic symptoms of tonsillitis often do not occur. In such cases, exacerbations of chronic tonsillitis occur without pronounced severity of all symptoms: the temperature corresponds to small subfebrile values (37.2-37.4 C), sore throat when swallowing is insignificant, a moderate deterioration in general health is observed. The duration of the disease is usually 3-4 days.

Screening

It is necessary to screen for chronic tonsillitis in patients with rheumatism, cardiovascular diseases, joint diseases, kidney diseases, it is also advisable to keep in mind that in general chronic diseases, the presence of chronic tonsillitis to one degree or another can activate these diseases as a chronic focal infection, therefore in these cases it is also necessary to examine for chronic tonsillitis.

Diagnosis of chronic tonsillitis

The diagnosis of chronic tonsillitis is established on the basis of subjective and objective signs of the disease.

The toxic-allergic form is always accompanied by regional lymphadenitis - enlargement of the lymph nodes at the angles of the lower jaw and in front of the sternocleidomastoid muscle. Along with determining the enlargement of the lymph nodes, it is necessary to note their pain upon palpation, the presence of which indicates their involvement in the toxic-allergic process. Of course, for clinical evaluation it is necessary to exclude other foci of infection in this region (teeth, gums, ocholaparesis sinuses, etc.).

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Treatment of chronic tonsillitis

In the simple form of the disease, conservative treatment is carried out and the course is 1-2 years in 10-day courses. In cases where, according to the assessment of local symptoms, the effectiveness is insufficient or an exacerbation occurs (tonsillitis), a decision may be made to repeat the course of treatment. However, the absence of convincing signs of improvement and especially the occurrence of repeated tonsillitis is considered an indication for the removal of the palatine tonsils.

In the toxic-allergic form of the first degree, conservative treatment of chronic tonsillitis can still be carried out, however, the activity of the chronic tonsillar focus of infection is already obvious, and general severe complications are possible at any time. In this regard, conservative treatment for this form of chronic tonsillitis should not be delayed if significant improvement is not observed. The toxic-allergic form of the second degree of chronic tonsillitis is dangerous due to rapid progression and irreversible consequences.

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