Chronic tonsillitis is a disease of the upper respiratory tract, characterized by a long-term inflammatory process of the tonsils. The cause of the development of chronic tonsillitis is most often an ineffective or incomplete course of treatment for acute tonsillitis. A long-term decrease in local immunity leads to the formation of foci of inflammation of the tonsils, in which pathogenic organisms are activated at the onset of exacerbation of the disease.
The prevalence of chronic tonsillitis is quite high: according to some data, up to 10% of the population of European countries and Russia are affected by the disease. The disease can affect both adults and children. In addition to the discomfort experienced by a patient with chronic tonsillitis, this infectious disease is dangerous due to the presence of a constant focus of inflammation and infection in the body, which leads to complications of tonsillitis such as rheumatism, pyelonephritis, rheumatic carditis, polyarthritis, development autoimmune diseases and so on. That is why any person should know everything about chronic tonsillitis, treatment and symptoms of this disease.
The palatine tonsils (in common parlance – tonsils), consisting of lymphoid tissue, are part of the body’s general immune system. Their main purpose is to fight infectious agents that penetrate the human throat. Normally, the human microflora consists of non-pathogenic and opportunistic microorganisms that are in a state of natural balance due to the combined work of all organs immune system. When the balance is disturbed and pathogenic organisms penetrate, the tension of local immunity leads to the destruction of viruses, fungi and bacteria. With frequent stress of the immune system, large amounts pathogenic flora, a general decrease in the body's resistance, lymphoid tissues become unable to produce sufficient amounts of interferons, lymphocytes, and gamma globulins to resist infectious agents.
With frequent and/or prolonged inflammatory processes in the pharynx, the palatine tonsils lose their ability to express resistance pathogenic organisms, cleansing of tissues and themselves become a source of infection, which leads to the development of chronic tonsillitis. Usually the tonsils become inflamed due to the presence of lacunae in them. Gland lacunae are reservoirs for the accumulation of epithelial cells and various microorganisms. Based on the results of microflora analysis, about 30 different pathogenic microorganisms are isolated on the surface of the tonsils in patients with tonsillitis; bacterial analysis of the contents of the lacunae most often reveals the presence of a high concentration of streptococci and staphylococci.
Most often, the chronic form of the disease develops precisely after an acute inflammatory process, sore throat. Occasionally, in 3 cases out of 100, a lesion chronic inflammation is formed without an acute form in immediate retrospect. The development of the chronic form of the disease is facilitated by the following pathologies and diseases of bacterial and viral etiology:
The role of hereditary predisposition to chronic tonsillitis and a number of factors that contribute to a decrease in local immunity in the nasopharynx are also highlighted:
In the presence of a chronic focus of inflammation, lymphoid tissue is replaced by connective tissue, scars are formed, and the external opening of the lacunae is narrowed, which causes the formation of lacunar and purulent plugs and purulent plaques. All this increases the general inflammation of the organ. Lacunar accumulations of pathogenic microorganisms, food particles, and purulent secretions lead to penetration into the bloodstream and spread of bacteria, the toxins they secrete, and destruction products throughout the body, causing chronic intoxication. The sensitivity of tissues and organs to irritants and foreign proteins increases, allergic, autoimmune processes, and severe complications of tonsillitis occur.
When making a diagnosis, local and systemic symptoms, anamnesis is collected, the patient’s complaints and the general clinical picture of tonsillar syndrome are analyzed. Local tonsillitis symptoms that are important in diagnosis are manifestations of any inflammatory processes in tissues palatine tonsils. In the chronic form, symptoms characteristic of the whole organism (systemic) are explained by the influence of cytokines and tissue breakdown products spreading from the infectious focus through the bloodstream. You should also take into account the influence of toxic substances released due to pronounced microbial invasion into the lymphoid tissue of the palatine tonsils. Depending on the nature, frequency of exacerbations and the general reaction of the body, several types of chronic tonsillitis are distinguished:
The toxic-allergic form of the disease includes two types. With the first type, a number of symptoms are observed that indicate an increase in the level of allergization and intoxication of the body. This is hyperthermia, pain in the heart area, increased fatigue, joint pain. The symptoms are not accompanied by functional disorders of organs and systems.
At the second stage, signs of intoxication are confirmed during examinations: cardiac abnormalities are detected, test results confirm inflammatory processes in joints and organs genitourinary system, kidneys, liver.
Common symptoms of chronic tonsillitis include:
Exacerbation of chronic tonsillitis is also sometimes called purulent tonsillitis. Exacerbation occurs in the form of bacterial or viral tonsillitis. Depending on the type of pathogen, it can be herpetic tonsillitis, streptococcal or adenoviral tonsillitis. The disease is accompanied by local manifestations (sore throat, severe swelling, redness of the tonsils and palatine arches, the presence of purulent foci), a sharp increase in temperature, signs of general intoxication of the body (fever, headaches, aches in the muscles, joints, nausea, weakness, etc. .).
Chronic tonsillitis is more typical for children age period, although it is often observed in adults, characterized by the predominance of local symptoms over general signs of the disease. Chronic tonsillar symptom in adulthood is most often a consequence self-treatment acute illness, sore throat, adenovirus infection. The cause may also be the presence of an infectious focus in the oral cavity: gingivitis, caries, etc.
In elderly people, there is a natural process of reduction in the volume of lymphoid tissues and a decrease in the concentration of immunocompetent cells, and therefore acute and chronic tonsillitis occur with erased symptoms; the clinical picture rarely shows febrile body temperature and severe pain syndrome, giving way to prolonged hyperthermia in the low-grade range and signs of general intoxication of the body.
The disease is dangerous due to the presence of a constant source of infection in the body, which contributes to the development of severe disturbances in the functioning of organs and systems. The most common consequences of the rheumatic type are:
Rheumatism develops under the influence of two factors: the influence of toxins secreted by pathogenic microorganisms on cardiac tissue and the similarity of the antigens of some strains of streptococcus with the inherent to the human body. The second factor causes a pathological systemic autoimmune response, in which immune cells begin to infect a person’s own cells, perceiving them as foreign. Besides overall influence On health, the inflammatory process can also develop locally, causing paratonsillitis, the formation of retropharyngeal and parapharyngeal abscesses.
Treatment is carried out on an outpatient basis or at home. The following methods can be used:
Combinations of various conservative treatment methods are often used.
For chronic form treatment medications found to be the most effective. Correct selection medications helps to carry out effective conservative treatment of tonsillitis in adults and children. Medicines used for the disease are aimed at systemic and local effects, depending on the medical history, clinical picture of inflammation, the presence of complications and test results.
The group of first-choice drugs for exacerbation of chronic forms are antibacterial agents. Their purpose is maximum possible removal bacteria from the oral cavity. Precise selection of antibiotics is carried out based on the results of assessing the concentration of pathogenic microorganisms in the contents of the lacunae of the palatine tonsils and their sensitivity to various groups antibiotics. In 70% of cases, the disease occurs due to damage to the tissues of the tonsils by hemolytic streptococcus, and therefore drugs are most often prescribed for its treatment penicillin series. In case of individual intolerance to drugs penicillin group antibiotics are prescribed wide range actions. When determining another causative agent of an inflammatory disease, it is necessary to select a targeted antibacterial action.
Self-treatment with antibacterial drugs is dangerous not only due to its low efficiency, but also due to the development of tolerance in pathogenic microorganisms to the active substance of the antibiotic, which can significantly complicate subsequent treatment of the disease.
Antibacterial therapy is not used for latent forms of the disease and during remission. The duration of antibiotic treatment is determined by a specialist. With prolonged therapy with antibacterial agents, broad-spectrum drugs, high doses of medications, in the presence of diseases gastrointestinal tract, digestive disorders, it is advisable to combine the use of antibiotics with probiotic preparations to restore the intestinal microflora.
It is also possible to use local antibiotics in the form of sprays for mild exacerbations, but the selection of the active substance should be based on the results of a bacterial culture analysis. The use of this type of medication is not a basic method of therapy, since superficial irrigation of the tonsils with an antibacterial composition has a temporary effect and does not contribute to the accumulation of the active substance in the lymphoid tissue. Frequent rinsing with antibacterial agents in the chronic form of the disease is currently recognized as an unjustified method of treatment: local exposure is not effective, but may contribute to the formation of antibiotic-resistant flora.
For chronic tonsillitis, it does not make much sense to take antiviral drugs, since in most cases the causative agent of the disease is bacteria.
If chronic tonsillitis is detected, treatment should include other groups of drugs. For severe pain in the throat, local and local painkillers are prescribed. general action. Tablet forms of nonsteroidal anti-inflammatory drugs (nimesulide, ibuprofen, paracetamol, ibuclin) are used for exacerbations of the chronic form of the disease.
Effective therapy is carried out using antiseptic drugs: sprays, solutions for lubricating the throat, gargling. Helps reduce the severity of swelling of the palatine arches and tonsils, as well as reduce the overall allergization of the body antihistamines, applied systematically.
To reduce the discomfort associated with inflammation of the mucous membrane of the tonsils and the surface of the pharynx, local, local emollients are used. Most ready-made forms of medications used for tonsillitis combine antiseptic, emollient, and anti-inflammatory effects. It is possible to use self-made saline solutions, herbal decoctions with antiseptic effect for rinsing, methods alternative medicine(herbal oils, herbal infusions) with the recommendation of a specialist and the absence of contraindications.
Since restoring the level of general and local immunity is important in the treatment of chronic inflammatory diseases, it is possible to prescribe immunostimulant drugs, as well as mandatory management healthy image life, with long-term remission - healing the body by hardening methods, playing sports, a nutritious diet, timely rest, eliminating harmful factors.
Conservative therapy methods offer a wide range of procedures included in the overall treatment of the chronic form of the disease. In most cases, conservative therapy methods, subject to treatment rules, are sufficient for the patient’s recovery.
When diagnosed with chronic tonsillitis, treatment often includes a method such as washing the lacunae of the palatine tonsils with aseptic solutions. It is considered the most common and widely available method of conservative therapy for tonsillitis. The goal is to remove plaque, lacunar plugs, accumulations of dead epithelium, leukocytes and other tissues and particles retained inside the lacunae due to sclerotic changes in the tissues that prevent the self-cleaning of the tonsils. The procedure is carried out using various instruments: the most commonly used, although less effective, is the use of a medical syringe with a curved cannula. More modern special nozzles make it possible to supply an aseptic solution under increased pressure and achieve complete cleansing gaps. Along with rinsing, it is possible to combine injection into the lacunae medicines in the form of a solution through a syringe, a rinsing nozzle or an ultrasonic device that creates a suspension of an antiseptic solution. To achieve the required therapeutic effect, a rinsing course of an average of 10-12 procedures is prescribed in combination with treating the surface of the tonsils with Lugol's solution.
Physiotherapy in the treatment of tonsillitis is one of the well-known and effective methods as part of complex therapy diseases. Most often they resort to ultraviolet irradiation of the tonsils and pharynx in order to sanitize the surface using physical methods, as well as warming the throat. To methods physical impact include the use of therapeutic laser therapy to reduce swelling and severity of inflammatory processes in the mucous membrane and vibroacoustic effects, which improve microcirculation and blood supply in the tissues of the tonsils.
Previously used methods of squeezing and suctioning the contents of lacunae have proven low efficiency and an increased risk of injury, causing both the spread of inflammation and the acceleration of the formation of scar tissue. At the moment, these methods are used solely for the purpose of removing content for research.
Complex treatment aimed at reducing the severity of the inflammatory process, tissue regeneration and restoration of the microflora of the palatine tonsils is carried out in courses. A combination of drug and conservative treatment should be carried out during the period of remission, in the absence of signs of exacerbation. To achieve clinical recovery, therapy is carried out 2 to 4 times a year, depending on the individual response of the patient.
Surgical methods can also be used for treatment, which include radical surgical removal palatine tonsils. Since in this case the body is deprived of one of the organs of the immune system, it is resorted to in cases where the disease progresses and conservative methods do not have the desired effect.
Indications for surgical treatment are considered:
Surgical removal of the tonsils eliminates tissues with inflammatory foci, removes the substrate of the disease and leads to a radical cure. However, when lymphoid tissue capable of regeneration and healing is removed, the body loses one of the “barrier” organs that resist infection at the entrance to the respiratory tract, so the presence of indications for surgical intervention must be strictly assessed by specialists.
Some other chronic diseases and dysfunctions of organs and systems that have a high risk of decompensation are considered contraindications for surgical intervention, for example:
Some diseases of all patients and physiological conditions of women are considered temporary contraindications to the operation:
The surgery is performed under the influence of local anesthetics in a clinical setting. The total duration of the tonsil removal procedure takes from several minutes to half an hour, depending on the patient’s age, duration preparatory stage, stages of tissue growth. The recovery period after surgery lasts from 3-4 to 7 days. Modern techniques, used for instrumental intervention, The main recommendations of the recovery period are eating and drinking in the temperature range of 25-30 ° C, preparing a diet in the first days after surgery from mucous porridges, soft, pureed soups, purees, excluding spicy, salty, sour, irritating mucous membrane of the throat of food, as well as increased load on vocal cords, smoking, any irritating effects on the wound surface of the pharynx until it heals completely.
Chronic tonsillitis - chronic inflammation of the palatine tonsils, if other tonsils are affected, the location is indicated - chronic adenoiditis, tonsillitis of the lingual tonsil. Exacerbation chronic tonsillitis always occurs in the form of a sore throat . Chronic tonsillitis and tonsillitis are various diseases, with different pathogenesis, pathomorphological picture. More often metatonsillar diseases (endocarditis, nephritis, rheumatism, tonsillitis sepsis, etc.) occur in patients with rare sore throats. Also recognized non-anginal form chronic tonsillitis. The age of patients with chronic tonsillitis is practically unlimited, the same number of men and women are affected, the number of patients is 2.5% in Russia, and in large cities up to 4.4%.
Causes of occurrence.
- frequent sore throats (maybe without previous sore throats), the presence purulent inflammation maxillary sinuses, inflammation of the adenoids, dental caries.
- deviated nasal septum,
- presence of nasal polyps (difficulty in nasal breathing).
- decrease in general and local resistance of the body after undergoing infectious diseases(scarlet fever, measles, etc.) and hypothermia.
Highlight simple (compensated) And toxic-allergic (decompensated) forms of chronic tonsillitis. Toxic-allergic form (TAF), in turn is divided into two subforms: TAF1 and TAF2.
- TAF1 (toxic-allergic form 1)
TO local characteristics inflammation is accompanied by general toxic-allergic manifestations: fatigue, periodic ailments and slight increases in temperature. Joint pain appears from time to time. Recovery periods respiratory diseases become long-lasting and protracted.
- TAF2 (toxic-allergic form 2)
The above manifestations of chronic tonsillitis are accompanied by functional disturbances of the heart with changes in the ECG pattern. Possible violations heart rate, prolonged low-grade fever. Functional disorders in the joints are detected, vascular system, kidneys and liver. General (acquired heart defects, infectious arthritis, rheumatism, tonsillogenic sepsis, a number of diseases) are added urinary system, thyroid and prostate glands) and local (pharyngitis, parapharyngitis, peritonsillar abscesses) associated diseases.
Symptoms. Outside of exacerbation, there are no general symptoms. In the acute phase sore throat clinic - chills, t-38-40 degrees, body aches, weakness, refusal to eat, insomnia; pain when swallowing, increased salivation, redness of the palate, uvula, arches, tonsils, vomiting (more often seen in children); enlarged lymph nodes (submandibular); plaque on the tonsils (white with yellowish tint); bad smell from the mouth. Characterized by frequent sore throats (up to 3 times a year) with a protracted period of recovery, which is accompanied by fatigue, malaise, general weakness and a slight increase in temperature. In the toxic-allergic form of chronic tonsillitis, tonsillitis develops more often than 3 times a year, often complicated by inflammation of neighboring organs and tissues (peritonsillar abscess, pharyngitis, etc.). The patient constantly feels weak, tired and unwell. The body temperature remains low-grade for a long time. Symptoms from other organs depend on the presence of certain associated diseases.
Complications. With chronic tonsillitis, the tonsils turn from a barrier to the spread of infection into a reservoir containing a large number of microbes and their metabolic products. Infection from affected tonsils can spread throughout the body, causing damage to the heart, kidneys, liver, and joints (associated diseases). The disease changes the state of the body's immune system. Chronic tonsillitis directly or indirectly affects the development of certain collagen diseases (dermatomyositis, scleroderma, periarteritis nodosa, systemic lupus erythematosus), skin diseases (eczema, psoriasis) and peripheral nerve damage (radiculitis, plexitis). Long-term intoxication in chronic tonsillitis is a risk factor for the development hemorrhagic vasculitis and thrombocytopenic purpura.
Diagnostics - examination by an otolaryngologist, careful collection of anamnesis (frequency of tonsillitis, etc.); blood tests; pharyngoscopy.
Treatment. The main method of treating chronic tonsillitis is surgical (tonsillectomy, tonsillectomy) , especially with paratonsillitis and metatonsillar diseases, with low-grade fever, frequent malaise, weakness, decreased performance, or with the development of purulent complications.
Chronic tonsillitis is a disease that is associated with repeated and prolonged inflammatory processes of the palatine and pharyngeal tonsils.
Most often, chronic tonsillitis occurs as a consequence of previous or untreated tonsillitis, scarlet fever, diphtheria, retropharyngeal abscess and other infectious diseases; during its course it is associated with inflammation of the mucous membrane of the pharynx. The cause of this disease can be the presence of not only bacterial pathogen, but also a banal curvature of the nasal septum.
This disease is not just a long-term inflammation of the tonsils and nearby tissues, it is also especially dangerous because it will be a constant source of infection in the body, which entails much more serious problems. Chronic tonsillitis continuously attacks the body, causing more and more complications. It is very difficult to determine the percentage of patients with chronic tonsillitis, all this because the course of tonsillitis, especially the simple form, is practically asymptomatic and very few people with this disease go to the doctor.
The simple form of chronic tonsillitis is expressed predominantly local symptoms(redness and sore throat), if in addition to these symptoms there is also an increase in body temperature, persistent cervical lymphadenitis, changes in work cardiovascular system, then the form of chronic tonsillitis develops into toxic-allergic. Rheumatism, thyrotoxicosis, nephritis and many other diseases often have a cause-and-effect relationship with chronic tonsillitis.
Chronic tonsillitis is a common problem. Children are more susceptible to the problem; 14% of the population suffers from the chronic form among children, and 5-7% among adults.
The causes of primary tonsillitis are as follows:
In addition, bacteria and viruses enter the oral cavity from the external environment. A weak immune system is unable to protect the body, and then disease occurs. A decrease in immunity provokes not only inflammatory processes in the oral cavity, but also the conditions of modern life: poor nutrition, polluted air, stress, etc.
Tonsillitis is caused by bacteria, viruses or fungi. The disease can be transmitted by airborne droplets; infection through the fecal-oral route is much less common. In the chronic form of tonsillitis, it is not dangerous to others.
Long-term interaction between the virus and the microorganism forms a focus of chronic tonsillitis and contributes to the development of tonsillogenic processes.
Also, in patients diagnosed with “chronic tonsillitis” (in particular, the toxic-allergic form), colonies of living, multiplying microbes were found in the lymphoid tissue (in the crypts of the tonsils and even in the lumen of blood vessels), which can become a factor in periodic subfebrile conditions (fever).
No bacteria were detected in the parenchyma (component elements) and vessels of healthy tonsils.
Currently, the question of the influence of biofilms on the course of a chronic infectious process in adenotonsillar tissue is being considered.
J. Galli et al. (Italy, 2002) in samples of adenoid tissue and tissues of the palatine tonsils of children who had chronic adenotonsillar pathology, they were able to detect cocci attached to the surface, organized into biofilms. Researchers hypothesize that biofilms formed by bacteria on the surface of the adenoid tissue and palatine tonsils will help to find out what is the difficulty in eradicating (destructing) the bacteria involved in the formation of chronic tonsillitis.
At the moment, the intracellular location has been confirmed:
In order to detect and identify the location of microorganisms inside cells, polymerase chain reaction (PCR) as well as in situ hybridization (FISH method) can be used.
However, the above studies do not allow us to identify one pathogenic microorganism that causes the clinic of chronic inflammation of the tonsils. Therefore, it is very likely that the course of the disease can be caused by any microorganism that is located in the oropharynx, under conditions that promote the inflammatory process in the tissue of the palatine tonsils. Similar conditions include gastroesophageal reflux.
A certain role in the occurrence of chronic inflammation of the tonsils and associated diseases is played by direct lymphatic connections of the tonsils with various organs, primarily with the central nervous system and heart. Lymphatic connections between the tonsils and brain centers have been morphologically proven.
There are simple (compensated) and toxic-allergic (decompensated) forms of chronic tonsillitis. The toxic-allergic form (TAF), in turn, is divided into two subforms: TAF 1 and TAF 2.
Most of all, patients are concerned with the question of what is the likelihood of becoming infected. During an exacerbation, the disease is very contagious and is transmitted by airborne droplets, especially in close contact.
During the period of remission, chronic tonsillitis retains the ability to be transmitted to other people, albeit to a small extent. Microbial activity in patients with this problem remains high even without an exacerbation, so doctors recommend that they avoid close contact with children and people with weakened immune systems.
Chronic tonsillitis (see photo) occurs with periods of remission and periods of exacerbation.
During the period of remission, the patient may have the following symptoms:
Also, in addition to the signs of tonsillitis itself, there may be symptoms of concomitant diseases - chronic pharyngitis, rhinitis, sinusitis.
With the development of the decompensated form, the following symptoms appear:
In addition, signs of complications may appear.
The most common complication in the decompensated form of chronic tonsillitis is peritonsillar abscess.
It begins as a sore throat, but later the patient cannot swallow or open his mouth at all. There is pronounced swelling of the pharyngeal tissue. The patient requires urgent medical care and hospitalization.
Exacerbation of chronic tonsillitis can be triggered by hypothermia, an acute respiratory viral infection, or drinking cold drinks or food.
With the development of exacerbation of chronic tonsillitis, signs of tonsillitis (acute tonsillitis) develop:
With chronic tonsillitis, there may be associated diseases, as well as concomitant diseases, the pathogenetic connection of which with chronic inflammation of the tonsils is carried out through local and general reactivity.
About 100 are known various diseases, which largely owe their origin to chronic tonsillitis:
Factors that reduce the body's resistance and cause exacerbation of chronic infection:
With the development of the disease and its exacerbation, the patient lacks general immunity so that the palatine tonsils actively fight infection. When microbes land on the surface of the mucous membrane, a real battle begins between the microbes and the human immune system.
Exacerbation of tonsillitis often leads to the development of peritonsillar abscess. This condition is serious, so the patient is often sent to hospital treatment.
The main methods of examination for angina:
Changes in blood tests for angina do not confirm the diagnosis. The main study for tonsillitis is pharyngoscopy. Catarrhal tonsillitis is determined by hyperemia and swelling of the tonsils. On pharyngoscopy with follicular tonsillitis, a diffuse inflammatory process is noticeable, there are signs of infiltration, swelling, suppuration of the tonsil follicles or already opened erosions.
With lacunar angina, pharyngoscopic examination reveals areas with a white-yellow coating that merge into films covering all the tonsils. When diagnosing Simanovsky-Plaut-Vincent tonsillitis, the doctor discovers a grayish-white coating on the tonsils, under which there is an ulceration shaped like a crater. Viral tonsillitis during pharyngoscopy is diagnosed by characteristic hyperemic vesicles on the tonsils, back wall pharynx, arches and uvula, which burst within 2-3 days from the onset of the disease and quickly heal without scarring.
A common mistake in the treatment of tonsillitis is insufficient diagnosis of the disease, on the basis of which the doctor prescribes the wrong treatment regimen to the patient. Before starting treatment procedures, it is necessary to determine the nature of the inflammatory process, namely: acute tonsillitis, chronic tonsillitis or exacerbation of chronic tonsillitis. Verification of the pathogenic agent is required: streptococcus, staphylococcus, spirochete, bacillus, virus or fungi. The doctor should determine whether the sore throat is primary or secondary (which developed against the background of other diseases, such as certain blood diseases). Analysis of all data when examining a patient will allow the doctor to take into account all the features of the disease and prescribe the correct treatment.
In the vast majority of cases, treatment of tonsillitis is limited to conservative methods, but sometimes surgery is used.
Conservative treatment of tonsillitis comes down to the use of following methods treatment:
In the case of acute tonsillitis (tonsillitis), it is extremely important to promptly provide qualified medical care and completely cure the disease, since untreated acute tonsillitis easily becomes chronic.
For surgery to remove the tonsils there must be clear, justified indications:
Doctors' opinions regarding tonsillectomy surgery are divided. On the one hand, after removal of the tonsils, which are a constant source of infection, the incidence of throat diseases decreases. On the other hand, during the operation a certain amount of tissue performing protective function, and perhaps this will lead to an increase in ARVI (bronchitis or pneumonia).
There are a lot of folk remedies for treating chronic tonsillitis. It is important to remember that all of them should be used as a complement to the main methods of treatment, but not in any way replace them. Let's look at some of the most interesting recipes that include honey and its derivatives:
Physiotherapeutic methods of treatment are used at the stage of remission, prescribed in courses of 10–15 sessions. The most commonly used procedures are:
Three methods are considered the most effective: ultrasound, UHF and ultraviolet radiation. They are the ones who are mainly used. These procedures are almost always prescribed in the postoperative period, when the patient is already discharged from the hospital to home and begins outpatient treatment.
Since the main reason for the development of infection is reduced immunity, in the process of treating chronic tonsillitis one cannot do without restorative procedures.
You can increase your immunity and resist exacerbations by:
The point about the need for hardening causes a justified protest in many people, because chronic tonsillitis is often aggravated due to hypothermia. But the hardening technique involves a gradual and very slow decrease in water or air temperature, allowing the body to adapt to changes and gently expand its comfort zone. You can pay attention to the hardening system Porfiria Ivanova. There are other methods for children: Komarovsky, Grebenkin, Tolkachev.
You can also carry out hardening with the help of a contrast shower, when hot (up to 45 degrees) and cool (up to 18 degrees) water is turned on alternately. The temperature contrast increases in stages: in the first days the temperature drops and rises by only two to three degrees from the comfortable level, then the temperature gap widens.
Procedures for hardening the body cannot be carried out during an exacerbation of any diseases, including chronic tonsillitis.
Viruses are able to rebuild the metabolism (metabolism) of cells and synthesize specific protein components, enzymes (enzymes) and nucleic acids. After some time from the moment of exacerbation of chronic tonsillitis, a certain barrier is destroyed and a path opens for the penetration of bacterial flora into the thickness of the palatine tonsil. Then the antimicrobial protection weakens and, under the influence of microbes, a new outbreak of inflammation of the palatine tonsils occurs.
The process of inflammation in the palatine tonsils becomes chronic, due to previous sore throat, even one-time. During a sore throat, the virulence (harmfulness) of the flora, which saprophiates (feeds on dead organic substances) on the tonsils and penetrates the parenchyma (internal tissue) of the tonsil tissue, which leads to the occurrence of an infectious-inflammatory process. Then there is inhibition of specific and nonspecific factors of the body’s natural resistance, increased permeability of the vascular walls, local circulation disorders, and local immunosuppression of the palatine tonsils.
With prolonged interaction infectious agent and macroorganism (human body), a chronic inflammatory focus is formed in the tonsils. Long term exposure on the tissue of the palatine tonsils of pathogenic flora, which is combined with a general decrease in the reactivity of the body, causing specific and nonspecific immune reactions.
Antigen-antibody immune complexes with chemotactic activity increase the proteolytic (protein breakdown) ability of macrophages. This leads to lysis (destruction) of tonsil tissue, denaturation (removal) of its own proteins. When absorbed into the blood, they promote the production of autoantibodies, which in turn are able to attach to cells and damage them.
In chronic tonsillitis, a delayed type of sensitization (increased sensitivity of tissues and cells) to microbial antigens, which often vegetate (grow and develop) in the lacunae of the palatine tonsils, appears. General sensitization of a nonspecific nature can make more severe course chronic tonsillitis.
The nervous apparatus of the palatine tonsils is also involved in the pathological process. As a result of changes in the nerve elements, the receptor function of the tonsils is distorted, and neuro-reflex connections with individual internal organs are disrupted.
Patients often complain of lethargy, decreased ability to work and fatigue, and low-grade (37-38 degrees) body temperature.
Local manifestations of long-term inflammation in the palatine tonsils are pharyngoscopic signs of developing chronic tonsillitis. Most often manifested following signs when diagnosing chronic tonsillitis:
Often there is adhesions and fusion of tonsils with arches and a triangular fold.
In terms of diagnosis, the size of the tonsils is not of great importance. Through the layer of epithelium that covers the palatine tonsil, they can show through round formations yellowish in color. They contain decaying white blood cells, lymphocytes and necrotic tissue.
The presence of purulent contents in the lacunae of the palatine tonsils, which sometimes has an unpleasant odor, can be considered one of the main signs of chronic tonsillitis. Regional lymph nodes are often enlarged and painful on palpation.
In chronic tonsillitis, morphological changes can be detected in different components of the palatine tonsils. In general terms, they correspond to the stages of development of this disease. For initial stage the process when chronic tonsillitis occurs, having a lacunar or lacunar-parenchymatous form, is characterized by the process of desquamation (scaly exfoliation) or keratinization of the epithelium of the lacunae, as well as damage to closely located areas of the parenchyma.
Active changes in cell structure (alteration), the formation of inflammatory infiltrates in the parenchyma indicate the onset of the next stage of the disease - chronic parenchymal tonsillitis.
The last stage, when chronic tonsillitis has a parenchymal sclerotic form, is characterized by increased growth connective tissue.
Most often, patients complain of frequently recurring sore throats, as well as an unpleasant odor from the mouth, dry throat, and a foreign body sensation in the throat that increases with swallowing. Reliable symptoms This disease is considered to be: loosening and thickening of the tonsils, caseous-purulent plugs, hyperemia, liquid pus formed in the lacunae of the tonsils, cicatricial adhesions between the arches and tonsils, enlargement of the submandibular lymph nodes. If there are two or more signs, then the ENT doctor has the right to make a diagnosis of chronic tonsillitis.
In accordance with the classification of B. S. Preobrazhensky, chronic nonspecific tonsillitis is divided into compensated, subcompensated and decompensated forms. In the compensated form, local signs of chronic inflammation in the tonsils appear, but general reaction does not arise. The subcompensated form stands between the compensated and decompensated states, and its clinical picture is quite understandable. In the decompensated form, local manifestations are accompanied by often recurrent, various pathological reactions and diseases of the organs and systems of the human body, namely the heart, kidneys and joints.
Friends! Timely and correct treatment will ensure you a speedy recovery!
In recent years, it has been customary to use a more recent classification, which was proposed by V. T. Palchun and A. I. Kryukov. They identified three forms of chronic tonsillitis: simple, toxic-allergic 1 (TAF-1) and toxic-allergic 2 (TAF-2). In the simple form, only local signs of chronic tonsillitis appear.
With TAF-1, symptoms characteristic of the simple form are diagnosed, as well as low-grade fever and signs of intoxication such as weakness, fatigue, malaise, and joint pain that occurs periodically.
TAF-2 is characterized by the same manifestations as TAF-1, only toxic-allergic reactions, which are more pronounced, due to the presence of another disease. Among the ENT diseases complicating chronic tonsillitis may be: in acute or chronic form. Of the common diseases, chronic tonsillitis provokes diseases of related organs: kidney disease (glomerulonephritis), heart disease (myocarditis), joint disease (arthritis), as well as some other systems and organs of an infectious-allergic nature.
Diagnosis of chronic tonsillitis does not cause any particular difficulties. But if there are certain doubts, then it is necessary to study the contents of the lacunae of the palatine tonsils, the microflora of the palatine tonsils, immunological parameters of the blood serum and hemogram (schematic recording of blood composition).
When choosing a treatment method for chronic tonsillitis, it is necessary to take into account the clinical form of the disease and the type of decompensation, having previously carried out sanitation of the oral cavity.
Conservative treatment is prescribed for compensatory (simple) form and decompensated (TAF-1 and TAF-2) with relapses, as well as in cases where surgical intervention has absolute and relative contraindications.
To treat chronic tonsillitis, medications are prescribed that increase the body's natural resistance: tissue therapy, gammaglobulin, iron supplements, plasma infusions, vitamins, etc. The use of desensitizing agents can reduce sensitivity to the allergen. To correct the immune system, immunostimulating drugs (imudon) are used, as well as irradiation of the tonsils with a therapeutic helium-neon laser. Be sure to prescribe agents that have a sanitizing effect on the palatine tonsils and regional lymph nodes. Among them are antiseptics and antibiotics that can be used for rinsing (Miramistin, Dioxidin).
Physiotherapeutic treatment is very effective: ultraviolet irradiation (UVR), sessions of vibroacoustic therapy, ultrasonic medicinal irrigation of the palatine tonsils and the posterior wall of the pharynx with antiseptic solutions.
Patients with chronic tonsillitis need to undergo (sanitation) washing of the lacunae of the palatine tonsils. By far the most effective way is - washing the lacunae of the palatine tonsils with the TONSILOR nozzle. The number of procedures depends on the severity of the inflammatory process, but, as a rule, at least 5 and no more than 10 treatment sessions are performed. It is advisable to wash daily or every other day. This increases the effectiveness of treatment, since during the course of treatment, the necessary pressure is created daily in the thickness of the palatine tonsils and with each new wash, a new, deep-lying portion of caseous masses and pathological mucus is washed out.
Washing with the TONSILOR device is effectively carried out not as monotherapy for chronic tonsillitis, but in combination with laser therapy, ultraviolet irradiation, sessions of vibroacoustic influence and ultrasonic medicinal irrigation. This gives the highest treatment results and stable clinical remission from 6 to 12 months.
Conservative treatment of chronic tonsillitis should be carried out in courses in spring and autumn; in case of frequent relapses of tonsillitis, the number of courses should be increased to 4 times a year.
If, in the decompensated (TAF-1 and TAF-2) form, conservative treatment does not give the required effect, a planned surgical operation is performed in the ENT department of the hospital - bilateral tonsillectomy.
If all diagnostic rules are followed, as well as timely and complete treatment by an ENT doctor, the prognosis is quite favorable.
is a chronic inflammation of the tonsils (tonsils) that occurs with exacerbations as a result of frequent sore throats. The disease causes pain when swallowing, sore throat, bad breath, swelling and soreness. submandibular lymph nodes. Being a chronic source of infection in the body, it reduces immunity and can cause the development of pyelonephritis, infective endocarditis, rheumatism, polyarthritis, adnexitis, prostatitis, infertility, etc.
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Chronic tonsillitis is a chronic inflammation of the palatine tonsils (glands) that occurs with exacerbations as a result of frequent sore throats. The disease causes pain when swallowing, sore throat, bad breath, enlargement and tenderness of the submandibular lymph nodes. Being a chronic source of infection in the body, it reduces immunity and can cause the development of pyelonephritis, infective endocarditis, rheumatism, polyarthritis, adnexitis, prostatitis, infertility, etc.
The palatine tonsils, together with other lymphoid formations of the pharyngeal ring, protect the body from pathogenic microbes that penetrate along with air, water and food. Under certain conditions, bacteria cause in the tonsils acute inflammation- sore throat. As a result of repeated sore throats, chronic tonsillitis can develop. In some cases (about 3% of the total number of patients), chronic tonsillitis is a primarily chronic disease, that is, it occurs without previous tonsillitis.
The risk of developing chronic tonsillitis increases with immune disorders. General and local resistance of the body decreases after suffering infectious diseases (scarlet fever, measles, etc.) and during hypothermia. In addition, the overall immune status of the body may be affected by incorrect treatment antibiotics or unjustified use of antipyretics for sore throat and other infectious diseases.
The development of chronic inflammation of the palatine tonsils is facilitated by impaired nasal breathing due to polyposis of the nasal cavity, enlargement of the inferior turbinates, curvature of the nasal septum and adenoids. Local risk factors for the development of chronic tonsillitis are foci of infection in neighboring organs (adenoiditis, sinusitis, carious teeth). About 30 different pathogenic microorganisms can be detected in the tonsils of a patient with chronic tonsillitis, however, in the depths of the lacunae, pathogenic monoflora (staphylococcus or streptococcus) is usually found.
There are simple (compensated) and toxic-allergic (decompensated) forms of chronic tonsillitis. The toxic-allergic form (TAF), in turn, is divided into two subforms: TAF 1 and TAF 2.
The simple form of chronic tonsillitis is characterized by scant symptoms. Patients are concerned about the sensation of a foreign body or awkwardness when swallowing, tingling, dryness, and bad breath. The tonsils are inflamed and enlarged. Outside of exacerbation, there are no general symptoms. Characterized by frequent sore throats (up to 3 times a year) with a protracted period of recovery, which is accompanied by fatigue, malaise, general weakness and a slight increase in temperature.
In the toxic-allergic form of chronic tonsillitis, tonsillitis develops more often than 3 times a year, often complicated by inflammation of neighboring organs and tissues (peritonsillar abscess, pharyngitis, etc.). The patient constantly feels weak, tired and unwell. The body temperature remains low-grade for a long time. Symptoms from other organs depend on the presence of certain associated diseases.
With chronic tonsillitis, the tonsils turn from a barrier to the spread of infection into a reservoir containing a large number of microbes and their metabolic products. Infection from affected tonsils can spread throughout the body, causing tonsillocardial syndrome, kidney, liver and joint damage (associated diseases).
The disease changes the state of the body's immune system. Chronic tonsillitis directly or indirectly affects the development of certain collagen diseases (dermatomyositis, scleroderma, periarteritis nodosa, systemic lupus erythematosus), skin diseases (eczema, psoriasis) and peripheral nerve lesions (sciatica, plexitis). Long-term intoxication in chronic tonsillitis is a risk factor for the development of hemorrhagic vasculitis and thrombocytopenic purpura.
The diagnosis of chronic tonsillitis is made on the basis of a characteristic history (recurrent tonsillitis), data from an objective examination by an otolaryngologist and additional studies.
