Chronic tonsillitis symptoms and treatment. Chronic tonsillitis: symptoms and treatment at home

Chronic tonsillitis - chronic inflammation of the palatine tonsils, if other tonsils are affected, the location is indicated - chronic adenoiditis, tonsillitis of the lingual tonsil. Exacerbation chronic tonsillitis always occurs in the form of a sore throat . Chronic tonsillitis and tonsillitis are different diseases, with different pathogenesis and pathomorphological picture. More often metatonsillar diseases (endocarditis, nephritis, rheumatism, tonsillitis sepsis, etc.) occur in patients with rare sore throats. Also recognized non-anginal form chronic tonsillitis. The age of patients with chronic tonsillitis is practically unlimited, the same number of men and women suffers, the number of patients is 2.5% in Russia, and in large cities up to 4.4%.

Causes of occurrence.

- frequent sore throats (maybe without previous sore throats), the presence of purulent inflammation of the maxillary sinuses, inflammation of the adenoids, dental caries.

- deviated nasal septum,

- presence of nasal polyps (difficulty in nasal breathing).

- decrease in general and local resistance of the body after infectious diseases (scarlet fever, measles, etc.) and during hypothermia.

Highlight simple (compensated) And toxic-allergic (decompensated) forms of chronic tonsillitis. Toxic-allergic form (TAF), in turn is divided into two subforms: TAF1 and TAF2.

- TAF1 (toxic-allergic form 1)

Local signs of inflammation are accompanied by general toxic-allergic manifestations: fatigue, periodic ailments and slight increases in temperature. Joint pain appears from time to time. Recovery periods for respiratory diseases become long and protracted.

- TAF2 (toxic-allergic form 2)

The above-mentioned manifestations of chronic tonsillitis are accompanied by functional disorders of the heart with changes in the ECG pattern. Possible heart rhythm disturbances and prolonged low-grade fever. Functional disorders in the joints, vascular system, kidneys and liver are detected. General (acquired heart defects, infectious arthritis, rheumatism, tonsillogenic sepsis, a number of diseases of the urinary system, thyroid and prostate glands) and local (pharyngitis, parapharyngitis, peritonsillar abscesses) associated diseases are added.

Symptoms Outside of exacerbation, there are no general symptoms. In the acute phase sore throat clinic - chills, t-38-40 degrees, body aches, weakness, refusal to eat, insomnia; pain when swallowing, increased salivation, redness of the palate, uvula, arches, tonsils, vomiting (more often seen in children); enlarged lymph nodes (submandibular); plaque on the tonsils (white with yellowish tint); bad breath. Characterized by frequent sore throats (up to 3 times a year) with a protracted period of recovery, which is accompanied by fatigue, malaise, general weakness and a slight increase in temperature. In the toxic-allergic form of chronic tonsillitis, tonsillitis develops more often than 3 times a year, often complicated by inflammation of neighboring organs and tissues (peritonsillar abscess, pharyngitis, etc.). The patient constantly feels weak, tired and unwell. The body temperature remains low-grade for a long time. Symptoms from other organs depend on the presence of certain associated diseases.

Complications. With chronic tonsillitis, the tonsils turn from a barrier to the spread of infection into a reservoir containing a large number of microbes and their metabolic products. Infection from affected tonsils can spread throughout the body, causing damage to the heart, kidneys, liver, and joints (associated diseases). The disease changes the state of the body's immune system. Chronic tonsillitis directly or indirectly affects the development of certain collagen diseases (dermatomyositis, scleroderma, periarteritis nodosa, systemic lupus erythematosus), skin diseases (eczema, psoriasis) and peripheral nerve damage (radiculitis, plexitis). Long-term intoxication in chronic tonsillitis is a risk factor for the development hemorrhagic vasculitis and thrombocytopenic purpura.

Diagnostics - examination by an otolaryngologist, careful collection of anamnesis (frequency of tonsillitis, etc.); blood tests; pharyngoscopy.

Treatment. The main method of treating chronic tonsillitis is surgical (tonsillectomy, tonsillectomy) , especially with paratonsillitis and metatonsillar diseases, with low-grade fever, frequent malaise, weakness, decreased performance, or with the development of purulent complications.

The palatine tonsils, like other lymphoid formations of the pharyngeal ring, belong to immune structures. They take on the attack of the infection when it tries to enter the body. To combat pathogenic microorganisms, lymphoid tissue can normally increase slightly, but after victory it returns to its previous size.

Thus, temporary hypertrophy of the palatine tonsils of the 1st degree is a variant of the norm for the acute period of an infectious disease. Enlargement of the tonsils to grades 2 and 3 leads to the appearance of symptoms of the disease and requires treatment. The pathology often occurs among children.

Hypertrophy of the tonsils can develop in parallel with an enlargement of the pharyngeal or lingual tonsil. Often, enlarged tonsils are diagnosed against the background of adenoids and vice versa.

Tonsils, depending on their size, can be classified as follows:

1st degree - characterized by a decrease in the throat lumen by a third; in the second degree – the diameter narrows by 2/3; the third degree is characterized by the connection of the surfaces of the tonsils, which completely closes the lumen of the throat.

Causes of hypertrophy

It is not possible to say exactly why the tonsil becomes hypertrophied. However, we can say with confidence that this is a protective reaction of the body to the action of an unfavorable factor.

In children, due to the underdevelopment of the immune system, lymphoid tissue is very variable, so its hyperplasia does not require long-term exposure to a damaging factor.

Predisposing factors that cause the proliferation of lymphoid tissue, which causes hypertrophy of the palatine tonsils in children, include:

decreased immune defense; exacerbation of chronic pathology; poor nutrition; frequent infections (ARVI, influenza); the presence of infection in the throat (pharyngitis) or nasopharynx (sinusitis); chronic tonsillitis, when microbes accumulate in the folds of the mucous membrane, supporting the inflammatory reaction; heavy physical activity; dry polluted air; occupational hazards.

Note that children whose parents suffered from adenoids or had their tonsils removed, that is, with a burdened heredity, suffer more often.

How does it manifest?

When contacting an otolaryngologist, in most cases, proliferation of lymphoid tissue not only of the tonsils, but also of the pharyngeal tonsil is diagnosed. The severity of clinical symptoms depends on the degree of hypertrophy of the tonsils and blockage of the lumen of the larynx.

When you try to independently examine the tonsils in the mirror, only in the second and third degrees can you notice their enlargement. Stage 1 growths are not so noticeable, so a person does not pay attention to the symptoms. Gradually, when grade 2 hypertrophy of the tonsils develops, signs indicating the disease begin to appear. As the tonsils enlarge, they become fused with each other and the uvula.

The consistency of the tonsils becomes compacted with a hyperemic (with inflammation) or pale yellow color. Clinically, a hypertrophied appearance of the tonsils can be noticed by the following signs:

the child begins to breathe heavily, this is especially noticeable when he plays outdoor games; difficulty swallowing; a foreign element is felt in the pharynx; The voice changes and becomes nasal. Sometimes it is not possible to understand what the child is saying the first time, because some sounds are distorted; Sometimes snoring and coughing are noted.

With further growth of lymphoid tissue, the passage of solid food becomes difficult. When the tonsils become inflamed, a sore throat develops. It is characterized by:

acute onset; rapid deterioration of condition; febrile hyperthermia; purulent plaque on the tonsils, suppuration of the follicles, pus in the lacunae.

Diagnostic examination

To make an accurate diagnosis, you need to see a doctor:

at the first stage, the doctor interviews complaints, studies the features of their occurrence, and also analyzes the life history (living conditions, previous and existing diseases). In addition, regional lymph nodes are palpated for inflammation; at the second stage, pharyngoscopy is performed, which makes it possible to examine the condition of the tonsils, assess the extent of the process and determine the degree of proliferation of lymphoid tissue. Rhinoscopy is also recommended; the third stage includes laboratory diagnostics. For this purpose, the patient is sent for microscopy and cultural examination. The material for examination is a smear from the tonsils.

Tests make it possible to confirm or exclude infectious lesions of the tonsils, as well as to establish the sensitivity of microbes to antibiotics.

To identify complications, otoscopy, rigid endoscopy, fibroendoscopy and ultrasound are performed. During the diagnostic process, hypertrophy must be differentiated from chronic tonsillitis, oncopathology and abscess.

Conservative direction in treatment

Before deciding what to use for treatment, it is necessary to analyze the diagnostic results. It is especially necessary to take into account the degree of proliferation of lymphoid tissue, the presence of infection and the inflammatory process.

For systemic action the following may be prescribed:

antibacterial agents (Augmentin, Zinnat); antiviral drugs (Nazoferon, Aflubin); antihistamines that reduce tissue swelling (Diazolin, Tavegil, Erius); vitamin therapy.

For local effects, rinsing the throat with solutions with antiseptic and anti-inflammatory effects is indicated. Furacilin, Chlorhexidine, Givalex and Miramistin are suitable for the procedure. Rinsing with herbal decoctions (chamomile, yarrow, sage) is also allowed.

If necessary, lubrication of the tonsils with solutions with an antiseptic, drying and moisturizing effect is prescribed. To adequately assess the effectiveness of drug therapy, it is necessary to regularly visit a doctor and undergo diagnostics. You can achieve good results by simultaneously strengthening your immune defense.

Surgical intervention

Hypertrophy of the palatine tonsils grade 3 in children should be treated surgically. With such an increase in the tonsils, not only the symptoms of the disease are disturbing, but complications also appear. Impaired breathing is fraught with hypoxia, which makes the child drowsy, inattentive and capricious.

Removal of tonsils, or tonsillectomy, lasts no more than 50 minutes.

To prepare for surgery, it is necessary to undergo a full examination to identify contraindications.

Surgery may be tolerated if:

acute course of an infectious disease; exacerbation of chronic pathology; coagulopathies; uncontrolled diseases of the nervous system (epilepsy); severe bronchial asthma.

In consultation with an otolaryngologist, the issue of removing the adenoids along with the tonsils may be considered if they are hypertrophied. Before surgery, it is necessary to find out the presence of allergic reactions to local anesthetics (novocaine, lidocaine).

Surgery can be performed under local anesthesia or general anesthesia. This is determined by the anesthesiologist during the conversation and based on the diagnostic results.

Typically, tonsillectomy is performed as planned, so the child can be fully examined, thereby preventing complications and easing the postoperative period.

Hospitalization for surgery is carried out when the child:

labored breathing; snore; speech is changed; hypertrophy of the palatine tonsils, grade 3.

In the postoperative period, as before surgery, parents should be with the child. This will calm him down a little and make the surgeons’ work easier. If the child is emotionally labile, in order to prevent him from being pulled out of the hands of the medical staff during the operation, general anesthesia is chosen.

Immediately after the operation, it is forbidden to cough or talk, so as not to injure the blood vessels and cause bleeding.

Do not be alarmed if your child produces copious amounts of saliva mixed with blood. In consultation with your doctor, you can drink water after a few hours, preferably through a straw.

Starting from the second day, liquid foods are allowed, such as yogurt, kefir or broth. Brushing your teeth should be postponed for several days. We emphasize that after the operation you may:

Pain when swallowing appears as a response to tissue injury. Analgesics are prescribed to reduce pain; low-grade hyperthermia; regional lymphadenitis; crusts in the throat; blood in saliva.

Discharge is possible after 10 days. However, this does not mean that you can return to your normal life. The consumption of solid foods, hot drinks and heavy physical activity is also prohibited. It is necessary to remember about the gentle voice mode.

With a slight enlargement of the tonsils, dynamic observation of children by a doctor is necessary, because the size of their tonsils can be normalized. Complications of the operation are extremely rare, so it is considered simple for otolaryngology.

Preventive measures

To protect your child from surgery, it is enough to adhere to the following recommendations:

regularly visit the dentist for a routine examination, because caries is a chronic infection; promptly treat inflammation and infections of the throat (tonsillitis) and nasopharynx (sinusitis); prevent chronic diseases of internal organs; Healthy food; devote enough time to sleep and rest; often walk in the fresh air; regularly ventilate the room, do wet cleaning and humidify the air; play sports (swimming, cycling); avoid contact with allergens; minimal contact with people sick with infectious diseases; do not visit places with large crowds of people during a flu epidemic; to harden; heal the body in sanatoriums on the seashore, in a forest area or in the mountains.

Tonsil hypertrophy in children is a fairly common pathology, but this does not mean that it cannot be avoided. Attention to a child’s health should be paid from birth to create a strong foundation for life.

An increase in size of the palatine tonsils is accompanied by discomfort.

The child feels severe pain, his condition is deteriorating significantly, parents need to think about treating the baby.

We will talk about the symptoms and treatment of tonsil hypertrophy in children in the article.

Read about the prevention of obstructive bronchitis in children here.

General concept

Tonsil hypertrophy in children - photo:

Tonsil hypertrophy is a disease characterized by increase in the size of the palatine tonsils. This disease affects children 4-7 years old.

As soon as a child develops a disease, his breathing becomes impaired. This leads to sleep disturbances and speech becomes unintelligible. The baby hears worse, and coughing often occurs.

If treatment is started on time, the child will recover within 1-2 weeks. In severe cases, the disease requires longer treatment.

The disease arises and develops for the following reasons:

Hypothermia tonsils This happens when breathing while walking in the cold season. Frequent sore throats, tonsillitis. The mucous tissue becomes irritated and the tonsils become enlarged. Infectious diseases. If a child has recently suffered from such an illness, the likelihood of enlarged tonsils increases significantly. Allergic reactions. May lead to enlarged tonsils. Lack of vitamins. This happens with poor nutrition, with a lack of certain substances. Operational disruptions endocrine system. It manifests itself with various symptoms, including enlarged tonsils. Hereditary predisposition. If one of the parents experienced such a process, it may also appear in the child.

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Experts divide this process into three stages of development:

1st degree. Enlarged tonsils occupy 1/3 of the space. The disease practically does not manifest itself, the child’s condition is good; 2nd degree. The tonsils have increased quite significantly, occupying 2/3. The child’s condition is serious, the disease leads to severe pain, weakness, and sleep disturbances; 3rd degree. The tonsils are in contact with each other, the space is almost completely filled with them. Treatment requires serious medications and strict supervision by a specialist. back to contents Symptoms and signs

The following symptoms help identify the disease:

Increase tonsils They become larger and take on a bright pink hue. Labored breathing. The baby is breathing heavily and shortness of breath appears. Pain while swallowing. This manifests itself while eating. Speech unintelligibility. To kid difficult to talk, nasality appears. Many sounds are distorted when pronounced. Cough. The child begins to cough heavily, especially at night. This negatively affects the quality of sleep. Lack of sleep leads to rapid fatigue and weakness. Pallor. The baby looks unhealthy. Promotion temperature. Happens in severe cases.

Signs of the disease also include dizziness, lethargy, and loss of appetite. The child does not play and lies down a lot. Performance is reduced.

If treatment is not started in time, serious complications may occur:

Pharyngitis. The mucous membrane is severely damaged, the tissues become even more sick. Tonsillitis. The sore throat increases significantly, and the temperature may rise. Nervousness. The baby becomes restless, often worried and nervous. Moodiness. Because of a sore throat, the baby cries and is capricious. It is very difficult to calm him down.

By starting treatment for your baby in a timely manner, these phenomena can be avoided.

Find out how to provide emergency care for broncho-obstructive syndrome in children from our article.

It is impossible to diagnose the disease on your own; you need the help of a doctor. The following methods are used to determine the disease:

Inspection child. The doctor carefully examines the baby’s throat and tonsils. General blood analysis. Helps to study the child’s condition and identify significant changes. General Analysis of urine. Thanks to this analysis, the specialist can determine the general condition of the baby. Fiberendoscopy. The procedure is performed using a flexible endoscope. Helps to examine the affected area. Ultrasound larynx. One of the most effective methods. Allows you to carefully examine the tonsils and determine the extent of the disease.

These methods are quite sufficient to determine the disease. Once the disease is identified, doctors prescribe the optimal treatment method.

The main principles of treatment are:

Reception medicines. Appointed by a specialist. Rinse antiseptic solutions. Help relieve swelling and pain. The tonsils gradually decrease to normal size. Avoiding hypothermia. They will only make the process worse. The child should avoid walking during treatment and go outside only in warm weather. Rest, bed rest. It is better for the child to rest and avoid physical activity.

Among the most commonly used solutions are:

silver nitrate. Solution 0.25-2%. The surface of the tonsils is treated with it twice a day. Using cotton wool, carefully lubricate the tonsils with this liquid. It significantly alleviates the child’s condition; Tannin- solution 1-2%. It is used to gargle and lubricate painful areas at least 2-3 times a day; Antiformin. Used for gargling. This is an effective antiseptic that restores healthy microflora of the mucous membrane.

Doctors prescribe medications for patients that have antimicrobial and antiviral properties:

Lymphomyosot. Fights the disease, improves the child’s immunity. The main symptoms of the disease disappear in the first 3-5 days of treatment. Made in the form of drops. You need to take 5 drops three times a day thirty minutes before meals; Umkalor. Effectively fights the disease, eliminates unpleasant symptoms and pain. Release form: drops. It is enough for a child to take the medicine 10 drops three times a day for recovery; Tonsilgon. Fights pathogenic bacteria, eliminates redness and swelling. The throat begins to heal quite quickly. The product is presented in the form of drops. The child is given medicine 10 drops 2-3 times a day.

The duration of treatment is determined by the doctor. Usually it does not exceed ten days. As a rule, these drugs are enough for the baby to recover.

If they do not help, doctors prescribe more serious medications individually. In severe cases, surgery is used.

Tonsil removal takes no more than an hour. The child is sent home the same day. The operation is performed under anesthesia. Recovery after surgery requires at least a week.

Surgery may be contraindicated for certain reasons, so it is used only in extreme cases. The main methods of treatment remain medications.

Experts recommend lubricate tonsils with aloe juice. To do this, juice is extracted from a fresh leaf and mixed with honey. The proportions should be 1:3. The resulting liquid should be lubricated with the baby’s tonsils three times a day. You should not eat food for 30 minutes after the procedure. Recommended gargle with chamomile infusion. To do this, you need to mix a glass of boiling water and a tablespoon of crushed plant. The solution is infused for an hour, then filtered and cooled. Gargle with a warm solution 3-4 times a day. Helpful sea ​​salt solution. To do this, mix a glass of warm boiled water and a teaspoon of sea salt. The finished medicine is used for rinsing 3-4 times a day.

To avoid the occurrence of this disease, you must remember the following preventive measures:

Avoid hypothermia. During the cold season, it is better to stay at home or dress warmly before going outside. Eat healthy foods filled with vitamins. This will strengthen the child's body. With a tendency to allergies the child should avoid contact with the irritant. Carry out regularly cleaning in the baby's room. He must breathe clean air. Rinse your mouth water after meals. This will remove any remaining food from the mouth. Germs will not accumulate in the mouth, and the likelihood of enlarged tonsils is reduced.

This disease is very serious and can cause harm to a child’s body.

With timely treatment, the child can recover in two weeks, Treatment of the child must begin immediately.

You can learn about problems with tonsils in children from the video:

Overgrowth of the glandular tissue of the palatine tonsils occurs in childhood. In the period from 2 years to puberty, children are diagnosed with enlarged tonsils. The causes of the pathological process lie in the underdeveloped organs of the lymphoid system located in the throat.

How does pathology manifest itself in children?

The tissue of the tonsils grows, they occupy more volume in the throat, but there is no inflammatory process. The color and consistency of the organ does not change. Hypertrophy of the tonsils in children occurs regularly; girls and boys are equally susceptible to this process. Treatment depends on the degree of tissue proliferation.

At the first examination, the doctor will determine which tonsils are affected:

Palatine and tubal (paired) glands. The first are located on the sides of the entrance to the pharynx, the second in the hearing organs. Pharyngeal and lingual (unpaired) glands. The first is located on the back wall of the pharynx, the second under the tongue.

The organs of the lymphatic system protect the body from infection, dust and viruses. In a child, they cannot fully perform their functions, since they are not yet developed enough.

Formation finally ends by the age of 12, and then it is expected that the hypertrophy of the palatine tonsils will begin to decline. Not all children require mandatory treatment.

Causes of tonsil enlargement

The palatine and pharyngeal glands are involved in the process. Overgrowth is provoked by recurring sore throats. The chronic inflammatory process largely affects the pharyngeal tonsil, then parents hear the diagnosis “adenoiditis”.

Treatment at the initial stage is aimed at relieving inflammation and reducing the volume of the gland. In serious cases, when hypertrophy of the glands affects breathing, impairs sleep and interferes with normal feeding, surgical removal (complete or partial) is indicated.

During the inflammatory process, the volume of the tonsils increases, and the number of lymphocytes in them increases, which protect the body from invading pathogens. With repeated infections and weak immunity, the tonsils do not have time to recover from inflammation and return to normal size. Staying in an increased state becomes chronic, which becomes a pathology.

There are many more factors for hypertrophy of the lymphatic organs; pharyngoscopy helps to establish the true cause:

susceptibility to allergies; unsuitable climate; caries, stomatitis, thrush; structural features of the maxillofacial apparatus; adrenal disease.

Symptoms of gland hypertrophy in a child

Parents tend to attribute changes in the child’s body to the inflammatory process of a cold. However, when the infection is cured, but breathing is difficult and the child is nasal, this is a reason to consult a doctor.

The following conditions cause a visit to the doctor:

At night, the baby’s breathing is uneven, sometimes with effort; breathing through the mouth predominates; the child is inhibited, speaks and hears poorly; speaks “on the nose”; difficulties with the pronunciation of consonants; pale skin; feeling of nasal congestion.

The child is lethargic, gets tired quickly, and may complain of a headache.

Forms of manifestation of hypertrophy

To select treatment, the degree of enlargement of the gland is determined. To do this, the doctor examines the oral cavity and palatine tonsils, which are visible without the use of special instruments.

In children, it is customary to distinguish 3 degrees of tonsil hypertrophy:

Visually, the palatine tonsils are enlarged, occupying a third of the height from the tongue to the arch of the palate. The lymph glands exceed the midline of the pharynx in height. The tonsils close the lumen of the pharynx, tightly touch or overlap each other.

Tonsil hypertrophy of degrees 1 and 2 in children requires hygiene, cleaning the mouth, rinsing with water and antiseptic solutions. When stage 3 overgrowth of the palatine tonsils has been established, partial or complete removal of the gland tissue is considered.

What are the dangers of a one-sided process?

When an infection occurs, both glands become “activated.” When the process becomes chronic, their simultaneous growth occurs. But, in rare cases, unilateral hypertrophy of the tonsils is diagnosed, which is considered a dangerous symptom.

In this case, you need to urgently visit a doctor to determine the cause of the pathology. The child is shown to an oncologist, a phthisiatrician and a venereologist. The cause of the growth of the gland is lung disease (tuberculosis), syphilis, and a tumor process. Tests help to establish a diagnosis: blood, smears, instrumental examination.

Unilateral proliferation of the tonsil occurs due to the anatomical features of the structure of the pharyngeal organs. In this case, no therapy is required.

Treatment of tonsils with overgrowth

In the initial stages, conservative methods are used:

rinsing; physiotherapy; inhalation; mouth sanitation

Restores the tonsils or prevents their further growth.

trips to the sea; hardening and air baths; strengthening immunity; varied diet.

If a pathological enlargement of the gland complicates the life of a small patient, an operation is performed to remove or partially excise the lymphatic tissue.

In case of pathology of the tonsils, observation of the small patient and compliance with the doctor’s instructions are indicated. With a high probability, the lymph glands will return to normal size and will perform their functional tasks.

The role of the palatine tonsils in maintaining immunity is very high. Hypertrophy of the palatine tonsils (tonsils) is a fairly serious disease. Hypertrophy leads to enlargement of the tonsils, but inflammation of the tonsils does not occur. This disease mainly affects children aged 4-14 years. Often, with hypertrophy of the tonsils, the adenoids are also enlarged in size.

What is palate hypertrophy in children?

The main reasons why hypertrophy of the palatine tonsils occurs in children are as follows:

Frequent inflammatory and infectious diseases of the respiratory system in a child. The disease occurs especially often after diseases such as scarlet fever and measles. Lack of vitamins and nutrients, unbalanced diet, unfavorable weather conditions. For example, in a newborn child, the tissue of the tonsils is not mature enough, therefore, when exposed to unfavorable external factors (inhalation of cigarette smoke from polluted air), it often grows. In this way, the baby’s body tries to resist the negative influence of the environment. Presence of concomitant diseases (chronic tonsillitis). Complicated childbirth (during such childbirth the child is subjected to prolonged asphyxia). Hereditary predisposition. Constant hypothermia. It occurs in cases where nasal breathing is impaired. Stress and heavy physical activity. Staying in conditions of radioactive exposure. Allergic diseases. The child has tuberculosis.

When the hypertrophic process occurs, the child’s breathing becomes difficult. Speech is often unintelligible and unclear, with incorrect pronunciation of some consonants. Sleep becomes restless, as the child is tormented by a cough and often wheezes in his sleep. Hearing impairment with tonsil dystrophy is a common occurrence.

External changes often occur: the child’s upper jaw lengthens and the upper teeth protrude forward. Swallowing food becomes difficult. The skin becomes pale and the shape of the chest changes. The child suffers from headaches, and the performance of school-age children noticeably decreases as their concentration and memory decrease. Children whose tonsils begin to hypertrophy are more likely to suffer from tracheitis and otitis media. Bedwetting may also occur.

Hypertrophy of the palatine tonsils 1st and 2nd degree

Hypertrophy of the tonsils in children has several degrees: the size of the already hypertrophied tonsils is of fundamental importance in the classification.

The first degree of the disease is not too severe. The enlargement of the gland does not interfere with full nasal breathing, but sometimes slight snoring appears. In the second degree of the disease, a strong growth of the tonsil occurs, it closes almost half of the entrance to the nasopharynx. At the third stage of the disease, the entrance is completely closed by overgrown tonsils. Nasal breathing becomes impossible, and the child has to breathe through the mouth.

Proper treatment of the disease helps restore the normal size of the tonsils and ensure their normal functioning. Treatment methods for tonsil hypertrophy are very diverse. At an early stage of the disease, conservative treatment is resorted to. In the treatment of tonsil pathology, the following are used:

Miramistin and Antiformin. They are used to gargle. Homeopathic remedies that have a lymphopropic effect. We are talking about Tonsillgon, Tonsilotren and other drugs. Silver solution. It is necessary to lubricate the tonsils. Drugs that strengthen weakened immunity are also used. If a child experiences an aggravation of tonsillitis, antibacterial therapy is carried out, and the throat must be gargled with antiseptic and disinfectant solutions. Various physiotherapeutic techniques. Particular attention should be paid to ozone therapy, vacuum hydrotherapy and laser therapy. Phonophoresis and balneotherapy are also justified. Visiting sea or mountain resorts is also useful. Therefore, rest in a sanatorium greatly alleviates the condition. The use of oxygen cocktails is also effective.

You can also use mud therapy, which involves applying mud applications to the neck.

At the initial stage of the disease, traditional methods of treatment can also be used. The recipes are simple and effective.

10 grams of honey should be diluted in 200 ml of warm water. Wait until the honey is completely dissolved; this remedy should be used for two weeks to gargle. Approximately 80 grams of dried blueberries should be brewed with half a liter of boiling water, and the mixture should be heated using a water bath. The liquid should reduce in volume by half when evaporated. You can gargle with this decoction. It is also taken orally, a quarter glass 4 times a day. Lubricating the tonsils with freshly squeezed aloe juice is also effective. The procedure must be carried out for at least two weeks. You can pour 20 grams of anise with alcohol. You need to take half a glass of alcohol. The infusion should stand in a dark place for about a week. The resulting tincture can be gargled twice a day for three weeks. It is also useful to lubricate the tonsils with a mixture consisting of peach and glycerin, taken in equal proportions (one to one).

With the initial degree of hypertrophy of the tonsils, it is not recommended:

Resort to self-treatment. You should definitely consult a specialist for advice. Monitor how the child breathes. If he breathes through his mouth, this can become a persistent habit that will be difficult to break in the future.

Hypertrophy of the palatine tonsils 2 and 3 degrees

For grades 2 and 3 of the disease, conservative treatment does not produce significant results. Therefore, surgery is performed. Before it, you need to undergo an examination: take blood and urine tests, do a bacterial test of your tonsils. Often they resort to pharyngoscopy, ultrasound examination of the pharynx or endoscopic examination. It is necessary to distinguish the pathology of the tonsils from the tumor process and infectious diseases of the nasopharynx.

Surgery for this disease is necessary in the following cases:

Due to the strong closure of the tonsils, breathing is difficult. There is a suspicion of a tumor and a biopsy is necessary. Development of gland abscess. Frequent sore throats.

Surgery is performed under appropriate anesthesia. The procedure is not pleasant, but it does not cause pain. A special tonsillotome instrument is used to fix the protruding part of the tonsil. The gland is then quickly removed. Sometimes part of the tonsil is not removed; if its size is small, then the so-called biting of the tonsil with a short contochotomy is performed. The postoperative period has a number of complications:

Possibility of bleeding from the wound. Development of infection and likelihood of suppuration. Possibility of trauma to the palate. Lymph node enlargement.

If the disease recurs, radiation therapy is necessary. After the operation, you cannot exercise for three weeks; it is recommended to eat soft food for a week. You should not take drugs that affect blood clotting for seven days. You should avoid visiting the bathhouse and swimming pool for a month.

Hypertrophy of the palatine tonsils in adults

This disease is observed quite rarely in adults. It can occur in a woman during pregnancy. Symptoms of the disease in an adult are approximately the same as in a child. If nasal breathing is difficult and night snoring occurs, you need to consult a doctor and determine whether there is an enlargement of the palatine tonsils.

Diagnosing pathology in an adult is more difficult than in a child. To examine the tonsil, you need special endoscopic equipment. Enlargement of the tonsil in an adult occurs due to chronic diseases that reduce the body's defense response. Proliferation of the tonsils occurs not only due to tonsillitis and chronic runny nose; caries and otitis media can also be the culprit of the disease. Pathology may occur due to nervous overstrain.

In adults, enlarged tonsils lead to a disease such as rhinitis. With a long course of the disease, kidney problems and heart problems may appear. This disease can be treated with homeopathic remedies, ultrasound, magnetotherapy, laser therapy, and traditional methods. For example, you can prepare a tincture of Kalanchoe, which is used for gargling. For the same purpose, lemon juice with the addition of honey is also useful.

You need to gargle three times a day. You can make compresses on the throat from sage, crushed potatoes or essential oils. If conservative treatment in an adult does not give the desired result, surgery is necessary. Surgical treatment is necessary to prevent the inflammatory process from spreading further. Women suffering from chronic tonsillitis or sinusitis need a comprehensive examination before planning pregnancy.

Because tonsil hypertrophy poses a threat to the health of mother and child. Due to the enlargement of the gland, the fetus experiences a lack of oxygen. This often leads to complications that are undesirable during pregnancy, in particular, it increases the risk of premature birth. If a pregnant woman is diagnosed with tonsil hypertrophy, she must carefully follow all doctor’s instructions to prevent exacerbation of the disease. After all, at the initial stage, antibiotics are not required to combat the disease. Full conservative or surgical treatment is carried out after childbirth or after stopping breastfeeding.

If you go to 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. This is why the tonsils are called tonsils. And since the tonsils are located in the soft palate, they are called palatine tonsils.

Also, in common parlance, the palatine tonsils are also called tonsils. They are one of the important organs of the pharyngeal immune system and form an important part of the Pirogov-Waldeer lymph-epithelial pharyngeal ring.

Palatine tonsil, tonsila palatina. It is located in the tonsillar fossa between the palatoglossus and velopharyngeal arches.

What other tonsils are there in the pharynx?

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 condition 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 at the root of the tongue, which, like the adenoids, is an unpaired organ.

There are also tubal ridges, which are also called tubal tonsils. They are located at the entrance to the pharyngeal mouth of the auditory tube. The tube ridges 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 entering the auditory tube. Since each of the tonsils of the lymphoepithelial pharyngeal ring deserves separate close attention, in this article we will only talk about the palatine tonsils and chronic tonsillitis. Other tonsils and the pathology they cause will be described in detail separately, in other relevant ENT articles.

Read more about tonsils

It must be said that the palatine tonsils are the largest lymphoid formations of the entire pharyngeal ring, and they play, perhaps, the leading role in the disposal 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 enter 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 depressions - lacunae, which in turn are exit holes for deep and sharply convoluted canals - 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, in each amygdala there are from 4 to 7 lacunae. The diameter of the lacunae can also vary, depending on gender, age, individual characteristics of the patient, as well as the duration and severity of the disease and the presence of scar changes in the tonsils themselves.

It is believed that the wider the exit hole - the lacuna - the higher the likelihood 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. Moreover, if the tonsil produces a large amount of caseous-necrotic detritus (plugs), the severity of the course also noticeably increases.

Normally, on the mucous membrane of the palatine tonsils, as well as in the thickness of the palatine tonsils, in the 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 the dangerous infection and normalizes a dangerous condition for the body. At the same time, the macroorganism, that is, the person, does not notice this in any way.

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

The palatine tonsils act as 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 about removing the tonsils.

Chronic tonsillitis

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

If harmful microbes get onto the surface of the mucous membrane and into the lacunae of the palatine tonsil, a real battle occurs between the microbes and the human immune system.

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

As a result of a lost fight, pus accumulates and stagnates in the lacunae of the tonsils, that is, dead leukocytes that come to the aid of the tonsil in the fight against a dangerous infection. The purulent masses irritate and inflame the tonsil tissue from the inside and have a toxic effect on it, thereby causing a sore throat - a severe infectious outbreak of inflammation of the 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 an attack of tonsillitis.

Forms of the disease

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

Chronic tonsillitis can affect both adults and children, 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 among them. Poor environment, 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 sore throats (acute tonsillitis). Very often, incompletely cured tonsillitis leads to chronic tonsillitis. Very often, tonsillitis is an exacerbation due to the accumulation of plugs in the tonsils - caseous-necrotic masses, which are often confused with food debris.

Main reasons for development

1. Unfavorable working conditions. The greatest influence is exerted by gas and dust levels in the air at work.
2. Poor environmental conditions, pollution from vehicle exhaust gases, harmful emissions into the atmosphere.
3. Low quality of consumed water.
4. Weak (low) immunity.
5. Severe hypothermia of the body.
6. Stressful situations.
7. The presence of chronic diseases in the nasal cavity, paranasal sinuses and oral cavity - dental caries, purulent sinusitis, etc., which often leads to infection of the tonsils.
8. Irrational or poor nutrition, in which excess amounts of proteins and carbohydrates are 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 the disease developing 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 and children can only be correctly determined by an ENT doctor. Below are characteristic signs - if you find them in yourself, consult a doctor.

The disease is characterized by symptoms such as:

1. Headache.
2. Feeling of something foreign in the throat, as if something was 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 another way - intoxication syndrome.
4. Aching pain in the joints and muscles (with severe illness).
5. Aching pain in the heart, with interruptions in heart function - extrasystole (with severe illness).
6. Pain in the lower back, in the kidney area (with severe disease).
7. Bad mood, and in some cases increased body temperature, and for a long time.
8. Persistent skin rashes, provided that there was no previous skin pathology.

All these symptoms appear due to the entry 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 bacterial infection in the lacunae (recesses of the tonsils) and crypts (their canals). Tonsils become a source of bacterial infection, which 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 as an immune organ, then even slight overwork, stress, or mild hypothermia can significantly reduce the immune defense and open the way for microbes and exacerbation of the disease.

Complications

Chronic tonsillitis is very dangerous due to rapidly occurring complications. The most severe of them 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 ligament tissue. 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 at great risk. Unfortunately, the development of diseases such as rheumatoid arthritis and glomerulonephritis is extremely high.

Due to the fact that the source of infection remains in the tonsils for a long time, a distortion of the body’s reactivity occurs, resulting in allergic changes. In some cases, just one course prescribed by a doctor can get rid of itching and allergic rashes, and in some cases stop the development of bronchial asthma attacks.

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 condition, that is, a condition outside of an exacerbation of tonsillitis, it is highly advisable to carry out a planned course as prescribed by a doctor. This will reduce the bacterial load on the entire body in general and on the palatine tonsils in particular.

It is very encouraging that doctors are now referring pregnant women and women who are just preparing for pregnancy for treatment of tonsillitis. Unfortunately, in some cases one of the reasons for not carrying a pregnancy to term is this disease, although at first glance it is hard to believe, tonsillitis is a traffic jam, 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 the disease and, if necessary, treat it as well. This will significantly reduce the risk of developing chronic tonsillitis in the 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 the child increases many times over.

Before pregnancy, it is very important to carry out comprehensive treatment of the symptoms of chronic tonsillitis. But even during pregnancy, it is recommended to repeat the course, preferably in the second trimester, when the woman’s condition is perhaps the most comfortable. It is important to note that physiotherapeutic procedures cannot be carried out during pregnancy, but it is highly desirable to wash the palatine tonsils using a vacuum method, followed by treatment with antiseptic solutions.

The right approach

Sore throat, 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 impaired, and mucus or mucopurulent discharge flows down the back wall 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 tonsils can cause serious harm to the defenses and immunity of the human body, otolaryngologists should try their best to preserve the tonsils and restore their functions without resorting to surgery to remove the tonsils. Modern methods of treating tonsillitis provide a greater chance of recovery without intervention.

Chronic purulent tonsillitis - treatment of a conservative type must always be carried out in an ENT clinic, performing a complex, pathogenetically based course of treatment, as well as using a medicinal approach - medications prescribed by an ENT doctor.

Friends! Timely and correct treatment will ensure you a speedy recovery!

A complex approach

First stage

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

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

The disadvantages of this method are that during the process of washing the palatine tonsils, the pressure created by the syringe is not sufficient to effectively wash out caseous masses from the lacunae of the tonsils. Also, this technique is contact and traumatic, since 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, the tip from the set with a syringe is used for rinsing the tonsils and injecting into the larynx. On the contrary, it is very wide in diameter and injures the tonsil tissue when inserting the tip into the lacuna, or in general, due to the large outer diameter, it cannot always get there.

Practice has shown that today, the best results are achieved by the approach when the ENT uses the Tonsilor attachment.

First, it is necessary to rinse the lacunae of the palatine tonsils with a modified attachment of the Tonsilor apparatus with a transparent antiseptic solution, for example, saline solution (also known as isotonic sodium chloride solution). This is necessary so that the doctor can clearly see what he is washing out of the palatine tonsils.

Second phase.

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

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

Fourth stage.

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

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

You can also install the laser emitter on the skin of the anterolateral surface of the neck in the projection of the location of the palatine tonsils and the posterior wall of the pharynx.

Fifth stage.

It is recommended to conduct sessions of vibroacoustic influence. They are carried out with the aim of normalizing microcirculation in the tissues of the palatine tonsils and improving the trophism (nutritional function) of the palatine tonsils themselves.

Sixth stage.

Effectively sanitize the microflora located on the surface of the palatine tonsils using ultraviolet irradiation (UVR).

In this case, it is necessary to approach courses. The number of procedures in each specific case is determined individually at the first consultation with an ENT specialist. But for a lasting effect to occur, at least five sessions must be performed. If, during the fifth procedure, caseous and mucous masses are still washed out of the lacunae of the palatine tonsils, rinsing and other procedures must be continued “until clean rinsing 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 cleanse themselves, and the patient feels much better and more energetic.

In order to have a lasting result, it is necessary to carry out conservative treatment 2 to 4 times a year, as well as independently once every 3 months, take homeopathic and antiseptic medications.

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

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

Drug treatment of chronic tonsillitis

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

More precise 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 plan 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 tonsils, then the operation to completely remove the tonsil tissue is called a bilateral tonsillectomy.

Partial removal of the tonsils is called a bilateral tonsillotomy.

It is extremely rare that the palatine tonsil is removed routinely on one side. There is also a practice in a number of hospitals (they like to do this in the Pirogov City Clinical Hospital No. 1) of removing the palatine tonsil or tonsils in case of a paratosillar abscess. This operation is called abscessonsillectomy. But it must be remembered that against the background of severe pain caused by an abscess, removal of the tonsil is extremely painful. Due to the purulent process, it is impossible to provide adequate anesthesia. Therefore, it is necessary to anesthetize the peri-almond tissue only with strong anesthetics: Ultracaine and Ultracaine DS-forte.

Routinely, palatine tonsils can be removed under local anesthesia or general anesthesia. Previously, this operation was performed only under local anesthesia.

Fortunately, there is now modern equipment that allows removal of palatine tonsils under general anesthesia or under anesthesia using cold plasma coagulation - Coblator.

Prevention of chronic tonsillitis

1. Drug therapy. If an ENT patient undergoes treatment courses in the clinic once every 6 months, then in addition to six-month procedures, he is recommended to take the drug Tonsilotren, with a frequency of once every 3 months, i.e. 4 times a year. The course of taking (resorption) of the drug is for 2 weeks (more precisely 15 days). It is also possible to instill 0.01% Miramistin solution, 4 pumps 4 times a day for 2 weeks, in courses 4 times a year.
2. Climatotherapy and spa therapy. An important point in the prevention of chronic tonsillitis is visiting seaside resorts. Sunbathing, humidified sea air, swimming and, as a result, the inevitable entry of sea water into the mouth have a beneficial effect on the prevention of chronic tonsillitis.
3. Work and rest schedule. In order for the periods of remission to be long, it is necessary to fully rest and not expose yourself to stress. It is not without reason that chronic tonsillitis, like sinusitis, is classified as a social disease, in which the more stress and workload there is at work, the higher the likelihood of exacerbation of chronic tonsillitis.
4. Diet. It is very important to eat right. Under no circumstances should you get carried away with fried, salty, peppery, sour, bitter, i.e. that food that irritates the mucous membrane of the back of the throat and palatine tonsils. Citrus fruits are contraindicated. The consumption of alcoholic beverages, especially strong ones, is also contraindicated. It is not advisable to eat very hot and very cold and solid foods.

Treatment or removal of tonsils?

Dear patients! If you have visited several specialists in this field, if a course of treatment for chronic tonsillitis has been carried out and none of the methods has brought the expected result, then only in this case should you think about removing the tonsils.

If a conservative approach gives lasting results 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 physiotherapeutically.

P.S.

Everything you just read was written, as I see it, impartially and true. I did not have the task of presenting this or that method of treatment as the best, most progressive and correct. The choice is always yours.

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

Chronic tonsillitis- symptoms and treatment

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

Definition of disease. Causes of the disease

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

The palatine tonsils are the site of infection for this disease. The human body perceives their inflammation as a foreign formation and turns on the autoimmune mechanism (the fight of the immune system against its own tissues).

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

The Society of Otorhinolaryngologists of Europe defines chronic tonsillitis as infectious inflammation in the tonsils and oropharynx, lasting from three months. European doctors argue that the diagnosis of “chronic tonsillitis” can only be made through clinical studies.

Indirectly, the presence of chronic tonsillitis is indicated by a sore throat that goes away under the influence of systemic antibiotics, which returns after discontinuation of use.

Thus, in modern otorhinolaryngology there are many unresolved issues related to chronic tonsillitis. There are disagreements regarding 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 notice 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 painful sensations in the throat, congestion;
• bad breath;
• lymphadenitis of the neck.

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

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

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

Pathogenesis of chronic tonsillitis

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

Also, in patients diagnosed with “chronic tonsillitis” (in particular, the toxic-allergic form), colonies of living, multiplying microbes were found in the lymphoid tissue (in the crypts of the tonsils and even in the lumen of blood vessels), which can become a factor in periodic subfebrile conditions (fever).

No bacteria were detected in the parenchyma (component elements) and vessels of healthy tonsils.

Currently, the question of the influence of biofilms on the course of a chronic infectious process in adenotonsillar tissue is being considered.

J. Galli et al. (Italy, 2002) in samples of adenoid tissue and tissues of the palatine tonsils of children who had chronic adenotonsillar pathology, they were able to detect cocci attached to the surface, organized into biofilms. Researchers hypothesize that biofilms formed by bacteria on the surface of the adenoid tissue and palatine tonsils will help to find out what is the difficulty in eradicating (destructing) the bacteria involved in the formation of chronic tonsillitis.

At the moment, the intracellular location has been confirmed:

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

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

However, the above studies do not allow us to identify one pathogenic microorganism that causes the clinic of chronic inflammation of the tonsils. Therefore, it is very likely that the course of the disease can be caused by any microorganism that is located in the oropharynx, under conditions that promote the inflammatory process in the tissue of the palatine tonsils. Similar conditions include gastroesophageal reflux.

A certain role in the occurrence of chronic inflammation of the tonsils and associated diseases is played by direct lymphatic connections of the tonsils with various organs, primarily with the central nervous system and the heart. Lymphatic connections between the tonsils and brain centers have been morphologically proven.

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 did not change 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 divides chronic tonsillitis into:

• compensated form;
• decompensated form.

However, the term “compensation” in relation to this disease is rather conditional, since no compensation (restoration of a healthy state) of the chronic inflammatory process in the tonsils and in the body occurs. 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 formulation.

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, and tonsillogenic sepsis. Intracranial complications are very rare, but life-threatening: meningitis, thrombosis of the meningeal sinuses, brain abscess.

Diagnosis of chronic tonsillitis

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

• Giese's symptom - hyperemia of the edges of the palatine arches;
• Zach's symptom - swelling in the area of ​​the upper angle between the palatoglossus and palatopharyngeal arches;
• Preobrazhensky's symptom is 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 with the contents of the lacunae of the tonsils, squeezed out when the arches are tense, for example during swallowing. Pharyngoscopy 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 pharyngoscopic symptom is adhesions between the arches and the surface of the tonsils. An indisputable sign of chronic tonsillitis is the presence of liquid purulent exudate (accumulated fluid) in the lacunae.

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 have not yet been identified.

The toxic-allergic form of degree I is characterized by the initial manifestations of the general disease. They are associated with exacerbations of chronic tonsillitis and are diagnosed for some time after a sore throat. The cardiovascular system is most often affected. At this stage of the disease, changes are functional in nature and are not detected on the electrocardiogram. The central mechanism of cardiac dysfunction at this stage has been proven experimentally. Other signs of the toxic-allergic form of the first degree are low-grade fever and tonsillogenic intoxication in the form of rapid fatigue, weakness, and decreased performance for some time after a sore throat. These signs are nonspecific and can be associated with various body conditions. Meanwhile, their identification and establishment of a connection with tonsil disease are of fundamental importance for the development of rational treatment of chronic tonsillitis. To establish the connection between low-grade fever and intoxication and chronic tonsillitis, a diagnostic technique is used - 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 degree II is characterized by an extensive manifestation of focal infection. Signs of chronic tonsillitis lose connection with exacerbations and exist constantly; they can be recorded during functional studies. In addition, this stage is characterized by the presence of associated diseases. Associated diseases include collagenosis (systemic lupus erythematosus, rheumatism, scleroderma, periarteritis nodosa, dermatomyositis), skin diseases (eczema, psoriasis, nephritis, erythema multiforme, thyrotoxicosis, etc.).

In Russia and in Europe, the diagnosis of “chronic tonsillitis” can only be established clinically. In the USA, if the above symptoms are present, studies are carried out to exclude asthma, gastroesophageal reflux disease, and allergies. Rheumatic tests and studies of immune status are not carried out.

Treatment of chronic tonsillitis

Chronic tonsillitis is usually treated with conservative and surgical methods.

A conservative treatment method is indicated if chronic tonsillitis has a compensated form. Conservative treatment is used if there are contraindications to surgical treatment.

Conservative treatment methods include:

1. Means that help increase the natural resistance (resistance) of the body: a rational daily routine, proper nutrition, vitamin therapy, spa treatment.
2. Hyposensitizing agents: drugs containing 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 antibiotic solutions using a syringe or using a tonsillor apparatus.
5. Means of reflex action: acupuncture, novocaine blockades.

If conservative treatment is ineffective, semi-surgical treatment methods are used: ultrasonic biological cleaning or laser vaporization of lacunae of the palatine tonsils.

In case of decompensation of chronic inflammation, complete removal of the tonsils is used - tonsillectomy.

The insufficient effectiveness of systemic antibiotic therapy for chronic tonsillitis is confirmed clinically. A study based on studying the bacteriological composition from the surface of the palatine tonsils in 30 children who had undergone 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 OSA;
• suspicion of a tumor 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. If the apnea/hypopnea index exceeds more than 5 episodes per hour in children, it is an indication for surgical intervention.

As a result of numerous studies, the following conclusions were drawn:

• Tonsillectomy does not have any consequences on general immunity.
• The patient's asthma and predisposition to allergies are not contraindications to surgery. The aggravating effect of tonsillectomy on the future life of children with atopy has not been proven.

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

The surgical technique involves isolating the upper pole of the tonsil using 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 manner. 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 involves general hygiene and sanitation measures. It is rightfully considered an effective measure of secondary prevention of diseases in the genesis of which sore throats and chronic tonsillitis play an important role. Of the general hygiene measures, the most important are hardening, balanced nutrition, and compliance with the rules of hygiene of the home and work premises. All patients with chronic tonsillitis must be monitored by an otorhinolaryngologist.

(or rather, toxic-allergic) is one of the forms of chronic tonsillitis. It’s worth understanding everything in order.

Tonsillitis is an inflammatory process in the palatine tonsils, consisting of lymphoid tissue.

Pathogenic microflora (viruses, bacteria, fungi, etc.), entering the human body through the respiratory tract, encounter defenders on its way in the form of gammaglobulin, lymphocytes, interferon. These substances are produced by the tonsils and lymph nodes.

The result of such a meeting, most often, is the death of harmful microorganisms, and nothing threatens human health.

But this doesn't always happen. If for some reason the protective substances cannot cope with pathogenic agents, then viruses, bacteria, etc. multiply intensively on the surface of the tonsils.

The tonsils eventually become inflamed and their immunoprotective ability is weakened. As a result, tonsillitis develops.

If acute inflammation of the tonsils (in other words, sore throat) occurs several times a year, i.e., has frequent frequency, then tonsillitis becomes chronic.

Causes of chronic tonsillitis.

1. Frequent frequency of sore throats. As a rule, tonsillitis occurs again and again due to improper or inadequate treatment. Some patients prescribe therapy for themselves, relying on “grandmother’s” knowledge and not taking into account many of the nuances of the disease.
2. Infections of the oral cavity: gingivitis, periodontal disease, stomatitis, etc. If these infections are not treated for a long time, then they greatly contribute to the development of chronic tonsillitis, supplying the body with a new “portion” of microbes, bacteria, fungi, etc.
3. Nasal infections. These include sinusitis and purulent sinusitis.
4. Impaired respiratory function of the nose, which can occur due to polyps in the nasal passage, enlarged adenoids, or a broken or deformed septum.
5. Dental caries. In the resulting tooth cavities, excellent conditions are created for the growth and reproduction of pathogenic bacteria.
6. Heredity. Children whose parents suffer from tonsillitis may inherit this disease.

All of the above reasons do not necessarily cause chronic tonsillitis (95% of the population has caries, but not everyone suffers from tonsillitis).

They (the reasons) begin to manifest themselves seriously if the person’s immune system is weakened. A decrease in immunity is influenced by a number of factors.

1. Previous illnesses for which strong medications or complex procedures were used.
2. Frequent hypothermia of the body (complete or partial).
3. High fatigue - physical or mental.
4. Tense nervous states of a person, depression, stress.
5. Lack of sleep, lack of proper rest and, as a result, chronic fatigue.
6. Alcoholism, smoking, drug addiction. These habits are called harmful because they significantly reduce immunity.
7. Harmful working conditions - increased dust, gas contamination, humidity in production. People who work in cryogenic installations also often suffer from tonsillitis.
8. Poor environmental situation. High concentrations of exhaust gases in large cities and industrial emissions into the atmosphere lead to an increase in the number of patients with chronic tonsillitis.

Having understood the causes of the disease, you should know what symptoms accompany it.

Distinctive features of the disease

It has a period of exacerbation and a time of remission. During the period of exacerbation, chronic tonsillitis exhibits certain symptoms.

1. Stinging, severe pain in the throat, which is felt in the tonsils and at the base of the tongue. When swallowing, the pain intensifies.
2. Sensation of a foreign body in the throat
3. during an exacerbation, it can reach high levels (up to 41 ° C); during remission, a low-grade temperature can be observed, i.e., it rises only in the evening and reaches 37-38 ° C.
4. Bad breath is explained by the presence of putrefactive formations in the tonsils in the form of gray-yellow lumps (caseous plugs).
5. Dizziness and headache. These symptoms manifest themselves due to the fact that the disease affects the cervical nerve plexuses and nodes.
6. Heart pain and rapid heartbeat.
7. Fatigue and weakness are common symptoms of chronic tonsillitis.

During remission, all symptoms are not as pronounced as during an exacerbation.

But symptoms alone are not enough to make a correct diagnosis. Chronic tonsillitis has its own characteristic symptoms.

1. The tonsils are enlarged and have a loose appearance.
2. On the surface of the tonsils, caseous plugs are visible, as well as pits that remain after their separation.
3. The cervical and submandibular lymph nodes are enlarged. On palpation the patient feels severe pain.
4. The anterior and posterior palatine arches are swollen.
5. Adhesion is detected between the palatine tonsils and the palatine arches.
6. The mucous membrane is sometimes red.

The described symptoms and signs give the doctor the right to diagnose chronic tonsillitis.

However, chronic tonsillitis has various forms of manifestation. At different times, different medical scientists proposed their own classifications of chronic tonsillitis.

Forms of chronic tonsillitis

Chronic tonsillitis has the following forms:

1. Simple form.
2. Toxic-allergic form.

In turn, the toxic-allergic form is divided into:

• toxic-allergic form of the 1st degree;
• toxic-allergic form of degree II.

It should be noted that any form of chronic tonsillitis can cause allergization and infection of the entire body, since the pathogenic agents located on the tonsils begin to actively “act” with a decrease in immunity.

The simple form of chronic tonsillitis is characterized by the fact that most patients (96%) suffer from frequent sore throats (2-3 times a year).

In this case, the recovery period becomes much longer, and the patient feels high fatigue and malaise.

In the simple form of chronic tonsillitis, the symptoms can be described as follows:

• tingling and mild sore throat;
• discomfort when swallowing;
• feeling of the presence of a foreign body;
• enlargement and swelling of the tonsils;
• [Unpleasant odor] in the mouth.
• Intoxication is mild or absent altogether.

During the period of remission, chronic tonsillitis of a simple form does not in any way affect the general condition of the patient, the work of other organs is not impaired in any way due to tonsillitis.

But do not forget that chronic tonsillitis can aggravate the course of certain diseases.

The toxic-allergic form of degree I has the same symptoms as the simple form. They are joined by the following signs:

• Low-grade fever;
• Headache;
• Muscle and joint pain;
• Weak condition and increased fatigue;
• Malaise and poor health;
• Enlarged and painful cervical lymph nodes;
• Interruptions in the heart (tachycardia, arrhythmia) during an exacerbation. In this case, no physiological changes in the heart are observed. During remission, all these manifestations disappear.
• There may be slight changes in laboratory blood and immunological parameters (acceleration of ESR, slight leukocytosis, etc.). However, these indicators are unstable and return to normal during the period of remission.

In the toxic-allergic form of stage I, patients suffer from tonsillitis more than 3 times a year, and the recovery periods after the illness are long.

Toxic-allergic form of degree II has the same symptoms as form I, but local and general diseases associated with allergic tonsillitis appear here, which can seriously threaten not only the health, but even the life of the patient.

Therefore, treatment of the toxic-allergic form of the second degree quite often comes down to surgical removal of the tonsils, since the tonsils themselves become not protectors from infections, but their active focus.

This form has more than a hundred associated diseases. Below are some of them.

Associated diseases with allergic tonsillitis

Due to toxic-allergic tonsillitis, local associated diseases and general associated ailments can develop.

Local associated diseases

• • Peritonsillar abscess (phlegmonous tonsillitis). The disease is characterized by the fact that suppuration occurs in the tissues near the tonsil. In this case, the tonsil is greatly enlarged, and unilateral swelling of the soft palate is observed. The patient's voice becomes nasal, the head is constantly tilted towards the inflammation. In this case, the person experiences severe pain. To treat this disease, surgery is required.
  • Parapharyngitis, or parapharyngeal phlegmon. Here inflammation occurs in the tissues of the peripharyngeal space. Often the disease acts as a complication of peritonsillar abscess. In this case, the patient may experience a sharp pain not only in the throat, but also radiate to the teeth and ear. A sudden movement of the head leads to unbearable painful sensations. If the parapharyngeal abscess is not opened in time, even more severe complications will appear: mediastinitis, purulent parotitis.

Common diseases associated with toxic-allergic tonsillitis

Here is an even more extensive list, since these diseases cover almost all human organs and systems.

The most common ones are the following:

• • • Collagen diseases (diseases in which diffuse damage to connective tissues and blood vessels occurs due to collagen damage). Among them are systemic lupus erythematosus, polyarthritis, rheumatism, dermatomyositis, etc.
    • Diseases of the cardiovascular system occur due to the fact that the pathogenic streptococcus produces antigens similar to heart antigens. As a result, the immune system “goes astray” and begins to fight its own antigens. As a result, myocarditis, endocarditis, and heart defects develop.
    • Kidney diseases occur for the same reason as cardiovascular diseases. The result can be such serious illnesses as glomerulonephritis (inflammation of the kidney glomeruli), pyelonephritis (inflammation of the kidneys), kidney failure, nephritis, etc.
    • Skin diseases. According to statistics, psoriasis is diagnosed in patients with allergic tonsillitis. Moreover, a direct relationship is observed between exacerbations of tonsillitis and increased manifestations of psoriasis.
    • Nonspecific lung diseases. With allergic tonsillitis, chronic pneumonia often worsens. Periobronchitis directly depends on inflammatory processes in the tonsils.
    • Eye diseases. Often, patients with allergic tonsillitis are diagnosed with myopia (myopia), and Behcet's disease may also manifest itself, which is fraught with the development of optic nerve atrophy, secondary glaucoma and, as a consequence, partial or complete loss of vision.
    • Diseases of the reproductive system. With allergic tonsillitis, hormonal levels may be disrupted, endometriosis, adenomatosis, and uterine fibroids may appear.
    • Diseases of the endocrine system. During the inflammatory process of the tonsils, the thyroid gland can be damaged - its hormone-producing function is enhanced, which leads to excess weight or weight loss, loss of appetite, thirst, profuse sweating, etc.
    • Diseases of the nervous system. Against the background of allergic tonsillitis, migraines, Meniere's syndrome, and Raynaud's syndrome may appear.

So, it becomes clear that chronic tonsillitis in its toxic-allergic form is a dangerous disease.

Its treatment should be taken very seriously. We hope that the symptoms of allergic tonsillitis will never be known to you.