ABSTRACTTonsillar disease (recurrent tonsillitis and/or tonsillar hypertrophy) is one of the most common human disorders, withStreptococcus pyogenes(group A beta-hemolytic streptococcus [GAS]) andHaemophilus influenzaerepresenting the most common pathogens. Until now, no study has investigated why some individuals are more susceptible to tonsillar infections caused by specific bacteria than others. The aim of this study was to uncover possible associations between common Toll-like receptor gene (TLR) polymorphisms and tonsillar disease. TheTLR2-R753Q,TLR4-D299G, andTLR4-T399I polymorphisms were determined in a cohort of 327 patients subjected to tonsillectomy due to recurrent tonsillitis (n= 245) and tonsillar hypertrophy (n= 82) and 245 healthy bone marrow donors. Associations of the aforementioned polymorphisms with the isolated bacterial strains after tonsillectomy were also investigated. Interestingly, carriers of theTLR4polymorphisms displayed an approximately 3-fold increased risk for GAS infections (forTLR4-D299G, odds ratio [OR] = 2.81, 95% confidence interval [CI] = 1.16 to 6.79,P= 0.038; forTLR4-T399I, OR = 3.01, 95% CI = 1.29 to 7.02,P= 0.023), and this association was more profound in patients with recurrent tonsillitis. On the contrary, the presence of theTLR4-T399I polymorphism was associated with a 2-fold decreased risk ofHaemophilus influenzaecarriage (OR = 0.38, 95% CI = 0.15 to 0.96,P= 0.038). In the end, no significant differences were observed, considering the genotype and allele frequencies of the above-mentioned polymorphisms, between patients and controls. Our findings indicate that, regarding tonsillar infections,TLR4polymorphisms predispose individuals to GAS infection, while they are protective againstHaemophilus influenzaeinfection. This result further elucidates the role that host immune genetic variations might play in the susceptibility to common infections and tonsillar disease.