Sore throat: causes, symptoms, types, diagnosis, treatment

Published: 10/22/2021 15:15:00 Updated: 10/25/2021

Sore throat is a disease of an infectious nature, manifested by acute inflammation of the lymphoid tissue of the pharynx. Most often the process affects the palatine tonsils, but other structures of the lymphadenoid pharyngeal ring can also be affected - the lingual and pharyngeal tonsils, lateral ridges or granules of the posterior pharyngeal wall.

The pathology in question is characterized by symptoms of intoxication, increased general temperature, sore throat that worsens during swallowing, enlarged and painful cervical lymph nodes. The palatine tonsils and arches are swollen, enlarged, bright red, and may have a white or dirty yellow coating.

Treatment of sore throat includes local treatment with antiseptics, painkillers and anti-inflammatory drugs, antibiotic therapy and detoxification measures. If complications develop or the process becomes chronic, surgical intervention may be required.

Causes of sore throat

Most often, inflammation is caused by the activity of beta-hemolytic streptococcus group A. Among the possible causative agents of the disease are also adenovirus, staphylococci, pneumococci, parainfluenza virus, mycoplasma, chlamydia, rhinovirus, respiratory syncytial virus, spirochete, Epstein-Barr virus, diphtheria bacillus, enterovirus Coxsackie B, fungi.
The risk of developing a sore throat increases when exposed to the following factors:

• general or local hypothermia;
• weakened immunity due to acute respiratory infections;
• fungal diseases;
• chronic pathologies of the nasopharynx, difficulty in nasal breathing, purulent processes and inflammation in the paranasal sinuses;
• caries;
• systematic exposure to irritating substances on the body, work in a smoky or dusty room;
• increased air dryness;
• regular drinking of alcohol, smoking;
• acute and chronic intoxication;
• poor nutrition, lack of vitamins in the diet.

Chronic tonsillitis during pregnancy

It is very important to pay attention to the disease during pregnancy. When planning a pregnancy, even in the case of a compensated condition, that is, a condition outside of an exacerbation of tonsillitis, it is highly advisable to carry out a planned course as prescribed by a doctor. This will reduce the bacterial load on the entire body in general and on the palatine tonsils in particular.

It is very encouraging that doctors are now referring pregnant women and women who are just preparing for pregnancy for treatment of tonsillitis. Unfortunately, in some cases one of the reasons for not carrying a pregnancy to term is this disease, although at first glance it is hard to believe, tonsillitis is a traffic jam, the treatment of which and other manifestations may seem in no way related to pregnancy.

Before conceiving a child, it would be correct to examine the future father of the child for the disease and, if necessary, treat it as well. This will significantly reduce the risk of developing chronic tonsillitis in the unborn child. And, on the contrary, the worse the condition of the future father and especially the mother, the risk of developing the disease in the child increases many times over.

Before pregnancy, it is very important to carry out comprehensive treatment of the symptoms of chronic tonsillitis. But even during pregnancy, it is recommended to repeat the course, preferably in the second trimester, when the woman’s condition is perhaps the most comfortable. It is important to note that physiotherapeutic procedures cannot be carried out during pregnancy, but it is highly desirable to wash the palatine tonsils using a vacuum method, followed by treatment with antiseptic solutions.

Types and symptoms of sore throat

Depending on the cause, angina may be primary if the site of inflammation is initially localized in the tonsils.
A secondary or symptomatic type of pathology is considered a manifestation of another disease - infectious mononucleosis, diphtheria, scarlet fever, tularemia, typhoid fever, leukemia, alimentary-toxic aleukia, agranulocytosis. Inflammatory damage to the palatine tonsils is called tonsillitis, and to the nasopharyngeal tonsils - adenoiditis. There is also tonsillitis of the lingual tonsil, lateral ridges of the pharynx and laryngeal tonsillitis.

Based on the depth and nature of inflammation of the lymphoid tissue, the following forms of the disease are distinguished:

• catarrhal;
• lacunar;
• follicular;
• ulcerative-membranous;
• necrotic;
• combined.

Characteristic manifestations of any form of angina are general symptoms of intoxication, including increased body temperature, weakness, decreased appetite, headache, as well as enlarged and painful regional lymph nodes.
The incubation period depends on the type of pathogen and the state of immunity, ranging from several hours to a week or more. Other signs of angina, such as sore throat and external changes in the tonsils, may have varying severity depending on the form of the disease.

Catarrhal

The inflammatory process primarily involves the mucous membrane of the tonsils.
The disease begins acutely. The temperature during catarrhal tonsillitis rises within 37.1-38.0 °C, symptoms of intoxication and sore throat during swallowing are moderate. Characterized by enlargement of the lymph nodes located in front of the sternocleidomastoid muscle at the level of the angle of the lower jaw. The palatine tonsils are moderately swollen, their mucosa, as well as the surface of the palatine arches and the soft palate, are brightly hyperemic. The duration of the disease is 2-3 days, after which recovery occurs or a transition to a more severe form occurs.

Viral sore throat occurs with symptoms of ARVI - runny nose, cough. When infected with Coxsackie enterovirus, blistering rashes are observed on the mucous membrane of the palate and tonsils.

Lacunar and follicular

The clinical course of both lacunar and purulent tonsillitis is severe.
Characterized by fever from 38.0 to 40.0 °C, severe intoxication syndrome: headache, general weakness, aches in joints and muscles, pain in the projection of the heart, chills, sleep and appetite disturbances. The pain in the throat during swallowing is sharp, often radiating to the ear. Severe inflammatory changes lead to dysphonia - the voice takes on a nasal tone. Swelling of the tonsils may be accompanied by difficulty breathing and temporary hearing loss. When a child has a sore throat, there may be increased salivation, drowsiness, vomiting, convulsions, and abnormal bowel movements. In the first 2-4 days, the symptoms increase rapidly, and then disappear just as quickly. In the lacunar form of the disease, in addition to swelling and pronounced redness of the mucous membrane, white, irregularly shaped overlays with a yellowish tint appear on the tonsils, which can be easily removed with tweezers. In the case of follicular tonsillitis, suppuration of the follicles occurs; individual pinpoint yellowish formations of regular shape, no larger than a pinhead, appear through the epithelium. The tongue is dry, covered with a white coating. On the 4-5th day, the surface of the lacuna begins to clear, and the purulent blisters gradually disappear.

Necrotic

The most severe form of the disease. A pronounced intoxication syndrome is characterized by persistent fever, impaired consciousness, and repeated vomiting that does not bring relief. Dirty yellow spots with a greenish tint, ulcers and ulcers appear on the surface of the tonsils.

Ulcerative-membranous

Simanovsky-Plaut-Vincent angina is caused by a spirochete and a spindle-shaped rod that constantly live in the oral cavity.
With exhaustion, a pronounced decrease in immunity or hypovitaminosis, opportunistic microorganisms can become active, causing inflammation. The difference between ulcerative membranous tonsillitis and other forms is the one-sidedness of the process. An ulcer with a gray-yellow coating on the surface appears on the tonsil mucosa. Characterized by a putrid odor from the mouth, moderate sore throat and enlarged regional lymph nodes on the same side as the inflammation. Symptoms of intoxication may be absent or mild. The duration of the disease is from 7 to 12 days. After cleansing of plaque, the ulcerative defect heals without scar formation. Extensive ulcerations can lead to bleeding, damage to the periosteum, and perforation of the palate.

Chronic tonsillitis

Chronic tonsillitis is an autoimmune disease that occurs as a result of frequent sore throats and a decrease in the body’s overall resistance since childhood. With the development of the disease and its exacerbation, a person does not have enough general immunity to keep the palatine tonsils “in working order” and adequately fight the infection.

If harmful microbes get onto the surface of the mucous membrane and into the lacunae of the palatine tonsil, a real battle occurs between the microbes and the human immune system.

The palatine tonsil fights all pathogenic and conditionally pathogenic infections, but not being able to fully resist attacking microbes, it provokes either a new outbreak of sore throat or an exacerbation of chronic tonsillitis (treatment cannot be delayed in any case), thereby triggering an infectious-inflammatory process in palatine tonsils.

As a result of a lost fight, pus accumulates and stagnates in the lacunae of the tonsils, that is, dead leukocytes that come to the aid of the tonsil in the fight against a dangerous infection. The purulent masses irritate and inflame the tonsil tissue from the inside and have a toxic effect on it, thereby causing a sore throat - a severe infectious outbreak of inflammation of the tonsils.

In the absence of quick and adequate treatment, the contents of the lacunae and crypts of the palatine tonsils serve as a breeding ground for pathogenic microbes and a constant source of infection, even after an attack of tonsillitis.

Complications of sore throat

During the disease, the infection can spread to neighboring organs, causing otitis media, lymphadenitis, sinusitis, and peritonsillitis. Among the local purulent complications of tonsillitis, one can note the formation of an abscess or phlegmon in the inflamed tissues. Their occurrence is accompanied by a new wave of fever, increasing sore throat, problems with swallowing and breathing. In the case where the pathology is caused by streptococcus, 3-4 weeks after clinical recovery, glomerulonephritis, reactive arthritis or rheumatic carditis may develop due to subsequent autoimmune processes.

The right approach

Sore throat, tonsillitis - treatment in children and adults is important to carry out immediately for all diseases of the oral cavity and nasopharynx that bother you. If breathing through the nose is impaired, and mucus or mucopurulent discharge flows down the back wall of the pharynx, then these symptoms should be given special attention.

Chronic tonsillitis - treatment (effective) can be conservative and surgical. Due to the fact that the removal of tonsils can cause serious harm to the defenses and immunity of the human body, otolaryngologists should try their best to preserve the tonsils and restore their functions without resorting to surgery to remove the tonsils. Modern methods of treating tonsillitis provide a greater chance of recovery without intervention.

Friends! Timely and correct treatment will ensure you a speedy recovery!

Chronic purulent tonsillitis - treatment of a conservative type must always be carried out in an ENT clinic, performing a complex, pathogenetically based course of treatment, as well as using a medicinal approach - medications prescribed by an ENT doctor.

Diagnosis of sore throat

At the patient’s initial visit, the doctor collects complaints and anamnesis, specifying the duration and circumstances of the onset of symptoms, and the nature of the pain.
This is followed by a general examination of the patient, a visual assessment of the mucous membranes of the mouth and throat, and palpation of regional lymph nodes. An endoscopic examination of the ENT organs – pharyngoscopy – is mandatory. It allows you to examine the tonsils in detail and thus determine the form of the disease. For angina, the following tests are prescribed:

1. Clinical blood test. Inflammation is indicated by neutrophilic leukocytosis with a shift to the left and accelerated ESR.
2. General urine analysis. It is possible that protein may appear in the biomaterial.
3. Rapid test from the tonsils using diagnostic strips to detect group A beta-hemolytic streptococcus.
4. Bacteriological examination of a smear for beta-hemolytic streptococcus and diphtheria. Material is collected from the surface of the palatine tonsils and the posterior wall of the oropharynx before using local antiseptic drugs and taking antibiotics.
5. If a patient is suspected of having infectious mononucleosis, a blood test is performed to test for IgM antibodies or to identify the genetic material of the Epstein-Barr virus.
6. As part of the diagnosis of herpetic sore throat, enterovirus RNA is determined in the blood and throat smear using the PCR method.

Diagnosis of complications of angina after clinical recovery includes the following laboratory and instrumental studies:

1. Control general analysis of blood and urine.
2. Rheumatic test. Determination of rheumatoid factor, C-reactive protein, antistreptolysin-O, seromucoid in the blood.
3. ECG. The electrocardiogram may show signs of hypoxia and conduction disturbances.

What other tonsils are there in the pharynx?

Other tonsils that form the lymphoid pharyngeal ring are: adenoid vegetations, or, more simply, adenoids, which are not a paired organ. They are located in the dome of the nasopharynx. It is impossible to see them with the naked eye. In order to recognize the condition of the adenoids, it is necessary to perform an endoscopic examination of the nasopharynx. Inflammation of the adenoids is called adenoiditis and is more common in children.

Also in the pharynx there is a lingual tonsil, located at the root of the tongue, which, like the adenoids, is an unpaired organ.

There are also tubal ridges, which are also called tubal tonsils. They are located at the entrance to the pharyngeal mouth of the auditory tube. The tube ridges are located deep in the nasopharynx, on the lateral (medial) surfaces of the nasopharynx on the right and left. Tubal tonsils perform an important function - they protect against infection entering the auditory tube. Since each of the tonsils of the lymphoepithelial pharyngeal ring deserves separate close attention, in this article we will only talk about the palatine tonsils and chronic tonsillitis. Other tonsils and the pathology they cause will be described in detail separately, in other relevant ENT articles.

Treatment of sore throat

Depending on the severity of the patient’s condition, treatment of angina occurs under the supervision of a doctor at home or in a hospital.
Bed rest is mandatory, a gentle dairy-vegetable diet enriched with vitamins, and plenty of warm drinks are recommended. For bacterial sore throat, broad-spectrum antibiotics are prescribed. If the disease is caused by streptococcus, penicillin drugs are used. In case of severe intoxication syndrome, intravenous infusion of glucose-saline solutions is performed. Non-steroidal anti-inflammatory drugs are used as antipyretics and pain relievers.

For sore throat, gargling with alkaline and water-salt solutions and irrigating the pharynx with painkillers and antiseptics are recommended. The use of drugs in the form of a spray for the treatment of sore throat is possible only in adults and children over 3 years of age. With the development of purulent complications of the disease, hospitalization of the patient followed by surgical intervention is required.

Author:

Pugonina Tatyana Alekseevna, Therapist

Forms of the disease

• recurrent form, that is, with frequently recurring sore throats;
• protracted form, when the inflammatory process in the palatine tonsils is characterized by a sluggish and prolonged course;
• compensated form, when episodes of sore throat and exacerbation of tonsillitis are not observed for a long time.

Chronic tonsillitis is the most common disease among all diseases of the pharynx and one of the most common diseases of all ENT organs, along with such a diagnosis as acute sinusitis.

Chronic tonsillitis can affect both adults and children, from the moment the palatine tonsils begin to develop (from 2-3 years). Moreover, the incidence of this disease in childhood is much higher.

Some respiratory diseases can also be classified as social diseases. For example, sinusitis and tonsillitis are among them. Poor environment, stress, lack of sleep, overwork, monotonous and poor nutrition, as well as poor heredity are predisposing factors to the development of the disease.

Incubation period

The period from the moment the pathogen enters the body until the appearance of the first characteristic symptoms can range from 2 to 6 days. During the first few days, the sick person is still unaware of his condition, becoming a source of infection for others. During the incubation period, the infection is actively transmitted by airborne droplets (through coughing, sneezing, kissing, talking). The onset of the disease is manifested by a feeling of chills, increased body temperature, weakness and headache. The sooner the patient sees a doctor, the easier the treatment is.

Prevention of chronic tonsillitis

1. Drug therapy
   . If an ENT patient undergoes treatment courses in the clinic once every 6 months, then in addition to six-month procedures, he is recommended to take the drug Tonsilotren, with a frequency of once every 3 months, i.e. 4 times a year. The course of taking (resorption) of the drug is for 2 weeks (more precisely 15 days). It is also possible to instill 0.01% Miramistin solution, 4 pumps 4 times a day for 2 weeks, in courses 4 times a year.
2. Climatotherapy and spa therapy
   . An important point in the prevention of chronic tonsillitis is visiting seaside resorts. Sunbathing, humidified sea air, swimming and, as a result, the inevitable entry of sea water into the mouth have a beneficial effect on the prevention of chronic tonsillitis.
3. Work and rest schedule
   . In order for the periods of remission to be long, it is necessary to fully rest and not expose yourself to stress. It is not without reason that chronic tonsillitis, like sinusitis, is classified as a social disease, in which the more stress and workload there is at work, the higher the likelihood of exacerbation of chronic tonsillitis.
4. Diet
   . It is very important to eat right. Under no circumstances should you get carried away with fried, salty, peppery, sour, bitter, i.e. that food that irritates the mucous membrane of the back of the throat and palatine tonsils. Citrus fruits are contraindicated. The consumption of alcoholic beverages, especially strong ones, is also contraindicated. It is not advisable to eat very hot and very cold and solid foods.

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The information in this article is for reference only and does not replace professional advice from a doctor. To make a diagnosis and prescribe treatment, consult a qualified specialist.

1. "Sore throats: diagnosis and treatment." L.N. Kunelskaya, A.B. Turovsky, Yu.S. Kudryavtseva/Moscow Scientific and Practical Center of Otolaryngology/General Medicine 3.2010/Art. 4-8.
2. “Sore throat” Head of the Department of Otolaryngology – I.B. Soldatov, professor N.S. Khrappo / Moscow, 1998 / art. 1-2.
3. “Sore throats” by M.T. Galchenko, M.V. Subbotina/textbook/Department of Otolaryngology/Ministry of Health/Irkutsk 2008/ Art. 38.
4. V.F. Undritz, K.L. Khilov, N.N. Lozanov, V.K. Suprunov “Diseases of the ear, nose and throat” (a guide for doctors). Publishing house "Medicine", 1969. Designed and republished by Alexey Kuimov in 2003./Acute (vulgar) banal sore throats Art. 465-467.
5. “Sore throat in the practice of a local therapist”: method. recommendations / E.V. Yakovleva, R.V. Khursa. – Minsk: BSMU, 2009./art.2–6.
6. “Lectures on otolaryngology” - Otolaryngology / 1990 I.B. Soldatov / p. 187.
7. “Principles of etiopathogenetic therapy of acute pharyngitis” / Methodological recommendations / S.V. Ryazantsev/St. Petersburg 2013 p.34-36.

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