Each person has two tonsils that sit on either side, at the back of their throat. Tonsils are important in the body’s defence against infections that could gain entry to your body during breathing or eating. They are most active in the first few years of life, after which other lymphoid tissue in the throat takes over.

Tonsillitis is an infection of one or both of the tonsils. Tonsillitis causes fever, pain in the throat, especially on swallowing, and glands to become swollen in the neck. If there is also a cough, tonsillitis is unlikely.

In most cases tonsillitis is caused by viruses, and even when it is caused by bacteria, antibiotics have little benefit. The general guidance is to treat tonsillitis with pain killers and rest. If this is failing to control symptoms or symptoms are getting worse then a course of antibiotics can be prescribed. Time off school or work is frequently required and there is significant impact to normal life.

In some children and young adults, tonsillitis keeps coming back. Recurring tonsillitis is diagnosed when someone has had

• 7 attacks of tonsillitis in the last year or

• 5 attacks of tonsillitis a year for each of the last 2 years or

• 3 attacks of tonsillitis a year for each of the last 3 years

In young children (under 6 years) it is normal to have between 4-11 cold-like infections a year. This is because the immune system is still immature and learning how to protect the body.

Since these infections occur sometimes in the ears (acute otitis media), sometimes in the nose (blocked or runny nose) and sometimes in the throat (tonsillitis or cough), they tend to be noticed less. When they occur at the same site, over and over again, they are more noticeable. But in most cases they are still the result of a maturing immune system, and will improve with age.

In some cases, the tonsils themselves have stopped defending the body and/or have themselves become colonised with bacteria.

In many cases if left alone without surgery the severity and frequency of tonsillitis attacks reduces over 2-3 years.

Whilst recurring tonsillitis tends to get better in many patients over time, there are consequences to waiting it out. Due to the unpredictable nature of infections, the patient may suffer unplanned interruptions of schooling and work. Those who get particularly severe attacks of tonsillitis requiring courses of antibiotics may be at risk of antibiotic resistance in the future.

A tonsillectomy can be considered to treat recurring tonsillitis.