Mar 05, 2018
Tonzillitis is a widespread infection that causes inflammation of the tonsils( lymphatic tissue that is located on both sides of the back of the mouth and is designed to fight infection).
Tonsillitis is most common in children aged five to fifteen years( although it can occur at any age) and is characterized by severe sore throat. Previously, it was believed that the tonsils only create problems, and they were often removed surgically. Now it is known that tonsils perform a certain, albeit somewhat limited, role in the immune system. They are the first line of defense of the respiratory system, capturing and neutralizing infectious agents before they can penetrate through the bronchial passages.
In children, tonsils are usually large;they reach the maximum size by the age of six or seven years and then begin to shrink. Due to the fact that they are continuously exposed to infectious agents, they are sometimes overwhelmed with infection, which leads to tonsillitis. Although tonsillitis usually passes itself in a week, nevertheless it is necessary to check with a doctor to identify the cause of the infection. Bacterial infections, especially streptococcal throat infection, require a certain course of treatment, since the immunological response to substances produced by group A streptococci causes glomerulonephritis or rheumatism. A severe infection can also lead to peritonsillar abscess - accumulation of pus in the tissues around the tonsils.
Chronic tonsillitis is a common infectious allergic disease with local manifestations in the form of persistent chronic inflammation of the palatine tonsils, characterized by a recurrent course and occurs more often as a complication of infectious pathology( angina, dental caries, etc.).
Chronic tonsillitis affects an average of 5 - 6% of the adult population and 10-12% of children. Interest in this problem in otorhinolaryngology is explained not only by the high prevalence of chronic tonsillitis, but also by the fact that, according to the WHO, with chronic tonsillitis there can be etiologically associated more than 100 somatic diseases.
The main etiologic factor in the development of chronic tonsillitis and its complications is still the P-hemolytic streptococcus of group A. Staphylococcus aureus, hemolytic staphylococcus and obligate anaerobic microorganisms, adenoviruses, influenza and parainfluenza viruses, the Epstein-Barr virus, and others also occur. One of the most important factors in the pathogenesis of chronic tonsillitis is a violation of the emptying of lacunae from pathological contents.
The development of chronic tonsillitis and its complications seems to be a versatile process in which an important role is played by the interaction of the infectious agent and the whole organism, as a result of which the palatine tonsils from the body of the immune defense become a chronic focus of infection with a counterproductive immune function.
Chronic recurring tonsillitis may require surgical removal of tonsils( tonsillectomy).
• Viruses are the most common cause;Bacteria respond in approximately 40 percent of cases of tonsillitis. Microbes that cause tonsillitis usually spread through a hand-arm or hand-to-mouth contact.
• Sore, red, wet throat;difficulty in swallowing.
• Gray or white spots on the tonsils or soft palate.
• Swollen lymph nodes in the jaw and neck.
• Nausea, vomiting, and abdominal pain( usually in children).
Often patients complain of a feeling of discomfort in the throat - tingling, dryness, perspiration, soreness, etc. Characteristic are complaints of bad breath, due, above all, the presence of purulent-caseous congestion in the lacunae of the palatine tonsils.
Local pharyngoscopic signs of the disease are of great importance:
There are groups of cells in the body that perform certain common and similar functions, these cells bear the name of tissue. There are cells responsible for developing immunity and forming lymphoid tissue. From the lymphoid tissue are tonsils - the most important organs of the lymphoid system. These tonsils are called palatines.
Palatine tonsils are located on the side walls of the oropharynx, at the crossroads of the respiratory and digestive tract. In a healthy state, their size is 20-25 mm in height, 12-15 mm in diameter, and 15-20 mm in an anteroposterior distance.
On the medial surface of the amygdala there are up to twenty depressions, or lacunae, in which crypts open, or slotted bags immersed in the depth of the tonsils.
Palatine tonsils themselves actively produce lymphocytes, that is, perform a hematopoietic function, especially pronounced at an early age. The protective function of the tonsils is the active participation of the formation of local and general immunity.
In 6-7 years, the morphological reorganization of palatine tonsils ends, which occupy the maximum surface area due to the full development of lacunae and crypts, and already at this stage, a violation of drainage of lacunae, stagnation of their contents is possible.
Normally, swallowing removes crypt products of phagocytosis and desquamated epithelium. In inflammation, this is hampered by the branched crypts, the presence of palatine arches and some other factors.
When infected, soft lymphoid tissue is affected, scars appear, some lacunae of the tonsils narrow and close, they form closed purulent foci, or plugs. And in them - the accumulation of necrotic epithelium of the mucous membrane of lacunas, which in principle is not so terrible, because the old epithelium should be peeled off, and the new epithelium should grow. But it's bad that he is not going away from the closed lacunae. Here, food particles, living and dead microbes, leukocytes accumulate. It is difficult to imagine the soil more favorable for reproduction of pathogenic microbes. Not surprisingly, sometimes tonsils are covered with liquid pus.
At the same time, they can increase, but can remain small. It does not matter. And in either case, the throat hurts, excruciates an obsessive cough, spoils the life of an unpleasant odor from the mouth, exhausts fast fatigue.
The incubation period for acute tonsillitis is from several hours to 2-4 days. The disease begins, as a rule, sharply: the temperature jumps up to 37.5-39 ° C, the patient beats chills, throats pershit and sarditis, the head, muscles and joints ache. Children also suffer from stomach pain, nausea, vomiting.
The duration of the disease( without treatment) is approximately 5-7 days. Enlargement of lymph nodes can persist up to 10-12 days. In the future, if there are no complications, fever passes, inflammation in the tonsils disappears.
The acute course of many diseases with insufficient treatment, weakened immunity, the presence of concomitant ailments can become chronic. This is also true of tonsillitis, which is also acute and chronic.
The most significant bacterial pathogen of acute tonsillitis is hemolytic group A streptococcus. More rarely acute tonsillitis is caused by viruses and other streptococci, extremely rarely - mycoplasma and chlamydia. The causative agent is transmitted by airborne route. Sources of infection are patients, less often - asymptomatic carriers.
The frequent development of chronic tonsillitis is caused by frequent tonsillitis, adenoids, due to which nasal breathing is disturbed, diseases of the paranasal sinuses, carious teeth - that is, any inflammation of the ear-throat-nose.
External chronic tonsillitis almost does not manifest itself. Sometimes the head hurts and the temperature jumps, weakness overcomes, but who will pay attention to such trifles? It happens that from time to time when swallowing sore throat, coughing. But it happens that the process is almost asymptomatic. And this is especially bad, because the patient does not know that the focus of infection has settled in his body and is freely located, which gradually undermines his strength and spreads to other organs.
Currently, there are more than 100 different diseases due to the appearance of chronic tonsillitis. They affect organs that are so far from the throat in which tonsillitis "lives" that it is difficult to believe in the connection of two diseases. The most pronounced changes in internal organs with a decompensated form of chronic tonsillitis.
• Need a medical history and physical examination. According to clinical features, streptococcal tonsillitis can not be distinguished from a viral disease.
• Sowing culture of smears from the throat is performed to identify the primary carrier of the infection and determine the correct way of treatment.
• Quick tests can be done to determine group A streptococcus.
When diagnosing chronic tonsillitis, frequent angina is taken into account in the anamnesis: 2 to 3 times, and often 4 to 6 times a year, but once in several years it is also frequent. In the diagnosis of chronic tonsillitis should be based on a combination of local and general signs of the disease. The most informative among other local signs of chronic tonsillitis is the presence of a pathological secret in the tonsillar lacunae and submandibular lymphadenitis.
At different times, many leading experts-otorhinolaryngologists offered all possible classifications of chronic tonsillitis. However, the modern clinical data and concepts of chronic tonsillitis most closely correspond to the classification of B.S.Preobrazhensky, augmented and somewhat modified by V.T.Palchoun.
Classification of chronic tonsillitis according to Preobrazhensky - Palchun.
• Simple form.
• Toxico-allergic form:
V I degree;
V II degree.
In all forms of chronic tonsillitis, concomitant diseases can occur that do not have a single etiological and pathogenetic basis with chronic tonsillitis, the pathogenetic relationship of these diseases is through general and local reactivity.
With a simple form, the patient can have frequent tonsillitis( in 96% of patients with a history of angina), there are local signs of chronic tonsillitis.
Toxico-allergic form I degree is characterized by signs of a simple form of chronic tonsillitis and general toxic-allergic phenomena.
To toxic-allergic signs include:
tonsillogenic toxicity( periodic or persistent weakness, weakness, malaise, fatigue, reduced ability to work, poor health);periodic pain in the joints;
functional disturbances of cardiac activity( which are manifested only in the period of exacerbations and are not determined by objective examination without exacerbations);
There may also be abnormalities in laboratory data( blood counts and immunological indices), but they are unstable and can not be attributed to the number of characteristic features.
In the case of toxic-allergic form II degree, these changes take on a permanent character, persist beyond exacerbation. Characteristic is the presence of local and general conditions associated with chronic tonsillitis.
• Local conjugated diseases: paratonzillitis, parafflingitis, chronic pharyngitis, etc.
• General conjugate diseases: tonsilgenic sepsis, rheumatic fever, infectious polyarthritis, acquired heart diseases, urinary system, joints, as well as infectious and allergic diseases of other organs and systems.
The infectious allergic process underlying these diseases is closely related to focal, torpid streptococcal infection, which is most often located in the palatine tonsils. Frequent exacerbations of chronic tonsillitis determine the allergic background, which is a trigger factor in the development of associated diseases.
• Antibiotics are prescribed for the treatment of streptococcal and other bacterial infections;they must be taken at least 10 days.
• Acetaminophen or other over-the-counter pain medications, as well as medications to reduce temperature are recommended to reduce discomfort. Do not give aspirin to children under 16 years of age, as this can cause a potentially life-threatening illness.
• Rinse throat with salt solution several times a day can reduce sore throat.
Local methods of treatment include:
The effectiveness of each of these methods varies depending on the degree of development of the disease and on the state of the body's defenses. So, gargling with solutions of antiseptics, medicinal herbs and other means for chronic tonsillitis is not as effective as in the treatment of sore throat or pharyngitis. This is due to the fact that when rinsing, only the golden surface of the tonsils is irrigated and the lacunae in which the microbes remain are inaccessible. But also to neglect rinsing it is not necessary, even a part of the infection can be removed from the body.
Flushing lacunae with a special syringe is one of the most reliable methods of sanitizing tonsils, especially if it is carried out by courses from 2 to 4 times a year. In addition, that when washing is removed pus, also the medicine gets directly to the tonsils. The difficulty here is that although the procedure is painless, but children and adults do not like it very much when they are manipulated in their throats. But we need to gather strength and fulfill all the doctor's prescriptions, get rid of the chronic process and after that do all that is necessary to never be ill.
• If an abscess develops, surgical drainage may be required.
Conservative treatment of chronic tonsillitis is carried out in order to eliminate or reduce the number of exacerbations of the pathological process, to achieve the disappearance or decrease in the severity of objective signs of the disease and its toxic-allergic manifestations. Treatment includes methods of local effects on tonsils and general restorative therapy.
The most effective local treatment method is the washing of tonsillar lacunae with various antiseptic solutions: dioxidine, miramistine, octanisept, ekteritsida, furatsilina, etc.
The method is based on purely mechanical leaching of pathological contents of lacunas, their sanation and restoration of drainage function. The course of treatment consists of 12 - 15 leaches of tonsils of tonsils, which are carried out every other day;during the year it is recommended to spend 2 - 3 courses of washes.
Among the methods of conservative treatment an important place is occupied by various physiotherapeutic procedures. Microwave therapy, UHF for the submandibular region, UFO for tonsils, laser therapy, magnetotherapy, mud therapy, etc. An obligatory component of conservative treatment is the use of agents that increase the body's resistance: vitamins( C, B, E, K);immunocorrectors( polyoxidonium, gepon, derinata, etc.), vaccines( imudona, IRS-19, ribomunil, etc.).
In chronic tonsillitis, semi-surgical methods of treatment are used: cryotonzillotomy, laser dissection of the tonsillar lacunae, galvanic caustic tonsils, etc.
• If tonsillitis becomes chronic or the size of the amygdala interferes with breathing or swallowing, tonsillectomy may be recommended. This procedure is often done on an outpatient basis.
With a simple form of the disease, it is recommended to be performed in the case when conservative treatment, carried out in a complex 2 - 3 course, proved ineffective. In the case of a toxic-allergic form of a disease of the 1st degree, the operation is also indicated if after 1-2 courses of conservative treatment it was not possible to achieve a sufficient effect. In case of toxic-allergic form of the second degree, tonsillectomy is indicated urgently.
For local anesthesia, use a 1% solution of novocaine or lidocaine or anesthesia. The amygdala is taken to the clamp, an arcuate incision of the mucous membrane measuring 1 to 1.5 cm is made along the groove between the amygdala and the anterior arch. Through the incision by the rasper or elevator, the anterior arch and the upper pole of the amygdala are extracted extracapsularly all the way, take it on the clamp and the same elevator(or a rasper), they separate the back arch. Next, a large spoon with a sharp spoon is removed to the lower pole. In the presence of cicatricial fusion that does not lend itself to an obtuse separation, the latter are dissected with scissors. On the palatine tonsil, a cutting loop is applied and must be cut off, and not cut off.
The most common complication in tonsillectomy is bleeding - arterial, venous or parenchymal. There are primary bleedings that occurred directly during tonsillectomy and secondary, which can appear both in the first hours of the postoperative period, and on the 2nd-5th day and at a later date.
There was a time when it was believed that this is the fastest, most reliable and effective method of dealing with tonsillitis, otitis and other diseases lurking in the ear-nose-throat. Infected and inflamed tonsils become producers and breeding grounds of bacteria that strive to spread throughout the body, and even to those organs and systems that are nearby - in the first place. So the desire to put an end to the existence of tonsils as a receptacle and spreader of infection is completely justified.
But then you should think about the fact that in nature there is nothing accidental. If tonsils exist, it means that they have a certain function. Is it easy for an organism to dispense with the help of tonsils, if they are removed? It's not even easy.
Tonsils are a barrier to pathogenic microorganisms. And if they do not, then one barrier on the path of bacteria will be less. Hence, the infection will immediately penetrate deeper along the respiratory tract. In addition, the inflammatory processes in the tonsils, especially in childhood, lead to the development of persistent immunity. They become a kind of testing ground on which the body works out the means of fighting infection. There will not be this "test site" for strength, the body will not learn to resist infections of all stripes.
So, when deciding whether or not to remove tonsils, it is necessary to proceed from the fact that there is a chance to restore their protective function or not. If there is hope, tonsils should be treated. If purulent tonsils no longer protect the body, but, on the contrary, they are the source of infection and can not be cured, then they will have to be removed.
It is proved that chronic tonsillitis:
From all of the above it can be concluded that chronic tonsillitis is not a harmless disease.
Chronic inflammatory process in the zone of the pharyngeal lymphoepithelial ring and palatine tonsils affects the entire body, violates its protective functions and provokes the development of a mass of diseases. Consequently, chronic tonsillitis should be considered as a focal infection, elimination( from Latin eliminare - expelling) which is an extremely important part of maintaining human health in general, as well as the successful treatment of concomitant diseases.
• Conventional infection control measures can help reduce tonsillitis.
• The main is frequent hand washing, especially in the winter, when germs are easier to spread due to indoor contact.
• Rapid treatment limits transmission of infection.
• Consult a doctor if the sore throat does not go away after 48 hours, especially if it is accompanied by a fever.
• Consult a doctor if sore throat deteriorates, especially on the one hand, despite antibiotic treatment.
In order to put an end to the repeated exacerbations of chronic tonsillitis, it is necessary, as with any chronic disease, 2 times a year, in spring and autumn, to prevent the disease. For this recommendation, which the doctor will give, you can supplement with the following tools.
Rinse the throat 2-3 times a day for a month with the following formulations.
Two big, without green shoots, a clove of garlic, rasstolkite, pour 1 cup of boiled warm milk, strain and rinse the throat, while the composition is not cooled.
In a glass of warm boiled water, add 1 teaspoon of apple cider vinegar, rinse the throat until the solution has cooled.
Add 1 tbsp.spoon the herb celandine in a glass of boiling water, cook for 5-10 minutes on a steam bath, leave for half an hour to settle, strain, rinse your throat until the solution is hot.
You can use one of these compounds, you can alternate them during the day or once every ten days - this is your business.
Then for a week 4 times a day( for children and two times will be enough), dissolve the antiseptic tablets.
If, for one reason or another, you do not want to use medicines, prepare a resorption formulation from natural ingredients. To do this, mix 2 tbsp.spoon of finely grated carrot, 1 tbsp.a spoonful of honey, 5-10 drops of pharmacy alcohol tincture of propolis, 3-5 drops of Lugol's solution, 0.5 ml of a 5% solution of ascorbic acid from the ampoule. You will get a portion that is sufficient for one procedure, which should be carried out as follows. With a small spoon, put a small amount of the mixture on the tongue, press to the sky, suck, and then swallow. At a time, use the whole portion( reduce the dose to children twice).Repeat 2 times a day for 2-3 weeks. How to use folk remedies for this disease look here.
To improve the body's defenses, such compounds are suitable.
Mix 2 tbsp.spoons of juice of red beet, a quarter of a liter of kefir, 1 teaspoon of rose hip syrup, juice of half a lemon. Take the whole portion at once. Spend 3 courses of 10 days each with a ten-day break between them. To treat babies and preschoolers, you need to divide the portion into two parts and give this delicious medicine in the morning and in the evening.
Well stimulates the immune system such a mixture.
In a glass of boiled water, add 1 teaspoon of honey and 1 drop of Lugol's solution. Take 1 time a day after meals for 10 days.
For those who do not know: Lugol's solution is an antimicrobial agent that contains 1 part of iodine, 2 parts of potassium iodide, 17 parts of water.
A mixture of nettle leaves, chamomile flowers, yarrow herbs has stimulating and tonic properties. Mix the herbs in equal parts, take 1 teaspoon of collection, pour 1 cup of boiling water, add 1 teaspoon of honey and drink instead of tea for 10 days.
This method of treating a sore throat with a cold is well known to any opera singer.
Pour 1 cup of water into a saucepan, pour half a cup of sunflower seeds into it, boil for 15 minutes. Then discard the seeds, and boil again boil, adding 1/4 cup of honey( better than lime) and 1 tbsp.spoon of cognac. Drink 1 tbsp.spoon every half hour. In a day from the disease there will be no trace.
Take a glass of hot water, 7 teaspoons of apple cider vinegar, 1 teaspoon of honey, mix well, drink in small sips, not allowing the liquid to cool. Take as often as possible during the day.
About that to treat a chill throat should not be nasty pills and all sorts of other drugs, and tasty food and drink, or, in other words, a diet, was well known to our distant ancestors.
So, the court doctor of Louis XV recommended to their majesty as a medicine from the throat to eat five raw eggs a day or to wash warm quail broth with warm red wine.
Flanders' doctors preferred a melted fat capon( cock), which should be drunk to all common colds. The logic of their recommendations is quite understandable: food, passing through the pharynx, exerts on its mucous membrane a thermal and chemical effect, which can be different. Acute, salty, fried, rough will irritate the loose surface of the oropharynx and intensify its swelling, and the mashed, slimy food, on the contrary, will soften the shell, soothe it.
That's why with a sore throat you need to drink as much liquid as possible, it moistens the mucous, and also rinses from it the remains of destroyed cells and toxic substances that are secreted by microorganisms.2-2.5 liters of warm( and not hot, as many believe) fluids per day will not be superfluous.
The acidity of what you drink is also important. A strong acidic medium( cranberry juice, citrus and pineapple juice, carbonated beverages) promotes the reproduction of microorganisms. Hence, we should give priority to alkaline drinking: water, tea, cocoa, decoctions of medicinal plants or berry nectars.
First of all, the body of should be strengthened.
For this, all the traditional wellness facilities are good. We all know them well: