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Chronic tonsillitis
– long-term inflammation of the pharyngeal and palatine tonsils (from the Latin tonsollitae – tonsil glands). Develops after a sore throat and other infectious diseases accompanied by inflammation of the mucous membrane of the pharynx (scarlet fever, measles, diphtheria), or without a previous acute illness.
Types of tonsillitis
- A simple form of chronic tonsillitis The simple form of chronic tonsillitis is characterized by only local symptoms (sore throat, etc.).
- Toxic-allergic form of tonsillitis – if they are accompanied by general phenomena (persistent cervical lymphadenitis, elevated body temperature, changes in the heart, etc.)
Compensated and decompensated stages of tonsillitis:
Compensated stage of tonsillitis represents a dormant focus of infection. There is no visible reaction from the whole body, no repeated sore throats. The barrier function of the tonsils and the reactivity of the body are not impaired.
Decompensated stage of tonsillitis. During decompensation, frequent sore throats are a concern; complications of tonsillitis in the form of abscesses, inflammatory diseases of the ear and sinuses, as well as damage to other organs (heart, kidneys) are often observed.
Pathomorphological classification of tonsillitis:
- Lacunar tonsillitis – the inflammatory process is limited to the lacunae of the tonsils.
- Lacunar-parenchymal tonsillitis – the inflammatory process is localized both in the lacunae and in the lymphadenoid tissue of the tonsils.
- Phlegmonous tonsillitis – the inflammatory process is localized mainly in the lymphadenoid tissue of the palatine tonsils.
- Sclerotic tonsillitis – abundant proliferation of connective tissue in the tonsils and surrounding tissues.
Causes of tonsillitis
Chronic tonsillitis can be caused by various infections. Among the pathogens in chronic tonsillitis, the most commonly found are staphylococci, streptococci, pneumococci, Haemophylus infl., moraxella, adenoviruses, Epstein-Barr virus, Coxsackie viruses, herpes virus, various anaerobes, mycoplasmas, chlamydia, and fungi.
The main etiological factor in the development of chronic tonsillitis is group A beta-hemolytic streptococcus.
In most patients with chronic tonsillitis, beta-hemolytic streptococci are found in association with Staphylococcus aureus.
Pathogenesis of tonsillitis
Chronic tonsillitis is a classic example of a focal infection, which is based on the development of a focus of chronic inflammation as a result of the prolonged presence of infection and the reaction to it.
A significant role in the pathogenesis of chronic tonsillitis belongs to dysfunction of the nervous system, especially the autonomic one.
The development of tonsillitis is promoted by:
- the presence of chronic foci of inflammation in the mouth, nose, paranasal sinuses, difficulty in nasal breathing, intoxication;
- unfavorable climatic conditions, working and living conditions (dust, air pollution);
- general and local cooling;
- poor nutrition.
Clinical manifestations of tonsillitis:
- Hyperemia and roller-like thickening of the edges of the palatine arches.
- Cicatricial adhesions between the tonsils and palatine arches.
- Loose or scarred and hardened tonsils.
- Caseous-purulent plugs or liquid pus in the lacunae of the tonsils.
- Regional lymphadenitis – the submandibular (more often) and cervical lymph nodes are enlarged and slightly painful when pressed.
The diagnosis is made in the presence of two or more of the above local signs of tonsillitis.
Accompanying illnesses
With chronic tonsillitis, there may be associated diseases, as well as concomitant diseases, the pathogenetic connection of which with chronic inflammation of the tonsils is carried out through local and general reactivity. There are about 100 different diseases that largely owe their origin to chronic tonsillitis:
- collagen diseases (collagenoses): rheumatism, systemic lupus erythematosus, periarteritis nodosa, scleroderma, dermatomyositis;
- skin diseases: psoriasis, eczema, polymorphic exudative erythema;
- eye diseases: Behcet’s disease;
- kidney diseases: nephritis;
- thyroid diseases: hyperthyroidism.
Treatment of chronic tonsillitis
should be comprehensive and step-by-step, aimed at influencing directly the source of inflammation and increasing immunity.
General recommendations: proper daily routine, balanced diet with sufficient vitamins, physical exercise.
Before starting treatment, the oral cavity is sanitized.
Conservative treatment of tonsillitis
Conservative treatment is indicated for compensated and decompensated forms of chronic tonsillitis, manifested only by recurrent tonsillitis;
Conservative treatment with preservation of the lymphoid tissue of the tonsils itself as an immune organ involves washing the tonsils and irrigating the throat with antiseptic solutions, inhalation, systemic antibacterial therapy and immunostimulation.
When choosing an antibacterial drug, the sensitivity of typical pathogens to it is of paramount importance. The increasing resistance of various microorganisms to many major antibiotics is a major problem in the treatment of bacterial infections.
Courses of conservative treatment are usually carried out 2 times a year, preferably in spring and autumn. With frequent relapses of tonsillitis, the number of courses of conservative treatment can be increased to four per year.
Surgical treatment of tonsillitis
A radical method of treating chronic tonsillitis is complete or partial removal of the tonsils, which is prescribed in case of ineffectiveness of conservative treatment or in the presence of serious complications from the internal organs or when tonsillitis passes into a decompensated form, when the tonsils cease to perform their functions and turn exclusively into a chronic source of infection.
Caution in deciding on surgical treatment is explained by the fact that the tonsils perform an important function in the body: they are a barrier to bacteria from entering the respiratory tract and gastrointestinal tract. In addition, the tonsils are one of the hematopoietic organs.
Prevention of tonsillitis
- General hygiene measures.
- Hardening.
- Balanced diet.
- Compliance with the rules of hygiene of home and work premises.
- Elimination of dust and air pollution.
- Sanitation measures: identification and treatment of diseases of the gums and teeth, sinusitis, otitis media, nasal breathing disorders.
It should be noted that even the implementation of all of the above measures does not at all guarantee the exclusion of relapses. In addition, in the pace of modern life, it is not always possible to promptly treat concomitant diseases and/or change working conditions, which can provoke sudden exacerbations.
At the Prima Medica medical center you can make an appointment with experienced otolaryngologists by calling +7 495 120-01-07. You can find out the cost of admission here.