Chronic tonsillitis: causes, methods of treatment, photo. Chronic tonsillitis: treatment methods Treatment of tonsils with growth

Tonsillitis is a disease that is manifested by inflammation in the palatine tonsils. The tonsils are located on the sides at the exit from the pharynx, so the problem can be easily seen in the photo. Tonsillitis can occur in two forms: acute and chronic. As a complication of tonsillitis, tonsillitis appears, it is characterized by more serious and pronounced symptoms.

Chronic tonsillitis is a common problem. Children are more exposed to the problem, among children 14% of the population suffer from a chronic form, among adults - 5-7%.

The causes of primary tonsillitis are as follows:

• violations of the new breath;
• minitrauma tissue of the tonsils;
• infectious diseases that violate the integrity of the lymphoid tissue of the pharynx;
• foci of chronic inflammation oral cavity and areas of the head, for example: caries, periodontal disease, sinusitis, adenoids.

In addition, bacteria and viruses enter the oral cavity from the external environment. A weak immune system is unable to protect the body, then disease occurs. A decrease in immunity provokes not only inflammatory processes in the oral cavity, but also the conditions of modern life: malnutrition, polluted air, stress, etc.

Tonsillitis is caused by bacteria, viruses or fungi. The disease can be transmitted by airborne droplets, infection by the fecal-oral route occurs much less frequently. At chronic form tonsillitis, it is not dangerous to others.

Chronic tonsillitis

Chronic tonsillitis is also divided into two forms: compensated and decompensated. In the first case, only local symptoms are inherent. The body copes with inflammation to a greater extent, therefore a person feels only discomfort in the throat. In the second case, there is a general deterioration in the condition. Also on the background of the disease may develop:

• paratonsillitis;
• paratonsillar abscess;
• angina;
• diseases of other body systems.

During acute form diseases and with an exacerbation of chronic, body temperature rises, pain in the joints appears, headache, when swallowing, there is pain in the throat, lymph nodes increase.

When diagnosing, the patient's complaints and clinical indicators are taken into account. laboratory research. Symptoms consist in unpleasant sensations in the throat, often painful, sensations can be of a different nature: perspiration, burning, sensation of a lump in the throat. The photo shows that there are curd masses in the pharynx on the tonsils, they are the cause of bad breath.

In the patient's card, you can find data on private tonsillitis. Most often, an exacerbation occurs after drinking cold or hot drinks, after hypothermia and colds. Therefore, the doctor must understand that such factors are not the root cause of the disease, and as a consequence of chronic tonsillitis.

The photo shows that with tonsillitis, yellow dots appear on the tonsils. During the exacerbation of this symptom is absent. This means that there is a follicular abscess.

If you press on the tonsil, then purulent contents will come out of it. This happens when purulent plugs soften. A large number of bacteria accumulate in the lacunae of the tonsils, their appearance and shape can be analyzed in laboratory conditions.

Treatment of acute and chronic tonsillitis

First of all, for treatment in a hospital, it is necessary to wash the lacunae of the tonsils in order to get rid of bacteria and remove purulent plugs. At home, you will need to continue treatment and gargle with disinfectant solutions and decoctions herbs. Miramistin and Chlorhexidine are used. It is mandatory to prescribe antibiotics depending on the nature of the bacteria. Many pathogens are sensitive to the drug "Rovamycin". Of the penicillins, Panklav is effective.

Not only the nature of the pathogen is taken into account, but also the age of the patient, the frequency of exacerbations and the severity of symptoms. The methods and effectiveness of previous treatment are evaluated. After that, further actions are planned: to treat conservatively or surgically. The operation is recommended only for the decompensated form.

The order of treatment is as follows:

• removal of purulent plugs and washing the lacunae of the tonsils;
• gargling with medicines and decoctions of herbs;
• taking antibiotics (with exacerbation);
• quantum therapy to strengthen immunity;
• methods of physiotherapy;
• inhalation;
• filling gaps with antiseptics (according to the method of Tkach Yu.N.).

Surgical treatment is advisable to carry out with frequent exacerbations and painful symptoms. The tonsils are removed, which in medicine is called tonsillectomy. Doctors try not to perform this kind of surgery, as this leads to a decrease in local immunity.

Surgery

Chronic tonsillitis is an unsafe disease. If we postpone its treatment in a distant box, then complications can spread to the heart and joints may develop endocarditis, pyelonephritis.

Tonsils are removed if the following problems are present:

• exacerbation occurs more than 2 times a year;
• exacerbations are accompanied by painful symptoms;
• there were complications on the heart or joints.

Treatment methods are effective: laser removal of the tonsils or a cryosurgical method, when the tonsils are frozen.

The operation is not performed if there is cardiovascular or renal insufficiency, diabetes, hemophilia, infectious diseases, pregnancy, menstruation. Treatment is carried out three weeks after the exacerbation.

It is possible to talk about a completely cured chronic form of tonsillitis when an exacerbation does not occur within two years.

The treatment of children is different from that of adults. IN childhood lymphocytes are actively produced, during which the tonsils with the entire lymphatic drainage system are involved. That's why can't start the disease because the tonsils need to be healthy and whole.

Chronic angina

Chronic tonsillitis occurs as a consequence of chronic tonsillitis. In the lymphoid tissue of the tonsils and throat, there is always an infection. With any external or internal adverse effect, an exacerbation occurs and a sore throat appears.

When a pathogen affects the tonsils for a long time, they cease to perform their protective function weakens local immunity. Chronic tonsillitis is the cause of persistent pharyngitis, bronchitis and other diseases of the throat and upper respiratory tract if the infection goes down.

As complications, heart diseases appear, the disease negatively affects gastrointestinal tract. The latter are much more difficult to deal with. The patient will have to take good care of your health and take preventive measures throughout life.

Symptoms of acute tonsillitis are closely intertwined with the symptoms of tonsillitis. The patient complains about:

• throat discomfort;
• increased body temperature and chills;
• intoxication;
• enlarged lymph nodes;
• the photo shows a white coating on the tonsils.

During the course of the chronic form of angina, the symptoms are not pronounced. The patient feels weakness, discomfort in the throat, when swallowing, a lump is felt in the throat. Such symptoms may last for several days and then disappear without medication. In this case, the infection is constantly in the body and negatively affects health.

In children, chronic angina is more pronounced. Constantly arise colds. The tissue of the tonsils undergoes changes, it swells, becomes loose, palatine darlings become denser. From mouth comes out bad smell , the cause of which are plugs in the gaps.

Treatment of angina folk methods

Treatment should not be neglected traditional medicine. In the period without exacerbation, in the morning and in the evening, the throat is gargled with herbal decoctions and saline solution This will help reduce the risk of an exacerbation. If possible massage of the neck area and chest. To raise the immune system are used: ginseng, echinacea, chamomile, garlic, propolis.

Many herbs are used for rinsing treatment, for example: chamomile, horsetail, marshmallow, linden, oregano, oak bark, sage, black elderberry, peppermint, fennel fruits.

You can independently prepare infusions for rinsing and inhalation. There are a few effective recipes for the treatment of angina.

The first is prepared as follows: crushed aloe leaves are covered with sugar and infused for three days. Then a mixture of leaves is poured with 40% alcohol in a ratio of 1:1 and infused for another 3 days. Tincture is applied every day, 50 drops of tincture are used per glass of water.

St. John's wort flowers (20 g) are poured with 100 ml of 70% alcohol, in this state the mixture is left for 2 weeks. 40 drops of tincture are diluted in a glass of water and taken every day.

A strong remedy for chronic angina and other diseases is eucalyptus tincture, it is sold in a pharmacy. One tablespoon of tincture is diluted in a glass of water.

For treatment, you can use sea buckthorn and fir oils. They are applied directly to the tonsils with a cotton swab for 1-2 weeks.

Despite the localization of inflammation, chronic tonsillitis is a common disease. Its danger cannot be underestimated.

palatine tonsils

Palatine tonsils (tonsillis palatinus) - tonsils or tonsils - an important peripheral organ of the immune system. All tonsils - lingual, nasopharyngeal (adenoids), tubal, palatine - are lined with lymphoid and connective tissue. They make up the barrier-protective lymphadenoid pharyngeal ring (lymphepithelial Pirogov-Waldeer ring) and take an active part in the formation of local and general immunity. Their work is regulated by nervous and endocrine system. The tonsils have the richest blood supply, which emphasizes their high working efficiency.

The term "chronic tonsillitis" means chronic inflammation of the palatine tonsils, because it occurs much more often than similar inflammation of all the other tonsils combined.

Pathological forms of chronic tonsillitis

Chronic tonsillitis

Symptoms from the ENT organs

More often enlarged, loose, spongy, uneven;

Reduced, dense, hidden behind the palatine arches.

Atrophy of the tonsils occurs in adults due to gradual scarring and replacement by connective tissue of the involved lymphoid tissue.

Inflamed, reddish or bright red.

Can be expanded, inlets (orifices) gaping.

Sometimes on the surface of the tonsils, in the mouths or through the epithelial cover, the purulent contents of the lacunae are visible - yellowish-white plugs.

Reddish or bright red;

The palatine arches can be soldered to the tonsils.

• The angle between the anterior and posterior palatine arches is often swollen.

• When pressing on the tonsil with a spatula, purulent or caseous mucus with an unpleasant pungent odor is released from the lacunae.

Common symptoms of chronic tonsillitis

• Angina, as repeated exacerbations of chronic tonsillitis:

May be frequent, on the slightest occasion;

Sometimes chronic tonsillitis proceeds without exacerbations (nonanginal form);

Atypical tonsillitis - proceed for a long time, with reduced or slightly elevated temperature bodies are accompanied by severe general intoxication (headache, nausea, pain in muscles and joints).

• Regional cervical The lymph nodes:

Often enlarged and painful. The enlargement of the jugular lymph nodes is of great diagnostic value.

Subfebrile (37 - 38 0 C) increase in body temperature in the evenings;

- "unmotivated" headache;

nausea, digestive problems;

Lethargy, fatigue, poor performance.

• Feeling of awkwardness, tingling, sensation of a foreign body, coma in the throat.

• Periodic sore throat radiating to the ear or neck.

• Bad breath.

Symptoms of chronic tonsillitis in some cases are mild, patients do not show any complaints.

Reasons for the development of chronic tonsillitis

1. Decreased general and local reactivity of the body.

Physiological reactivity is the body's ability to respond to environmental changes (infection, temperature changes, etc.), as a factor that disrupts its normal state.

The capabilities of each person's own immunity are genetically determined and do not change throughout life. For example:

Carriers of the system of leukocyte antigens (immune passport) HLA B8, DR3, A2, B12 are characterized by a strong immune response;

For carriers of HLA B7, B18, B35 - weak.

However, the implementation of the available immune capabilities (reactivity) may vary depending on external and internal conditions.

With a negative decrease in reactivity (dysergy), external immune processes are inhibited, depressed, the protective function of the tonsils is weakened: the phagocytic activity of lymphoid cells is reduced, the production of antibodies is reduced. The weakening of local immunity in the nasopharynx is manifested by a sluggish, protracted inflammatory process with erased symptoms - chronic tonsillitis. Dysergia can also reveal itself as a perverted (atypical) reaction - an allergic inflammatory reaction.

Factors that reduce the reactivity of the body:

• Hypothermia.

• Starvation, hypovitaminosis, unbalanced diet:

lack of protein in food, deficiency of vitamins C, D, A, B, K, folic acid reduces the production of antibodies.

• Overheating.
• Radiation.
• Chronic chemical poisoning:

alcoholism, smoking, taking a number of medicines, environmental or occupational exposure to toxic substances, etc.

• Diseases of the nervous system, stress syndrome:

proved that high level in the blood, ACTH, adrenaline, cortisone inhibits the production of antibodies.

patients with uncontrolled diabetes or impaired function thyroid gland often suffer from suppurative processes in the tonsils.

Insufficient sleep, overwork, physical overload.

• Transferred acute illness, severe operation, profuse blood loss lead to a temporary decrease in reactivity.
• Childhood.

Until the age of 12-15, there is a dynamic balancing between the nervous and other systems of the body, the formation of an "adult" hormonal background. In such changing internal conditions, the reactivity of the organism is not always adequate.

The attenuation of the general metabolism and changes in the hormonal status lead to dysergia.

2. Depletion of the immune system or secondary immunodeficiency states (IDS).

Local weakening of immunity in the nasopharynx and the development of symptoms of chronic tonsillitis in some cases is a consequence of secondary IDS.

Secondary immunodeficiency is an acquired decrease in the effectiveness of certain parts of the immune system. IDS causes various chronic inflammations, autoimmune, allergic and neoplastic diseases.

Common causes of secondary CIDs:

• Protozoal diseases, helminthiases:

malaria, toxoplasmosis, ascariasis, giardiasis, enterobiasis (pinworm infection), etc.

• Chronic bacterial infections:

leprosy, tuberculosis, caries, pneumococcal and other infections.

viral hepatitis, herpetic (including EBV, cytomegalovirus) infections, HIV.

obesity, cachexia, protein, vitamin, mineral deficiency.

• common diseases, pathological processes, intoxication, tumors.

The risk of developing chronic tonsillitis and the outcome of the inflammatory process in the tonsils mainly depend on the state of the whole organism.

IgA deficiency and chronic tonsillitis

To destroy pathogenic bacteria and viruses, tonsil lymphocytes produce immunoglobulin antibodies of all classes, as well as lysozyme, interferon, and interleukins.

Immunoglobulins of class A (IgA) and secretory SIgA (unlike IgM, IgG, IgE and IgD) penetrate well into saliva and mucous membranes of the oral cavity. They play a decisive role in the implementation of local immunity.

Due to a weakening of reactivity or a violation of the biocenosis of the oropharynx, a local deficiency in the production of IgA occurs. This leads to chronic inflammation in the tonsils and the formation of a local focus of chronic microbial infection. IgA deficiency causes overproduction of IgE reagins, which are primarily responsible for the allergic reaction.

Chronic tonsillitis is an infectious-allergic disease.

In an attempt to balance the production of immunoglobulins, lymphoid tissue can grow. Hyperplasia of the palatine and nasopharyngeal tonsils (adenoids) are common symptoms of chronic tonsillitis in children.

Clinical forms of chronic tonsillitis Symptoms

1. Liquid pus or caseous-purulent plugs in gaps.

2. Loose, uneven tonsils.

3. Edema and hyperplasia of the edges of the palatine arches.

4. Union, adhesions of the tonsils with palatine arches and folds.

I degree TAF I

1. All symptoms of a simple form.

2. Periodic increase in body temperature

3. Weakness, fatigue, headaches.

4. Pain in the joints.

5. Inflammation cervical lymph nodes- lymphadenitis.

1. All symptoms of TAF I.

2. Pain in the region of the heart, arrhythmia. Functional disorders of the heart are recorded on the ECG.

3. Clinical and laboratory symptoms of disorders of the urinary system, gastrointestinal tract, cardiovascular system, and joints are registered.

4. Complications of chronic tonsillitis are registered:

rheumatic diseases, infectious diseases joints, heart, urinary and other systems, infectious-allergic nature.

In chronic tonsillitis, there are more than 30 combinations of various microorganisms in the tonsils. Pathogenic streptococci, staphylococci, viruses, fungi penetrate the general lymph and bloodstream, poison and infect the entire body, lead to the development of complications and autoimmune diseases.

The diagnosis is made on the basis of the anamnesis, the patient's complaints and is based on a thorough, repeated examination of the tonsils in the non-acute period of the disease, checking the depth and nature of the contents of the lacunae (sometimes with the help of special devices).

Bacteriological examination of the lacunae mucus is not of decisive diagnostic value, because pathogenic microflora in crypts, including hemolytic streptococcus, is often found in healthy people.

It is important to identify the condition of the jugular lymph nodes.

1. Cleansing the tissues of the palatine tonsils from pathological contents helps to form normal local reactivity.

The most effective today is the course vacuum washing of the entire thickness of the tonsils on the Tonsillor apparatus.

Lacuna flushing is also used antiseptics(furatsilin, boric acid, rivanol, potassium permanganate, iodinol) according to the Belogolovov method.

After cleansing the lacunae from pus and plugs, they are irrigated mineral waters, interferon preparations, etc.

• Washing of lacunae with antibiotics should be avoided due to undesirable complications (allergy, fungal infection, impaired mucosal regeneration).

• Gargling with herbal infusions or antiseptic solutions is an ineffective method of treating chronic tonsillitis.

Washing the tonsils is contraindicated during the period of exacerbation of the symptoms of tonsillitis (tonsillitis), in the acute period of other diseases.

2. An important stage in the restoration of local immunity is sanitation and oral hygiene: treatment of diseased teeth (caries) and gums, cleansing the oropharynx from food debris (regular rinsing, brushing teeth after eating). Sanitation of the nasopharynx and nasal mucosa: treatment of adenoids, pharyngitis, vasomotor or allergic rhinitis; as well as sinusitis, ear diseases.

3. Wet mucous membranes are a prerequisite for the normal course of local immune reactions. Measures to combat the drying of the nasopharynx:

Irrigation of mucous membranes with aerosol preparations of sea water, low-salt solutions;

Humidification of inhaled air: ventilation, installation of air humidifiers in heated rooms;

Moisturizing the mucous membranes in a natural way: drinking plenty of water during exacerbations of tonsillitis. During the period of remission, the drinking regimen is about 2 liters of pure water per day.

4. Local / general background immunocorrection is prescribed by an immunologist-allergist. Treatment with immunotropic drugs is carried out strictly individually, taking into account the immune and allergological status of the patient.

Absolute contraindication for the use of natural or other biostimulants:

Oncological (including benign, treated) diseases in the patient's history;

Suspicion of a tumor process.

5. Physiotherapy for the tonsil area:

Physiotherapy restores local immunity, improves lymph and blood circulation in the tonsils, improves lacunar drainage (self-cleaning).

Contraindications: oncological diseases or suspected cancer.

6. Reflexotherapy - stimulation of the reflexogenic zones of the neck with the help of special injections activates the lymph flow and restores the immune reactivity of the mucous membranes of the oropharynx.

7. Tonsillectomy - surgical removal of the tonsils - is performed only in case of reliable symptoms of chronic tonsillitis TAF II or in the absence of the effect of a full-fledged multi-course conservative treatment of TAF I.

Surgical treatment relieves the symptoms of chronic tonsillitis from the ENT organs, but does not solve all the problems of weakened immunity. After the removal of the palatine tonsils, the risk of developing bronchopulmonary pathology increases.

8. healthy image of life, sufficient physical activity, regular walks in the fresh air, a balanced diet, hardening of the body (general and local), treatment of neurosis, endocrine and general diseases - all this plays a decisive role in the treatment and prevention of chemotherapy.

Chronic tonsillitis is a symptom of a decrease in the body's defenses. Timely detection and complex painstaking treatment of this pathology is a warning of cardiovascular, rheumatic, renal, pulmonary, endocrine diseases.

Chronic tonsillitis is a situation when it is necessary to treat not “plugs in the tonsils”, but a person.

2 comments

Interesting Facts. Thank you.

I did not have tonsillitis, but it appeared and I did not even notice. I went to the doctor and they treated me. I went to wash every week, but they told me that I need to come for procedures next year. Time passed, about half a year, and my tonsils clogged again. I went to the store for tea and then I met THYME. This is not tea, but herbs based on thyme. It was these herbs that helped me get rid of the disease. It wasn't long before these herbs helped me, but I still use them. In addition, I drink fermented milk products against bacteria, such as; tan, ayran, etc. They taste nasty, but what can't you do for the sake of health?!

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I have to remove the tonsils, what is this procedure?

Classification of chronic tonsillitis:

toxic-allergic form I (TAF I) - (local signs + frequent sore throats in history 2-3 times a year + complaints, i.e. subjective feelings- pain in the joints, heaviness in the lower back, cardiac arrhythmias, prolonged low-grade fever, NOT clinically confirmed using laboratory and instrumental methods of research)

toxic-allergic form II (TAF II) - (local signs + frequent sore throats in history 2-3 times a year + the presence of ASSOCIATED diseases - rheumatism, pyelonephritis, rheumatic heart disease, prolonged low-grade fever, CONFIRMED clinically using laboratory and instrumental methods of research) and / or a history of peritonsillar abscess

In connection with the foregoing, there are two main methods of treating chronic tonsillitis without exacerbation - conservative (consists in the course sanitation of palatine tonsil lacunae in combination with local and general immunomodulation) and surgical (directly tonsillectomy).

Now about the indications for the choice of one or another treatment tactics.

Conservative treatment is prescribed in courses 2-3 times a year in the presence of simple and TAF I forms of chronic tonsillitis.

Surgical tactics is appropriate in the following cases:

1. With a simple form of chronic tosillitis in combination with a high degree of hypertrophy of the palatine tonsils (III or IV degree)

2. Lack of effect from conservative treatment in the presence of TAF I

3. TAF II (is absolute reading to remove the tonsils)

infections transmitted by airborne droplets, as the obstruction (gland) will be removed.

Have you had your adenoids removed?

If yes, then the action goes deeper. It is more disgusting and more painful.

If not, then imagine a scalpel and an evil uncle-doctor, climbing into your throat in nasty gloves and cutting off innocent tonsils with a razor-sharp knife.

Chronic tonsillitis: treatment and symptoms

Chronic tonsillitis is a chronic inflammatory disease palatine tonsils, in which the focus of infection is located, with periods of exacerbation (tonsillitis) and remissions.

Epidemiology and prevalence

In adults, this disease occurs in 7% of cases, in children - in 13% of cases. More often, the disease occurs in those people who have a predisposition to it, associated with the anatomical and histological features of the structure of the palatine tonsils.

Symptoms of chronic tonsillitis

Chronic tonsillitis occurs with alternating phases of exacerbation (tonsillitis) and remission.

With an exacerbation of this disease, symptoms such as sore throat when swallowing, difficulty in eating, an increase in palatine tonsils, the appearance of white deposits on them, which are easily separated with a spatula, come to the fore. At the same time, body temperature rises, health worsens, body aches, headaches, and sometimes muscle pains appear.

Such exacerbations can occur from 1 to 6 times a year. Therefore, when contacting a doctor, the main complaint of patients is the presence of recurring tonsillitis.

In the period of remission, patients are concerned about bad breath, a feeling in the throat of a foreign body, especially when swallowing.

When examining the throat, one can detect an increase and loosening of the palatine tonsils, redness of the palatine arches and other tissues around the tonsils. On the tonsils themselves, white-yellow small formations up to 2 mm in size can be detected - purulent inflammation of the follicles of the palatine tonsils. Sometimes pus with an unpleasant odor can be released from them.

Another sign of this disease is an increase in the cervical and submandibular lymph nodes, their pain on palpation.

Forms of chronic tonsillitis

There are two forms of this disease:

The simple form is manifested by all the symptoms described above, but the phenomena of intoxication are weakly expressed or not expressed at all. With this form, chronic tonsillitis does not cause a violation in remission of the disease. general condition sick.

With this form, in addition to the main symptoms of chronic tonsillitis, symptoms of allergization and intoxication are added to it. This is expressed in an increase in body temperature, the appearance of fatigue, a decrease in efficiency, the appearance of pain in the head, joints, muscles and heart.

The toxic-allergic form is divided into two degrees according to the severity and likelihood of complications. Moreover, if a patient with chronic tonsillitis has associated diseases (mainly these are diseases associated with beta-hemolytic streptococcus serogroup A), then this immediately determines the second degree of severity of the toxic-allergic form.

Treatment of chronic tonsillitis

Treatment of a simple form of chronic tonsillitis begins with conservative therapy. If conservative therapy is not effective (no effect after three courses), then the question arises of removing the palatine tonsils surgically.

Treatment of the toxic-allergic form of chronic tonsillitis depends on its severity. In the first degree of severity, treatment is also started with conservative treatment, and if this treatment does not work after 1-2 courses, then the tonsils are surgically removed.

The second degree of severity of chronic tonsillitis is a direct indication for the surgical removal of inflamed tonsils.

Treatment of chronic tonsillitis in the acute stage

With an exacerbation of chronic tonsillitis, a sore throat occurs. It is due to the development of pathogenic microflora in the tonsils. Therefore, the main drugs in the treatment should be antibiotics and antiseptics.

Treatment of chronic tonsillitis with antibiotics begins immediately when symptoms of hyperemia, sore throat and fever appear. Antibiotics can be used both in tablet form and as injections. The main antibiotics that should be used in this disease are antibiotics of the penicillin group (ampicillin, amoxicillin) and cephalosporins (cefazolin, ceftriaxone).

The lack of effect after 48 hours from the start of antibiotic treatment (no decrease in body temperature, pain and swelling of the tonsils), indicates that this drug does not work and it is necessary to change it to another one. This can happen if you have been repeatedly treated with this type of antibiotic and bacteria have developed resistance to it. To more accurately determine the antibiotic resistance of bacteria, it is necessary to perform bacteriological examination with the determination of the sensitivity of bacteria to antibiotics.

Apart from antibacterial treatment it is necessary to rinse the throat and mouth with antiseptic solutions (furacillin, iodinol and others). Such rinses are performed 5-10 times a day.

Also, as local treatment sprays are used (ingalipt, hexoral and others), the use of which is carried out according to the instructions.

To reduce sore throat and provide an antiseptic effect, there are a variety of special sucking lollipops (faringosept and others).

There are several methods of conservative treatment of chronic tonsillitis without exacerbation:

Method of washing the tonsils. Due to a certain anatomical feature the structure of the tonsils in some patients with chronic tonsillitis, the physiological washing of the tonsils in a natural way is disturbed. Because of this, in the lacunae of the tonsils there is a stagnation of the contents and the development of various pathogenic bacteria there. Washing of the tonsils is carried out using a syringe with a curved cannula or using special equipment. For washing, antiseptic solutions of furacilin, boric acid, iodinol and others are used. The purpose of washing is to mechanically remove the purulent contents of the lacunae and destroy bacteria with antiseptic solutions. Typically, such washing should be performed every other day for 15 days. The course is repeated after three months.

Methods of extrusion, suction and removal of the contents of lacunae with special tools. This method is rarely used due to its low efficiency and the possibility of injury.

The method of introducing drugs into the tissue of the tonsils and surrounding tissues. At the same time, substances such as antibiotics, sclerosing agents, hormones, enzymes, etc. are introduced. It is difficult to talk about the effectiveness of this method, since this technique is used extremely rarely due to the possibility of developing abscesses in the tonsils.

Physiotherapeutic methods of treatment of chronic tonsillitis. For such treatment, ultraviolet radiation, electromagnetic waves, ultrasound are used. Usually this physiotherapy is performed in 15 sessions. This increases the ability of the tonsils to resist infection.

Surgery

Treatment of decompensated chronic tonsillitis (lack of effect from conservative therapy, toxic-allergic form of the second degree, paratonsillitis, sepsis) is only operational.

Preparation for the surgical removal of the tonsils (tonsillectomy) is carried out on an outpatient basis. To do this, they collect an anamnesis of the disease and an anamnesis of life, take various laboratory tests, change arterial pressure, take an ECG, examine various specialists.

If possible, before surgery, the patient is treated for concomitant diseases, symptomatic therapy of the underlying disease is carried out. Before the operation, the patient is given sedatives, sedatives. The operation is performed on an empty stomach.

As a rule, a tonsillectomy is performed with the patient unconscious under local anesthesia in a sitting position. Anesthesia is carried out with the help of dikain (lubrication) and novocaine 0.5% with adrenaline (tonsil tissues are cut off).

The tonsil is removed with a special tool (loop) or scalpel. First, it is pulled back, separated from the surrounding tissues, then inserted into the loop and cut under the base. Clamps are applied to the bleeding surface and sutured.

After the operation, the patient is sent to the ward, put to bed and an ice pack is placed on the neck. The operated area may bleed a little, so the patient is placed on his side so that the blood does not drain into the throat and further into the esophagus, but into the oral cavity. This allows you to control the amount of blood loss.

On the first day after the operation, the patient should not eat, but you can drink a little water. For sore throats, the patient is given topical anesthesia (for example, strepsis-plus-spray). Every other day, the patient can be fed liquid food.

The patient is discharged from the hospital on the fifth day. He is given a hospital stay for a week and recommendations are given (to avoid strong physical activity, keep a sparing diet, etc.).

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Chronic tonsillitis

Definition

Prevention of chronic tonsillitis

Classification of chronic tonsillitis

There are two clinical forms of chronic tonsillitis: simple and toxic-allergic of two degrees of severity.

A simple form of chronic tonsillitis

Liquid pus or caseous-purulent plugs in the lacunae of the tonsils (may be odorous);

Tonsils in adults are often small, can be smooth or with a loosened surface;

Persistent hyperemia of the edges of the palatine arches (sign of Giza);

The edges of the upper parts of the palatine arches are edematous (a sign of Zach);

Roll-like thickened edges of the anterior palatine arches (a sign of Preobrazhensky);

Fusion and adhesions of the tonsils with arches and a triangular fold;

An increase in individual regional lymph nodes, sometimes painful on palpation (in the absence of other foci of infection in this region).

Concomitant diseases include those that do not have a single infectious basis with chronic tonsillitis, the pathogenetic relationship is through general and local reactivity.

Toxic-allergic form I degree

Periodic episodes of subfebrile body temperature;

Episodes of weakness, weakness, malaise; fast fatigue, reduced work capacity, bad feeling;

Periodic pain in the joints;

Increase and pain on palpation of regional lymph nodes (in the absence of other foci of infection);

Functional disorders of cardiac activity are unstable, they can manifest themselves during exercise and at rest, during an exacerbation of chronic tonsillitis;

Deviations from the norm of laboratory data can be unstable and changeable.

Concomitant diseases are the same as in the simple form. They do not have a single infectious basis with chronic tonsillitis.

Toxic-allergic form II degree

Periodic functional disorders cardiac activity (the patient complains, ECG disturbances are recorded);

Palpitations, heart rhythm disturbances;

Pain in the region of the heart or joints occur both during a sore throat and outside of an exacerbation of chronic tonsillitis;

Subfebrile body temperature (may be prolonged);

Functional disorders of an infectious nature in the work of the kidneys, heart, vascular system, joints, liver and other organs and systems, recorded clinically and using laboratory methods.

Associated diseases have common infectious causes with chronic tonsillitis.

Acute and chronic (often with veiled symptoms) tonsillogenic sepsis;

Acquired heart defects;

Infectious-allergic nature of the disease of the urinary system, joints and other organs and systems.

Etiology of chronic tonsillitis

In most cases, the onset of chronic tonsillitis is associated with one or more tonsillitis, after which chronic inflammation in the palatine tonsils occurs.

The pathogenesis of chronic tonsillitis

Clinic of chronic tonsillitis

In chronic tonsillitis, moderate symptoms of general intoxication are observed, such as periodic or constant subfebrile temperature body, sweating, increased fatigue, including mental fatigue, sleep disturbance, moderate dizziness and headache, loss of appetite, etc.

Chronic tonsillitis often causes the development of other diseases or aggravates their course. Numerous studies conducted over the past decades confirm the relationship of chronic tonsillitis with rheumatism, polyarthritis, acute and chronic glomerulonephritis, sepsis, systemic diseases, dysfunction of the pituitary and adrenal cortex, neurological diseases, acute and chronic diseases of the bronchopulmonary system, etc.

Thus, the basis clinical picture chronic tonsillitis is considered a symptom complex associated with the formation of a focus of chronic infection in the palatine tonsils.

Diagnosis of chronic tonsillitis

Physical examination

Chronic focal infection in the tonsils due to its localization, lymphogenous and other connections with organs and life support systems, the nature of the infection ( B-hemolytic streptococcus etc.) always has a toxic-allergic effect on the entire body and constantly creates a threat of complications in the form of local and general diseases. In this regard, in order to establish a diagnosis of chronic tonsillitis, it is necessary to identify and evaluate the patient's common concomitant diseases.

Laboratory research

The pharyngoscopic signs of chronic tonsillitis include inflammatory changes in the palatine arches. A reliable sign of chronic tonsillitis is purulent contents in the crypts of the tonsils, which is released when pressed with a spatula on the tonsil through the anterior palatine arch. It may be more or less liquid, sometimes mushy, plug-like, cloudy, yellowish, copious or scanty. The palatine tonsils in chronic tonsillitis in children are usually large pink or red with a loose surface, in adults they are often medium in size or small (even hidden behind the arches), with a smooth, pale or cyanotic surface and extended upper lacunae.

The remaining pharyngoscopic signs of chronic tonsillitis are expressed to a greater or lesser extent, they are secondary and can be detected not only in chronic tonsillitis, but also in other inflammatory processes in the oral cavity, pharynx and paranasal sinuses. In some cases, an ECG, X-ray of the paranasal sinuses may be required. Differential Diagnosis

In differential diagnosis, it must be borne in mind that some local and general signs characteristic of chronic tonsillitis can be caused by other foci of infection, such as pharyngitis, gum disease, and dental caries.

Treatment of chronic tonsillitis

Non-drug treatment

Apply also the impact on the tonsils with a magnetic field using the apparatus "Pole-1", which contributes to the stimulation of antibody production in the tonsils and non-specific resistance factors.

Medical treatment

With favorable results, courses of conservative therapy are carried out 2-3 times a year. Conservative treatment of chronic tonsillitis is used only as a palliative method. Chronic tonsillitis can be cured only through the complete elimination of the chronic focus of infection through bilateral tonsillectomy.

Surgery

The prognosis is usually favorable.

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The content of the article

Definition

Chronic tonsillitis is an active, with periodic exacerbations, chronic inflammatory focus of infection in the palatine tonsils with a general infectious-allergic reaction.

Prevention of chronic tonsillitis

Prevention is based on the general principles of strengthening general and local immunity, sanitation of the upper respiratory tract and dentition. In the early detection and treatment of chronic tonsillitis, preventive examinations and medical examinations are of paramount importance.

Classification of chronic tonsillitis

Based on previous classifications and new data, the B.C. classification was created. Preobrazhensky and V.T. Palchun, according to which clinical forms of the disease are differentiated and from modern scientific and practical positions, which determine the treatment tactics.
There are two clinical forms of chronic tonsillitis: simple and toxic-allergic of two degrees of severity.

A simple form of chronic tonsillitis

It is characterized only by local signs and in 96% of patients - the presence of a history of tonsillitis.
Local signs:
liquid pus or caseous-purulent plugs in the lacunae of the tonsils (may be with a smell);
tonsils in adults are often small, can be smooth or with a loosened surface;
persistent hyperemia of the edges of the palatine arches (sign of Giza);
edematous edges of the upper sections of the palatine arches (sign of Zach);
roller-like thickened edges of the anterior palatine arches (a sign of Preobrazhensky);
fusion and adhesions of the tonsils with arches and a triangular fold;
an increase in individual regional lymph nodes, sometimes painful on palpation (in the absence of other foci of infection in this region).
Concomitant diseases include those that do not have a single infectious basis with chronic tonsillitis, the pathogenetic relationship is through general and local reactivity.

Toxic-allergic form I degree

It is characterized by local signs characteristic of a simple form, and general toxic-allergic reactions.
Signs:
periodic episodes of subfebrile body temperature;
episodes of weakness, weakness, malaise; fatigue, reduced ability to work, poor health;
periodic pain in the joints;
enlargement and pain on palpation of regional lymph nodes (in the absence of other foci of infection);
functional disorders of cardiac activity are intermittent, can occur during exercise and at rest, during an exacerbation of chronic tonsillitis;
deviations from the norm of laboratory data can be unstable and changeable.
Concomitant diseases are the same as in the simple form. They do not have a single infectious basis with chronic tonsillitis.

Toxic-allergic form II degree

It is characterized by local signs inherent in a simple form, and general toxic-allergic reactions.
Signs:
periodic functional disorders of cardiac activity (the patient complains, ECG disturbances are recorded);
palpitations, cardiac arrhythmias;
pain in the heart or joints occur both during a sore throat and outside of an exacerbation of chronic tonsillitis;
subfebrile body temperature (may be prolonged);
functional disorders of an infectious nature in the work of the kidneys, heart, vascular system, joints, liver and other organs and systems, recorded clinically and using laboratory methods.

Concomitant diseases can be the same as in the simple form (not associated with infection).
Associated diseases have common infectious causes with chronic tonsillitis.
Local diseases:
paratonsillar abscess;
parapharyngitis.
Common diseases:
acute and chronic (often with veiled symptoms) tonsillogenic sepsis;
rheumatism;
arthritis;
acquired heart defects;
infectious-allergic nature of the disease of the urinary system, joints and other organs and systems.

Etiology of chronic tonsillitis

In the palatine tonsils, the infection comes into contact with immunocompetent cells that produce antibodies. Microflora from the mouth and pharynx penetrates into the crypts, and lymphocytes from the parenchyma of the tonsils. Live microorganisms, their dead bodies and toxins are antigens that stimulate the formation of antibodies. Thus, in the walls of the crypts and lymphoid tissue of the tonsil (along with the entire mass of the immune system), the formation of normal immune mechanisms occurs. These processes are most active in childhood and young age. Normally, the body's immune system keeps the activity of physiological inflammation in the tonsils at a level that is no more than sufficient for the formation of antibodies to various microbial agents entering the crypts. Due to certain local or common causes, such as hypothermia, viral and other diseases (especially repeated tonsillitis), which weaken the immune system, physiological inflammation in the tonsils is activated, the virulence and aggressiveness of microbes in the crypts of the tonsils increases. Microorganisms overcome the protective immune barrier, limited physiological inflammation in the crypts becomes pathological, spreading to the tonsil parenchyma.

Among the bacterial flora, constantly growing in the palatine tonsils and causing under certain conditions the occurrence and development of chronic tonsillitis, there may be streptococci, staphylococci and their associations, as well as pneumococci, influenza bacillus, etc.

Viruses are not the direct cause of the development of inflammation of the tonsils - they weaken the antimicrobial protection, and the inflammation occurs under the influence of the microbial flora.

Most often, adenoviruses, influenza and parainfluenza, Epstein-Barr, herpes, enteroviruses I, II and V serotypes contribute to the occurrence of chronic tonsillitis.
In most cases, the onset of chronic tonsillitis is associated with one or more tonsillitis, after which chronic inflammation in the palatine tonsils occurs.

The pathogenesis of chronic tonsillitis

The pathogenesis of focal infection in the tonsils is considered in three areas: the localization of the focus, the nature of the infection and inflammation, and defense mechanisms. One of the factors explaining the exceptional activity of infection metastasis from a chronic tonsillar focus (compared to other localizations of focal infection) is the presence of wide lymphatic connections of the tonsils with the main life-support organs, through which infectious, toxic, immunoactive, metabolic and other pathogenic products from focus of infection.

A feature of a tonsillar focal infection is the properties of the microflora of the focus, which play a decisive role in intoxication and the formation of a toxic-allergic reaction in the body, which ultimately determines the nature and severity of complications of chronic tonsillitis. Among all the microorganisms found in the tonsils in chronic tonsillitis and vegetating in the crypts, only B-hemolytic and to some extent green streptococci are capable of forming a focus of infection that is aggressive towards distant organs. B-hemolytic streptococcus and its metabolic products are tropic to individual organs: the heart, joints, meninges - and are closely related to the entire immunological system of the body. Other microflora in the crypts of the tonsils are considered as concomitant.

In the pathogenesis of chronic tonsillitis, a significant role is played by violations of the protective mechanism that delimits the focus of inflammation. When the barrier function is partially or completely lost, the focus of inflammation turns into an entrance gate for infection, and then the damage to specific organs and systems is determined by the reactive properties of the whole organism and individual organs and systems.

Speaking about the pathogenesis of chronic tonsillitis, it is also important to note that the natural role of the palatine tonsils in the formation of immunity is completely distorted, since in chronic inflammation new antigens are formed in the tonsils under the influence of pathological protein complexes (virulent microbes, endo- and exotoxins, tissue and microbial destruction products). cells, etc.), which causes the formation of autoantibodies against their own tissues.

Clinic of chronic tonsillitis

The clinical picture of chronic tonsillitis is characterized by the recurrence of angina, more often 2-3 times a year, often once every few years, and only 3-4% of patients do not have angina at all. For tonsillitis of another etiology (not as an exacerbation of chronic tonsillitis), the absence of their recurrence is characteristic.
In chronic tonsillitis, moderately pronounced symptoms of general intoxication are observed, such as periodic or constant subfebrile body temperature, sweating, increased fatigue, including mental fatigue, sleep disturbance, moderate dizziness and headache, loss of appetite, etc.
Chronic tonsillitis often causes the development of other diseases or aggravates their course. Numerous studies conducted over the past decades confirm the relationship of chronic tonsillitis with rheumatism, polyarthritis, acute and chronic glomerulonephritis, sepsis, systemic diseases, dysfunction of the pituitary and adrenal cortex, neurological diseases, acute and chronic diseases of the bronchopulmonary system, etc.
Thus, the symptom complex associated with the formation of a focus of chronic infection in the palatine tonsils is considered the basis of the clinical picture of chronic tonsillitis.

Diagnosis of chronic tonsillitis

Physical examination

The toxic-allergic form is always accompanied by regional lymphadenitis - an increase in lymph nodes at the corners of the lower jaw and in front of the sternocleidomastoid muscle. Along with enlarged lymph nodes, it is necessary to note their pain on palpation, which indicates their involvement in the toxic-allergic process. Of course, for clinical assessment, it is necessary to exclude other foci of infection in this region (in the teeth, gums, paranasal sinuses, etc.).
Chronic focal infection in the tonsils, due to its localization, lymphogenous and other connections with organs and life support systems, the nature of the infection (B-hemolytic streptococcus, etc.), always has a toxic-allergic effect on the entire body and constantly creates a threat of complications in the form of local and general diseases. In this regard, in order to establish a diagnosis of chronic tonsillitis, it is necessary to identify and evaluate the patient's common concomitant diseases.

Laboratory research

Need to do clinical analysis blood, take a smear from the surface of the tonsils to determine the microflora. Instrumental Research
The pharyngoscopic signs of chronic tonsillitis include inflammatory changes in the palatine arches. A reliable sign of chronic tonsillitis is purulent contents in the crypts of the tonsils, which is released when pressed with a spatula on the tonsil through the anterior palatine arch. It may be more or less liquid, sometimes mushy, plug-like, cloudy, yellowish, copious or scanty. The palatine tonsils in chronic tonsillitis in children are usually large pink or red with a loose surface, in adults they are often medium in size or small (even hidden behind the arches), with a smooth, pale or cyanotic surface and extended upper lacunae.
The remaining pharyngoscopic signs of chronic tonsillitis are expressed to a greater or lesser extent, they are secondary and can be detected not only in chronic tonsillitis, but also in other inflammatory processes in the oral cavity, pharynx and paranasal sinuses. In some cases, an ECG, X-ray of the paranasal sinuses may be required. Differential Diagnosis
In differential diagnosis, it must be borne in mind that some local and general signs characteristic of chronic tonsillitis can be caused by other foci of infection, such as pharyngitis, gum disease, and dental caries.

Treatment of chronic tonsillitis

Non-drug treatment

Centimeter wave therapy is prescribed with the Luch-2, Luch-3 devices or ultrasonic treatment with the help of the LOR-1A, LOR-3, UZT-13-01-L devices. A separate course is carried out with ultraviolet irradiation of the tonsils. At the same time, 10 UHF sessions are prescribed for regional lymph nodes.
Apply also the impact on the tonsils with a magnetic field using the apparatus "Pole-1", which contributes to the stimulation of antibody production in the tonsils and non-specific resistance factors.

Along with other physical methods, aerosols and electroaerosols with biologically active preparations are used: Kalanchoe juice, 3% water-alcohol emulsion of propolis, which improve the barrier functions of the tonsils and have a bactericidal effect. They also use low-energy helium-neon laser systems in the red and infrared ranges and low-intensity incoherent red light installations ("LG-38", "LG-52", "Yagoda", etc.).

Medical treatment

With a simple form of the disease, conservative treatment is carried out for 1-2 years with 10-day courses. If local symptoms do not respond well to therapy or an exacerbation (angina) occurs, a second course of treatment can be carried out. However, the absence obvious signs improvements, and even more so repeated tonsillitis, are considered an indication for the removal of palatine tonsils.

With toxic-allergic form I degree of chronic tonsillitis, conservative treatment should not be delayed unless a significant improvement is observed. The toxic-allergic form of the II degree of chronic tonsillitis is dangerous with rapid progression and irreversible consequences.

Treatment should begin with sanitation of the oral cavity, nose and paranasal sinuses, pharynx, etc. According to the indications, general strengthening treatment (vitamins, physiotherapy, immunostimulating therapy, desensitization) should be carried out.

The most common conservative treatment for chronic tonsillitis is the washing of tonsil lacunae according to N.V. Belogolin with various solutions (sulfacetamide, potassium permanganate, miramistin *. ascorbic acid, etc.), as well as immunostimulating agents: levamisole, interferon, lysozyme, etc. The course of treatment consists of 10 washing procedures, usually upper and middle lacunae. Washing under negative pressure using the Utes and Tonsillor devices is considered more effective. Then the surface of the tonsils is lubricated with Lugol's solution or 5% collargol solution *.
With favorable results, courses of conservative therapy are carried out 2-3 times a year. Conservative treatment of chronic tonsillitis is used only as a palliative method. Chronic tonsillitis can be cured only through the complete elimination of the chronic focus of infection through bilateral tonsillectomy.

Surgery

Surgical treatment (tonsillectomy) is carried out with the ineffectiveness of conservative therapy and with the toxic-allergic form of the II degree of chronic tonsillitis.
Forecast
The prognosis is usually favorable.

Chronic tonsillitis- symptoms and treatment

What is chronic tonsillitis? We will analyze the causes of occurrence, diagnosis and methods of treatment in the article of Dr. Selyutin E. A., ENT with an experience of 24 years.

Definition of illness. Causes of the disease

Chronic tonsillitis- This is a long-term persistent chronic process of inflammation of the palatine tonsils, which is accompanied by such recurrent exacerbations as tonsillitis and a general toxic-allergic reaction.

The palatine tonsils are the focus of infection of this disease. The human body perceives their inflammation as a foreign formation and includes an autoimmune mechanism (the fight of immunity against its own tissues).

However this theory The autoimmune cause of inflammation has not yet been fully proven, since no significant changes have been found in the indicators of systemic immunity due to their transient (temporary) nature.

The Society of Otorhinolaryngologists of Europe under chronic tonsillitis means infectious inflammation in the tonsils and oropharynx, lasting from three months. European doctors argue that the diagnosis of "chronic tonsillitis" can only be carried out through clinical trials.

Indirectly, the presence of chronic tonsillitis is evidenced by the pain in the throat passing under the action of systemic antibiotics, which returns after withdrawal from the application.

So, in modern otorhinolaryngology there are many unresolved issues related to chronic tonsillitis. There are disagreements about the classification, diagnostic methods and treatment tactics among doctors in Russia and other countries of the world. Therefore, the topic of chronic tonsillitis is very relevant.

If you experience similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of chronic tonsillitis

The diagnosis of "chronic tonsillitis" can be established using the following clinical signs:

• constant sore throat, congestion;
• bad breath;
• neck lymphadenitis.

Among the causes of chronic inflammation of the tonsils, American scientists single out asthma, allergies, bacteria and viruses (in particular, the Epstein virus), gastroesophageal reflux disease (reflux of acidic stomach contents into the esophagus).

However, the mechanism of influence of these causes on the appearance of chronic tonsillitis foreign experts is not explained. Questions remain open:

• How exactly can the reasons listed above by American scientists contribute to the infection of the lymphatic tissue?
• How actively are these factors involved in the pathogenesis of chronic inflammation of the tonsils?

The pathogenesis of chronic tonsillitis

Long-term interaction of the virus and the microorganism forms a focus of chronic tonsillitis and contributes to the development of tonsillogenic processes.

Also, in patients with a diagnosis of "chronic tonsillitis" (in particular, a toxic-allergic form) in the lymphoid tissue (in the crypts of the tonsils and even in the lumen of the vessels), colonies of live multiplying microbes were found, which can become a factor in periodic subfebrile condition (temperature increase).

No bacteria were found in the parenchyma (constituent elements) and vessels of healthy tonsils.

Currently, the issue of the influence of biofilms on the course of a chronic infectious process in the 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. The researchers suggest that biofilms formed by bacteria on the surface of adenoid tissue and palatine tonsils will help to find out what is the difficulty in eradicating (destroying) the bacteria involved in the formation of chronic tonsillitis.

So far, the intracellular location has been confirmed:

• Staphylococcus aureus;
• pneumococcus;
• hemophilic bacillus;
• aerobic diplococcus (Moraxella catarrhalis);
• group A beta-hemolytic streptococcus.

In order to detect and identify the location of microorganisms within cells, polymerase chain reaction (PCR) as well as in situ hybridization (FISH method) can be used.

However, the above studies do not allow to identify one pathogenic microorganism that causes a clinic of chronic inflammation of the tonsils. Therefore, it is very likely that any microorganism that is in the oropharynx can cause the course of the disease, under conditions that contribute to the inflammatory process in the tissue of the palatine tonsils. These 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 bodies, especially from the central nervous system and heart. Morphologically proven lymphatic connections of the tonsils and brain centers.

Classification and stages of development of chronic tonsillitis

In Russia, there are two classifications of chronic tonsillitis, formed about 40 years ago: B.S. Preobrazhensky - V.T. Palchun 1965 and I.B. Soldatov 1975.

Classification B.S. Preobrazhensky - V.T. Palchuna includes two clinical forms of chronic tonsillitis:

a) simple;

b) toxic-allergic:

• first degree;
• second degree.

Established clinical diagnostic criteria were created by descriptive medicine and have not changed with the advent of evidence-based medicine. For example, the signs of a simple form of chronic inflammation of the tonsils are subjective and depend mainly on the individual perception of the doctor.

Classification by I.B. Soldatova subdivides chronic tonsillitis into:

• compensated form;
• decompensated form.

However, the term "compensation" in relation to this disease is rather conditional, since there is no compensation (restoration of a healthy state) of the chronic inflammatory process in the tonsils and in the body. The signs of the decompensated form are similar to the toxic-allergic form of chronic tonsillitis, isolated by B.S. Preobrazhensky.

All these classifications are united by a subjective approach, since the same conditions of the palatine tonsils differ only in their wording.

Complications of chronic tonsillitis

The most common complication is bleeding. It is estimated that 2-8% of patients suffer from bleeding. Other complications after tonsillectomy include subcutaneous emphysema, pneumonia, abscess and atelectasis of the lung, paresis of individual nerves or their branches, mediastinitis, tonsillogenic sepsis. Very rare, but life-threatening are intracranial complications: meningitis, thrombosis of the sinuses of the meninges, brain abscess.

Diagnosis of chronic tonsillitis

When diagnosing chronic tonsillitis, it is important to determine the presence of the following symptoms:

• Giza's symptom - hyperemia of the edges of the palatine arches;
• Zak's symptom - edema in the region of the upper angle between the palatoglossal and palatopharyngeal arches;
• symptom of Preobrazhensky - a roller-like thickening of the edges of the anterior and posterior palatine arches.

These signs of chronic tonsillitis occur due to irritation of the mucous membrane by the contents of the lacunae of the tonsils, squeezed out when the temples are strained, for example, during swallowing. Pharyngoscopically, the symptoms of chronic inflammation of the palatine tonsils are easily determined, but their diagnostic value is limited by the fact that they can occur in other diseases (for example, in acute exacerbation of chronic pharyngitis). The next pharyngoscope symptom is adhesions between the arches and the surface of the tonsils. An indisputable sign of chronic tonsillitis is the presence of a liquid purulent exudate (accumulated fluid) in the gaps.

All these signs characterize a simple (according to B.S. Preobrazhensky) or compensated (according to I.B. Soldatov) form of chronic tonsillitis, in which symptoms of focal infection are not yet detected.

The toxic-allergic form of the I degree is characterized by initial manifestations common disease. They are associated with exacerbations of chronic tonsillitis and are diagnosed for some time after a sore throat. Most often affected the cardiovascular system. At this stage of the disease, the changes are functional in nature and are not detected on the electrocardiogram. The central mechanism of disturbance of cordial activity in this stage is proved experimentally. Other signs of the toxic-allergic form of the 1st degree are subfebrile condition and tonsillogenic intoxication in the form fatigue, weakness, decreased performance for some time after a sore throat. These signs are nonspecific and may be associated with various conditions of the body. Meanwhile, their identification and establishing a connection with the disease of the tonsils are of fundamental importance for the development of a rational treatment for chronic tonsillitis. To establish a connection between subfebrile condition and intoxication with chronic tonsillitis, a diagnostic technique is used - a trial treatment. If, after a course of washing the lacunae of the palatine tonsils, the symptoms disappear, they are associated with chronic tonsillitis.

The toxic-allergic form of the II degree is characterized by a developed manifestation of focal infection. Signs of chronic tonsillitis lose their connection with exacerbations and exist constantly, they can be registered during functional studies. In addition, this stage is characterized by the presence of associated diseases. Associated diseases include collagenoses (systemic lupus erythematosus, rheumatism, scleroderma, periarteritis nodosa, dermatomyositis), skin diseases (eczema, psoriasis, nephritis, erythema multiforme exudative, thyrotoxicosis, etc.).

In Russia and in the countries of Europe, the diagnosis of "chronic tonsillitis" can only be established clinically. In the USA, in the presence of the above signs, studies are carried out to exclude asthma, gastroesophageal reflux disease, and allergies. Rheumoprobes and research of the immune status are not carried out.

Treatment of chronic tonsillitis

Chronic tonsillitis is usually treated with conservative and surgical methods.

A conservative method of treatment is indicated if chronic tonsillitis has a compensated form. Conservative treatment is used in the presence of contraindications to surgical method treatment.

Conservative treatments include:

1. Means that contribute to an increase in the natural resistance (resistance) of the body: a rational daily routine, proper nutrition, vitamin therapy, spa treatment.
2. Hyposensitizing agents: drugs that include calcium, ascorbic acid, antihistamines.
3. Immunocorrective agents - the use of immunocorrection drugs (levamisole, thymalin, etc.) and immunostimulating effects (irradiation of the tonsils with a helium-neon laser).
4. Means with a sanitizing effect on the palatine tonsils: washing the lacunae of the palatine tonsils with antiseptic solutions or an antibiotic solution using a syringe or on the tonsillor apparatus.
5. Means of reflex action: acupuncture, novocaine blockade.

In case of ineffectiveness of conservative treatment, semi-surgical methods of treatment are used: ultrasonic biological cleaning or laser vaporization of palatine tonsil lacunae.

With decompensation of chronic inflammation, a complete removal of the tonsils is used - tonsillectomy.

Insufficient effectiveness of systemic antibiotic therapy in chronic tonsillitis is confirmed clinically. A study based on the study of the bacteriological composition from the surface of the palatine tonsils in 30 children who underwent their removal proved that the antibiotics that the children took six months before the operation did not affect the bacteriology of the tonsils at the time of tonsillectomy.

Indications for tonsillectomy are:

• acute recurrent form of tonsillitis (from 3 episodes per year);
• relapses of paratonsillitis;
• symptoms of chronic tonsillitis (exudation, lymphadenitis, if they are resistant to treatment and persist for more than 3 months);
• hypertrophy of the tonsils, complicated by OSAS;
• suspicion of a tumoral change in the tonsil.

In the population, obstructive sleep apnea due to hypertrophy of the lymphatic ring of the pharynx is recorded in 11% of children. Exceeding the apnea/hypopnea index in children by more than 5 episodes per hour is an indication for surgical intervention.

As a result of numerous studies, conclusions have been drawn:

• Tonsillectomy does not affect general immunity.
• Asthma and a predisposition to allergies in a patient are not contraindications to surgery. The aggravating effect of tonsillectomy on the later life of children with atopy has not been proven.

Currently, in many medical institutions, tonsillectomy is performed under general anesthesia.

The technique of the operation consists in isolating the upper pole of the tonsil with a scalpel, scissors or a special tip from electrosurgical devices (coblator, quasar, laser, etc.). Then the tonsil is separated from the arches and paratonsillar tissue in a blunt way. At the final stage of the operation, the lower pole of the tonsil is cut off from the underlying tissues.

Forecast. Prevention

Prevention of chronic tonsillitis is general hygienic and sanitation measures. It is rightfully considered an effective measure of secondary prevention of diseases, in the genesis of which tonsillitis and chronic tonsillitis play an important role. Of the general hygienic measures, the most important are hardening, rational nutrition, compliance with the rules of hygiene of the home and work premises. All patients with chronic tonsillitis must be registered with an otorhinolaryngologist at the dispensary.

If you approach the mirror and open your mouth wide, you can see two formations that are located on the side surfaces, in the depths of the pharynx, which are shaped like an almond. That is why tonsils are called tonsils. And since the tonsils are located in the area soft palate They were called palatine tonsils.

Also, in the common people, the palatine tonsils are also called tonsils. They are one of the important organs of the immune system of the pharynx and form an important part of the lympho-epithelial pharyngeal Pirogov-Waldeyer ring.

Palatine tonsil, tonsila palatina. It is located in the tonsil fossa between the palatoglossal and palatopharyngeal arches.

What other tonsils are there in the throat?

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 state 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 on the root of the tongue, which, like the adenoids, belongs to unpaired organs.

There are also tube rollers, which are also called tube tonsils. They are located at the entrance to the pharyngeal mouth of the auditory tube. The tube rollers 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 in the auditory tube. Since each of the tonsils of the lymphoepithelial pharyngeal ring deserves special attention, this article will focus only on the palatine tonsils and chronic tonsillitis. Other tonsils and the pathology they cause will be described in detail separately, in other relevant ENT articles.

More about palatine tonsils

It must be said that the palatine tonsils are the largest lymphoid formations of the entire pharyngeal ring, and they probably play the leading role in the utilization of bacterial and viral infections that enter the pharynx by airborne droplets.

Due to their size, the palatine tonsils are the first to stand in the way of microbes that have entered the oral cavity from the external environment, and protect the body from infection by viruses, bacteria, spirochetes, protozoa and other microorganisms.

The palatine tonsils have recesses - lacunae, which in turn are outlets for deep and sharply tortuous channels - crypts, which are located in the thickness of the palatine tonsil, leading to its root. The number of lacunae and crypts can vary from 1 to 14, but on average, 4 to 7 lacunae are found in each tonsil. The diameter of the lacunae can also vary, depending on the gender, age, individual characteristics of the patient, as well as the duration and severity of the disease and the presence of cicatricial changes in the tonsils themselves.

It is believed that the wider the outlet - the lacuna, the higher the probability of the palatine tonsil to self-cleanse. This statement is true. Accordingly, the smaller the diameter of the lacuna, the more pronounced and severe the tonsillitis proceeds. Moreover, if the amygdala produces a large amount of caseous-necrotic detritus (plugs), the severity of the flow also increases noticeably.

Normally, on the mucous membrane of the palatine tonsils, as well as in the thickness of the palatine tonsils, in lacunae and crypts, there is a growth of non-pathogenic and conditionally pathogenic microflora, in normal (permissible) concentrations. If there are more microorganisms (for example, due to intensive growth, or the addition of other pathogenic microflora from the outside), the palatine tonsil immediately destroys and utilizes a dangerous infection and normalizes a state that is dangerous for the body. At the same time, the macroorganism, that is, the person, does not notice this at all.

The following main protective substances are produced in the tissues of the palatine tonsils: lymphocytes, interferon and gamma globulin.

The palatine tonsils play the role of a serious infectious and inflammatory barrier and are an important component in creating not only local, but also general immunity in the human body. Therefore, when it comes to removing the palatine tonsils, you first need to think ten times, weigh the pros and cons, and only after that make a decision to remove the palatine tonsils.

Chronic tonsillitis

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

In the event that harmful microbes enter the surface of the mucous membrane and into the lacunae of the palatine tonsil, a real battle takes place between microbes and immune system person.

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 tonsillitis or an exacerbation of chronic tonsillitis (treatment cannot be postponed in any case), thereby triggering an infectious-inflammatory process in palatine tonsils.

As a result of a lost fight, in the lacunae of the tonsils, pus accumulates and stagnates, that is, dead leukocytes that came to the aid of the tonsil in the fight against dangerous infection. Purulent masses irritate and inflame the tissues of the tonsil from the inside and act toxically on it, thereby causing tonsillitis - the brightest infectious outbreak of inflammation of the palatine 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 suffering an attack of sore throat.

Forms of the disease

• recurrent form, that is, with frequently recurring tonsillitis;
• a protracted form, when the inflammatory process in the palatine tonsils is characterized by a sluggish and prolonged course;
• compensated form, when episodes of tonsillitis 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.

Both adults and children can suffer from chronic tonsillitis, 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 just among them. Poor ecology, stress, lack of sleep, overwork, monotonous and poor nutrition, as well as poor heredity are predisposing factors to the development of the disease.

Causes

The development of the disease is closely related to frequent tonsillitis (acute tonsillitis). Very often, not fully cured angina leads to chronic tonsillitis. Very often, angina is an exacerbation with the accumulation of plugs in the tonsils - caseous-necrotic masses, which are often confused with food debris.

The main reasons for the development

1. Unfavorable working conditions. The greatest influence is exerted by the gas content and dust content of the air in the workplace.
2. Poor environmental ecology, car exhaust gas pollution, harmful emissions into the atmosphere.
3. Poor quality of water consumed.
4. Weak (low) immunity.
5. Severe hypothermia.
6. stressful situations.
7. Availability chronic diseases in the nasal cavity, paranasal sinuses and oral cavity - dental caries, purulent sinusitis, etc., which often leads to infection of the palatine tonsils.
8. Irrational or poor nutrition, in which an excess amount of proteins and carbohydrates is consumed.
9. Heredity (mother or father suffers from chronic tonsillitis). It is very important for a woman to undergo one or two courses of treatment for tonsillitis during pregnancy (depending on the severity of the process), in order to minimize the likelihood of developing the disease in the unborn child.
10. Frequent overwork, fatigue syndrome, inability to fully rest.
11. Smoking and alcohol abuse.

Symptoms

How to independently recognize chronic tonsillitis? Symptoms and treatment in adults, children can only be correctly determined by an ENT doctor. Below are characteristics- if you find them in yourself - consult a doctor.

The disease is characterized by such symptoms as:

1. Headache.
2. Sensation of something foreign in the throat, as if something were stuck in the throat. In fact, this is nothing more than large accumulations of caseous masses, that is, plugs in the thickness of the palatine tonsils.
3. Increased fatigue, weakness, decreased performance. All this is due to the so-called tonsillogenic intoxication, or in other words - intoxication syndrome.
4. Pain of a aching nature in the joints and muscles (with severe disease).
5. Aching pain in the heart, with interruptions in the work of the heart - extrasystole (with severe illness).
6. Pain in the lower back, in the region of the kidneys (with severe disease).
7. Bad mood, and in some cases an increase in body temperature, and for a long time.
8. Persistent skin rashes, provided that there was no skin pathology before.

All these symptoms appear due to the ingress of waste products of microorganisms into the blood from the palatine tonsils, i.e. staphylococcal and streptococcal infections, poisoning the entire body.

Bad breath appears due to the accumulation of organic substances and the decomposition of a bacterial infection in the lacunae (recesses of the palatine tonsils) and crypts (their canals). Tonsils become a source of a bacterial infection that can spread throughout almost the entire body and cause inflammation of the joints, myocardium, kidneys, paranasal sinuses, prostatitis, cystitis, acne and other diseases.

If the tonsils do not cope with their function of the immune organ, then even slight overwork, stress, not severe hypothermia can significantly reduce immune defenses and open the way for microbes and exacerbation of the disease.

Complications

Chronic tonsillitis is very dangerous because of the rapidly occurring complications. The most severe of these are heart disease - myocarditis, inflammation of the joints - rheumatism and serious kidney damage - glomerulonephritis.

Some toxins that are produced by microbes in the tonsils and then enter the bloodstream can damage cartilage and ligaments. The result is inflammation and pain in the muscles and joints. Other toxins often cause persistent fever, changes in blood tests, fatigue, depression, and severe headaches.

For the same reason, articular surfaces and kidney tissue are under great threat. Unfortunately, the development of diseases such as rheumatoid arthritis and glomerulonephritis are extremely high.

Due to the fact that there is a focus of infection in the tonsils for a long time, a perversion of the body's reactivity occurs, resulting in allergic shifts. In some cases, carrying out just one course prescribed by a doctor allows you to get rid of itching and allergic rashes, and in some cases stop the development of seizures. bronchial asthma.

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 state, that is, a state without exacerbation of tonsillitis, it is highly desirable to conduct a planned course as prescribed by a doctor. This will reduce the bacterial load on the entire body as a whole and on the palatine tonsils in particular.

I am very pleased with the fact that now doctors refer pregnant women and women who are just preparing for pregnancy for the treatment of tonsillitis. Unfortunately, in some cases, one of the reasons for not carrying a pregnancy is this disease, although at first glance it is hard to believe in it, tonsillitis is a plug, 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 a disease and, if necessary, treat it in the same way. This will significantly reduce the risk of developing chronic tonsillitis in an 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 a child increases many times over.

Before pregnancy, it is very important to conduct a comprehensive treatment of the symptoms of chronic tonsillitis. But even during pregnancy, it is recommended to conduct a second course, preferably in the second trimester, when the woman's condition is perhaps the most comfortable. It is important to note that it is impossible to carry out physiotherapeutic procedures during pregnancy, but it is highly desirable to wash the palatine tonsils with a vacuum method, followed by treatment with antiseptic solutions.

The right approach

Angina, 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 disturbed, and mucus or mucopurulent discharge flows down the back 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 the tonsils can cause serious damage to the body's defenses and immunity, otorhinolaryngologists should try their best to preserve the tonsils and restore their functions without resorting to surgery to remove the palatine tonsils. Modern methods tonsillitis treatments give a great chance of recovery without intervention.

Chronic purulent tonsillitis - treatment of a conservative type should always be carried out in an ENT clinic, performing a comprehensive, pathogenetically substantiated course treatment, as well as applying a drug approach - medications prescribed by an ENT doctor.

Friends! Timely and proper treatment ensure you a speedy recovery!

A complex approach

First stage

Viral tonsillitis - treatment with a good and pronounced effect gives washing of the lacunae of the palatine tonsils. There are two ways to wash the palatine tonsils.

A very old method is washing the tonsils with a syringe. Previously, this method was widely used, but today it is used for lack of a better one or with a very pronounced gag reflex in the patient.

The disadvantages of this method is that in the process of washing the palatine tonsils, the pressure created by the syringe is not sufficient to effectively wash out the caseous masses from the tonsil lacunae. Also, this technique is contact and traumatic, because when using a straightened attic needle, its thin and sharp end can prick the inner surface of the palatine tonsil, namely the crypts - the channels into which the needle enters. Also, a tip from a set with a syringe is used for washing the tonsils and infusions into the larynx. On the contrary, it is very wide in diameter and injures the tonsil tissue when the tip is inserted into the gap, or in general, due to the large outer diameter, it cannot always get there.

Practice has shown that today, the highest result is given by the approach when the ENT uses the Tonsilor nozzle.

At the beginning, it is necessary to wash the lacunae of the palatine tonsils with a modified nozzle of the Tonsilor apparatus with a clear antiseptic solution, for example, saline (also known as isotonic sodium chloride solution). This is necessary so that the doctor can clearly see what he washes out of the palatine tonsils.

Second phase.

Since the tonsils are washed from the pathological secret, it is necessary to immediately act on the tissues of the palatine tonsils with low-frequency ultrasound. At the same time, a medicinal solution passes through the ultrasonic tip of the Tonsilor apparatus, which, due to the ultrasonic effect of cavitation, turns into a finely dispersed medicinal suspension, which, due to hydraulic shock, with force hits the tissues of the palatine tonsil and the posterior pharyngeal wall and impregnates the medicinal solution into the submucosal layer of the tonsil.

The procedure for exposure to ultrasound is correctly called: Ultrasonic medicinal irrigation. We use 0.01% solution of Miramistin in our clinic. This drug is good because it does not lose its properties under the influence of ultrasound. Miramistin is a very strong antiseptic drug, and the ultrasonic effect further enhances the resistance of the physiotherapeutic effect.

Third stage.

It is necessary to treat (lubricate) the palatine tonsils with Lugol's solution, which is also a strong antiseptic, based on iodine with glycerin.

Fourth stage.

The otorhinolaryngologist of our clinic conducts a session of laser therapy on the tissues of the palatine tonsils and the mucous membrane of the posterior pharyngeal wall. Laser treatment of tonsillitis in adults is very effective. Its action is aimed at reducing swelling and inflammation of the tissues of the palatine tonsils.

The source of laser radiation can be installed in the oral cavity and act in close proximity to the palatine tonsils and the mucous membrane of the posterior pharyngeal wall, thereby achieving the best results.

It is also possible to install a laser emitter on the skin of the anterior-lateral surface of the neck in the projection of the location of the palatine tonsils and the posterior pharyngeal wall.

Fifth stage.

It is recommended to conduct sessions of vibroacoustic exposure. They are carried out in order to normalize microcirculation in the tissues of the palatine tonsils and improve the trophism (nutritional function) of the palatine tonsils themselves.

Sixth stage.

It is effective to carry out the sanitation of the microflora located on the surface of the palatine tonsils, due to ultraviolet irradiation (UVI).

In this case, it is necessary to approach the courses. The number of procedures in each case is determined individually at the first ENT consultation. But for the onset of a lasting effect, you must perform at least five sessions. If, during the fifth procedure, caseous and mucous masses are still washed out of the lacunae of the palatine tonsils, washings and other procedures must be continued “until clean washing waters”. As a rule, the number of ENT procedures does not exceed 10 treatment sessions.

After a full course, the lacunae of the palatine tonsils restore their ability to self-cleanse, and the patient feels much better and more cheerful.

In order to have a stable result, it is necessary to carry out conservative treatment from 2 to 4 times a year, as well as independently 1 time in 3 months, take homeopathic and antiseptic preparations.

In this case, you will most likely be able to avoid exacerbations of this disease and the need to remove the palatine tonsils.

If 2-4 weeks after the end of the course, caseous detritus begins to accumulate again in the thickness of the palatine tonsils, and the patient's ENT begins to be disturbed by complaints, as before the start of the course, conservative treatment of chronic tonsillitis in children and adults is recognized as ineffective. In this case, the patient is asked to consider the option surgical removal palatine tonsils. But such an outcome (result) fortunately is quite rare.

Drug treatment of chronic tonsillitis

Dear patients! In this article, I will only describe general principles and approaches.

More accurate treatment will be offered to you at the initial ENT consultation, where an accurate diagnosis, form and degree of the disease will be made, as well as an optimal recovery scheme will be proposed and a prognosis for the duration of remission will be given.

Surgical removal of tonsils

If we talk about the removal of the palatine tonsils, then the operation to completely remove the tonsil tissue is called bilateral tonsillectomy.

Partial removal of the palatine tonsils is called bilateral tonsillotomy.

In a planned manner, on the one hand, the palatine tonsil is removed extremely rarely. There is also the practice of a number of hospitals (this is very much done in the Pirogov City Clinical Hospital No. 1) of removing the palatine tonsil or tonsils with a frolic paratosillar abscess. This operation is called an abscesstonsillectomy. But it must be remembered that against the background of the expressed pain syndrome caused by an abscess, the removal of the tonsil is extremely painful. Due to the purulent process, it is impossible to conduct adequate anesthesia. Therefore, it is necessary to anesthetize the peri-almond tissue only with strong anesthetics: Ultracaine and Ultracaine DS-forte.

In a planned manner, the palatine tonsils can be removed under local anesthesia or under general anesthesia. Previously, this operation was performed only under local anesthesia.

Fortunately, now there is modern equipment that allows you to remove the palatine tonsils under general anesthesia or under anesthesia using cold plasma coagulation - Coblator.

Prevention of chronic tonsillitis

1. Medical therapy. If an ENT patient undergoes treatment courses in the clinic once every 6 months, then, in addition to semi-annual procedures, he is recommended to take Tonsilotren, with a frequency of 1 time in 3 months, i.e. 4 times a year. The course of taking (resorption) of the drug for 2 weeks (more precisely 15 days). It is also possible to carry out instillations of 0.01% solution of Miramistin, 4 clicks 4 times a day for 2 weeks, courses 4 times a year.
2. Climatotherapy and spa therapy. An important point in the prevention of chronic tonsillitis is visiting seaside resorts. Sunbathing, moistened sea air, swimming and, as a result, the inevitable ingress of sea water into the mouth, have a beneficial effect on the prevention of chronic tonsillitis.
3. Mode of work and rest. In order for the periods of remission to be long, it is necessary to fully relax and not expose yourself to stress. No wonder chronic tonsillitis, like sinusitis, is classified as a social disease, in which the more stress and workload there is, the higher the likelihood of exacerbation of chronic tonsillitis.
4. Diet. It is very important to eat right. In no case should you get carried away with fried, salty, peppery, sour, bitter, i.e. that food that irritates the mucous membrane of the posterior pharyngeal wall and palatine tonsils. Citrus fruits are contraindicated. It is also contraindicated to use alcoholic beverages especially strong ones. It is not advisable to take very hot and very cold and hard food.

Treatment or removal of palatine tonsils?

Dear patients! If you have bypassed several specialists in this field, if a course of treatment for chronic tonsillitis was carried out and none of the methods brought the expected result, then only in this case it is worth thinking about removing the palatine tonsils.

If a conservative approach gives a stable result for 4-6 months or more, then the palatine tonsils are able to fight on their own. Your task is to help the tonsils by regularly sanitizing them and stimulating their work with physiotherapy.

P.S.

Everything that you have just read is written, as I see it, impartially and corresponds to the truth. I had no task to present this or that method of treatment as the best, progressive and correct. The choice is always yours.

I hope that you will give a correct assessment of your condition and choose the best and effective method treatment of chronic tonsillitis.