Features of the treatment of chronic tonsillitis: signs and symptoms, treatment and prevention

Tonsillitis is an inflammation of areas of lymphoid tissue (tonsils) located on the back wall of the pharynx. They protect the body from the penetration of potentially dangerous viruses or bacteria, but in some cases they themselves can become infected. In many acute cases, the disease is viral in nature, so tonsillitis can be treated without the use of antibiotics. The chronic form of the disease is associated with the long-term existence of bacteria in the tonsil tissue. It requires complex therapy, and in some cases, surgical intervention. Tonsillitis most often affects children, but it can develop in people of any age.

Chronic tonsillitis: symptoms in adults and children

Tonsillitis is a disease caused by infection that affects the tonsils - organs that are located in the nasopharynx and form a ring barrier that protects the body from the penetration of viruses and bacteria, triggering the action of the immune systems.

The surface of the tonsil is covered with depressions - lacunae. These depressions can cause chronic inflammation, as food debris and dead cells settle there, which are a favorable environment for pathogens.

When the self-cleaning process of lacunae is disrupted, pathogenic microflora multiplies, causing chronic inflammation.

When damaged by microbes, the tonsils themselves turn into a source of infection and contribute to the spread of pathogenic flora throughout the body.

The main causative agents of tonsillitis are:

Pneumococcus
streptococcus
staphylococcus
hemophilus influenzae

According to the nature of the disease, tonsillitis is distinguished:

acute , which is characterized by high fever, sore throat when swallowing, chills, general malaise chronic , when microbes affect the tonsils for a long time, resulting in inflammation in the palatal area

Chronic tonsillitis can be of various types:

follicular - small pustules predominate on the affected tissue
lacunar – widened lacunae predominate
catarrhal - enlarged tonsils are covered with plaque
fibrous-membranous - tissues covered with a film
phlegmonous - the most severe and dangerous form with purulent inflammation

In addition, doctors distinguish between the following forms of tonsillitis:

simple – inflammation of the tonsils is slight, and the body’s reaction is not significant
toxic-allergic – inflammation is widespread, in which disturbances are observed in other systems in the body

The main symptoms of chronic tonsillitis can be:

sore throat causing dry cough
pain of a constant nature, which periodically decreases or intensifies
swelling of the nasopharyngeal area
negative reaction of the throat mucosa to cold
pus is released from the tonsil when pressed
general weakened state and fatigue
body temperature is increased
in some cases there is aching in the joints
specific odor from the mouth due to purulent plugs
submandibular lymph nodes enlarge, become dense and sensitive to palpation

Reasons that provoke the development of the disease:

nasal polyps
frequent inflammation of the tonsils
chronic adenoiditis
purulent sinusitis
deviated nasal septum, which interferes with proper breathing

Chronic tonsillitis seems to be a very serious disease, since the human body is exposed to toxic components of the infection for a long time, which can cause damage to internal organs. In addition, purulent discharge from the tonsils enters the gastrointestinal tract.

These factors can lead to various complications

diseases of the cardiovascular system
kidney damage
dysfunctions of the genitourinary system
rheumatism
dysbacteriosis
polyarthritis
nervous system disorders
pneumonia
psoriasis
exacerbations of allergic reactions
in cases of prolonged absence of treatment – the development of an autoimmune disease

Causes of tonsillitis

Depending on the nature of the course, tonsillitis can be:

acute (also called sore throat),
chronic1,2,3.

The cause of acute inflammation of the tonsils is infection1. It can be viral, bacterial or mixed1,2.

The viral nature of sore throat predominates in adults and children over 15 years of age1,2. It usually develops with ARVI, which is caused by rhinoviruses, adenoviruses, and parainfluenza viruses1. In this case, tonsillitis is accompanied by rhinitis, pharyngitis, laryngitis and other respiratory tract diseases1.

In children 5-15 years old, bacterial tonsillitis is more common, and in first place (up to 30% of cases) among them is the most dangerous type of sore throat, caused by beta-hemolytic streptococcus of group A1. In adults, this type of tonsillitis is much less common1, and among the bacteria that cause the disease, streptococci of other groups, corynebacteria, Haemophilus influenzae, Neisseria, and staphylococci predominate1.

The cause of chronic tonsillitis is also an infection, but, unlike acute processes, it is caused by less aggressive pathogens2. In this case, there may be no acute inflammation of the tonsils; the process is initially chronic in nature and is hidden behind frequent acute respiratory viral infections and inflammatory diseases of the oral cavity and pharynx (non-anginal form of chronic tonsillitis)2.

Chronic inflammation leads to the death of functional, that is, lymphoid, tissue of the tonsils and its replacement with connective tissue1. The tonsils gradually lose their protective functions, often become easy prey for microbes and viruses, become inflamed and turn into a breeding ground for infection1 and an irritant for the immune system. As a result of chronic tonsillitis, immune disorders often occur, leading to the development of infectious-allergic and autoimmune diseases1,2.

Chronic tonsillitis - treatment in adults

Diagnosis of chronic tonsillitis is often difficult. An otolaryngologist treats tonsillitis. Using tests, he determines the degree of inflammation and tissue damage.

As a rule, the following tests are prescribed:

swab from the throat and nasal mucosa
general blood and urine test
biochemistry of saliva
immunogram

Treatment methods for this disease depend on the nature of its course:

conservative – drug therapy aimed at treating inflammation, the infection that caused it, as well as diseases that can provoke exacerbation.
surgical - complete removal of the tonsils or only their affected parts.

Treatment of chronic tonsillitis always begins with a conservative method. In cases where no positive dynamics are observed after 3 courses of therapy, a decision is made to remove the tonsils - tonsillectomy. The toxic-allergic stage requires a surgical method after 2 courses of unsuccessful drug treatment.

The main condition for achieving a positive result is an integrated approach, which, in addition to eliminating the source of infection, includes:

sanitation of the oral cavity (treatment of caries)
elimination of chronic inflammation of the nasal cavity (rhinitis, sinusitis, adenoiditis)
strengthening the immune system

Conservative treatment of chronic tonsillitis

Using a conservative method, chronic tonsillitis is treated in courses, preferably in spring or autumn.

This therapy includes several stages:

cleansing the tonsils from pathological flora, pus and plugs (rinsing with antiseptics, using ultrasound);
introduction of medications into cleaned lacunae in the form of ointments, solutions, emulsions, pastes
taking anti-inflammatory drugs;
if necessary, prescribing antibiotics;
elimination of secondary allergization of tissues;
relieving large swelling with antihistamines;
prescription of immunostimulating drugs;
irrigation of mucous membranes with complex salt solutions, which eliminates allergic reactions and strengthens the immune system;
medical physiotherapeutic procedures (UHF, ozokerite compresses on the lymph node area, UV irradiation of the tonsils);
reflex therapy (cervical spine massage, acupuncture);
inhalations using medications;
gargling with decoctions of medicinal plants.

The success of conservative treatment lies in an integrated approach and regularity of procedures.

If you have tonsillitis, you should not self-medicate. Even inhalations must be prescribed by a doctor, since any treatment methods often have a number of contraindications.

Chronic tonsillitis: surgical treatment

If there is no positive result after conservative treatment, a decision is made on a surgical operation to remove the tonsils (tonsillectomy), when the affected tissue is removed and the areas in contact with it are cauterized. The procedure is performed under anesthesia (general or local).

Indications for surgical intervention are:

paratonsillar abscess
toxic-allergic form
chronic or acute sepsis
excessive enlargement of the tonsils, which interferes with the mechanical process of swallowing
apnea
dysfunction of internal organs

Modern clinics offer various methods of performing tonsillectomy:

Classic: using surgical instruments - the procedure is quite painful, accompanied by blood loss. This method is considered obsolete.
Laser is the least traumatic method, making it possible to remove not the entire tonsil, but only the affected part.
Electrocoagulation is exposure to high-frequency current.
Ultrasonic – uses the energy of ultrasonic vibrations.
Radiofrequency ablation - tissue is cut without thermal energy. Trauma and blood loss are minimal.
Cold plasma - exposure to the source of the cold plasma component. It is considered one of the safest methods for removing tonsils.

The nature of the operation is determined based on:

the size of the growth of pathological tissues
presence of scars
the degree of fusion of the tissues of the tonsils with the tissues of the nasopharynx

Contraindications to tonsillectomy are:

acute inflammatory process
tuberculosis
diabetes
blood and vascular diseases
acute renal failure
heart disease
menstruation period

Doctors give the following recommendations to patients on how to behave in the postoperative period:

If possible, do not talk for 24 hours
keep bed rest
sleep on your side
exclude rough foods
Hot baths and saunas are prohibited during the week
exclude the pool for 4 weeks

Complications after surgery are rare. To avoid this, you must strictly adhere to your doctor’s recommendations.

Many people fear that after removal of the tonsils, the body’s protective properties will noticeably decrease. This fear is completely justified. However, there is no significant decrease in immunity in patients after surgery. A number of experts believe that the remaining tonsils of the pharyngeal ring continue to successfully serve as a barrier against infections.

Chronic tonsillitis in a child: treatment

Tonsillitis is quite common among children. According to statistics, more than half of frequently ill children have a chronic form of the disease. Tonsillitis can develop and become chronic in a child at any age.

Children with:

allergies
chronic rhinitis
hypovitaminosis
rickets
low immunity

Sometimes it is possible to develop chronic tonsillitis without a cold. This is due to congenital pathologies of the palatine tonsils. In such cases, tonsillitis, as a rule, is provoked by diseases of the oral cavity (caries, stomatitis), and the tonsils are involved in the general inflammatory process.

Pediatricians give the following recommendations for parents of a child with chronic tonsillitis:

undergo preventive treatment at least 2 times a year
It is preferable to use homeopathic remedies
at an early age, when the child cannot yet gargle, let him drink chamomile decoction
teach your child to keep his mouth clean
Provide your baby with a nutritious diet enriched with vitamins and minerals
take a walk in the fresh air every day
avoid severe hypothermia
toughen up the child
accustom your tonsils to cold (during remission, drink chilled drinks in small portions)
If possible, provide your child with a vacation on the seashore
Give your baby a gentle throat massage from top to bottom using stroking movements
Keep in mind that ultrasound and microwave physiotherapy is indicated from 6 to 7 years of age

Exacerbation of chronic tonsillitis: treatment

During an exacerbation of chronic tonsillitis, pathogenic microflora is activated. This condition can be triggered by the following factors:

ARVI
severe hypothermia
stressful situation
low immunity
allergies
fungal and viral infections

During an exacerbation, infectious agents begin to actively penetrate the vessels and tissues of the tonsils. And the release of toxins causes an acute allergic reaction.

Exacerbation of this disease can lead to negative changes in the structure of the tonsils:

hyperplasia - fibrous tissue grows, cysts form, and the tonsils enlarge
atrophy - lymphoid tissue is replaced by fibrous tissue, and the size of the tonsils decreases

In cases of exacerbation, the following treatment methods are usually used:

antibiotic treatment
the use of bacteriophages, especially in cases where the infectious agent is not sensitive to various antibiotics
Irrigation of the tonsil area with disinfectants
use of antimicrobial drugs
physiotherapeutic procedures

Prevention

Prevention is based on:

giving up bad habits, smoking;
carrying out hardening procedures;
establishing a balanced diet;
avoiding hypothermia and drinking cold drinks;
timely release of nasal breathing and clearing of the nose from purulent accumulations;
proper treatment of tonsillitis and sore throat, avoiding complications.

If primary signs appear, do not hesitate to consult a doctor, otherwise inflammation of the tonsils, especially in a child, can lead to cardiovascular diseases, rheumatism, and the consequences may well become irreversible

Chronic tonsillitis: treatment with antibiotics

To treat chronic tonsillitis, antibiotics are often prescribed to stop the infection and prevent it from spreading further. These funds can be:

wide range
local action

Antibiotic drugs belong to different groups:

Cephalosporins – Cefix, Cefodox, Cefazolin, Tricaxon, Ceftriaxone
Penicillins – Amoxiclav, Flemoklav, Unazin, Timentin, Penicillin, Amoxicillin
Macrodids - Erythromycin, Azithromycin, Clarithromycin, Roxithromycin
Lincosamides – Lincomycin, Clindamycin

The choice of an antibiotic of one group or another is determined only by a doctor after an appropriate examination. It is strictly prohibited to start taking these medications on your own and without medical supervision.

When taking these medications, consider the following:

antibiotics are taken in a course;
taking medications is stopped after 3-5 days of normalization of the condition;
the use of reduced antibiotic standards can lead to resistant strains of microorganisms, which will complicate treatment in the future.

Possible complications

Despite its apparent harmlessness, tonsillitis is a rather dangerous condition that can lead to the following consequences:

Inflammation in the middle ear area, which in turn will provoke decreased or complete loss of hearing (in the absence of adequate and timely therapy).
Acute rheumatism of the heart and joints.
Formation of prolapses in the heart valves.
Glomerulonerite.
Purulent inflammation of the tissues in the pharynx.
Peritonsillar abscess.
Severe pneumonia (unilateral or bilateral).
Exacerbation of allergic reactions.

Komarovsky: treatment of chronic tonsillitis

The famous children's doctor Evgeny Komarovsky draws the attention of parents to the fact that many confuse sore throat with chronic tonsillitis. These are two different illnesses. Sore throat is an acute infectious disease that is always caused by microbes and cannot appear only after hypothermia. Damage to the tonsils in such cases is an indicator of the severity of the disease. And chronic tonsillitis is a disease of the palatine tonsils themselves, in which various factors can provoke an exacerbation.

Komarovsky considers the main cause of exacerbations of chronic tonsillitis to be a decrease in the body’s protective properties. Therefore, the main task is to strengthen the immune system. In addition, the doctor recommends:

do not use Lugol’s solution to lubricate the tonsils in children, as it contains a high concentration of iodine;
avoid dryness of the mucous membranes of the mouth and nose;
humidify the air in the room;
limit the use of local antiseptics;
do not forbid your child to eat cold foods, since cold stimulates blood circulation and thereby improves immunity; be sure to treat caries;
teach your child to rinse his mouth after eating.

Enlarged tonsils - the reason?

There are several reasons why your tonsils start to hurt. Consider the inflammation of the tonsils in the throat in the photo. This picture can be seen if microbes that cause abnormalities - streptococci, staphylococci and others - settle in the throat. Another reason may be the invasion of viruses or fungi into the oral cavity.

The tonsils consist of a large concentration of lymph nodes. Their product is lymphocytes, which fight all infections that penetrate us. If there are not enough lymphocytes, or they are unable to overcome the infection themselves, then the tonsils become inflamed.

Treatment of chronic tonsillitis with laser

Laser tonsillectomy is one of the progressive methods of treating chronic tonsillitis. Unidirectional laser radiation is used in both conservative and surgical treatment. With conservative therapy, the laser beam has an anti-inflammatory effect.

Features of this method:

laser is applied in courses 2 times a year
the course includes an average of 10 procedures
Process duration: about 4 minutes
after removal of tonsils, this procedure has a healing effect
local irradiation of lacunae is possible
goes well with drug therapy

The surgical treatment method, in which tonsils are removed using a laser, has its own characteristics:

Before surgery, immunomodulators are prescribed to increase the resistance of body cells to bacteria
the procedure is performed under local anesthesia
Typically the operation takes about 20 minutes
no pain or other discomfort
the likelihood of bleeding is quite low
the rehabilitation period lasts about a week

With the help of a laser, 2 methods of surgical treatment are possible:

complete removal of tonsils
partial excision

Contraindications to laser tonsillectomy are:

age up to 10 years
oncological diseases
exacerbation of chronic diseases
blood and vascular diseases
pregnancy

Treatment of sore throat

When treating angina, it is important to begin symptomatic treatment at the first signs of the disease and carry out all procedures regularly and as often as possible.

Drug treatment should be prescribed only by a doctor, after examination and consultation of the patient.

At the first signs of a sore throat you should:

gargle as often as possible - this helps to mechanically remove microorganisms, suppress their activity, reduce inflammation and pain. You can gargle with any antiseptic solutions - furatsilin solution, decoctions of chamomile, sage, soda-salt solution (0.5 tsp of salt and soda per 1 cup of water), iodine solution (1-2 drops per 1 cup of water), 1% solution hydrogen peroxide (10-30 drops per 1 cup of water), propolis solution (2-5 drops per 1 cup of water) and so on. Such rinses should be carried out as often as possible, up to 10-12 times a day, but at least 4-6 times a day;
drink more alkaline liquid - the patient needs to drink 2-2.5 liters of liquid per day. This could be warm milk, an hour with lemon and honey, broth, mineral water, compotes, jelly, and so on;
do inhalations - such procedures can only be carried out at normal body temperature. Inhalations are done with sage, chamomile, boiled potatoes or special preparations;
take lozenges and tablets - various cough lozenges help soothe the throat and reduce inflammation; for sore throat, they can be used as an adjuvant. Such drugs as Adjisept, Travisil, Faringosept, Sprepsils, Septolete, Angisept and others have a good effect;
use sprays - to treat sore throat in young children, you can use spray medications; they help reduce inflammation and destroy microorganisms. For the treatment of sore throat, Ingalipt, Yox, Bioparox, Stopangin and others are used.

Chronic tonsillitis: treatment, drugs

For chronic tonsillitis, medications are selected after determining the cause of the disease. Taking into account the type of pathogens of the disease and the form of its course, the following remedies can be prescribed:

Local and broad spectrum antibiotics.

Augmentin is a penicillin series, quite effective and popular
Sumamed is a group of macrolides, widely used in the treatment of the respiratory tract.
Ceftriaxone (powder for injection) – administered intramuscularly or intravenously
Bioparox (aerosol) – has an antiseptic, antifungal and anti-inflammatory local effect
Miramistin is a mild antibiotic used for inhalation

Antiseptics that affect the pathogenic flora of the tonsils, disinfect and disinfect the nasopharyngeal area:

Faringosept (lozenges) – has a bacteriostatic effect on most pathogens.
Falimint (tablets) – in addition to being antiseptic, it has a slight anesthetic effect.
Tonsilgon (drops and tablets) is a plant-based antiseptic with an anti-inflammatory effect.
Chlorophyllipt – has antibacterial properties against antibiotic-insensitive pathogens. An alcohol solution is used for rinsing, and an oil solution is used to lubricate the tonsils.
Chlorhexidine (solution, spray) – used as a rinse and irrigation.
Lugol (spray, solution) – for treating tonsils.
Decasan - has an antiseptic effect, increases the sensitivity of microbes to antibiotics.
Decathylene (lozenges) – has a bactericidal effect, eliminates pain symptoms.
Trachisan (lozenges) – has an antimicrobial effect.

Anti-inflammatory, promoting tissue regeneration and eliminating inflammation:

Tantum verde (tablets, spray, solution) - also has analgesic properties.
Ingalipt (aerosol) – has an antimicrobial and cooling effect on the mucous membrane.
Strepfen (lozenges) - belongs to the group of local non-steroids. Eliminates inflammation, relieves sore throat.
Septolete (lozenges) – indicated for inflammatory and infectious diseases.

Painkillers - to relieve pain in the throat:

Grammidin (tablets) – also have an antiseptic and anti-inflammatory effect
Strepsils (tablets) – fungicidal and antibacterial medicine containing menthol and vitamin C
Stopangin (rinse solution, spray) – has analgesic and antimicrobial properties
Acetaminophen (tablets) – relieves pain and fever symptoms, has an anti-inflammatory effect

Combined, affecting the body in several directions:

Proposol (spray) is an antimicrobial, wound-healing and anti-inflammatory drug.
Tonsilotren (tablets) is a homeopathic remedy that restores tissue structure and has anti-inflammatory and immunomodulatory properties.
Aqualor – has an antiseptic, anti-inflammatory and restorative effect, improves immunity.
Givalex (irrigation solution) – has antibacterial, antifungal, analgesic effects.
Tera-Flu (spray) is a product with antiallergic, antipyretic, and analgesic effects.
Lizobakt (lozenges) – on a natural basis, has antiviral, antifungal and antiseptic effects, regulates the immune system.

If necessary, antiviral auxiliary agents can be prescribed, which are prescribed in cases where the disease is caused by a viral infection:

Acyclovir
Valaciclovir
Pharmciclovir
Viferon
Arbidol

Antipyretics for high temperatures:

Ibuprofen
Paracetamol
Aspirin

Immunomodulatory, helping to normalize the immune system:

Imudon (lozenges) – increases the body’s resistance, eliminates bacterial infections
IRS-19 (nasal spray) – can be used from three months of age
Ribomunil (tablets, granules) – used as a therapeutic and prophylactic agent
Broncho-munal (capsules) – reduces the frequency and severity of infectious diseases

Antihistamines – in case of allergic reactions:

Tsetrin
Loratadine
Suprastin
Tavegil

Chronic decompensated tonsillitis: treatment

Experts distinguish the following types of chronic tonsillitis:

compensated – the inflammatory process does not extend beyond the area of the palatine arches, the person’s general well-being is not disturbed
decompensated - the inflammatory process is combined with a disruption of the functioning of other body systems, an increase in temperature

This stage is the most severe form of the disease, in which the infected tonsils practically do not perform their functions.

Signs of decompensated form:

frequent recurrence of relapses (more than 3 times a year);
spread of inflammation beyond the tonsils - the tissues around them are also affected by infectious microorganisms, and general suppuration begins;
formation of scars or other damage to the tonsils;
persistent acute pain in the throat;
difficulty opening the mouth;
severe intoxication of the whole body;
heat.

The decompensated form is a direct indication for surgical removal of the affected tonsils. Conservative therapy in this case will not bring results.

Symptoms of inflammation of the tonsils

Inflammation of the tonsils (photo) is characterized by discomfort in the throat. The first feeling is the sensation of a pain in the throat. Then a slight soreness occurs, which will gradually intensify. After this, the discomfort develops into pain. They manifest themselves especially strongly when a person swallows food. Upon examination, redness of the tonsils of the palate can be detected. In addition, they swell significantly.

Inflammation of the tonsils, the symptoms of which can be fairly easily identified, is a serious disease, the treatment of which should not be delayed. If treatment is not started on time, the patient will gradually develop breathing problems. Every day it will become more and more difficult not only to swallow food and water, but also to breathe.

You feel tired, weak, lethargic, and apathetic. These are all signs of illness. Body temperature rises. It can reach 29 degrees. The patient experiences chills and fever. You feel achy and your head starts to hurt.

Upon further examination, purulent discharge may be detected on the tonsils. The pus will be white-yellow in color. Lymph nodes in the neck and submandibular area will begin to grow. Pain will be felt upon palpation. Moreover, the lymph nodes will remain enlarged even after all other signs of the disease disappear during treatment.

In addition, the voice begins to hoarse. In some cases, you can even lose it temporarily. This is due to the fact that when the tonsils swell, they prevent the vocal cords from closing. If a sore throat is not treated, an acute form of laryngitis develops. Then the patient will begin to cough heavily.

Sore throat is an acute form of inflammatory processes in the tonsils of the palate. This disease has several types: phlegmatous, lacunar, follicular and catarrhal. The catarrhal type of sore throat is considered the mildest in the course of the disease. With the follicular type, follicles are formed - ulcers. They reach the size of a buckwheat grain. The pain will be so severe that even your ears begin to hurt. Body temperature is very high. With the phlegmatous type of the disease, an abscess develops. Body temperature rises to 40 degrees. With the lacunar type, pus will concentrate on the lacunae.

The lingual tonsil becomes inflamed quite rarely. Characteristic symptoms include pain when moving the tongue.

Adenoids are tonsils that are located in the pharynx. They can become inflamed on their own or together with the tonsils.