CHRONIC TONSILLITIS: MODERN DIAGNOSTIC AND TREATMENT APPROACHES

Abstract

Chronic tonsillitis is a common and often underrecognized inflammatory condition of the palatine tonsils that places a substantial burden on patients and healthcare systems worldwide. This narrative review synthesizes current evidence on the epidemiology, pathophysiology, diagnosis, and management of chronic and recurrent tonsillitis, drawing on clinical practice guidelines, systematic reviews, and consensus statements from otolaryngology and infectious disease societies. Pathogenesis is increasingly understood to center on the formation of bacterial biofilms within tonsillar crypts, which sustain a self-perpetuating cycle of microbial colonization, chronic local immune activation, and recurrent acute exacerbation. Diagnosis relies on a structured clinical history, validated scoring systems for group A streptococcal pharyngitis, and, for recurrent disease, standardized frequency criteria used to guide the decision between continued medical management and surgical referral. Treatment follows a stepwise approach: supportive care and, when bacterial infection is confirmed, targeted antibiotic therapy for acute episodes; a period of structured observation, or watchful waiting, for most patients with recurrent disease; and tonsillectomy reserved for patients who meet established frequency criteria or who have qualifying modifying factors. Continued refinement of diagnostic criteria and individualized, evidence-based selection for surgery remain central to optimizing outcomes and reducing unnecessary intervention.