Chronic tonsillitis - signs, symptoms, causes, diagnosis and methods of treating the disease

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NOT TONSOLS, BUT PALATINAL TONSIS

— Sergei Valentinovich, people far from medicine often say: “My tonsils are inflamed!” But there is no such term in medicine?

— Tonsils is really a common term; it doesn’t exist in medicine. There is a term "tonsils". Doctors abroad would say that this is tonsillopharyngitis. We separate two concepts: pharyngitis is a disease of the back wall of the pharynx, mucous membrane, and tonsillitis is a disease of the tonsils. There is inflammation - bacterial or viral. 70 percent of all inflammations in the pharynx are viral inflammations. Classic inflammation has five signs: redness, swelling, pain, fever, dysfunction. But a sore throat does not always indicate that a person has a viral or bacterial infection. It can be caused, for example, by a temperature reaction: a person drank ice water and his throat hurt; I drank too hot tea and my throat hurt. Some chemicals - for example, pepper or alcoholic drinks, environmentally harmful substances - can also create discomfort in the throat.

Exacerbation of chronic tonsillitis: symptoms

Often, for a long time, chronic tonsillitis occurs without symptoms or has scanty symptoms (in a simple form). There may be discomfort when swallowing food and liquids, a sensation of a foreign body in the throat, dry mouth, halitosis (bad odor) and tingling. Externally, the tonsils increase in size and there are signs of inflammation. The disease is characterized by exacerbations of sore throats up to three times a year, long periods of recovery, with general symptoms of asthenia and prolonged low-grade fever.

For the toxic-allergic form, more frequent exacerbations are typical, often with complications in the area of neighboring tissues (pharyngitis, peritonsillar abscesses), and the almost constant presence of asthenia and prolonged fever are typical.

The clinical picture of chronic tonsillitis during an exacerbation is as follows:

sore throat that gets worse when swallowing;
redness of the throat and tonsils;
characteristic plaque;
purulent discharge from the tonsils;
bad breath;
swelling of the nasopharynx;
temperature increase;
weakness;
headache;
fast fatiguability;
arrhythmia;
enlarged lymph nodes;
dyspnea.

Prevention of complications after tonsillitis

To prevent the development of life-threatening complications, the patient should:

Start drug therapy as early as possible from the onset of the disease.
Use medications prescribed by your doctor for treatment. Antibiotics are prescribed to each patient individually, taking into account the sensitivity of pathogenic microorganisms to antibacterial agents.
During the period of rising temperature, strictly adhere to bed rest.
Drink as much as possible. Drinking large amounts of water and unsweetened compotes accelerates the removal of microbes and their toxins from the body.

If you have complications after a sore throat, you can contact our clinic for treatment. Qualified doctors will not only conduct a thorough diagnosis and identify the slightest undesirable changes, but will also correctly select medications taking into account the type of pathogenic microbes, the patient’s age and concomitant diseases.

After the main therapy, the clinic’s doctors also give their patients a list of recommendations, compliance with which will minimize the negative impact of tonsillitis on the body.

Causes, main risk factors

Up to 30 different colonies of pathogenic microbes can be sown on the surface of the tonsils of patients suffering from chronic tonsillitis. But in crypts and lacunae staphylo- or streptococcus is usually determined. A key role in the pathogenesis of chronic tonsillitis is played by beta-hemolytic strains of streptococcus (type A). Other flora - gram-negative coccal, fungal, viral - have an impact on local immunity, they support inflammation.

There are a number of factors contributing to the occurrence of the disease:

hypothermia;
decreased immunity;
microtrauma of the tonsils;
foci of inflammation in the mouth and in the head area (caries, sinusitis, adenoids, etc.);
smoking;
poor nutrition;
allergy.

Viruses and bacteria that cause tonsillitis can come from the external environment.

Types of most likely complications

Tonsillitis develops due to the penetration of bacteria and viruses into the oropharynx, which cause pain and symptoms of intoxication. Timely intake of antibacterial agents and compliance with all doctor’s recommendations allows you to destroy the causative agent of the disease in the primary focus of microbial development. If this does not happen, there is a high probability that bacteria will spread throughout the body through the blood or lymph flow, which leads to inflammation of the internal organs.

All possible complications of any type of tonsillitis are divided into local and systemic (general). Local ones are easier to tolerate, although they lengthen the recovery time and significantly weaken the immune system. General complications are less common, but they are much more dangerous for the patient.

Classification

Doctors distinguish various clinical forms of chronic tonsillitis, differing in clinical manifestations, severity of the condition and prognosis, risk of complications, as well as treatment tactics.

The simple form of chronic tonsillitis is characterized by a predominance of local symptoms. If general manifestations and lymphadenitis occur, this is referred to as a toxic-allergic form of tonsillitis. It comes in two versions:

Toxic-allergic chronic tonsillitis 1st degree . Sore throats are typical for him, which can worsen after ARVI, combined with general symptoms.

Toxic-allergic chronic tonsillitis of the 2nd degree - the symptoms are more pronounced, associated with diseases that have common factors of etiology and pathogenesis.

According to the degree of compensation of the process, the disease is divided into two options:

chronic tonsillitis, compensated form - the source of infection is in a dormant state, there are no reactions from the body, repeated sore throats do not occur; The function of the tonsils and general reactivity are not impaired.
chronic tonsillitis is a decompensated form - relapses of sore throat occur, complications of the heart, damage to the paranasal sinuses, middle ear, and renal complications are possible.

According to pathomorphological criteria, the process is divided into the following options:

lacunar tonsillitis with predominant damage to the area of the lacunae;
parenchymal-lacunar, involving in addition to the lacunae also the area of the lymphoid tissue of the tonsils themselves;
phlegmonous - inflammation is predominantly localized in the area of lymphoid tissue;
sclerotic with abundant growth of connective tissue fibers in the area of the tonsils and surrounding tissue.

Under what “masks” can inflammatory damage to the heart be hidden? Cases from practice

The clinic for heart defects is very individual. The patient was hospitalized with a diagnosis of pneumonia. The high temperature lasts for three weeks, there are obvious signs of heart failure - shortness of breath, general weakness, swelling of the legs, tachycardia. The attending physician suspected endocarditis - inflammation of the inner lining of the heart. We carry out ultrasound diagnostics, or more precisely, echocardiography. We identify a tricuspid heart valve completely destroyed by the virus. Pneumonia in this case developed as a result of so-called “remnants” of the destroyed valve entering the lungs (through the bloodstream).

Ultrasound diagnostics showed that the aortic valve was destroyed. Its, so to speak, “remnants” traveled through the bloodstream to the brain, which led to impaired cerebral circulation.

In some cases, endocarditis may be disguised as a stroke. A young man with a high fever and signs of a stroke was admitted to the intensive care unit of an infectious diseases hospital. Ultrasound diagnostics showed that the aortic valve was destroyed. Its, so to speak, “remnants” traveled through the bloodstream to the brain, which led to impaired cerebral circulation. I'm starting to figure out the source of the infection. Then I pay attention to the small abrasions on my fingers. It turns out that the young man works as a car mechanic without using personal protective equipment. These skin lesions were most likely the entry point for infection.

A subsequent operation to replace the damaged valve with an artificial prosthesis allowed the patient to return to normal life.

Complications of chronic tonsillitis

Against the background of a chronic inflammatory process in the tonsil area, various complications are possible. Therefore, it is important to know why chronic tonsillitis is dangerous. Thus, the tonsils themselves, losing their function as a barrier to infection, become its breeding ground. Inside them are pathogens with the products of their metabolism. The infection can spread throughout organs and tissues, affecting the renal parenchyma, joint and heart tissue, and liver. In addition, tonsillitis adversely affects the functioning of the immune system and can be a provocateur of collagen diseases - lupus, scleroderma, dermatomyositis, periarteritis. The skin and peripheral nerve fibers may also be affected. With prolonged intoxication against the background of the disease, damage to blood vessels (vasculitis) and platelets (purpura) is possible.

Local complications

The development of local complications of tonsillitis, covering the ENT organs and respiratory system, is indicated by the addition of new symptoms, deterioration of health against the background of the beginning of recovery.

The most likely consequences of a sore throat are:

Peritonsillar abscess
. This is the formation of an abscess in the tissue of the pharynx. It is manifested by the appearance of increasing pain on one side of the throat, a secondary increase in temperature, tension in the neck muscles, and difficulty swallowing. The patient cannot turn his neck normally and open his mouth completely.
Otitis
is an inflammation of the middle ear. It occurs both in parallel with a sore throat and a few days after the completion of the acute stage of tonsillitis.
Swelling of the larynx
. Occurs due to inflammation of the vocal cords. It manifests itself as hoarseness, difficulty swallowing and deterioration in breathing.
Inflammation of the lymph nodes
. The submandibular ones are most often affected, less often the clavicular and supraclavicular, cervical ones.
If left untreated, tonsillitis can also cause bronchitis, pneumonia, and tracheitis.

Diagnostics

Diagnosis of chronic tonsillitis occurs on the basis of complaints, examination of the patient, and questioning of the patient. Objective signs, manifestations of chronic tonsillitis, and the general condition of the tonsils are important; the doctor determines the stages of the process and the form.

The following diagnostic procedures are also carried out:

throat swab for flora;
general blood and urine tests;
blood test for antibodies to streptococcus.

This helps determine treatments for chronic tonsillitis.

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.

Treatment methods in adults

In most cases, they resort to conservative treatment of chronic tonsillitis. Source: Modern methods of treating chronic tonsillitis. Ryazantsev S.V., Eremina N.V., Shcherban K.Yu. Medical Council, 2021. p. 68-72:

therapy for inflammation in the head and oral cavity;
procedures that increase immunity (hardening, taking vitamins, physical education, etc.);
hyposensitizing drugs (to suppress allergic reactions);
immunomodulators (normalize the immune system);
means of reflex action (acupuncture, manual therapy);
washing the tonsils with antiseptics;
administration of drugs to the tonsils.

The treatment plan is complemented by physical therapy for chronic tonsillitis.

A radical method of treating chronic tonsillitis is surgical removal of the tonsils (tonsillectomy). The operation is performed in cases where inflammation occurs more than five times a year and does not respond to complex conservative treatment of chronic tonsillitis. Source: Choosing an antibiotic for exacerbation of tonsillitis. Karpishchenko S.A., Kolesnikova O.M. Medical Council, 2015. p. 40-43.

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

Prevention of chronic tonsillitis in adults

Preventive measures to prevent chronic tonsillitis include:

proper hygiene;
hardening;
balanced diet;
maintaining cleanliness in the home and workplace, eliminating dust;
timely treatment of inflammationSource: Treatment and prevention of chronic tonsillitis. Atagulova G. Zh. Medicine and ecology, 2012.

Chronic tonsillitis is a very common disease that causes a lot of inconvenience to the patient. But is it possible to cure chronic tonsillitis? If your tonsils often become inflamed, then do not self-medicate, but consult a doctor who will select the optimal treatment regimen for you and determine how to get rid of chronic tonsillitis. You can make an appointment with a medical specialist in St. Petersburg by calling the phone number listed on the website.

Article sources:

Treatment and prevention of chronic tonsillitis. Atagulova G. Zh. Medicine and ecology, 2012
Chronic tonsillitis in the practice of an otolaryngologist and cardiologist. Yalymova D.L., Kostyuk V.N., Vishnyakov V.V., Yalymov A.A., Shekhyan G.G., Zadionchenko V.S. Cardio Somatics, 2014. p. 60-65
Choice of antibiotic for exacerbation of tonsillitis. Karpishchenko S.A., Kolesnikova O.M. Medical Council, 2015. p. 40-43
Modern methods of treating chronic tonsillitis. Ryazantsev S.V., Eremina N.V., Shcherban K.Yu. Medical Council, 2021. p. 68-72

Comments

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26.11.2021, 01:24

I think that Tonsilotren is an excellent remedy in the fight against tonsillitis. It has a cumulative effect and can be taken over a long period without harm to the body. I treat myself with these tablets and give them to my child when he complains of a sore throat.

— TiAnna

13.10.2020, 12:31

Since childhood, my daughter’s throat has been her weakest point. Sore throats are also quite common in our country. I don’t want to constantly stuff my child with antibiotics, but Tonsilotren helps the throat very well.

—Mati0xxx

24.04.2019, 01:00

Gargling with salt, soda and iodine is very effective; there is even a ready-made drug called iodangin, which will clear up your neck in a couple of days.

—Sergo34

01.02.2017, 05:20

If you choose an antibiotic to quickly cure tonsillitis, then I recommend Azitral to everyone. It's inexpensive. I took one capsule a day for three days, 2 hours after lunch. After the third I felt fine. Azitral really helps.

— Marie (guest)

01.02.2017, 02:52

If you are afraid to take antibiotics, then it is in vain. You can safely take Azitral. The eldest son fell ill, and then received a complication - an earache. The doctor said it was otitis media. Prescribed Azitral. I was afraid that there would be all sorts of side effects. But it helped my son. Drink Azitral once a day before meals. If you need a proven antibiotic, then take Azitral.

— Nastya Sharova (guest)

31.01.2017, 21:36

If you are afraid to take antibiotics, then it is in vain. You can safely take Azitral. The eldest son fell ill, and then suffered a complication - tonsillitis. Prescribed Azitral. I was afraid that there would be all sorts of side effects. But it helped my son. Drink Azitral once a day before meals. If you need a proven antibiotic, then take Azitral.

— Kira (guest)

22.12.2016, 02:13

I agree with your opinion, Daria. I generally have a weak throat, just a few times I caught a cold like laryngitis, pharyngitis, tonsillitis...... I’m already used to it, on the one hand, but it also often happens in this habit to trigger the situation. Then I turn to antibiotics and Azitral became the best for me. It really gives a quick effect in recovery and without side effects. I recommend!

— Stas (guest)

17.12.2016, 01:49

Julia, I agree with you. I am very skeptical about antibiotics. But due to the fact that I have chronic tonsillitis since childhood, I have tried a lot of things... Doctors prescribe antibiotics, and sometimes they have to be used too. I noticed the greatest and best effect from Azitral capsules. And it helped quickly and didn’t notice any negative effects. Combined with rinses. So I recommend it!

— Darsha (guest)

11.12.2016, 00:19

I have had chronic tonsillitis since childhood. If I have ARVI or the flu, then every once in a while I get a sore throat. I have a weak throat. Rinsing helps, but not always. The doctor prescribes antibiotics. I don't really like antibiotics because they are harmful to the stomach. But there is nowhere to go. This year the doctor prescribed Azitral. It helped quickly and there were no side effects. I took two capsules a day two hours after lunch. A good and inexpensive antibiotic, I recommend it to everyone.

— Yulia Tarasenko (guest)

07.04.2016, 16:23

The disease is insidious and fraught with consequences. At the first sign of a sore throat, Tonsilotren helps. He treated my throat more than once. I love these tablets for their natural origin and the absence of dyes. I also give it to my child without fear.

- Dina

11.02.2016, 04:22

A sore throat is a common problem. I am being treated with Tonsilotren. Take 1 tablet every 2 hours. Relief comes quickly. I usually try to take it at the first discomfort, then tonsillitis goes away quickly and without complications.

- Dina

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