Chronic tonsillitis is a chronic inflammation of the palatine tonsils.
The palatine tonsils (popularly called tonsils) are an important part of the human immune system.
Bacteria, viruses, and microscopic fungi enter us with food and air. They settle on the mucous membranes, where they are picked up by a constant current of mucus, and this “river” flows in the direction of the oropharynx, just where the tonsils are located behind the palatine arches.
The palatine tonsils are like a sponge. They are dotted with gaps. When we swallow a bolus of food soaked in infected mucus, this mucus enters the lacunae of the tonsils. There, foreign microorganisms are attacked by the guard cells of the primary immune response: neutrophils and macrophages. The latter not only kill the infection, but also “cut” it into small molecular fragments, on which young cells of the secondary immune response—lymphocytes—are then “trained.” Prepared and trained lymphocytes emerge from the tonsils and “spread” throughout the mucous membranes of the pharynx and nose, forming a fairly reliable secondary specific defense.
Anatomy of the throat
In the pharynx, on the sides and along the back wall, as well as on the border of the oral and nasal cavities, there are accumulations of lymphoid tissue - the so-called lymphoid-pharyngeal ring. It performs a protective function, and each of the tonsils of this ring is an important organ of our immunity.
The largest accumulations of lymphoid tissue are called tonsils (they are also called tonsils ) and there are several of them: two palatine, two tubal, one pharyngeal (aka adenoid) and one lingual.
Inflammation of the palatine tonsils (in everyday life they are called tonsils) is called acute tonsillitis or tonsillitis .
What it is?
Chronic tonsillitis is a long-term inflammation of the pharyngeal and palatine tonsils (from the Latin tonsollitae - tonsil glands). Develops after a sore throat and other infectious diseases accompanied by inflammation of the mucous membrane of the pharynx (scarlet fever, measles, diphtheria), or without a previous acute illness.
Causes of tonsillitis
The most common pathogens should be highlighted:
| PATIENT | A COMMENT | ||
| pathogen: | Bacteria: beta-hemolytic streptococcus of group A and other groups, pneumococcus, Staphylococcus aureus, Neisseria, enterobacteria | a comment: | Particularly worth highlighting is streptococcal tonsillitis, in which infection occurs with group A beta-hemolytic streptococcus, which occurs in almost 30% of cases and is responsible for the further development of acute tonsillitis and exacerbation of chronic tonsillitis.3 |
| pathogen: | Viruses: adenoviruses, enterovirus, Epstein-Barr virus, influenza viruses, herpes virus | ||
| pathogen: | Mushrooms: yeast-like fungi of the genus Candida |
The infection is transmitted by airborne droplets through direct contact, penetrating the mucous membrane of the tonsils. But it can also be in the body without manifesting itself in any way. Periods of outbreaks of seasonal ARVI, hypothermia, the presence of chronic diseases of the pharynx, poor diet, bad habits, injuries - all these factors can lead to a decrease in immunity, which in turn provokes the growth of bacterial, less often fungal flora, and activates some viruses.
All these factors lead to inflammation of the tonsils and surrounding structures.
Depending on the pathogen, there are:
- Purulent tonsillitis (caused by bacteria)
- Viral tonsillitis
- Fungal tonsillitis
What is the role of the palatine tonsils?
Tonsils are organs consisting of lymphoid tissue that are located in the nasopharynx and perform the function of immune defense. They got their name because of their external resemblance to an almond, which is why anatomists began to use the name “almond.”
Lymphoid tissue in the pharynx is present not only in the palatine tonsil, but also in other structures:
- lingual and nasopharyngeal tonsil;
- lymphoid foci of the posterior pharyngeal wall.
The lymphoid tissue of the pharynx is an important part of the immune system, since on its surface contact of the body’s immune cells with the environment occurs. The information received by the immune cells in the lymphoid structures of the pharynx is transmitted to the next level of immune organs (thymus, bone marrow, lymph nodes) for the production of protective proteins (immunoglobulins). Subsequently, they neutralize pathogenic viruses, bacteria, fungi and protozoa that enter the body from the external environment.
With age, the role of the tonsils as immune organs is gradually lost. Lymphoid tissue is gradually replaced by connective tissue elements, so involution (reverse development) of organs begins. The nasopharyngeal tonsil is the first to undergo involution, later it spreads to the lingual and palatine tonsils. Therefore, in the elderly, the tonsillar tissue (tonsil) decreases to the size of a pea.
The palatine tonsil is the most complex in structure. It consists of a large number of channels - crypts (or lacunae). Some crypts look like a shallow, more or less straight tubule, others have greater depth, branch like a tree, and some crypts are interconnected. Often, where the crypt opens into the pharynx, there is a narrowing of the canal. This makes it difficult to clear it of its contents, against the background of which an inflammatory process develops.
The palatine tonsil is bounded by a capsule - a dense connective tissue membrane. Outside of it there is a layer of loose tissue - paratonsillar or peritonsillar tissue. With severe inflammation, the infection destroys the barrier of the capsule and goes beyond it, causing inflammation of this fiber. This condition is called paratonsillitis. It refers to a serious complication, which, if treated incorrectly or untimely, can have serious consequences, such as the development of a purulent focus in the soft tissues of the neck (peritonsillar abscess, phlegmon of the neck), sepsis, and damage to internal organs. Therefore, it is necessary to start treatment as early as possible.
Forms of tonsillitis
There is a large classification of forms of acute tonsillitis :
Catarrhal
The mildest form, in which the mucous membrane of the tonsils is affected. The palatine tonsils are not very enlarged, the mucous membrane of the throat is red, there is no plaque or pus.
Follicular
In this form, the follicles of the tonsils, that is, the deeper structures of the tonsils, are affected. They are visible through the tissue of the tonsils in the form of whitish-yellow round formations.
Lacunarnaya
It leaks more severely. When examined, yellowish-white and purulent plaques can be seen on the tonsils.
Fibrinous
A dense film of grayish fibrin forms on the tonsil, which is difficult to remove with a spatula.
Herpetic
Characterized by the appearance of blisters on the tonsils. When they rupture, painful, difficult-to-heal ulcers form.
Phlegmonous
With this form, after 1-2 days of acute tonsillitis, an abscess (cavity with pus) develops.
Ulcerative-necrotic
Angina of Simanovsky-Plaut-Vincent.
As a rule, one tonsil is involved in the process, on which a grayish-yellowish coating forms with the development of ulcers underneath it.
Mixed forms
In this variant of the disease, infection occurs with several pathogens at once, as a result of the addition of a secondary infection or with a severe decrease in immunity.
Chronic form of tonsillitis
Relevant in the same way as acute.
Understanding the significance and prevalence of bacterial tonsillitis pathogens, especially group A beta-hemolytic streptococcus, has a huge role in preventing the development of chronic tonsillitis. Allergic syndrome is caused by the allergenic effect of streptococcal lipopolysaccharides, which, when absorbed throughout the disease, cause an allergic mood and create the preconditions for the development of local and general complications.
Surgical removal of tonsils
If we talk about the removal of the tonsils, then the operation to completely remove the tonsil tissue is called a bilateral tonsillectomy.
Partial removal of the tonsils is called a bilateral tonsillotomy.
It is extremely rare that the palatine tonsil is removed routinely on one side. There is also a practice of a number of hospitals (they like to do this in the Pirogov City Clinical Hospital No. 1) of removing the palatine tonsil or tonsils in case of a paratosillar abscess. This operation is called abscessonsillectomy. But it must be remembered that against the background of severe pain caused by an abscess, removal of the tonsil is extremely painful. Due to the purulent process, it is impossible to provide adequate anesthesia. Therefore, it is necessary to anesthetize the peri-almond tissue only with strong anesthetics: Ultracaine and Ultracaine DS-forte.
Routinely, palatine tonsils can be removed under local anesthesia or general anesthesia. Previously, this operation was performed only under local anesthesia.
Fortunately, there is now modern equipment that allows removal of palatine tonsils under general anesthesia or under anesthesia using cold plasma coagulation - Coblator.
Symptoms of acute tonsillitis
The onset of the disease is characterized by an acute and abrupt onset.
- Pain in the throat and when swallowing is the main symptom of a sore throat. The pain can be very intense, intensifies when swallowing, radiates into the ear, and this greatly reduces the patient’s quality of life
- The development of a sore throat is explained by irritation of a large number of nerve endings in the throat due to swelling and inflammation.4
- Depending on the form of acute tonsillitis, there is an increase in temperature from 37 to 39, and sometimes up to 40 degrees
- Against the background of increased temperature and intoxication, headache, weakness, weakness, and loss of appetite may occur.
- The submandibular and cervical nodes increase in size and may be painful when pressed
Surgical treatment
Such treatment is mainly carried out when decompensated chronic tonsillitis is detected and in the absence of a positive effect from repeated conservative treatment.
A tonsillectomy can be complete or partial. A total tonsillectomy involves total excision of the affected tonsils. Partial tonsillectomy can reduce the size of enlarged tonsils, but this operation is now rarely performed due to the high risk of relapse of the disease. Rare types of surgical treatment include galvanocaustics and diathermocoagulation.
New types of treatment for tonsillitis include laser lacunotomy, an operation to remove the tonsils is performed using a surgical laser. It is possible to carry out such treatment using surgical ultrasound.
Cryodestruction – freezing the tonsils with liquid nitrogen – is gaining popularity. Its use is justified with a slight increase in the size of the tonsils.
Tonsillectomy (removal of tonsils)
What tests need to be taken for tonsillitis?
In order to determine the pathogen and determine further treatment, the doctor may prescribe a number of laboratory tests to the patient, for example:
- a smear from the tonsils, arches and back of the throat to identify bacteria and their resistance to various groups of antibiotics, but such a study may take several days
- rapid test for the detection of group A beta-hemolytic streptococcus to determine streptococcal tonsillitis5
- a general blood test with a leukocyte formula, which pays attention to elements that reflect inflammation and the immune response to the disease. Increased band neutrophils, leukocytes, increased ESR, decreased lymphocytes
- CRP (C-reactive protein - a marker of inflammation) is the most sensitive protein responsible for inflammation in the body
Classification B.S. Preobrazhensky
| Form of the inflammatory process | Distinctive manifestations |
| Simple (uncomplicated) form | Only local signs are present: Pus and dense plugs from it, closing the lumen of the lacunae, and the inflamed surface of the tonsils (they are loose, red, swollen). Inflamed edges of the arches of the palate (they are swollen, red, infiltrated). |
| Toxic-allergic tonsillitis 1st degree | Local manifestations of an uncomplicated form are superimposed by general symptoms of an allergic-toxic nature: Periodic low-grade fever (temperature readings up to 37.5°C). Tonsillogenic intoxication, present constantly or periodically - decreased performance, fatigue, poor appetite, general weakness, malaise, feeling of weakness throughout the body. Enlargement of the lymph nodes of the neck, their soreness. Periodically appearing joint pain. Changes in blood tests - increased leukocytes, accelerated ESR. |
| Toxic-allergic tonsillitis 2nd degree | Signs of the 1st degree are accompanied by severe manifestations of a toxic-allergic nature: Functional ECG changes. Heart pain. Heart rhythm disturbances. Long-lasting low-grade fever. Development of autoimmune complications of tonsillitis. |
How to treat acute tonsillitis
Treatment of acute tonsillitis or tonsillitis depends on the pathogen and the severity of the disease.
1. If we are talking about bacterial infection, then it is necessary to prescribe antibacterial drugs of different groups.
Only a doctor can prescribe an effective antibiotic!
Antibiotics are not effective against viral tonsillitis.
2. Symptomatic treatment:
Includes taking antipyretics, painkillers, as well as the use of local anti-inflammatory and antimicrobial drugs in the form of solutions, lozenges, tablets.
3. A gentle diet. Namely, the exclusion of spicy, fried, and sour foods will help reduce irritation to the inflamed tissues of the throat.
4. If treatment is ineffective or complications occur, hospitalization is indicated. In the hospital, the patient will be under the close attention of doctors, blood tests will be monitored, and hormonal and anti-inflammatory drugs may be administered. It is possible to use systemic antibiotics in the form of tablets or intravenously or intramuscularly.
If necessary, surgical intervention is performed.
Regardless of the severity of the disease, pathogen and form, treatment must be comprehensive, that is, have an antimicrobial, anti-inflammatory and analgesic effect. Uncontrolled treatment with folk remedies can only do harm.
Literature
- S. Ya. Kosyakov, I. B. Angotoeva. Modern ideas about tonsillopharyngitis. Medical Council, No. 17, 2015, pp. 32-36.
- T. S. Polyakova, E. P. Polyakova. Chronic tonsillitis: diagnosis, treatment, prevention. Russian Medical Journal, No. 2, 2004, pp. 65-68.
- G. R. Kaspranskaya, A. S. Lopatin. Chronic tonsillitis: different views on an old problem. Medical Council, No. 5–6, 2013, pp. 69-71.
- Instructions for use of the drug HEXORAL® solution.
- Instructions for use of the drug HEXORAL® aerosol.
- Instructions for use of the drug HEXORAL®TABS.
- Instructions for use of the drug HEXORAL®CLASSIC.
- Instructions for use of the drug HEXORAL®TABS EXTRA.
Acute tonsillitis in pregnant women
The pregnancy period is always accompanied by a physiological decrease in immunity due to complex hormonal changes, therefore, during the period of colds, the body's susceptibility to bacteria and viruses increases or activation of any chronic foci of infection, including chronic tonsillitis, is possible.
throat or acute tonsillitis are extremely undesirable diseases during pregnancy, since treatment of this group of patients can be difficult due to restrictions on the use of most medications, especially antibiotics. Therefore, the prevention of colds during the period of influenza and ARVI is of great importance: avoid crowded places, avoid contact with people with sore throat, thoroughly wash your hands, ventilate rooms, walk in the fresh air.
Pregnant women suffering from chronic tonsillitis without exacerbation are recommended for local treatment in the form of gargling with herbal solutions at home.12
The use of ANY medications, including dietary supplements, is permissible only after consulting your obstetrician-gynecologist!
Consequences
When tonsillitis becomes chronic, the body's immune response decreases, which can affect the functioning of internal organs. In severe cases, when symptoms of intoxication appear, some complications develop.
Prolonged infections lead to complications associated with cardiac dysfunction and kidney disease. Often, advanced tonsillitis is accompanied by rheumatism and tonsillocardial syndrome. Serious damage to health is caused by toxins that are released during sore throats.
Complications of tonsillitis
With proper treatment, recovery occurs in 7-10 days. If medications are ineffective, life-threatening complications may develop:
- paratonsillitis - acute inflammation of the tissues near the tonsils;
- peritonsillar abscess - the formation of a cavity with pus inside the same area;
When the process spreads into deeper tissues, phlegmon may develop. All types of complications are observed and treated exclusively in the hospital, with further use of surgical treatment methods .
Prevention of tonsillitis
There are individual preventive measures aimed primarily at strengthening the immune system.
A healthy lifestyle and the absence of bad habits such as smoking and drinking alcohol play a key role. Don’t forget about hardening the body, doing physical exercise, regularly spending time in the fresh air, and consuming enough vitamins with food.
In the modern world, special attention is paid to the use of various biologically active additives (BAS) to improve health, including for the prevention of colds and strengthening the immune system.
The composition of such supplements is very diverse and rich, including various vitamins, minerals, nutrients, and substances of plant origin.
They come in the form of tablets, lozenges, dragees, drops, etc. But you shouldn’t count on “magic”; such supplements will not cure all diseases, but they will really help direct the body to work in the right direction and improve the effect of the main treatment. It is also important to choose the right biological supplement, focusing on the body’s needs and its problem. For example, lozenges can help strengthen the immune system.
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Plants from which bees collect and carry resinous substances have bactericidal, anti-inflammatory, immunomodulating, and antiviral properties.14 Find out more
Not being a medicine, Tantum® Propolis can support the patient’s immunity during seasonal ARVI and influenza, reduce pain, irritation and itching in the throat, and also replenish the lack of vitamins in the patient’s body.
In preventing complications, it is very important to consult a doctor on time, follow the prescribed treatment regimen and recommendations, and avoid self-medication.
Answers to popular questions about tonsillitis
What antibiotics are prescribed for tonsillitis?
In the treatment of acute tonsillitis, there are several groups of antibiotics:
- aminopenicillins;
- amoxicillin;
- amoxicillin with clavulanic acid;
- II-III generation cephalosporins;
- macrolides - azithromycin, clarithromycin;
Only a doctor can prescribe antibiotics. Uncontrolled self-use of antibiotics is prohibited, as this is associated with the development of bacterial resistance to the antibiotic, which leads to the ineffectiveness of a certain drug against the bacterium in the future. Antibiotic treatment is not indicated for viral tonsillitis !
Is it possible to get vaccinations for tonsillitis?
You should definitely consult your doctor. Vaccination can be done for chronic tonsillitis, but ONLY IN THE ABSENCE OF EXCERNSATION.
Which doctor treats tonsillitis?
In modern medicine, acute tonsillitis or tonsillitis can be treated by an otolaryngologist (ENT), an infectious disease specialist, and a therapist.
Is it possible to do inhalations for tonsillitis?
The use of inhalation for acute tonsillitis is permissible only after consulting a doctor! This procedure is not suitable for all forms of angina. Indications and contraindications depend on the form of acute tonsillitis and the causative agent, so differential diagnosis plays a key role. Only a doctor can prescribe a medicine for inhalation and its correct dosage. Your doctor will also help you choose the right type of nebulizer.
Is it possible to eat ice cream if you have tonsillitis?
Eating ice cream for a sore throat is not recommended. There are many private opinions that cold ice cream will reduce a sore throat, but this is not entirely true. Cold does have a local anesthetic effect by affecting nerve endings, but only for a short time, it does not have any benefit or positive effect. Outside of an exacerbation, you can eat melted ice cream.
What tests are prescribed for tonsillitis?
- pharyngeal smear - from the tonsils, arches, posterior pharyngeal wall to determine the pathogen and antibiotic resistance, including for diphtheria;
- general blood analysis;
- general urine analysis;
- ESR;
Can tonsillitis occur on only one side?
Basically, tonsillitis always occurs with bilateral damage to the tonsils, but there are exceptions. Tonsillitis can occur not only as an independent disease, but also be a manifestation of some other disease. For example, with tularemia or primary syphilis, tonsillitis appears on one side.
How long does it take to treat tonsillitis?
On average, treatment can take 7 days. For example, antibacterial therapy is prescribed for 5-10 days. It all depends on the antibiotic group and the presence of complications.
Complex therapy of chronic tonsillitis at the ENT Clinic of Doctor Zaitsev.
The method of complex treatment of the disease did not appear immediately. Our specialists have tried various methods of treating tonsillitis in practice. As a result of many years of experience in the study and treatment of chronic tonsillitis, this technique has taken root and is the most effective. It includes several stages.
The first stage is anesthesia of the tonsils. The tonsil is lubricated with lidocaine. The second stage is vacuum washing of the tonsils from caseous masses. The third stage is medicinal treatment of the tonsils using ultrasound. The fourth stage is irrigation of the tonsils with an antiseptic.
Stage five - lubricating the surface of the tonsils with Lugol's antiseptic solution. The sixth stage is physical therapy using a laser - this procedure relieves swelling and inflammation of the tonsils. The next stage is a vibroacoustic effect on the tonsils, due to which the blood flow rushes directly to the tonsils, and pathogenic substances are removed with it. The final stage of complex treatment is a session of ultraviolet irradiation, which heals the tonsils and fights pathogens.
The entire session takes about twenty minutes. To achieve a positive result, the patient usually needs five complex procedures.
