Sarcoidosis resolves spontaneously in many cases on a long-term basis. However, there are many cases whose resolution is delayed. We have experienced a frequent association of chronic tonsillitis (CTL), and dental caries in those patients of persistent course. We hypothesized that the presence of chronic or recurrent inflammatory foci in the upper airway may adversely affect the natural resolution of sarcoidosis. We analyzed the difference of regression of bilateral hilar lymphadenopathy on chest roentgenogram (CXR) in relation to changes in serum angiotensin converting enzyme (SACE) in sarcoidosis patients with and without CTL, and the effect of tonsillectomy (TLT) on the clinical course. In this study, we focused only on the tonsil for the sake of simplicity of analysis. Sarcoidosis resolved spontaneously in 10 of 28 (36%) patients with CTL and in 19 of 25 (76%) without CTL, and after TLT 9 cases became favorable in the course and the rate of unfavorable turned similar to those without CTL. The presence of CTL may be adversely related to the resolution of sarcoidosis.