Epidemiology and prevalence
In adults, this disease occurs in 7% of cases, in children - in 13% of cases. More often, the disease occurs in those people who have a predisposition to it, associated with the anatomical and histological features of the structure of the palatine tonsils.
Chronic tonsillitis is an infectious disease. Up to 30 different types of bacteria can be found on the tonsils, the bulk of which are streptococci and staphylococci. These bacteria differ from those found in the opportunistic microflora of a healthy person. They differ in their increased aggressiveness and therefore can be transmitted from a sick person to a healthy one, and cause the latter to have the same disease.
Chronic tonsillitis symptoms
Chronic tonsillitis proceeds with alternating phases of exacerbation (tonsillitis) and remission.
NSWith an exacerbation of this disease, symptoms such as sore throat when swallowing, difficulty in eating, enlargement of the tonsils, the appearance of white deposits on them, which are easily separated with a spatula.
At the same time, the body temperature rises, the state of health worsens, body aches, headaches, and sometimes muscle pain appear.
Such exacerbations can occur from 1 to 6 times a year. Therefore, when contacting a doctor, the main complaint of patients is the presence of recurrent tonsillitis.
In the period of remission, patients are worried about bad breath, sensation of a foreign body in the throat, especially when swallowing.
Examination of the throat reveals enlargement and loosening of the tonsils, redness of the palatine arches and other tissues around the tonsils. On the tonsils themselves, you can identify white-yellow small formations up to 2 mm in size - purulent inflammation of the follicles of the palatine tonsils. Sometimes they can discharge pus with an unpleasant odor.
Another sign of this disease is an increase in the cervical and submandibular lymph nodes, their pain on palpation.
Forms of chronic tonsillitis
There are two forms of this disease:
- simple form;
- toxic-allergic form.
Simple form
The simple form manifests itself with all the symptoms described above, but at the same time the phenomena of intoxication are weakly expressed or not expressed at all. With this form in remission of the disease, chronic tonsillitis does not cause a violation of the general condition of the patient.
Toxic-allergic form
With this form, in addition to the main symptoms of chronic tonsillitis, symptoms of allergy and intoxication are added to it. This is expressed in an increase in body temperature, fatigue, decreased performance, pain in the head, joints, muscles and heart.
The toxic-allergic form is divided into two degrees according to the severity and likelihood of complications. Moreover, if a patient with chronic tonsillitis has associated diseases (mainly these are diseases, associated with beta-hemolytic streptococcus serogroup A), then this immediately determines the second degree of severity toxic-allergic form.
Chronic tonsillitis treatment
Treatment of a simple form of chronic tonsillitis begins with conservative therapy. If conservative therapy is not effective (no effect after three courses), then the question arises of removing the palatine tonsils by surgery.
Treatment of the toxic-allergic form of chronic tonsillitis depends on its severity. At the first degree of severity, treatment is also begun with conservative treatment, and if this treatment does not give an effect after 1-2 courses, then the tonsils are surgically removed.
The second degree of severity of chronic tonsillitis is a direct indication for the surgical removal of inflamed tonsils.
Conservative treatment
Treatment of chronic tonsillitis in the acute stage
With exacerbation of chronic tonsillitis, angina occurs. It is due to the development of pathogenic microflora in the tonsils. Therefore, the main drugs in the treatment should be antibiotics and antiseptics.
Treatment of chronic tonsillitis with antibiotics begins immediately when symptoms of hyperemia, sore throat and fever appear. Antibiotics can be used both in tablet form and in the form of injections. The main antibiotics that should be used for this disease are antibiotics of the penicillin group (ampicillin, amoxicillin) and cephalosporins (cefazolin, ceftriaxone).
No effect after 48 hours from the start of antibiotic treatment (no decrease in body temperature, pain and swelling of the tonsils), suggests that this drug does not work and it is necessary to change it to another. This can happen if you have been repeatedly treated with this type of antibiotic and the bacteria have developed resistance to it. For a more accurate determination of the antibiotic resistance of bacteria, it is necessary to perform a bacteriological study to determine the sensitivity of bacteria to antibiotics.
In addition to antibacterial treatment, it is necessary to rinse the throat and mouth with antiseptic solutions (furacillin, iodinol and others). Such rinses are performed 5-10 times a day.
Also, sprays (inhalipt, hexoral and others) are used as a local treatment, the use of which is carried out according to the instructions.
To reduce sore throat and provide an antiseptic effect, there are a variety of special sucking lozenges (pharingosept and others).
There are several methods of conservative treatment of chronic tonsillitis without exacerbation:
Method of washing the tonsils. In connection with a certain anatomical feature of the structure of the tonsils in some patients with chronic tonsillitis, the physiological lavage of the tonsils in a natural way is disturbed. Because of this, stagnation of the contents and development of various pathogenic bacteria occurs in the lacunae of the tonsils. Washing the tonsils is carried out using a syringe with a curved cannula or using special equipment. For washing, antiseptic solutions of furacilin, boric acid, iodinol and others are used. The purpose of washing is to mechanically remove the purulent contents of the lacunae and destroy bacteria with antiseptic solutions. Typically this should be done every other day for 15 days. The repetition of the course is carried out after three months.
Methods for extrusion, suction and removal of the contents of the gaps with special tools. This method is rarely used due to its low efficiency and the possibility of trauma.
The method of introducing drugs into the tissue of the tonsils and surrounding tissues. At the same time, substances such as antibiotics, sclerosing substances, hormones, enzymes, and so on are introduced. It is difficult to talk about the effectiveness of this method, since this technique is used extremely rarely due to the possibility of developing abscesses in the tonsils.
Physiotherapy treatments for chronic tonsillitis. For such treatment, UFO, electromagnetic waves, ultrasound are used. This physiotherapy is usually performed in 15 sessions. After that, the tonsils have an increased ability to resist infection.
Surgery
Treatment of decompensated chronic tonsillitis (lack of effect from conservative therapy, toxic-allergic form of the second degree, paratonsillitis, sepsis) is only operative.
Preparation for surgical removal of tonsils (tonsillectomy) is carried out on an outpatient basis. For this, an anamnesis of the disease and anamnesis of life are collected, various laboratory tests are taken, blood pressure is changed, an ECG is taken, and examined by various specialists.
If possible, before the operation, the patient is treated for concomitant diseases, symptomatic therapy of the underlying disease is carried out. Before the operation, the patient is given sedatives, sedatives. The operation is performed on an empty stomach.
Operation progress
As a rule, tonsillectomy is performed with the patient unconscious under local anesthesia in a sitting position. Anesthesia is carried out with the help of dicaine (lubrication) and novocaine 0.5% with adrenaline (injecting the tissues of the tonsils).
The tonsil is removed with a special instrument (loop) or scalp. First, it is pulled back, separated from the surrounding tissues, then inserted into the loop and cut under the base. Clamps are applied to the bleeding surface and sutured.
After the operation, the patient is sent to the ward, put to bed and an ice pack is placed on his neck. The operated area may bleed a little, so the patient is placed on his side so that the blood flows not down the throat and further into the esophagus, but into the oral cavity. This allows you to control the amount of blood loss.
On the first day after the operation, the patient should not eat, but you can drink a little water. For sore throat, the patient is given application anesthesia (for example, strepsis-plus-spray). Every other day, the patient can be fed with liquid food.
The patient is discharged from the hospital on the fifth day. He is given a hospital regimen for a week and recommendations are given (to avoid strenuous physical exertion, follow a sparing diet, etc.).
