From the Guidelines
Infected bile is not a recognized cause of recurrent tonsillitis. Recurrent tonsillitis is typically caused by bacterial infections (most commonly Group A Streptococcus) or viral pathogens, not by bile. Bile is produced in the liver and stored in the gallbladder, functioning in the digestive system with no direct connection to the throat or tonsils. For recurrent tonsillitis, treatment typically includes antibiotics such as penicillin V (500 mg twice daily for 10 days) or amoxicillin (500 mg three times daily for 10 days) for bacterial infections. If a patient experiences more than 7 episodes in one year, 5 episodes per year for two consecutive years, or 3 episodes per year for three consecutive years, tonsillectomy might be considered, as suggested by the American Academy of Otolaryngology-Head and Neck Surgery guidelines 1. To prevent recurrence, good hygiene practices like regular handwashing, avoiding close contact with sick individuals, and not sharing personal items are recommended. The concept of "infected bile" affecting the tonsils represents a misunderstanding of human anatomy and pathophysiology, as these systems are not connected in a way that would allow bile to reach the tonsils.
Some key points to consider in the management of recurrent tonsillitis include:
- Documentation of recurrent throat infections to determine the need for tonsillectomy, including the presence of a sore throat plus findings from a subjective physician assessment, such as fever, pharyngeal or tonsillar erythema, tonsil size, tonsillar exudate, cervical adenopathy, or microbiologic test results 1.
- The role of modifying factors, such as exceptions to recognized criteria based on individual features of illness, specific clinical syndromes, or poorly validated clinical indications, in the decision to perform a tonsillectomy 1.
- The importance of watchful waiting and close monitoring of patients with recurrent throat infections, as many cases may resolve without surgery, and the potential benefits of tonsillectomy may not outweigh the risks in all cases 1.
Overall, the management of recurrent tonsillitis should be guided by the most recent and highest-quality evidence, with a focus on minimizing morbidity, mortality, and improving quality of life. As stated in the 2019 clinical practice guideline update, tonsillectomy may be considered for recurrent throat infection with a frequency of at least 7 episodes in the past year, at least 5 episodes per year for 2 years, or at least 3 episodes per year for 3 years, with documentation in the medical record for each episode of sore throat and at least one of the following: temperature >38.3°C, cervical adenopathy, tonsillar exudate, or positive test for group A beta-hemolytic streptococcus 1.
From the Research
Causes of Recurrent Tonsillitis
- The exact cause of recurrent tonsillitis is not explicitly stated to be infected bile in the provided studies 2, 3, 4, 5, 6
- Recurrent tonsillitis is often caused by viral or bacterial infections, with group A beta-hemolytic streptococcus being a common bacterial cause 2, 4, 5
- Biofilms in the tonsils can also contribute to recurrent tonsillitis 3
Role of Bacteriology in Recurrent Tonsillitis
- Studies have investigated the bacteriology of recurrent tonsillitis, with Staphylococcus aureus being the most commonly isolated bacterium in one study 4
- However, the study found no relationship between bacteriology and recurrent infections 4
- Other studies have focused on the treatment of recurrent tonsillitis, including the use of antibiotics and tonsillectomy 2, 5, 6
Treatment of Recurrent Tonsillitis
- Treatment options for recurrent tonsillitis include supportive care, antibiotics, and tonsillectomy 2, 5, 6
- Tonsillectomy is indicated in cases of recurrent tonsillitis with a high frequency of episodes 5
- The use of a scoring system, such as the Centor score, can help estimate the probability of bacterial tonsillitis and guide treatment decisions 2, 5