Binding of Isaac: Rebirth Wiki

Added in Afterbirth †

Tonsil is a trinket added in The Binding of Isaac: Afterbirth †.


  • After taking 12-20 hits, a removed tonsil familiar starts following Isaac, blocking enemy shots.
    • The effect can happen twice, after which the trinket will be destroyed.
    • The familiar does not deal damage to enemies.


Added in Afterbirth † / Removed in Repentance
  • When the familiar is generated, Isaac will gain the familiar permanently as a passive item. This allows Isaac to drop the trinket while keeping the familiar.
    • Removed in Repentance The passive Tonsil item does not exist in any item pool; thus, this is the only way to find it and make it appear in the Collection Page aside from starting with it as Eden Eden.
  • Removed in Repentance If Eden starts with the passive tonsil item and picks up the trinket, the trinket will spawn only one familiar before being consumed.
  • Sources of self-inflicted damage, like IV Bag IV Bag or Blood Donation Machine.png Blood Donation Machines, can spawn a familiar.
  • Damage that is blocked by Holy Mantle Holy Mantle or the Added in Afterbirth †Holy Card Holy Card does not count to the number of hits that are needed for the tonsil familiar to spawn.

In-game Footage[]


  • Tonsils are soft tissue located near the back of the throat which, in the event of inflammation to the point of obstructing the throat, can be removed without much noticeable difference.
  • Added in Repentance The passive item form of Tonsil is technically the only item to be removed from the game. However, it was never actually intended to appear on the collection page.