The immunological study believes that when antigenic bacteria accumulating inside tonsillar crypts have contacted the tonsillar tissue for a long time, this will result in the formation of the autotogous antigen,giving rise to complex allergic reactions. Therefore, autoallergy is the important cause of chronic tonsillitis. The main pathological changes of the disease lie in crypts, and include injury of the cryptal mucosa, epithelial pachynsis or ulceration and formation of caseous substance with the mixture of epithelial cells, exudate, white blood cells and bacteria discharging from crypts. The scar may form after the ulcer heals.

The disease belongs to the category of "Manru'e" (chronic tonsillitis)in TCM. When acute tonsillitis lasts long without cure after prolonged treatment, pathogenic heat will consume yin to cause visceral asthenia and flaring-up of asthenic fire, giving rise to the disease. Accordingly, the disease is also called "Xuhuo Ru'e" (tonsillitis due to asthenic fire). This is the way most chronic tonsillitis occurs.