Chronic tonsillitis
and Martina Feichter, medical editor and biologistRicarda Schwarz studied medicine in Würzburg, where she also completed her doctorate. After a wide range of tasks in practical medical training (PJ) in Flensburg, Hamburg and New Zealand, she is now working in neuroradiology and radiology at the Tübingen University Hospital.
More about the expertsMartina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.
More about the experts All content is checked by medical journalists.
One speaks of chronic tonsillitis if an acute tonsillitis flares up again and again. In between there are usually symptom-free or low-symptom intervals. It is therefore more correct to use the term recurrent (acute) tonsillitis. The only sensible therapy for affected patients is often the removal of the tonsils. Here you can read everything you need to know about recurrent or chronic tonsillitis.
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. A36J35J03
Recurrent / chronic tonsillitis: what is it?
Some people have tonsillitis more often - with more or less short symptom-free or symptom-poor periods in between. Then the diagnosis is "chronic tonsillitis".
The guidelines do not clearly specify how many tonsillitis people must have in order to make the diagnosis.
According to the currently valid guidelines, the term "chronic tonsillitis" should no longer be used anyway, because the palatine tonsils are naturally always in an inflammatory reaction: their job is to intercept pathogens that could penetrate the body through the mucous membrane of the mouth and throat . Contact with these germs triggers an immune reaction - i.e. inflammation - in the tissue of the tonsils.
So it is normal for the tonsils to be permanently in a state of inflammation. This only becomes a disease if this local inflammation increases. It is then accompanied by other symptoms such as swallowing difficulties and (systemic) inflammation symptoms (e.g. fever) affecting the whole body.
If this tonsillitis repeats itself over and over again within a certain period of time, the guideline-compliant diagnosis is: Recurrent (acute) tonsillitis (RAT). However, some doctors continue to speak of chronic tonsillitis if the inflammation has been smoldering for three months and the patient is never completely symptom-free.
Recurrent / chronic tonsillitis: cause
The starting point of a recurrent (chronic) tonsillitis is usually an acute tonsillitis caused by bacteria, usually with the involvement of certain streptococci (beta-hemolytic group A streptococci). Usually the immune system gets a grip on such an acute infection - it gets rid of all the bacteria in the tonsils. Or antibiotic therapy can help to get the bacterial tonsillitis under control.
Reinfections: It can also happen that individual germs remain in the deep crevices (crypts) or encapsulated foci in the tonsils. These can cause acute tonsillitis over and over again.
New infections: In other cases, dead germ material maintains the inflammation. The tonsils are more “vulnerable” on this soil: New pathogens have an easier time of it.
Whether known or new bacteria: The tonsillitis can become "chronic" in this way, that is, flare up again and again (that is, recur = relapse). In between, those affected have little or no complaints.
Recurrent / chronic tonsillitis: symptoms
If tonsillitis occurs more frequently, recurrent (chronic) tonsillitis may be present. Those affected usually have varying and mostly minor complaints such as a scratchy throat. In addition, the following symptoms of "chronic" tonsillitis can occur:
- Bad breath
- Strange taste in the mouth
- Permanently enlarged lymph nodes on the neck
- Slight difficulty swallowing
- Sore throat of varying severity
Sometimes severe symptoms of acute inflammation can recur and thus indicate recurrent (chronic) tonsillitis.
Recurrent / chronic tonsillitis: diagnosis
When a patient reports recurrent tonsillitis and shows the symptoms described above, the doctor usually quickly thinks of the possibility of recurrent (chronic) tonsillitis. He will also ask other questions, such as:
- How often have you had tonsillitis?
- When did you last have tonsillitis? How many in the past 12 months?
- Do you have symptom-free periods?
- What was the treatment like so far? Have you ever had an operation on your tonsils?
The suspicion is usually confirmed on examination of the throat. Recurrent (chronic) tonsillitis is usually associated with a reddened throat. The surface of the palatine tonsil appears strongly fissured, scarring indicate frequent inflammatory processes. Because of this scarring, the tonsils can hardly be moved with a spatula - an important sign of recurrent (chronic) tonsillitis. If the doctor presses against the tonsils with the spatula, a mushy secretion (detritus) or pus usually emerges.
The size of the tonsils does not help in establishing the diagnosis: In the case of recurrent (chronic) tonsillitis, the tonsils can be small and stunted as well as enlarged.
Sometimes further tests are helpful, for example blood tests (e.g. measuring inflammation values) or a throat swab (for the detection of pathogens).
Recurrent / chronic tonsillitis: consequences
Recurrent (chronic) tonsillitis, like acute tonsillitis, can lead to inflammation in other parts of the body. Possible consequences are, for example:
- Rheumatic fever
- Inflammation of the kidney corpuscles (glomerulonephritis)
- Inflammation of the heart muscle (myocarditis)
- Inflammation of the lining of the heart (endocarditis)
- Inflammation of the pericardium (pericarditis)
- Joint inflammation (rheumatoid arthritis)
Recurrent / chronic tonsillitis: therapy
In the case of recurrent (chronic) tonsillitis, doctors often recommend surgically removing the tonsils.
They consider this so-called tonsillectomy if a patient has been diagnosed with three to five episodes of purulent tonsillitis within 12 months and has been treated with antibiotics. If there are further episodes (up to the number six) within the next six months, it may be useful to remove the tonsils. If there are more than six episodes per year, tonsil surgery is definitely a therapeutic option.
Before removing the tonsils, however, it must be ensured that the symptoms are actually based on bacterial tonsillitis and not on a viral infection.
If recurrent (chronic) tonsillitis results in complications or secondary diseases, doctors usually also recommend removing the tonsils.
Tags: alternative medicine pregnancy menopause
