Tonsillitis in children: treatment, symptoms, complications, prevention
The content of the article:
- The reasons for the development of the disease
- Symptoms of tonsillitis in children
- Diagnostics
- Treatment of tonsillitis in children
- Complications
- Prevention
- Video
Tonsillitis in children is a common upper respiratory tract infection. At the same time, there is no trend towards a decrease in the number of complications. Therefore, the appointment of adequate therapy is one of the important tasks of otolaryngology.
With tonsillitis, the appointment of timely adequate therapy is required
Tonsillitis can be acute or chronic. The process usually involves not only the palatine tonsils, inflammation can spread to the pharyngeal, lingual tonsils and larynx. Viral tonsillitis is more often observed in children under 3 years old, after 5 years the number of bacterial forms of infection increases.
The main causative agents of the disease in children are viruses and bacteria
Timely treatment of acute tonsillitis prevents the appearance of a chronic process and complications from the heart, lungs, kidneys, joints.
Knowledge of age characteristics in children plays an important role in the diagnosis and treatment of diseases of the pharynx and, in particular, palatine tonsils. In the first year of life, the active development of the lymphoid ring begins. It consists of the pharyngeal, two tubal, two palatine and lingual tonsils, as well as the lymphoid tissue of the posterior pharyngeal wall.
The development of follicles in the tonsils is completed by the end of the first year of life, but possibly earlier, since the body immediately after birth is exposed to bacteria and toxic environmental substances.
The palatine tonsils reach full development at 3 years. In young children, the narrow passages of individual lacunae end with extensions, which contributes to the onset of the inflammatory process.
Tonsils reach their maximum size by 5-7 years. The lymphoid tissue becomes hypertrophied due to the intensive formation of active immunity and immunobiological restructuring of the body during the neutralization of infectious-toxic agents that have penetrated the tonsils.
After 10 years, age-related involution of lymphoid tissue begins with partial replacement by fibrous, connective tissue. The size of the tonsils is gradually decreasing, and by the age of 16 their small remains remain.
The reasons for the development of the disease
Most often, acute tonsillitis is caused by a viral infection. The leading role is taken by respiratory viruses, adenovirus, Epstein-Barr virus, enteroviruses. In children, up to 30% of cases of acute tonsillitis is caused by pyogenic streptococcus, or beta-hemolytic streptococcus of group A. Less commonly, staphylococci, pneumococci or fungal infection act as an etiological agent.
Acute tonsillitis is most often caused by viruses, in particular adenovirus
Ways of penetration of infection into the tonsils:
- airborne (together with inhaled air);
- enteral (for example, with dairy products);
- traumatic (after injuries or operations on the posterior parts of the nasal cavity and nasopharynx);
- endogenous: as a result of the activation of the microflora of the tonsils lacunae in patients with chronic tonsillitis, with purulent sinusitis, the presence of carious teeth, against the background of inflammatory diseases of the oral cavity or gastroenteritis.
The infection, penetrating into the tonsils, causes an acute inflammatory process, accompanied by tissue edema, lymphostasis and plethora. Vascular thrombosis with the appearance of microabscesses is possible.
In chronic tonsillitis, the general immune reactivity of the body decreases. The onset of chronic inflammation is caused by disturbances in biological processes in the tonsils. This is facilitated by:
- deep, narrow and densely branching lacunae of the tonsils;
- slit passages, penetrating the entire thickness of the palatine tonsil;
- obstructed drainage from deep sections of lacunae;
- cicatricial changes in blood and lymph vessels after acute inflammatory processes;
- follicle reactivity;
- the state of the receptor apparatus;
- large suction surface of the lacunar epithelium.
Protein masses, mucus, colonies of microorganisms stagnate in the lacunae and cause irritation of the mucous membrane, contributing to the exacerbation and spread of the inflammatory process to the parenchyma and capsule of the tonsils.
In the development of chronic tonsillitis, viruses do not cause inflammatory changes, but, causing circulatory and lymph circulation disorders, they create conditions for the multiplication of bacteria and the appearance of a recurrent course of the disease.
There is a connection between the tonsils and the endocrine system: with angina, the secretion of corticosteroids increases, and with chronic tonsillitis, the function of the adrenal cortex is reduced.
Children with allergies are at risk of developing chronic tonsillitis
Chronic tonsillitis often occurs in children with allergies, rickets, exudative diathesis, chronic rhinitis, sinusitis.
Pathogenic flora at a certain stage can become a trigger factor in the development of autoimmune processes.
Symptoms of tonsillitis in children
The severity of the symptoms of tonsillitis is determined by the form of the disease, its duration, the general condition of the body and may vary depending on the age of the child.
With tonsillitis, an increase in regional lymph nodes is possible
Signs of tonsillitis in children:
- sore throat;
- pain or discomfort when swallowing;
- increased body temperature;
- headache;
- increased salivation;
- pain in muscles and joints;
- enlargement and soreness of regional lymph nodes;
- irritability, tearfulness, apathy.
In the presence of a pronounced inflammatory process, nasalness, difficulty breathing, irradiation of pain when swallowing into the ear and temporary hearing loss may occur.
In chronic tonsillitis, a putrid odor from the mouth, dry cough, malaise, poverty of the skin, decreased appetite, and increased fatigue appear.
Diagnostics
The main methods for diagnosing tonsillitis include:
- examination by an otorhinolaryngologist or pediatrician;
- pharyngoscopy;
- clinical blood test;
- general urine analysis;
- bacteriological culture from tonsils for pathological flora and antibiotic sensitivity.
According to the indications, the doctor can send for a chest X-ray, ECG (electrocardiography), ultrasound examination of the heart. In chronic tonsillitis, you may additionally need to consult a cardiologist, rheumatologist, nephrologist, neuropathologist, infectious disease specialist, and dentist.
Pharyngoscopy determines:
- hyperemia, enlargement and swelling of the tonsils, anterior and posterior arches, partially soft palate;
- loosened surface of the tonsils;
- sharp or solid deposits on the tonsils of white, off-white or yellow;
- caseous-purulent plugs in the gaps.
Pharyngoscopy is performed to make a diagnosis.
From the video and photo of the throat taken during pharyngoscopy, the boundaries of the pathological process are clearly visible. With a compensated form of the disease, inflammation is limited to the palatine tonsils. The younger the child, the more pronounced the symptoms.
In chronic tonsillitis, cicatricial changes in the tonsils are possible, due to which their surface becomes uneven, bumpy. They can hypertrophy or atrophy.
In most cases, C-reactive protein is found in children with chronic tonsillitis
The blood picture reflects changes characteristic of acute inflammation: leukocytosis, an increase in ESR (erythrocyte sedimentation rate), an increase in the number of neutrophils (with bacterial damage) or lymphocytes (with viral etiology of the disease). In chronic tonsillitis, C-reactive protein is found in 60% of cases.
In the general analysis of urine, traces of protein may appear.
Bacteriological culture reveals the type of pathogen and its sensitivity to antibacterial drugs.
If you suspect a group A beta-hemolytic streptococcus, an express test is performed
To diagnose the presence of group A beta-hemolytic streptococcus, an express test is prescribed. It is carried out within 5 minutes and helps not to miss streptococcal sore throat in the early stages. Thus, the test avoids complications associated with late diagnosis and treatment of this form of tonsillitis.
Treatment of tonsillitis in children
How to treat tonsillitis in a child is decided by a pediatrician or an ENT doctor.
Shown bed rest, plentiful drink. Food should be easily digestible, gentle, rich in vitamins, mainly dairy and vegetable.
During the period of therapy, it is recommended to give preference to a dairy-plant diet.
If suspected, as well as when the bacterial form of angina is confirmed, broad-spectrum antibiotics are prescribed:
- penicillins (Amoxicillin);
- cephalosporins (cephalexin);
- macrolides (josamycin).
The drugs of choice for treating streptococcal tonsillitis are Amoxicillin or Phenoxymethylpenicillin. The antibiotic should only be prescribed by a specialist.
With a viral infection, antibiotic therapy is not performed. In this case, the doctor selects antiviral and immunostimulating drugs.
Miramistin is one of the most commonly prescribed topical drugs
Local therapy plays an important role. Warm gargles are prescribed with antimicrobial or antiseptic agents:
- furacilin solution;
- a weak solution of potassium permanganate;
- Chlorhexidine or Miramistin solution;
- sodium bicarbonate solution;
- decoction of sage, calendula, chamomile;
- solutions with sea salt.
The area of the tonsils and pharynx is lubricated with Protargol, Lugol's solution.
Inhalations are also prescribed with a solution of Cromohexal, Tonsilgon N, Miramistin. Positive reviews confirm that these funds have the maximum therapeutic effect when using a nebulizer, which converts the solution into an aerosol.
At high temperatures (38–38.5 ° C), non-steroidal anti-inflammatory drugs (Nurofen, Paracetamol) are indicated. Severe intoxication combined with high fever can provoke seizures, vomiting and loss of consciousness, especially in newborns and infants.
To replenish the water balance, you can use a rosehip decoction
On the advice of Dr. E. O. Komarovsky, it is very important to replenish the water balance. At home, frequent drinking in small sips is recommended. Mineral water, tea with raspberries, lemon and / or honey, rosehip decoction, fruit juices are suitable for this. In a hospital setting, the volume of fluid lost with temperature is replenished by intravenous infusions.
In chronic tonsillitis, physiotherapeutic methods of treatment are used that have a stimulating effect on the body. Often used:
- UHF (ultra high frequency therapy);
- exposure to a helium-neon laser;
- ultraviolet irradiation of the tonsils;
- electrophoresis of calcium chloride;
- ultraphonophoresis of interferon, aloe extract;
- mud therapy.
With a recurrent course of the disease, the tonsils must be removed.
Complications
In severe cases, complications may develop:
- paratonsillar and parapharyngeal abscesses;
- acute inflammation of the middle ear;
- laryngitis;
- laryngeal edema;
- phlegmon of the neck;
- mediastinitis;
- endocarditis;
- rheumatic heart disease;
- articular rheumatism;
- systemic lupus erythematosus;
- pyelonephritis;
- diffuse glomerulonephritis;
- dysfunction of the adrenal cortex;
- sepsis.
Prevention
Prevention of tonsillitis includes:
- sanitation of the oral cavity;
- restoration of normal nasal breathing in pathology of the nose and paranasal sinuses;
- increasing the general resistance of the body;
- frequent hand washing.
One of the most effective preventive measures for the development of tonsillitis is hand hygiene.
It is necessary to timely detect and treat acute and chronic infectious diseases of the upper and lower respiratory tract.
In order to prevent the development of serious complications, when children develop sore throats, it is necessary to consult a doctor and follow all clinical recommendations assigned to them.
Video
We offer for viewing a video on the topic of the article.
Alina Ervasova Obstetrician-gynecologist, consultant About the author
Education: First Moscow State Medical University. THEM. Sechenov.
Work experience: 4 years of work in private practice.
Found a mistake in the text? Select it and press Ctrl + Enter.
