Chronic tonsillitis toxic allergic form 1. How to treat allergic tonsillitis

Chronic tonsillitis is an inflammatory process with localization in the palatine tonsils, which has taken a sluggish, protracted form. The form of the disease is characterized by periodic relapses (recurrence at certain intervals in the presence of predisposing factors of acute episodes of the disease).

Given that we are talking about an important organ that plays a decisive role in the chain of formation of the immune and physiological types of body defense, the importance of diagnosis and effective mechanisms for treating pathology in physicians is beyond doubt. This is an article prepared by our specialists based on the materials of the work of practicing otolaryngologists.

What it is?

Chronic tonsillitis is a long-term inflammation of the pharyngeal and palatine tonsils (from the Latin tonsollitae - tonsil-shaped glands). Other infectious diseases also develop, accompanied by inflammation of the mucous membrane of the pharynx (,), or without a previous acute illness.

Causes

Factors that contribute to the development of chronic tonsillitis in adults and children:

• curvature of the nasal septum;
• decrease in local and general immunity;
• frequent runny nose;
• inflammatory diseases that develop in other ENT organs;
• caries;
• the presence in the human body of foci of chronic infection;
• allergic mood of the body.

Chronic tonsillitis is an infectious-dependent inflammatory process that develops as a result of the pathogenic activity of microorganisms. Normally, tonsils in the body exist in order to trap infectious agents and prevent them from penetrating deeper into Airways. If there is a decrease in the local or general defenses of the body, then the pathogenic microorganisms that linger on the tonsils begin to actively develop and multiply, provoking the progression of the disease.

Symptoms

Chronic tonsillitis in adults occurs with periods of remission and periods of exacerbations. With the development of an exacerbation, signs of angina develop ():

• a sharp increase in body temperature to febrile figures (39-40 degrees);
• intense sore throat;
• regional lymph nodes increase;
• purulent plaque appears on the tonsils;
• there may also be purulent follicles on the mucous membrane of the tonsils.

During the period of remission, the patient may have the following symptoms of chronic tonsillitis:

• throat discomfort;
• sensation of a lump in the throat;
• slight pain in the morning;
• bad breath;
• plugs on the tonsils;
• small accumulations of pus in lacunae.

Also, in addition to the signs of tonsillitis itself, there may be symptoms of concomitant diseases - chronic pharyngitis, rhinitis, sinusitis.

With the development of a decompensated form, the following symptoms appear:

• increased fatigue;
• general malaise;
• headache;
• prolonged subfebrile condition (temperature is kept around 37 degrees).

In addition, there may be signs of complications. The most common complication in decompensated chronic tonsillitis is paratonsillar abscess.

It begins as a sore throat, but later the patient cannot swallow and open his mouth at all. There is marked swelling of the tissues of the pharynx. The patient needs urgent health care and hospitalization. To provoke an exacerbation of chronic tonsillitis can hypothermia, acute respiratory viral infection, drinking cold drink or food.

What does chronic tonsillitis look like: photo

The photo below shows how the disease manifests itself in adults.

Diagnostics

On examination, the doctor palpates the lymph nodes and directly examines the tonsils. But specialists are not limited to this, given how many complications can be caused by this disease. The content of the gaps is also taken, which is sent for analysis. Taking material for laboratory testing is carried out by pressing on the tonsil, from which pus is released. If the pus has a mucous structure and an unpleasant odor, then most likely there is a chronic form of tonsillitis. But even this analysis cannot show the complete clinical picture and accurately determine the diagnosis.

To make an accurate diagnosis, doctors look at general state organism and the presence of deviations from the norm. Such deviations are primarily considered to be thickened edges. palatine arches and hyperthermia. Also, experts determine cicatricial adhesions between the palatine arches and tonsils.

Tonsils, with a chronic form of tonsillitis, have a loosened appearance, have a scar-modified surface. In the lacunae of the tonsils there are purulent plugs, or purulent discharge.

Consequences

With the transition of tonsillitis to chronic form there is a decrease in the body's immune response, which can affect the functioning of internal organs. In severe cases, when symptoms of intoxication appear, some complications develop.

Prolonged infections lead to complications associated with disruption of the heart, kidney disease. Often, advanced tonsillitis is accompanied by rheumatism, tonsillocardial syndrome. Serious damage to health is caused by toxins that are released during sore throats.

Treatment of chronic tonsillitis

In the treatment of a compensated form and in the absence of complications, conservative treatment of chronic tonsillitis is carried out at home using effective drugs. If the patient has signs of decompensation of chronic tonsillitis and complications develop, then surgery may be required.

First of all, measures are taken to strengthen the body's defenses - proper nutrition, reducing bad habits. In the presence of concomitant diseases, which are also sources of permanent infection, they need to be cured:

• mandatory sanitation oral cavity- treatment of inflammatory diseases (caries,);
• treatment , .

How to treat chronic tonsillitis: a list of drugs

For the conservative treatment of chronic tonsillitis in adults, the following drugs:

1. with tonsillitis. This group of drugs is prescribed only in the presence of an exacerbation of the chronic form of tonsillitis, antibiotic therapy is recommended based on the data of the tank. sowing. Blindly prescribing drugs is not worth it, as this can cause a lack of effect and loss of time, not to mention side effects and worsening of the condition. Depending on the severity of the inflammatory process in angina, the doctor may prescribe a short course of the safest and easiest means, since with long courses of strong drugs, it is necessary to supplement the treatment with a course of probiotics. In the latent course of chronic tonsillitis, treatment with antimicrobial drugs is not indicated, since this further disrupts the microflora of the oral cavity and gastrointestinal tract, and also provokes immune suppression.
2. Painkillers. With pronounced pain syndrome, the most optimal is Ibuprofen or Nurofen, they are used as symptomatic therapy and with minor pain their use is not advisable (see. full list and prices of non-steroidal anti-inflammatory drugs in the article Injections for back pain).
3. Probiotics. When prescribing aggressive forms of broad-spectrum antibiotics and in the presence of concomitant pathologies of the gastrointestinal tract (reflux, colitis, gastritis), it is imperative to take probiotics before taking antibiotics that are resistant to the former - Normoflorin, Gastrofarm, Primadophilus, Narine, Rela Life, Acipol.
4. Antihistamines. To reduce swelling of the mucous membrane, tonsils, swelling of the posterior pharyngeal wall, it is necessary to take desensitizing drugs, they will also contribute to a better absorption of other medicines. From this group of drugs, it is better to use the latest generation of drugs, since they have a prolonged action and do not have a sedative effect, they are safer and stronger. Among antihistamines, the best are Fexofast, Feksadin, Telfast, Zodak, Letizen, Zirtek, Parlazin, Cetrin.
5. antiseptic local treatment. An important condition effective treatment is gargling, for this you can use various solutions, both ready-made sprays, and dilute special solutions yourself. It is most convenient to use Miramistin (250 rubles), which is sold with a spray 0.01% solution, Octenisept (230-370 rubles), which is diluted with water 1/5, and Dioxidin (1% solution 200 rubles 10 ampoules), 1 amp. diluted in 100 ml of warm water (see list of all throat sprays). Aromatherapy can also provide positive action if performed by gargling or inhalation essential oils- lavender, tea tree, eucalyptus, cedar.
6. Antiseptic local treatment. An important condition effective therapy is a gargle. For these purposes, you can use both ready-made sprays and self-prepared solutions. It is most convenient to use Miramistin 0.01% solution, Octenisept, Dioxylin, which are diluted with warm water. Aromatherapy also has a positive effect if you gargle and inhale with essential oils - cedar, eucalyptus, tea tree, lavender.
7. Immunostimulatory therapy. Among the drugs that can be used to stimulate local immunity in the oral cavity, perhaps only Imudon is indicated for use, the course of therapy for which is 10 days (absorbable tables 4 r / day). Among the means of natural origin for raising immunity, you can use Propolis, Pantokrin, ginseng, chamomile.
8. Emollients. From inflammation in the throat and taking some medicines dry mouth, sore throat, perspiration may occur, in such cases it is effective to use sea buckthorn, peach, apricot oils, provided that there is no individual intolerance to them. In order to soften the nasopharynx well, you can instill one of the oils into the nose in the morning and in the evening, a few drops, during the procedure you should tilt your head back. Another method of soothing the throat is 3% hydrogen peroxide, which is used to gargle for as long as possible, after which the mouth is rinsed with warm water.

Purulent plugs in chronic tonsillitis

Physiotherapy methods

Physiotherapy treatment of chronic tonsillitis can effectively act during remission - laser therapy is recognized as very effective, due to its antibacterial and anti-inflammatory effect, due to a direct effect on the tonsils. Short-wave UV radiation of the throat and oral cavity is also used.

There are methods of ultrasonic impact on the tonsils, which act on the very source of the disease, destroying the structure of the formed curd mass. Using ultrasound, you can also irrigate the tonsils with antiseptic solutions.

Moist steam inhalation is an effective remedy. But there is one contraindication here - heat, so the temperature must first be brought down, and only then carry out inhalation. Inhalations can be used with various medicinal herbs- chamomile, calendula, etc., chlorhexidine solution, or you can just breathe over potatoes. You should not take deep breaths during inhalation, because in the case of tonsillitis, only the inflamed tonsils should be affected.

Treatment of tonsillitis at home

Consider some of the most interesting recipes for the treatment of tonsillitis at home, which include honey and its derivatives:

• For oral administration, prepare onion juice and honey in half. Mix thoroughly and drink 1 teaspoon 3 times a day;
• Mix chamomile flowers and oak bark in proportions 3:2. Pour four tablespoons of the mixture with 1 liter of hot water and boil over low heat for 10 minutes. Before turning off, add a tablespoon of linden flowers. Allow to cool, strain, add a teaspoon of honey to the solution. Mix thoroughly and gargle while warm.
• To lubricate the tonsils, a mixture is prepared, consisting of 1/3 of freshly squeezed juice of aloe leaves and 2/3 of natural honey. The mixture is gently mixed and stored in the refrigerator. Before use, the medicinal composition must be warmed to 38-40 degrees Celsius. With a wooden or plastic spatula, the composition is carefully applied to sore tonsils 1-2 times a day, at least 2 hours before meals. Repeat the treatment daily for two weeks. Then the procedure is done every other day.

Surgical treatment

Such treatment is mainly carried out when decompensated chronic tonsillitis is detected and in the absence of a positive effect from repeated conservative treatment.

Tonsillectomy can be total or partial. With a total tonsillectomy, a total excision of the affected tonsils is performed. Partial tonsillectomy can reduce the size of enlarged tonsils, but this operation is now rarely performed due to the high risk of recurrence of the disease. to rare species surgical treatment include galvanocaustics and diathermocoagulation.

New treatments for tonsillitis include laser lacunotomy, an operation to remove the tonsils using a surgical laser. It is possible to carry out such treatment with the use of surgical ultrasound.

Cryodestruction is gaining popularity - freezing the tonsils with liquid nitrogen. Its use is justified with a slight increase in the size of the tonsils.

Tonsillectomy (removal of the tonsils)

Prevention

Prevention of exacerbations of chronic tonsillitis:

1. Compliance with the rules of hygiene of the home and work premises.
2. Elimination of dust, air pollution.
3. General hygienic measures.
4. hardening.
5. Balanced diet.
6. Sanitation measures: detection and treatment of diseases of the gums and teeth, sinusitis, otitis media, nasal breathing disorders.

It should be noted that even the implementation of all of the above measures does not at all guarantee the exclusion of relapses.

Chronic tonsillitis is a condition of the palatine tonsils, in which, against the background of a decrease in local natural protective functions, their periodic inflammation occurs. Therefore, the tonsils (tonsils) become a constant focus of infection, with chronic allergization and intoxication of the body. Symptoms of chronic tonsillitis are clearly manifested during periods of relapse, when during an exacerbation the body temperature rises, lymph nodes increase, pain appears, sore throat, pain when swallowing,.

Against the background of reduced immunity and in the presence of a chronic focus of infection, patients with chronic tonsillitis can subsequently suffer from diseases such as rheumatism, pyelonephritis, adnexitis (see), prostatitis, etc. Chronic tonsillitis, sinusitis, sinusitis are social diseases of a modern resident of a metropolis , since the unfavorable ecological situation in cities, monotonous chemicalized nutrition, stress, overwork, an abundance of aggressive, negative information have a very negative effect on the state immune system population.

Why does chronic tonsillitis occur?

The main function of the palatine tonsils, as well as other lymphoid tissues in the human pharynx, is to protect the body from pathogenic microorganisms that enter the nasopharynx with food, air, and water. These tissues produce such protective substances as interferon, lymphocytes, gamma globulin. In the normal state of the immune system, both non-pathogenic and conditionally pathogenic microflora are always present on the mucous membrane and in the depths of the tonsils, in lacunae and crypts, in the correct, natural concentrations, without causing inflammatory processes.

As soon as there is an intensive growth of bacteria coming from outside or opportunistic bacteria present, the palatine tonsils destroy and remove the infection, leading to the normalization of the condition - and all this happens unnoticed by a person. When the balance of microflora is disturbed for various reasons described below, a sharp growth of bacteria can cause tonsillitis - an acute inflammation that can occur in the form of or

If such inflammations become protracted, often recur and are difficult to treat, the process of resistance to infection in the tonsils weakens, they do not cope with their protective functions, lose their ability to self-cleanse and themselves act as a source of infection, then a chronic form develops - tonsillitis. In rare cases, in about 3%, tonsillitis can develop without a preliminary acute process, that is, its occurrence is not preceded by angina.

In the tonsils of patients with chronic tonsillitis, bacterial analysis highlights almost 30 pathogenic bacteria, but in the lacunae, streptococci and staphylococci are considered the most numerous.

Before starting therapy, it is very important to take an analysis of the bacterial flora with the establishment of sensitivity to antibiotics, since there is a wide variety of pathogenic microorganisms and each of them can be resistant to certain antibacterial agents. When prescribing antibiotics at random, with bacterial resistance, the treatment will be ineffective or not at all effective, which will lead to an increase in the recovery period and the transition of angina to chronic tonsillitis.

Diseases that provoke the development of chronic tonsillitis:

• Violation of nasal breathing with - polyps (adenoids (), purulent sinusitis, sinusitis (), as well as dental caries) - can provoke inflammation of the palatine tonsils
• Decreased local and general immunity with infectious diseases- measles (see), scarlet fever, tuberculosis, etc., especially with severe course, inadequate treatment, improperly selected drugs for therapy.
• Hereditary predisposition - if there is a family history of chronic tonsillitis in close relatives.

Adverse factors provoking exacerbation of chronic tonsillitis:

• Small amount of liquid consumed per day. A person must drink at least 2 liters of fluid per day, as well as the poor quality of the water consumed daily (use only purified water for cooking, special water filters)
• Severe or prolonged hypothermia of the body
• Strong stressful situations, constant psycho-emotional overstrain, lack of proper sleep and rest, depression, chronic fatigue syndrome
• Work in hazardous production, dustiness, gas contamination of premises at the workplace
• The general unfavorable environmental situation in the place of residence - industrial enterprises, an abundance of vehicles, chemical production, an increased radioactive background, an abundance of low-quality household goods in the living room that emit harmful substances into the air - cheap household appliances, carpet products and furniture made from toxic materials, (chlorine-containing products, washing powders and dishwashing detergents with a high concentration of surfactants, etc.)
• Alcohol abuse and smoking
• Improper nutrition, an abundance of carbohydrates and proteins, limited consumption of cereals, vegetables, fruits.

When the process begins to take on a chronic form in the tonsils, the lymphoid tissue from tender gradually becomes denser, being replaced by connective tissue, scars appear that cover the gaps. This leads to the appearance of lacunar plugs - closed purulent foci in which particles of food, tobacco tar, pus, microbes, both living and dead, dead cells of the epithelium of the mucous membrane of lacunae accumulate.

In closed gaps, figuratively speaking, pockets where pus accumulates, very favorable conditions are created for the preservation and reproduction of pathogenic microorganisms, whose toxic waste products are carried through the body with blood flow, affecting almost everything. internal organs leading to chronic intoxication of the body. Such a process is slow, the overall work of immune mechanisms is confused, and the body may begin to respond inadequately to a constant infection, causing allergies. And the bacteria themselves (streptococcus) cause severe complications.

Symptoms and complications of tonsillitis

Chronic tonsillitis according to the nature and severity of the course of inflammation is divided into several types:

• Simple relapsing form, when sore throats often occur
• A simple lingering form is a long-term sluggish inflammation in the palatine tonsils.
• A simple compensated form, that is, relapses of tonsillitis and episodes of tonsillitis are quite rare.
• Toxic-allergic form, which is of 2 types

With a simple form of chronic tonsillitis, the symptoms are scarce, limited only to local signs - pus in the lacunae, purulent plugs, swelling of the edges of the arches, lymph nodes increase, there is a sensation of a foreign body, discomfort when swallowing, smell from the mouth. During periods of remission, there are no symptoms, and during exacerbations, sore throats occur up to 3 times a year, which are accompanied by fever, headache, general malaise, weakness, and a long recovery period.

1 toxic-allergic form - in addition to local inflammatory reactions, general signs of intoxication and allergization of the body are added to the symptoms of tonsillitis - fever, heart pain with normal ECG values, joint pain, increased fatigue. The patient is more difficult to tolerate, recovery from diseases is delayed.

2 toxic-allergic form - with this form of the disease, the tonsils become a constant source of infection, and there is a high risk of its spread throughout the body. Therefore, in addition to the above symptoms, there are disorders in the joints, liver, kidneys, functional disorders of the heart, detected by ECG, heart rhythm is disturbed, acquired heart defects may occur, rheumatism, arthritis, diseases of the urinary-genital area develop. A person constantly experiences weakness, increased fatigue, subfebrile temperature.

Conservative local treatment of chronic tonsillitis

Treatment of chronic tonsillitis can be surgical and conservative. Naturally, surgery is an extreme measure that can cause irreparable harm to the immune system and the protective functions of the body. Surgical removal of the tonsils is possible when, with prolonged inflammation, the lymphoid tissue is replaced by connective tissue. And in cases where a paratonsillar abscess occurs with a toxic-allergic form 2, its opening is indicated.

• Enlarged tonsils interfere with normal nasal breathing or swallowing.
• More than 4 sore throats per year
• Peritonsillar abscess
• Conservative therapy without effect for more than a year
• There was an episode of acute rheumatic fever or there is a chronic rheumatic disease, renal complications

The palatine tonsils play an important role in creating an infectious barrier and inhibit the inflammatory process, they are one of the components of support for both local and general immunity. Therefore, otolaryngologists try to save them without resorting to surgery, they try to restore the functions of the palatine tonsils various methods and procedures.

Conservative treatment of an exacerbation of a chronic process should be carried out in the ENT center, with a qualified specialist who will prescribe an adequate complex therapy depending on the form and stage of the disease. Modern methods Treatment of tonsillitis is carried out in several stages:

• Washing lacunae

There are 2 ways of washing the lacunae of the tonsils - one with a syringe, the other with the help of the nozzle of the Tonsilor apparatus. The first method is considered obsolete today, because it is not effective enough, the pressure created by the syringe is insufficient for thorough washing, and the procedure is traumatic and contact, often causing a gag reflex in patients. The greatest effect is achieved if the doctor uses the Tonsilor nozzle. It is used both for washing and for the introduction of medicinal solutions. First, the doctor flushes the lacunae with an antiseptic solution, while he clearly sees what is being washed out of the tonsils.

• Ultrasonic medicinal irrigation, Lugol treatment

After cleaning from a pathological secret, you should change the tip to an ultrasonic one, which, due to the ultrasonic effect of cavitation, creates a medicinal suspension and with force delivers the medicinal solution to the submucosal layer of the palatine tonsils. A 0.01% solution is usually used as a medicine; this remedy is an antiseptic that does not lose its properties under the action of ultrasound. Then, after this procedure, the doctor may treat the tonsils with Lugol's solution (see).

• Therapeutic laser

Recent studies by scientists lead to the conclusion that in chronic sinusitis, sinusitis, tonsillitis, an important role is played by the imbalance of the microflora of the nasopharyngeal mucosa and conditionally pathogenic microorganisms begin to multiply with an insufficient amount of beneficial flora that inhibits the growth of pathogenic bacteria. (cm. )

One of the options for the preventive and maintenance treatment of tonsillitis can be gargling with preparations containing live cultures of acidophilic lactic acid bacteria - Narine (liquid concentrate 150 rubles), Trilakt (1000 rubles), Normoflorin (160-200 rubles). This normalizes the balance of the microflora of the nasopharynx, contributes to a more natural recovery and a longer remission.

Medication effective treatment

Only after establishing an accurate diagnosis, clinical picture, degrees and forms of chronic tonsillitis, the doctor determines the tactics of managing the patient, prescribes a course of drug therapy and local procedures. Drug therapy consists in the use of the following types of drugs:

• Antibiotics for tonsillitis

• Probiotics

When prescribing aggressive broad-spectrum antibiotics, as well as with concomitant diseases of the gastrointestinal tract (gastritis, colitis, reflux, etc.), be sure to take antibiotic-resistant probiotic preparations simultaneously with the start of therapy - Rela Life, Narine, Primadophilus, Gastrofarm, Normoflorin ( see whole )

• Painkillers

With a pronounced pain syndrome, Nurofen is the most optimal, they are used as symptomatic therapy and with minor pain their use is not advisable (see the full list and prices of non-steroidal anti-inflammatory drugs in the article).

• Antihistamines

To reduce swelling of the mucous membrane, swelling of the tonsils, posterior pharyngeal wall, it is necessary to take desensitizing drugs, as well as for more efficient absorption of other drugs. Among this group, it is better to use the latest generation drugs, they have a longer, prolonged action, do not have a sedative effect, are stronger and safer. Among the antihistamines, the best ones can be distinguished - Parlazin, Zirtek, Letizen, Zodak, as well as Telfast, Feksadin, Fexofast (see). In the case when one of these drugs helps the patient with prolonged use, you should not change it to another.

• Antiseptic topical treatment

An important condition for effective treatment is gargling, for this you can use various solutions, both ready-made sprays, and dilute special solutions yourself. It is most convenient to use Miramistin (250 rubles), which is sold with a spray 0.01% solution, Octenisept (230-370 rubles), which is diluted with water 1/5, and Dioxidin (1% solution 200 rubles 10 ampoules), 1 amp. diluted in 100 ml of warm water (see). Aromatherapy can also have a positive effect if you gargle or inhale with essential oils - lavender, tea tree, cedar.

• Immunostimulating therapy

Among the drugs that can be used to stimulate local immunity in the oral cavity, perhaps only Imudon is indicated for use, the course of therapy for which is 10 days (absorbable tables 4 r / day). Among the means of natural origin for raising immunity, you can use Propolis, Pantokrin, ginseng,.

• Homeopathic treatment and folk remedies

An experienced homeopath can choose the optimal homeopathic treatment and, if his recommendations are followed, it is possible to prolong remission as much as possible after the removal of an acute inflammatory process by traditional methods of therapy. And for gargling, you can use the following medicinal plants:, chamomile, eucalyptus leaves, willow buds, Icelandic moss, aspen bark, poplar, as well as the roots of burnet, elecampane, ginger.

• Emollients

From the inflammatory process and taking certain medications, itching, soreness in the throat appears, in which case it is very effective and safe to use apricot, peach, sea ​​buckthorn oil, taking into account the individual tolerance of these funds (lack of allergic reactions). To properly soften the nasopharynx, one should instill any of these oils into the nose a few drops in the morning and evening, while instilling the head should be thrown back. Another way to soften the throat is 3% hydrogen peroxide, that is, a 9% and 6% solution should be diluted and gargle with it for as long as possible, then gargle with warm water.

• Nutrition

Diet therapy is an integral part of successful treatment, any hard, hard, spicy, fried, sour, salty, smoked food, very cold or hot food, saturated with flavor enhancers and artificial additives, alcohol - significantly worsens the patient's condition.

Chronic tonsillitis is a sluggish inflammatory process that occurs in the palatine tonsils. Patients with chronic tonsillitis for a long time feel discomfort and pain in the throat, they have an increase in temperature, reddening of the tonsils with the formation of purulent plugs in the gaps.

What are tonsils and how does the disease appear

The palatine tonsils consist of lymphoid tissue, which performs a protective function. The tonsils are pierced by deep and complex channels - crypts, which end on the surface of the tonsils with lacunae - special recesses through which the contents of the lacunae are brought out. On average, there are 2 to 8 lacunae on the amygdala. It is believed that the larger the size of the gaps, the easier and faster the discharge is removed.

In addition to the palatine tonsils, there are other formations in the pharynx that perform a protective function: the lingual tonsil is located on the root of the tongue, adenoid vegetations (adenoids) are located on the back wall of the nasopharynx, and tubal tonsils are located in the depths of the nasopharynx around the auditory tube.

Inflammation of the tissues of the palatine tonsils is called tonsillitis, and a protracted inflammatory process is called chronic tonsillitis.

Types of chronic tonsillitis

Depending on how the disease proceeds, chronic tonsillitis can be:

• compensated;
• decompensated;
• protracted;
• recurrent;
• toxic-allergic.

Compensated tonsillitis proceeds secretly: the tonsils are not disturbed by discomfort and inflammation, the patient does not have an increase in temperature, however, redness is visible on external examination, the tonsils are usually enlarged.

In chronic tonsillitis, from time to time there is discomfort in the throat - perspiration, slight pain. Exacerbations of the disease - tonsillitis - disturb the patient with a recurrent form of tonsillitis.

Toxic-allergic chronic tonsillitis is divided into two forms:

• the first form is characterized by the addition to the main symptoms of such complications as joint pain, fever, pain in the heart area without worsening the electrocardiogram, increased fatigue;
• the second form turns the palatine tonsils into a stable source of infection that spreads throughout the body and complicates the work of the heart, kidneys, joints, and liver. The patient feels tired, efficiency decreases, heart rhythm is disturbed, joints become inflamed, diseases of the urogenital area become aggravated.

Depending on the location of the spread of the inflammatory process, chronic tonsillitis can be:

• lacunar, in which inflammation affects the lacunae - depressions in the tonsils;
• lacunar-parenchymal, when inflammation occurs in the lacunae and lymphoid tissue of the tonsils;
• phlegmonous, when the inflammatory process is accompanied by purulent fusion of tissues;
• hypertrophic, accompanied by increased proliferation of tissues of the tonsils and surrounding surfaces of the nasopharynx.

Causes of chronic tonsillitis

Chronic tonsillitis in most cases develop after being transferred to patients acute form diseases - acute tonsillitis or tonsillitis. Untreated tonsillitis may reappear or become aggravated due to plugs in the lacunae and crypts of the tonsils, which are clogged with caseous-necrotic masses - purulent secretions, waste products of bacteria and viruses.

The main causative agents of the disease are most often:

• viruses - adenoviruses, herpes simplex, Epstein-Barr virus;
• bacteria - pneumococci, streptococci, staphylococci, moraxella, chlamydia;
• fungi.

In addition, the following factors can affect the appearance of chronic tonsillitis:

• non-observance of safety precautions in production: a large amount of dust, the presence of smoke, gas contamination, suspensions harmful substances in the inhaled air;
• chronic diseases of the oral cavity, ears, nasopharynx: chronic otitis, sinusitis, caries, pulpitis, periodontitis and periodontal disease, in which purulent secretions fall on the tonsils and provoke the development of the inflammatory process;
• decreased immune function of the palatine tonsils: the protective substances secreted by the lymphoid tissue can no longer cope with a large number of bacteria and viruses, which, in turn, accumulate and multiply;
• abuse of household chemicals;
• eating food containing a small amount of vitamins and minerals, irregular meals, low-quality food;
• heredity factor: either of the parents suffered or is suffering from chronic inflammation of the tonsils;
• bad habits - drinking alcohol and smoking, which, in addition to a negative effect on the immune system, complicate the course of the disease;
• frequent stressful situations, prolonged exposure to a state of strong emotional stress;
• lack of a normal mode of work and rest: lack of sleep, overwork.

It is extremely difficult to determine on your own whether a person has chronic tonsillitis: this should be done by an experienced otolaryngologist. However, you need to know the main symptoms and signs of the disease, the appearance of which should immediately consult a doctor:

• headache;
• an unpleasant sensation of foreign bodies in the throat: crumbs with sharp edges, small fragments of food (caused by the accumulation of putrefactive deposits and plugs of mucus, waste products of bacteria and viruses on lacunae and scripts);
• persistent rash on the skin that does not go away for a long time, provided that the patient has not had any rashes before;
• increase in body temperature;
• pain in the lumbar region: chronic inflammation of the tonsils often causes complications in the work of the kidneys;
• pain in the heart, unstable heart rhythm;
• pain in the muscles and joints: chronic tonsillitis often leads to rheumatic damage to the joints;
• fast fatiguability, decreased performance, bad mood;
• swollen lymph nodes behind the ears and on the neck;
• increase in palatine tonsils;
• the appearance of scars, adhesions, films on the tonsils;
• plugs in lacunae - formations of yellow, light brown, brown shades of solid or mushy consistency.

Most of the additional signs of chronic tonsillitis appear when other organs and vital systems fail: the heart, kidneys, blood vessels, joints and immune system.

Only an otolaryngologist can correctly establish the presence, form and type of chronic tonsillitis, so timely contact with the clinic is the key to a quick diagnosis and treatment.

The most accurate signs chronic disease obtained by studying the medical history and conducting an external examination of the palatine tonsils: the greatest likelihood of tonsillitis will be indicated by frequent sore throats, as well as purulent deposits and plugs in lacunae and crypts.

In addition to studying the anamnesis and examination, apply laboratory research blood and cultures from the pharynx for flora and sensitivity to antibiotics.

Treatment

For the treatment of chronic tonsillitis, conservative and surgical methods. An otolaryngologist prescribes a surgical operation only as a last resort: the palatine tonsils play an important role in the human immune system, protecting the nasopharynx from the penetration of pathogens. Removal of the tonsils can only be carried out if they are in force pathological change tissues can no longer perform their protective function. When deciding on the surgical removal of the palatine tonsils, you need to remember once again that this is the most important part of the overall immune system of the body, responsible for protecting the organs of the nasopharynx.

Treatment of chronic tonsillitis is carried out on an outpatient basis in medical institution otolaryngologist. The treatment process can be divided into several stages, each of which performs its function.

Stage one: washing the palatine tonsils

At this stage, the patient is washed with tonsils, freeing lacunae and crypts from caseous-necrotic masses and plugs. In the absence of modern equipment, such work is usually performed with an ordinary syringe: a disinfectant solution is drawn into it and squeezed out with a piston onto the surface of the tonsils and into the gaps. The disadvantages of this method are too low pressure of the solution jet, which does not allow deep washing and cleaning of the crypts, as well as the possible occurrence of a gag reflex caused by touching the syringe to the tonsils.

In most cases, modern equipment is used - the Tonsillor ultrasonic vacuum device used by modern clinics and ENT centers. The rinsing nozzle allows you to thoroughly rinse the tonsils without touching them, without causing gag reflexes. The advantage of using the nozzle is that the doctor can observe and control the process of washing out pathological contents from the tonsils.

Stage two: antiseptic treatment

After cleansing the tonsils, an antiseptic is applied to them using ultrasound: ultrasonic waves convert the antiseptic solution into steam, which is applied under pressure to the surface of the tonsils.

To consolidate the antibacterial effect, the tonsils are treated with Lugol's solution: it contains iodine and potassium iodide, which have a powerful antibacterial property.

Stage Three: Physiotherapy

One of the effective, painless and free side effects methods of physiotherapy is laser therapy. Its positive properties:

• anesthesia;
• activation of metabolic processes;
• improvement of metabolism in the affected organ;
• regeneration of affected tissues;
• increased immunity;
• a significant improvement in the properties and functions of blood and blood vessels.

To neutralize harmful microorganisms in the oral cavity, ultraviolet radiation is used.

The number of procedures for washing, treatment with antiseptics and physiotherapy is prescribed by the doctor on an individual basis. On average, in order to completely cleanse the tonsils and restore their ability to self-cleanse, washing must be repeated at least 10-15 times. To completely eliminate the need surgical intervention, courses of conservative treatment are repeated several times a year.

In extreme cases, when the lymphoid tissue of the tonsils is replaced as a result of the disease connective tissue and the tonsils cease to protect the body from microorganisms, being a constant source of pathogens, a tonsillectomy is prescribed. Tonsillectomy - surgery for the removal of palatine tonsils. It is performed in a hospital setting under local or general anesthesia.

Prevention of chronic tonsillitis

Preventive measures to avoid recurrence of the inflammatory process in the region of the palatine tonsils include several comprehensive measures:

• proper nutrition: do not eat food that irritates the mucous membranes of the tonsils - citrus fruits, spicy, spicy, fried, smoked foods, strong alcoholic drinks;
• strengthening of general immunity: hardening, walking in the fresh air, taking vitamin and mineral complexes;
• rest and work regimen: it is necessary to get enough sleep, devote time for proper rest, avoid long hours of work without interruptions.

is a chronic inflammation of the palatine tonsils.

The palatine tonsils (popularly called tonsils) are an important part of the human immune system.

Bacteria, viruses, microscopic fungi enter us with food and air. They settle on the mucous membranes, where they are picked up by a constant current of mucus, and this “river” flows in the direction of the oropharynx, just where the tonsils are located behind the palatine arches.

The palatine tonsils are like a sponge. They are dotted with lacunae. When we swallow a food bolus soaked in infected mucus, this mucus enters the lacunae of the tonsils. There, the guard cells of the primary immune response attack foreign microorganisms: neutrophils and macrophages. The latter not only kill the infection, but also “cut” it into small molecular fragments, on which the young cells of the secondary immune response – lymphocytes – are then “trained”. Prepared and trained lymphocytes leave the tonsils and “spread” along the mucous membranes of the pharynx and nose, forming a fairly reliable secondary specific defense.

Causes of chronic tonsillitis

In fact, in the tonsils, inflammation takes place all the time - this is their function. But sometimes the protective resources of the tonsils are not able to cope with the infection, and then the inflammation, which has escaped from control, turns into a serious disease - tonsillitis.

Symptoms of chronic tonsillitis

The inflammatory process in the tonsils can spread to neighboring organs, and then the person may complain of nasal congestion, sore throat, dry cough, and these secondary symptoms may be predominant.

In chronic tonsillitis, there may also be complaints of pain in the joints (knee, elbow, wrist), especially in the evening and when the weather changes, flying pains in the heart, feeling without physical exertion, pain in the lumbar region. On can be detected and .

Such symptoms are a serious cause for concern, since they can accompany the development of severe autoimmune diseases of the kidneys, heart, nervous system which are complications of tonsillitis. This happens when inflammation in the tonsils causes the immune system to malfunction; as a result, antibodies are produced, but not to the causative agent of the disease, as it should be, but to the heart muscle, joint tissue and connective tissue. The frustrated defense system of the body tries to destroy the body itself.

The insidiousness of chronic tonsillitis also lies in the fact that it can occur without obvious symptoms. In this case, between outbreaks of angina, a person does not complain about anything, although a focus of inflammation remains in the tonsils.

The main symptoms of chronic tonsillitis itself are:

Sore throat

In chronic tonsillitis, there are sore throats when swallowing, especially in the morning. The appearance or intensification of such pain can cause swallowing of cold food or liquids.

Feeling of discomfort in the throat

There may be no pain as such, but there may be discomfort when swallowing, a sensation of a foreign body in the throat.

subfebrile temperature

In chronic tonsillitis, there may be a temperature that does not decrease for a long time (37.2-37.5 ° C).

Bad smell from mouth

Inflammation in the tonsils can be manifested by persistent bad breath.

General weakness

Typical manifestations of chronic tonsillitis are fatigue, sweating, weakness, and poor health.

Methods of treatment of chronic tonsillitis

It is very important to defeat chronic tonsillitis: otherwise, a constant source of infection and intoxication of the whole organism remains, not to mention the threat of severe autoimmune complications.

Home remedies can reduce the severity of symptoms, but it is difficult to achieve a complete cure. Tonsillitis is a disease that is too complex in nature and the nature of the course. Therefore, if you suspect chronic tonsillitis, you should consult a doctor.

First of all, you should comprehensive examination, allowing to determine the pathogen and the stage of development of the disease.

Before treating tonsillitis, it is necessary to eliminate other sources of infection - to cure carious teeth, inflammation in the nose and paranasal sinuses. If your child often suffers from tonsillitis, then it is very likely that one of the family members is a carrier of the infection. In this case, it makes sense to be examined by the whole family.

With complaints corresponding to the symptoms of chronic tonsillitis, you can consult a doctor general practice( or ) or to a specialized specialist - an otolaryngologist (ENT).

Sluggish long inflammation of the palatine tonsils- chronic tonsillitis. Its symptoms, unlike acute tonsillitis (tonsillitis), are not always obvious. Despite the localization of inflammation, chronic tonsillitis is a common disease. Its danger cannot be underestimated.

palatine tonsils
Their meaning

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

• Tonsils:

- 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.

• The mucous membrane of the tonsils:

- inflamed, reddish or bright red.

• Lacunae:

- 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.

• Palatine arches:

- reddish or bright red;
- the edges are edematous;
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:

- can be frequent, for the slightest reason;
- sometimes chronic tonsillitis proceeds without exacerbations (nonanginal form);
- atypical tonsillitis - proceed for a long time, with reduced or slightly elevated temperature body, accompanied by severe general intoxication ( headache nausea, muscle and joint pain).

• Regional cervical The lymph nodes:

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

• Intoxication:

- subfebrile (37 - 38 0 C) increase in body temperature in the evenings;
- "unmotivated" headache;
- nausea, digestive problems;
- lethargy, fatigue, low 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.

• Diseases of the endocrine system:

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

• Violation of the regime of work and rest:

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.

• Elderly age.

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 secondary IDS:

• Protozoal diseases, helminthiases:

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

• Chronic bacterial infections:

leprosy, tuberculosis, caries, pneumococcal and other infections.

• Persistent viruses:

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

• Nutrition Defects:

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

HT form. Treatment tactics.	Clinical symptoms
Simple form. Conservative treatment.	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. 5. Regional lymphadenopathy.
Toxic-allergic form I degree TAF I Conservative treatment.	1. All symptoms of a simple form. 2. Periodic increase in body temperature 37-38 0 С. 3. Weakness, fatigue, headaches. 4. Pain in the joints. 5. Inflammation cervical lymph nodes- lymphadenitis.
Toxic-allergic form II degree TAF II Tonsillectomy	1. All symptoms of TAF I. 2. Pain in the region of the heart, arrhythmia. Functional disorders the work of the heart is recorded on the ECG. 3. Clinical and laboratory symptoms of a violation of the urinary system, gastrointestinal tract are registered, of cardio-vascular system, joints. 4.Register complications of chronic tonsillitis: - paratonsillar abscess; - pharyngitis, parapharyngitis; - rheumatic diseases, infectious diseases joints, heart, urinary and other systems, infectious-allergic nature. - tonsillogenic sepsis.

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.

Diagnosis of chronic tonsillitis

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 often found in healthy people.

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

Treatment of chronic tonsillitis
symptomatic/local/general

The basis of conservative treatment of chronic tonsillitis is the restoration of local, general immunity and desensitization (suppression of allergic reactions) of the body.

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 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 the inhaled air: ventilation, installation of air humidifiers in heated rooms;
- moisturizing the mucous membranes in a natural way: drink 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 appoints 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:
- UV irradiation, quartz treatment;
- UHF, microwave;
- ultrasound treatment.
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 tonsils - is carried out 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, balanced nutrition, 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.

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