Tonsillectomy is considered the most common major surgical operation performed in pediatric age group

Tonsillectomy is considered the most common major surgical operation performed in pediatric age group. More than 400,000 tonsillectomies performed annually in the U.S. with an evidence that this number is continuously increasing. The most common cause of tonsillectomy is mainly infectious (Bagwell et al., 2018).
Chronic tonsillitis is the most common clinical diagnosis encountered in primary healthcare centers and is the commonest indication of tonsillectomy (Wittlinger et al., 2017).
Chronic tonsillitis implies a chronic inflammatory state characterized by a number of clinical signs such as recurrent infection, anterior pillar inflammation, tonsillar hypertrophy and cervical lymphadenopathy. Although not fully understood, but the main cause of recurrence was believed to be due to failure of eradication of the core tonsillar organism either due to inappropriate antibiotic, subclinical dose or poor penetration of the tonsillar tissue (Haq et al., 2017a).
As a result, diagnosis of chronic tonsillitis must not be based only on clinical observation but has to be accomplished by bacteriological and laboratory studies (Khadilkar et al., 2017).
Consequently, empirical treatment of recurrent tonsillitis must be directed toward bacteria dormant in the core of the tonsil rather than that on the tonsillar surface. Many studies were established for identification of the causative organisms of chronic tonsillitis. It was observed that surface tonsillar swabs doesn’t reflect the core organism according toScottish National Health Service (NHS) guidelines (Agrawal et al., 2014).
However, many other studies concluded that surface swab and culture can give a true reflection of the core bacteria and so can be reliable in culture based treatment of chronic tonsillitis (Manandhar et al., 2016) Raju and Selvam 2012).