Treatment Of Chronic Tonsillitis In Adults: Recommendations, Reviews

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Chronic tonsillitis treatment: how to treat, symptoms, recommendations

The content of the article:

Causes, types and symptoms of chronic tonsillitis
Diagnostics of the chronic tonsillitis
How to treat chronic tonsillitis
1. Conservative treatment
2. Surgical intervention
Video

The treatment of chronic tonsillitis differs from the treatment of the acute form of the disease - angina. It often occurs in connection with a decrease in the immune system, frequent hypothermia, severe fatigue, or colds. Its causative agents can be viruses, bacterial or nonspecific infections, acute leukemia, etc. The chronic process takes a long time in the tonsils and in most cases develops as a result of ineffective or incomplete therapy of acute tonsillitis.

Treatment of acute and chronic tonsillitis is different

The main differences between these forms of pathology are the symptoms and the degree of their manifestation. In the acute course, the symptoms of the disease are pronounced. Patients have a rapid and significant increase in body temperature (up to 41 ° C), they complain of headache, lack of appetite, malaise and general weakness, pain in the throat and joints. They have an increase in lymph nodes and tonsils, as well as the formation of purulent plaque and plugs on the second, and their staining in red.

The chronic course of tonsillitis is characterized by a sluggish inflammatory process in the throat, with periods of remission and exacerbation. A significant increase in body temperature, like purulent plugs, is extremely rare. A distinctive feature of this type of pathology is nasal congestion, which never occurs with angina.

Diagnostics and selection of effective treatment for chronic tonsillitis in adults is carried out by an otolaryngologist, in children - by a pediatrician or pediatric ENT. Conservative methods of therapy can be used, in extreme cases - removal of the tonsils. Self-medication at home with folk remedies without consulting a doctor is not recommended.

Causes, types and symptoms of chronic tonsillitis

Palatine tonsils, composed of lymphoid tissue, are part of the body's general immune system. Their main function is to protect against infectious agents entering the pharynx.

Pathology is characterized by a violation of the protective functions of the palatine tonsils

The human microflora consists of opportunistic and pathogenic microorganisms, which are in a state of balance due to the general work of all parts of the immune system. If this balance is disturbed, and pathogenic organisms penetrate, bacteria, fungi or viruses are destroyed through the tension of local immunity. Lymphoid tissues, with a general decrease in the body's resistance, the presence of a large number of pathogenic flora and frequent tension of the immune system, do not produce a sufficient amount of gamma globulins, lymphocytes and interferons to resist infectious agents.

Prolonged and / or frequent inflammatory processes in the pharynx lead to the loss of the ability of the palatine tonsils to cleanse tissues and resist the pathogenic flora, thereby they turn into a focus of infection and lead to the development of chronic tonsillitis. The presence of reservoirs (lacunae) of the accumulation of various microorganisms and epithelial cells makes them most susceptible to the chronic course of inflammation.

The appearance of inflammation can lead to damage by adenoviruses, staphylococci, enterococci, greening or hemolytic streptococcus. Also, the disease may be associated with the activation of the non-pathogenic saprophytic flora of the upper respiratory tract against the background of a violation of the protective and adaptive mechanisms of the body. In this case, chronic tonsillitis is classified as a disease caused by autoinfection.

Trigger factors for the development of chronic tonsillitis include frequent hypothermia

The factors leading to the onset of pathology include:

untreated sore throat;
anatomical, topographic and histological features of the tonsils;
the presence of vegetation conditions in microflora crypts;
adenoiditis, sinusitis or sinusitis of a purulent course, as well as inflammatory processes and pathologies of the structure of the nasal passages, leading to a violation of nasal breathing;
gingivitis, caries and other foci of accumulation of pathogens in the oral cavity;
recent scarlet fever, measles, the presence of tuberculosis and other infections at the current time;
hereditary predisposition;
monotonous or insufficient nutrition, lack of minerals and vitamins in the diet;
low fluid intake;
prolonged hypothermia, frequent and sudden changes in ambient temperature;
depression, mental exhaustion, pronounced psycho-emotional overstrain;
gas pollution, the presence of harmful substances in the air;
alcohol abuse, smoking.

The following types of chronic tonsillitis are distinguished, depending on the general reaction of the body, the frequency of exacerbations and the nature of the course of the disease:

toxic-allergic;
simple recurrent, with frequent acute tonsillitis;
simple protracted, with a constant sluggish inflammatory process;
simple compensated, with rare relapses and long periods of remission.

Toxic-allergic tonsillitis has two types. Against the background of the first, the patient has no functional disorders of organs and systems. At the same time, allergization and intoxication of the body increases, manifested by pain in the joints and in the region of the heart, increased fatigue and hyperthermia. Against the background of the second, cardiac disorders, inflammatory processes in the liver, kidneys, organs of the genitourinary system and joints are revealed.

The disease is characterized by pain when swallowing and an increase in the mandibular lymph nodes

Common signs of a chronic course of the disease are:

frequent exacerbations of sore throats with hypothermia, starvation, overwork, bacterial or viral infection (for example, with a simple form - from 3 to 5 times a year);
foreign body sensation and pain when swallowing;
dryness of the mucous membrane of the pharynx;
periodic, and in the case of the toxic-allergic form of the second type - a constant increase in body temperature up to 37.5 ° C;
bad breath;
soreness and increase in the size of the mandibular lymph nodes;
decreased body resistance, headache, general fatigue;
lacunar plugs, thickening, hyperemia and swelling of the tonsils and palatine arches.

Tonsillitis as a disease is more typical for the childhood age, although it is often observed in adults, differing in the predominance of local symptoms over general signs of the disease. Chronic tonsillar symptom in adulthood is most often the result of self-treatment of angina or adenovirus infection at home.

In elderly patients, there is a natural process of reducing the total volume of lymphoid tissues and a decrease in the concentration of immunocompetent cells. Because of this, both acute and chronic forms of pathology proceed with erased symptoms. In the clinical picture, general intoxication of the body and prolonged hyperemia in the subfebrile range are often noted, and severe pain syndrome and febrile body temperature (37.1–38.0 ° C), on the contrary, are extremely rare.

The danger of chronic tonsillitis is a high risk of complications, including rheumatic ones

Chronic inflammation is dangerous because there is a constant focus of infection in the body, which contributes to the emergence of severe disorders from the work of various organs and systems. Often, patients develop rheumatic consequences - inflammatory lesions of the skin of the rheumatic type, rheumatic colitis with damage to the nervous system, rheumatic polyarthritis, rheumatic heart disease. Factors contributing to the onset of rheumatism include:

the effect of toxins released by pathogenic microorganisms on the heart tissue;
the similarity of the antigens of the human body to those secreted by some strains of streptococci.

Diagnostics of the chronic tonsillitis

To make a diagnosis, the otolaryngologist pays attention to local and systemic symptoms, collects anamnesis, analyzes the patient's complaints and the general clinical picture of the disease. Since the objective and subjective manifestations of pathology are not always detected at the same time, both the cumulative assessment of all symptoms and the clinical significance of each of them are important. If necessary, a photo of the throat is taken to confirm the diagnosis and control therapy.

To diagnose and prescribe treatment, you must consult a doctor

The diagnostics carried out during an exacerbation is unreliable, since in this state all complaints and signs will indicate the severity of the process, and not its chronic course. The most sure signs of chronic tonsillitis include purulent content in the crypts of the tonsils and anamnesis data, indicating frequent tonsillitis.

How to treat chronic tonsillitis

With an exacerbation of the disease, an acute process develops - angina, which is accompanied by such manifestations as:

severe swelling and redness of both the tonsils and palatine arches;
a sharp increase in body temperature;
general intoxication of the body - weakness, nausea, fever, headache, aching joints and muscles.

Also, patients complain that they constantly have a sore throat. Treatment of chronic tonsillitis with exacerbation may vary depending on the individual characteristics of the patient and the cause of the pathology. In this regard, for differential diagnosis and the appointment of a course of therapy, it is necessary to consult with an ENT specialist. During the period of inflammation subsiding, the doctor may recommend tempering the body, regular physical activity and proper nutrition.

How to cure chronic tonsillitis once and for all? For this, conservative and surgical methods are used. The goals of the treatment are:

reduction or elimination of exacerbations;
lowering or elimination of pharyngoscopic signs;
reduction or disappearance of toxic-allergic manifestations of the disease.

The form of pathology directly affects the tactics of treatment. So, with a simple form, conservative methods and physiotherapy can be used. The course lasts for 10 days and is repeated 2-3 times a year. If this technique turns out to be ineffective, they resort to the standard treatment of the disease - tonsillectomy.

In cases of the toxic-allergic form of the first type, 1-2 courses of conservative treatment are performed. In the absence of a pronounced positive effect, the tonsils are removed. In the second type of this form of pathology, only surgical intervention is used.

Conservative treatment

Conservative therapy should be comprehensive and include restorative treatment and methods of local impact on the tonsils.

As part of a comprehensive treatment, tonsil lavage is prescribed

Almost all patients are advised to flush the tonsils. The procedure is carried out by alternately introducing a special thin cannula through each lacuna into the crypt. It is connected to a syringe and under pressure passes an antiseptic solution that flushes out the contents of the lacunae. Antibiotics are not recommended for this purpose, since no greater efficiency is achieved from their use, but various side effects may develop. Usually 2-3 upper crypts are washed, but since they are connected with other crypts by their branches, many of them are drained and cleaned. In total, 10-15 procedures are carried out in 1 day, and after each of them the surface of the tonsils is lubricated with a solution of Iodinol, Lugol or Collargol 5%.

Rinsing the mucous membrane of the pharynx or inhalation with antiseptic agents, squeezing out the contents of the lacunae by means of a hook or suction is not desirable and usually not practiced, since these methods are ineffective and traumatic.

One of the most effective physiotherapy procedures - applications with therapeutic mud

Physiotherapy treatments recommended for chronic tonsillitis include:

ultraviolet irradiation: has an antimicrobial effect, stimulates local and general immunological processes, increases the barrier function and resistance of the tonsils. It is carried out through a special tube, affects both the area of regional lymph nodes and directly on the tonsils. On average, patients are prescribed 10 to 15 sessions;
UHF therapy: through the effect on the lymph nodes and tonsils, it expands small blood vessels and provides blood flow to the site of inflammation. For the procedure, ultrasonic aerosols are used, which purposefully deposit drugs on the mucous membrane of the tonsils (Gumisol, Hydrocortisone, Dioxidin solution 1%, Lysozyme). Carry out from 8 to 12 procedures lasting 10-15 minutes every other day;
ozokerite and medicinal mud in the form of applications: they have a hyposensitizing and anti-inflammatory effect. The materials are heated to 42–45 ° C and applied externally for 15 minutes. The recommended course varies from 10 to 12 sessions.

It should be borne in mind that the appointment of physiotherapy is contraindicated in pregnancy, angina pectoris, decompensation of the cardiovascular system and oncological diseases.

The complex of conservative treatment also includes drug therapy. It is recommended to take drugs that increase the body's resistance, namely:

immunostimulants (Ribomunil, Imudon, IRS-19);
vitamins B, C, E, K;
biostimulants (Apilak);
immunocorrectors (Derinat, Polyoxidonium).

Surgical intervention

With the ineffectiveness of conservative treatment methods, the presence of serious complications from the internal organs or the transition of the disease to a decompensated form, the tonsils are completely removed along with the capsule adjacent to them.

If conservative treatment is ineffective, tonsillectomy is prescribed

However, not in all cases it is possible to carry out tonsillectomy due to a number of contraindications, which include:

pulmonary tuberculosis in active form;
diseases of the hematopoietic system, accompanied by hemorrhagic diathesis, including hemophilia;
chronic kidney disease with severe renal failure;
severe diabetes mellitus, in the presence of ketonuria;
heart disease with symptoms of severe heart failure II – III degree.

Temporary contraindications for surgery are acute inflammatory diseases, including angina, the presence of carious teeth, the period of menstruation and the last weeks of pregnancy.

The operation is performed under local anesthesia with the possible use of intubation anesthesia if necessary. The patient is in a sitting position with his head thrown back. Removal can be done by laser, cryosurgery or excision. How to carry out tonsillectomy is determined by the surgeon individually.

During the recovery period after tonsillectomy, preference should be given to liquid warm food

During the day after the intervention, patients are not recommended to talk, drink or eat. Warm liquid food is preferred for the next 5–6 days. Bed rest is only necessary for the first 48 hours.

Since the functions of the tonsils are associated with the body's immune defenses, after their removal, the mechanism for protecting the airways from infections is weakened. In most cases, the immune system functions normally without them, but it takes some time to rebuild.

According to reviews, the operation is not painful, and only in rare cases complications arise after it. Among them, they mainly indicate bleeding, temporary pain and discomfort in the throat, a slight increase in body temperature (up to 37.2 ºC) for a period of up to several weeks. If bleeding occurs, as well as an increase in body temperature to 38–39 ºC, it is recommended to consult a doctor, as this may indicate the development of an infectious process.

Chronic tonsillitis is a serious disease that requires timely access to an ENT and the implementation of all its clinical recommendations.