Chronic tonsillitis

The text is presented for informational purposes only. We urge you not to self-medicate. When the first symptoms appear, consult a doctor. Recommended reading: “Why not self-medicate?”. Chronic tonsillitis is a disease of the upper respiratory tract, namely a prolonged inflammatory process in the tonsils. The chronic form mainly develops as a result of inadequate treatment or its complete absence in acute tonsillitis. In addition to the fact that the disease causes significant discomfort to the patient, it provokes a constant pathogenic load on his body, leading to the development of complications.

According to the ICD 10 code, chronic tonsillitis is classified as J35.0.

Classification by pathogen type

Chronic tonsillitis, however, like acute, causes several factors. First of all, we are talking about infectious pathogens. All of them belong to the pathogenic microflora – these are viruses, bacteria, fungi. Accordingly, tonsillitis is viral, bacterial and fungal – these forms are contagious. Non-infectious type of chronic tonsillitis – allergic, or allergic-toxic.

If we consider the disease according to the types of course, chronic tonsillitis can be divided into simple recurrent (with frequent sore throats), simple protracted with constant inflammation of a sluggish nature, simple compensated and toxic-allergic type.

Viral. With viral tonsillitis, an inflammatory process begins in the tissues of the tonsils, due to which the tonsils cease to perform their protective function – the function of containing the infection from entering the throat. It is manifested by very characteristic symptoms, so the development of the disease is difficult not to notice.

The cause of the occurrence is the entry of a viral infection into the body, which means that the disease can be transmitted by airborne droplets, less often by contact. Chronic viral tonsillitis usually develops from an acute form.

The first symptoms of an acute course appear 2-3 days after infection. The patient feels weakness and headache, his appetite disappears. Gradually, an increase in lymph nodes and tonsils, sore throat, fever are added. Difficulty in swallowing and breathing. In the absence of treatment, or if the selected therapy does not work, the disease becomes chronic. The chronic form proceeds without a high temperature, the pains are mild, there is constant tickling in the throat, and an unpleasant odor comes from the mouth.

The causative agents of chronic viral tonsillitis are herpes viruses types 1 and 2, cytomegalovirus, adenovirus, Epstein-Barr virus, influenza virus, measles, and some others. Accordingly, varieties of the viral type are herpes, measles, adenovirus and other types of viral chronic tonsillitis.

Bacterial. Chronic bacterial tonsillitis is a type of inflammation of the tonsils caused by bacterial activity. Most often, the disease is provoked by staphylococci and streptococci, causing, respectively, a staphylococcal or streptococcal form.

The lymphoid tissue that makes up the palatine tonsils acts as a filter that protects the body from the penetration of foreign organisms, inhibiting their reproduction. Naturally, all pathogens that attack the human body first fall on the tonsils. Against the background of hypothermia or a decrease in immunity, the tonsils cease to cope with their functions, a person becomes ill.

The main types of chronic tonsillitis:

• catarrhal;
• fibrinous;
• follicular;
• lacunar;
• phlegmonous.

Fungal. Tonsillomycosis is a special type of lesion of the mucous membrane of the tonsils and throat – it is caused by multiplying fungi. External manifestations are similar to the streptococcal form.

The causative agents are putrefactive or yeast fungi of the genus Candida. Very rarely, the disease develops due to the activity of saccharomycetes.

Provoking factors:

• transferred colds and viral diseases;
• avitaminosis;
• weakening the body with diets or malnutrition;
• chronic diseases of the upper respiratory tract;
• smoking;
• chronic inflammatory processes of internal organs;
• the presence of endocrine or oncological pathologies;
• chronic candidiasis.

In addition, this form of chronic tonsillitis is more common in children, especially one year old and younger, due to the peculiarities of their immune system.

Allergic. Manifested in allergy sufferers:

• after the development of anaphylactic shock;
• seasonally in spring due to the flowering of grasses and trees;
• as a manifestation of a food allergy.

Causes

The development of the disease does not occur in every person, despite the fact that aggressive pathogens are constantly in the environment. There are a number of reasons that contribute to inflammation in the tonsils:

• frequent sore throats;
• the presence of polyps in the nasal passages;
• stable violation of nasal breathing due to the curvature of the nasal septum;
• foci of infectious processes in the upper respiratory organs;
• low immunity;
• the presence of chronic adenoiditis or purulent sinusitis.

One way or another, the development of chronic tonsillitis signals that the body’s defenses have weakened and cannot contain the load of viruses, bacteria, allergies or fungi.

Children’s tonsillitis is a fairly common occurrence. Due to the peculiarities of the structure, the child’s tonsils are most predisposed to the development of chronic inflammation in the tissues – they contain deep and densely branching lacunae, multiple slit passages penetrating the entire thickness of the tonsils. The inflammatory process covers all departments and structures of this body.

It is believed that psychosomatics also plays a role in the appearance of the disease – that supposedly, with constant restraint of emotions and words, a person develops throat pathologies.

Symptoms of tonsillitis

The clinic of the acute type of tonsillitis, of course, is more pronounced, and often precedes the appearance of the chronic form. Signs of tonsil damage appear after the end of the incubation period of the disease, and include pain when swallowing, sore throat of varying severity and localization, redness and hyperemia of the tonsils, a characteristic white coating or white purulent “plugs” on the tonsils.

The overall picture is complemented by manifestations of intoxication – the patient’s lymph nodes inflame on the neck, in the upper parts of the body. The high temperature persists for the first few days.

Timely access to a doctor and the appointment of adequate treatment contributes to the fact that after 2-4 days, acute symptoms gradually fade. In cases where the disease continues to actively manifest itself within 20-30 days, we can talk about its transition to a chronic type of course. At the same time, there is a partial improvement in well-being, but it is impossible to speak of a complete recovery.

Symptoms of chronic tonsillitis:

• white, yellowish or gray plugs in the throat;
• pain in the tonsils, in the throat (may be moderate or severe, it is permanent);
• swelling of the nasopharynx;
• sore throat, sensation of a lump;
• possible difficulty in nasal breathing;
• constantly elevated body temperature;
• inflammatory reactions of the throat and pharynx in response to cold drinks, ice cream;
• unpleasant, putrid odor from the mouth;
• increased fatigue, general state of weakness.

Prolonged chronic tonsillitis gradually provokes the appearance of shortness of breath, aching and pulling pains in the joints, especially the wrist and knee.

Course of the disease

The development of chronic tonsillitis goes through certain stages in sequence, which are determined by several factors – the nature of the selected treatment or its absence, the immune response, the age of the patient.

Stages. Differentiation of the stages of the development of the disease is carried out according to the results of the analysis of local and general current symptoms. Local symptoms are manifestations of inflammatory processes in the tissues of the tonsils. A more general picture is formed under the influence of tissue breakdown products and cytokines. These substances spread with the bloodstream from the focus of inflammation throughout the body, gradually affecting the internal organs.

Morphological changes affect various structural components of the tonsils, depending on the onset of one or another stage of the development of the disease.

Stages of development of chronic tonsillitis:

• chronic lacunar or lacunar-parenchymal tonsillitis (at this initial stage, keratinization of the epithelium of lacunae occurs, inflammation affects closely located areas of the parenchyma);
• the stage of active alteration or chronic parenchymal tonsillitis, in which inflammatory infiltrates form in the parenchyma;
• chronic parenchymal sclerotic tonsillitis with increased proliferation of connective tissue to replace the affected areas of the tonsils.

The chronic course is characterized by the presence of compensated and decompensated (subcompensated) stages that replace each other.

Compensation is a period of a dormant state of infection, while there are no visible reactions of the body, as well as recurring tonsillitis. The barrier function of the tonsils is not affected. It is also called anginaless.

Decompensation is characterized by the presence of frequent tonsillitis with complications in the sinuses of the nose, in the ears, with inflammatory lesions of the internal organs.

In fact, compensation corresponds to a state of remission, and decompensation corresponds to an exacerbation of the disease.

Subcompensated tonsillitis occurs if tonsillitis bothers the patient, but they are easily treatable, proceed quickly and without any particular exacerbations. This means that the body still has enough strength to cope with the load of the inflammatory process.

Complications. Complications of the disease are usually formed as a result of neglected forms that occur without treatment. Due to the active influence of a bacteriological, allergic, viral or fungal load factor, as well as due to a violation of the normal course of the neuro-reflex mechanisms, failures appear in the work of most body systems.

The ability of the immune system to recognize antigens is reduced as a result of the deactivation of the protective function of B and T lymphocytes.

In addition, against the background of tonsillitis, the following can develop:

• psoriasis, neurodermatitis and other forms of skin allergic pathologies;
• eye diseases due to severe intoxication;
• septic arthritis;
• relapses of pneumonia and nonspecific lesions of the respiratory system;
• Meniere’s syndrome, Raynaud’s syndrome, other manifestations of cerebral angioedema, rheumatism, endocarditis;
• nephritis;
• violation of the output of bile, inhibition of liver function;
• disruptions in the work of the endocrine system (in women they manifest themselves in the form of menstrual irregularities, a decrease in the production of certain hormones, uterine bleeding, in men potency weakens);
• obesity, poor appetite.

duration of the disease. Chronic tonsillitis is usually a direct consequence of the acute type of the disease. It is characterized by a long course in which periods of remission are replaced by exacerbations. In general, the duration depends on the type of pathogen, the timeliness and adequacy of the selected treatment.

As for acute tonsillitis, it is much easier to identify and easier to treat. Subject to the appointment of antibiotic therapy, the bacterial and purulent type of the disease disappears after 3-5 days. Viral tonsillitis can last up to 7-10 days. The most difficult form to treat is fungal. Its treatment involves taking antifungal drugs, and usually lasts at least 2 weeks. In difficult cases, the course of treatment has to be repeated.

The problem with the chronic form is that it is rarely possible to cure it completely. It is only possible to achieve a long-term remission, in which exacerbations occur 2-3 times a year and quickly pass.

Advanced forms of the disease require treatment from one to several months, sometimes up to six months. Fungal chronic tonsillitis is especially difficult to treat. Provided that remissions are achieved, intermittent exacerbations respond more intensely to therapy and last up to several weeks.

The prognosis for the treatment of acute tonsillitis is more favorable – it is almost always possible to get rid of the disease completely if you consult a doctor in time and follow all the instructions.

Diagnostics

To establish the diagnosis of chronic tonsillitis, the attending physician needs to obtain information about the subjective and objective signs of the disease. Depending on the nature of the infection, the doctor prescribes studies, tests, collects anamnesis of the disease using:

• physical examination;
• instrumental research;
• laboratory analyses.

When making a differential diagnosis of the disease, the doctor needs to keep in mind the likelihood of the presence of common signs that are characteristic not only of tonsillitis, but can also be caused by other foci of infection, for example, caries, pharyngitis, inflammation of the gums. Inflammation of the palatine arches and lymph nodes also accompanies nonspecific polyarthritis and rheumatism.

Methods. The study of the physical condition of the patient, the external manifestations present in him is the first thing the doctor faces.

The allergic-toxic form is determined by inflammation of the regional lymph nodes of the lower jaw, in front of the sternocleidomastoid muscle. On palpation, the nodes give pain.

The presence of a chronic focus of infection in the tonsils always affects the body as a toxic poisoning, provoking allergic reactions. Therefore, in the presence of chronic tonsillitis, the patient always needs to determine common concomitant diseases.

Instrumental studies involve studying the condition of the tissues of the patient’s tonsils. A characteristic sign of tonsillitis is the presence of purulent contents in the crypts of the tonsils. Pus is released when pressing on the tissue through the anterior arch of the palate. In the normal state of the tonsils, there is no pus in the gaps.

The purulent contents separated from the patient can be liquid or thicker, in the form of gruel or plugs, yellow, white or gray. The very fact of the presence of pus of any type in the crypts indicates the presence of chronic tonsillitis.

An external examination of the inflamed tonsils in children shows that they are enlarged, have a pink or reddish color, and a loose surface. In adults, the tonsils are usually normal in size, may be reduced, hidden behind the temples. The surface is smooth, pale, the upper lacunae are expanded.

The remaining signs, which are of a pharyngoscopic nature, are usually less pronounced, and are found not only in chronic tonsillitis, which is why their differential value is less significant.

In addition, the doctor may prescribe an X-ray of the sinuses, an ECG, and a fluorography.

Analyzes. In order to determine the nature of the disease, laboratory studies of biological material are mandatory. The patient needs to pass the following tests:

• general blood test;
• analysis for C-reactive protein;
• a smear on the flora from the pharynx, from the surface of the tonsils;
• indicators antistreptolysin-O;
• analysis for the Epstein-Barr virus.

First of all, the doctor pays attention to the results of a general blood test – this analysis is usually prepared the fastest, and immediately gives an understanding of the picture of inflammation. An increase in the number of leukocytes above 10 * 109 / l against the background of a large number of their immature forms, together with an increased ESR, give grounds for a preliminary diagnosis of tonsillitis.

Therapies

Medical products (drugs, medicines, vitamins, medicines) are mentioned for informational purposes only. We do not recommend using them without a doctor’s prescription. Recommended reading: “Why can’t you take medications without a doctor’s prescription?”. All methods of treating chronic tonsillitis can be divided into two groups:

• conservative;
• surgical.

In the first case, we are talking about therapy, which includes the use of drugs that enhance immunity – biostimulants, iron preparations. The patient needs to establish a normal daily routine, a complete diet with enough vitamins.

In addition, to normalize the state are assigned:

• antihistamines;
• medicines for immunocorrection;
• novocaine blockades and other means of reflex action;
• preparations and procedures that have an antiseptic and healing effect directly on the tonsils (washing the lacunae of the tonsils, removing their contents, introducing drugs into the lacunae, rinsing, shading the tonsils).

Physiotherapeutic effects include procedures for laser therapy, microwave therapy, phonophoresis, inductothermy, ultraviolet irradiation, inhalation.

Antibiotics are a mandatory part of the treatment regimen for acute tonsillitis. In the case of the chronic form, they can also be prescribed.

The cardinal way to treat chronic tonsillitis is surgery, namely the removal of the palatine tonsils. It is prescribed only for decompensated flow. Indications for surgery are an increase in the tonsils on both sides, which causes obstruction of the upper respiratory tract and sleep disturbances, lack of effect from conservative treatment, unilateral enlargement of the tonsils with suspicion of oncology, tonsillogenic sepsis.

Treatment of a disease at home, using traditional medicine recipes, is only permissible as an addition to general therapy, with the permission of a doctor. At home, you can use decoctions and infusions of herbs for rinsing, honey, propolis and vegetable juice to increase immunity.

preventive measures

Is it possible to prevent the development of chronic tonsillitis? Given that the disease has a disappointing prognosis for recovery, it is easier to prevent its occurrence than to treat it later.

Doctors advise you to follow a few simple rules that are aimed at general strengthening of the body.

First of all, it must be remembered that both overheating and hypothermia are favorable for the development of tonsillitis. In the cold season, when the street is sometimes wet, sometimes windy, sometimes damp, you must definitely wear a scarf and a warm hat.

In the summer, in the heat, you need to beware of drafts and gusts of wind, especially if the body is hot.

After consulting with a therapist, you can resort to hardening procedures, for example, dousing with cool water. At the same time, the water temperature must be lowered gradually so as not to provoke stress for an unprepared organism.

Constant wet cleaning and ventilation of the room are rules that must also be remembered not only for the prevention of tonsillitis, but also for general strengthening of the body, especially if there is a sick person in the house.

Proper nutrition, a sufficient amount of vegetables, fruits, dairy products, meat, cereals is an integral part of a healthy lifestyle and a healthy body. Doctors recommend periodically taking vitamin complexes, no more than 2-3 times a year.

Do not forget about other diseases, acute and chronic. Rhinitis, diseases of the oral cavity, sinusitis, dysbacteriosis, infectious skin lesions, diseases of the intestines and kidneys – all this in the background undermines the resistance of the immune system to pathogenic factors, and especially contributes to the development of tonsillitis.

As for drug prevention, there are no drugs or vaccinations against chronic tonsillitis as such. Vaccination with the Prevenar vaccine, designed to protect the body from streptococcal activity, can only reduce the likelihood of acute tonsillitis.

What is dangerous disease

Chronic tonsillitis, in fact, is a focus of inflammation, which is constantly present in the body, leading to its infection and allergization. The prolonged course of the disease, in the absence of qualified medical care, leads to complications and dangerous consequences.

The main danger of chronic tonsillitis is its exacerbations, sore throats, which are constantly repeated and last from a week to several months. Severe types of the disease turn into cervical phlegmon, and a decrease in the protective function of the tonsils leads to the formation of bronchitis and pharyngitis.

In addition to such obvious complications, the disease has a negative impact on other systems in the body. Tonsils are organs whose work is related to the functioning of other organs of the human body.

The infection, concentrated in the tonsils, moves through the body, revealing vulnerabilities and manifesting itself in them. The presence of chronic tonsillitis can cause the development of about 120 diseases, including severe damage to the heart, kidneys, joints, and skin.

Inflammation affects the appearance of scleroderma, systemic lupus erythematosus, dermatomyositis, polyarthritis, rheumatism in a patient.

Often manifested sore throats contribute to the development of cardiovascular diseases – myocarditis, endocarditis, heart defects. In women and men who suffer from tonsillitis under the age of 30, cardialgia is noted. Damage to the vessels of the brain occurs due to a constant toxic load.

Chronic tonsillitis is the cause of diseases of the digestive organs, since the infectious pathogenic element, which is constantly present in the throat, enters the digestive tract through the esophagus along with food and water.

Against the background of chronic tonsillitis, prerequisites are created for the appearance of diseases of the skin and subcutaneous fatty tissue – acne, psoriasis, neurodermatitis, atopic dermatitis and microbial eczema.

The respiratory organs are directly connected with the tonsils, therefore, due to tonsillitis, they are affected by bronchial asthma and chronic bronchitis.

Optometrists claim that the disease negatively affects the work of the accommodative apparatus of the eyes, causing recurrent conjunctivitis, blepharitis in the patient, and neglected forms affect the dynamics of myopia development.

The focus of infection in the tonsils directly affects the functioning of the pancreas, inhibiting it, against which the affected person may develop diabetes mellitus.

Kidney disease (glomerulonephritis, pyelonephritis) is a common complication of chronic tonsillitis.

For adults of childbearing age, the disease is especially dangerous, as it affects reproductive function.

Chronic tonsillitis reduces a woman’s ability to conceive, leads to hormonal disruptions, menstrual irregularities, endometriosis and uterine fibroids, and in men to a weakening of potency. During pregnancy, a constant infectious and inflammatory background from the tonsils creates a real threat of miscarriage and the onset of premature birth. In the presence of the disease, it is undesirable for a woman to breastfeed a child, as this contributes to the infection of the baby.

Do they die from tonsillitis? The presence in the body of a permanent source of infection in a neglected form, and especially its complications, sometimes lead to a peritonsillar abscess, give complications to the brain and heart. According to statistics, 2-3% of advanced chronic tonsillitis leads to death.

Do’s and Don’ts for Tonsillitis

The chronic form of tonsillitis is such a harmless disease, as it might seem at first glance. The lifestyle of the patient has a serious impact on the nature of the course of the disease, its intensity and duration. The text is for informational purposes only. We urge you not to use diets, do not resort to any medical menus and fasting without medical supervision. Recommended reading: “Why you can not go on a diet on your own.” Nutrition is based on diet No. 13, the diet of which is recommended for the body with inflammatory colds, and helps to remove toxins from the body, strengthens the immune system, and has a gentle effect on the mucous membranes of the tonsils. The description of the diet has common features with diet #5 and #1. All food is steamed or boiled, mashed and ground to a puree consistency. You need to eat 5-6 times a day, in small portions. The temperature of the food consumed is not lower than 60 degrees.

Foods that can and should be eaten by patients:

• yesterday’s wheat bread, lean crackers, biscuit and dry biscuits;
• lean meat, fish, weak broths from them;
• steam omelet and soft-boiled eggs;
• dairy products, butter;
• cereals with milk and water;
• boiled vegetables and vegetable soups;
• fresh non-acidic tomatoes;
• grated fresh fruits and berries, baked apples;
• mousses, honey, jam, marshmallow, marmalade, sugar.

It is allowed to drink coffee, cocoa on the water with milk, weak tea, fruit and vegetable juices, rosehip broth.

You can not eat the following foods:

• rye bread, any kind of rich pastries and fresh bread;
• fatty meat and fish, sausage, ham, canned meat and fish;
• spicy cheese;
• Smoked products;
• fried and boiled eggs;
• spicy and hard vegetables (cucumbers, cabbage, garlic, onions, radishes, turnips, turnips);
• mushrooms;
• chocolate, cakes and other sweets, except for those permitted;
• grape juice;
• spicy dishes.

Sports with tonsillitis – on this issue, doctors give only general recommendations. You can engage in physical activity if the disease is in remission. It is allowed to train with:

• stuffy nose and minor breathing difficulties;
• soreness of the head;
• mild pain in the teeth and throat.

In this case, the main thing is to observe the principle of moderation in training.

As for the stage of exacerbation of the disease, you can’t play sports at this time, as it creates an additional burden on a weakened body, interfering with the healing process. In case of acute inflammation with high fever, sore throat, nausea and vomiting, severe headache, it is strictly forbidden to play sports. The patient should observe bed rest, you can not walk and visit public places. The same applies to visiting dances, sports clubs, swimming in the pool.

Is it possible to go to resorts and swim in the sea and other open water with tonsillitis? Doctors believe that during remission, rest on the seashore with salty iodine air is very useful for diseases of the respiratory organs, including tonsillitis, but only in remission. At the same time, one should swim in the sea very carefully, making sure that water does not get into the mouth, pharynx, esophagus, as it contains a huge number of microorganisms.

Smoking, as well as drinking alcohol, is prohibited with tonsillitis of any form, because tobacco and ethyl alcohol aggravate inflammation by irritating the mucous membranes of the tonsils. However, alcohol and smoking turn healthy people into sick people.

A visit to the bath for patients with chronic tonsillitis has a therapeutic value, but only during the remission of inflammation. The bath in this case works as a factor in the prevention of recurrence of tonsillitis and strengthening the immune system.

Another rule for patients is that you cannot squeeze out pus from the tonsils, especially on your own at home. Such a procedure for cleaning the lacunae of the tonsils should be carried out by a doctor.

FAQ

Do they take to the army with tonsillitis. In the Russian Federation, chronic tonsillitis is not considered such a dangerous disease that a young man should not be drafted into the army. Conscripts with chronic tonsillitis are considered fit for service and are taken into the army. At the time of exacerbations of the disease, the soldier is given a deferment for treatment, he is sent to a medical and sanitary institution for treatment.

Conscripts with a diagnosis of “chronic tonsillitis” are assigned category B, which means for him a restriction in the choice of the type of troops for service.

Is it possible to ice cream with tonsillitis. Regarding ice cream in chronic tonsillitis, doctors unambiguously forbid eating it – any food that is too cold can provoke an exacerbation of the disease. However, there is an opinion among the people that, on the contrary, ice cream with tonsillitis is something like a wedge with which a wedge is knocked out, and that supposedly with the help of ice cream it is possible to prevent the spread of inflammation. Physicians do not share this point of view.

Chronic tonsillitis is a condition in which the focus of an infectious lesion is concentrated in the tonsils. In the throat, inflammation is constantly present, which periodically turns into an exacerbation – into a sore throat. The disease affects adults, adolescents, but most often children, as their immunity does not have sufficient resources to fight the disease.

Classification according to the type of pathogen divides tonsillitis into viral, bacterial and fungal. Depending on the forms, exacerbations occur with different durations, and chronic tonsillitis itself is generally considered an incurable disease that lasts for years. However, subject to drug therapy and compliance with the rules of nutrition, daily routine and lifestyle, even with this inflammatory pathology, a person can live normally, practically without suffering from tonsillitis.

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