Treatment of tonsillitis in adults: methods and features of therapy
The content of the article:
- The reasons for the development of the disease
- Tonsillitis symptoms
-
Treatment of tonsillitis in adults
- Local therapy
- General therapy
- Chronic tonsillitis treatment
- Operative treatment
- Physiotherapy
- Features of therapy in elderly patients
- Video
Treatment of tonsillitis in adults is carried out in a comprehensive manner. It depends on the form of the disease, the etiological agent, the general somatic condition of the patient and includes general and local therapy.
The causes and symptoms of acute and chronic tonsillitis are different, therefore, therapy should be prescribed by a doctor
The high prevalence of tonsillitis among all age groups of the population and the many proposed methods of conservative or surgical therapy makes us look for an answer to a very urgent question - how to treat tonsillitis in adults?
The reasons for the development of the disease
The etiological factor in the development of acute tonsillitis (angina) is bacteria, viruses and fungi. Up to 15% of cases in adults, beta-hemolytic group A streptococcus is detected. Staphylococcus aureus, Haemophilus influenzae, gonococci, pneumococci, mycoplasmas, anaerobes, adenoviruses, cytomegaloviruses, herpes virus, yeast-like fungi, etc. are also common.
Tonsils have a protective function
The tonsils are actively involved in the formation of local and general immunity. With prolonged exposure to an exogenous stimulus, specific and nonspecific biologically active substances, lysozyme, interferons, interleukins, immunoglobulins (IgA, M, G, E), lymphocytes and macrophages are produced, which are secreted into the lumen of the pharynx and are carried through the blood and lymph throughout the body.
With untimely or inadequate treatment, the acute process can turn into a chronic one.
The development of chronic inflammation of the palatine tonsils is based on the suppression of nonspecific factors of the body's natural resistance, violation of the humoral and cellular links of immunity.
At the same time, an increased antigenic load, for example, when exposed to a bacterial antigen, leads to an overproduction of IgE, which causes an infectious-allergic pathogenesis of chronic tonsillitis. Soon, the lymphoid tissue begins to grow, which causes hyperplasia of the palatine and pharyngeal tonsils.
But not always chronic tonsillitis is preceded by a transferred tonsillitis. The disease can develop imperceptibly, disguising itself as symptoms of frequent acute respiratory viral infection (ARVI), adenoiditis, stomatitis, periodontitis. In this case, the palatine tonsils are secondarily involved in the inflammatory process.
Tonsillitis symptoms
With the development of acute tonsillitis, sore throat most often appear, especially when swallowing, weakness, fever, headache, chills.
One of the symptoms of tonsillitis is an increase and soreness of regional lymph nodes.
With the transition of an acute process into a chronic sore throat, they are intermittent or there may be discomfort, dry throat, and bad breath.
In order to choose the correct therapeutic tactics and cure chronic tonsillitis forever, it is necessary to establish the form or stage of the disease. A simple form or an initial stage is characterized by:
- the presence of liquid pus or purulent-caseous plugs in the lacunae of the tonsils, submucous purulent follicles;
- fusion with arches and triangular fold;
- an increase and soreness of regional lymph nodes, most often of the submandibular group;
- the presence of concomitant diseases.
Toxic-allergic form I (TAF I) is characterized by general toxic-allergic symptoms:
- subfebrile body temperature (37.1–38.0 ° C), which occurs periodically;
- weakness, malaise, fatigue;
- joint pain;
- pain in the heart during an exacerbation (without abnormalities on the ECG).
The severity of symptoms is aggravated after acute respiratory illness.
Toxic-allergic form II (TAF II) is characterized by the following features:
- prolonged low-grade body temperature;
- heart pain and rhythm disturbance;
- cardiac disorders that are recorded on the ECG;
- functional disorders in the kidneys, liver, joints, vascular system, which are detected in the laboratory.
With toxic-allergic form II, local and general diseases associated with a chronic process are determined:
- paratonsillar abscess;
- pathology of the thyroid gland;
- parapharyngitis;
- pharyngitis;
- acute and chronic tonsillogenic sepsis;
- rheumatism;
- infectious arthritis;
- acquired heart defects;
- diseases of the urinary system, prostate;
- meningitis.
Treatment of tonsillitis in adults
Local therapy
Local treatment of an acute form of pathology involves a direct effect on the area of the tonsils and oropharynx with various drugs, solutions and physiotherapeutic methods:
- gargling and washing the lacunae with saline or antiseptics such as Octenisept, Chlorhexidine, Miramistin, Ektericid. The course of treatment is 10-15 days;
- treatment of palatine tonsils with hydrogen peroxide;
- introduction of antibacterial and antiseptic drugs into the lacunae of the tonsils;
- treatment of palatine tonsils with 1% Lugol's solution;
- the use of antiseptic sucking tablets: Septolete, Neo-Angin, Strepsils, Hexaliz;
- the use of local immunomodulators to restore immunity: spray IRS-19, Ribomunil;
- treatment with the "Tonsilor" apparatus, which by means of ultrasound acts on the tissue of the tonsils, as well as their irrigation with an antiseptic solution and the evacuation of the pathological contents of the lacunae and pockets of the tonsils;
- physiotherapeutic effect on the region of regional lymph nodes: laser therapy, magnetotherapy;
- aromatherapy in the form of rinsing and inhalation. For this, essential oils of eucalyptus, tea tree, cedar, grapefruit, lavender are used;
- sanitation of the oral cavity, nose and paranasal sinuses.
The method of local therapy and the drugs necessary for its implementation should be selected by a doctor
Despite the seeming harmlessness of local therapy, it is better to entrust the selection of drugs to a specialist, due to the risk of developing local complications: pharyngitis, allergic reactions or microtrauma of the palatine tonsils, which can provoke degeneration of lymphoid tissue. The doctor will determine how long and how to apply a particular drug.
General therapy
General therapy includes antibiotics, anti-inflammatories, and immunostimulants.
The use of antibiotics is justified in the bacterial form of tonsillitis
Antibiotic therapy is indicated for acute tonsillitis or exacerbation of a chronic form of pathology.
For the correct selection of the drug or correction of the prescribed treatment, a bacteriological study of the pharyngeal microflora is performed and its sensitivity to the action of the antibiotic is determined. Recent data confirm a wide variety of species of pathogens, among which opportunistic flora is increasingly detected, especially in chronic tonsillitis.
A rapid test is performed if there is a suspicion of pyogenic streptococcus
In order to determine the pyogenic streptococcus, dangerous by the development of various complications, an express test is actively used, based on the detection of the pathogen antigen. The test is performed within a few minutes and makes it possible to choose the right antibiotic in a timely manner.
With an inadequate choice of medicine and the duration of treatment, the pathogen not only remains in the focus of inflammation, but a resistant flora appears. It also contributes to the chronicity of the acute process.
The drugs of choice for coccal flora are the following groups of antibiotics:
- semi-synthetic penicillins of a wide spectrum of action: Amoxicillin, Ampicillin, Amoxiclav, Augmentin;
- 1st generation cephalosporins: Cephalexin, Cefazolin;
- macrolides: Erythromycin, Rovamycin;
- Fusidin.
The course of treatment is selected individually and ranges from 5 to 14 days.
In the presence of Haemophilus influenzae, gonococcal or anaerobic infection, drugs of the following groups are prescribed:
- penicillins: Ticarcillin, Piperacillin, Azlocillin;
- cephalosporins II and III generation: Cefoxitin, Cefaclor, Cefamandol, Ceftriaxone;
- macrolides: Rovamycin, Azithromycin.
When prescribing antibiotics, the doctor recommends means for the prevention of dysbiosis: Acipol, Linex, Bifidumbacterin.
Anti-inflammatory therapy is required when the body temperature rises above 38.5 ° C and severe pain syndrome. Usually, Paracetamol, Ibuprofen, Aspirin are prescribed.
For the prevention of candidiasis, antimycotic drugs are used.
Chronic tonsillitis treatment
How to get rid of tonsillitis if it has already become chronic?
Patients with a simple form of the disease and TAF I undergo conservative treatment. With TAF II, tonsillectomy is indicated.
Conservative therapy for exacerbation of chronic tonsillitis also includes antibacterial and anti-inflammatory drugs.
Treatment with antibiotics for chronic tonsillitis without exacerbation is inappropriate, since they themselves suppress the immune system, disrupt the flora of the oral cavity, gastrointestinal tract, and thus may contribute to the development of a vicious circle.
At the time of exacerbation and outside it, the main background of treatment is immunostimulating therapy.
Modern immunocorrectors, most often prescribed by specialists:
- preparations of extracts of the thymus gland: Timalin, Vilozen, Timoptin;
- antigenic lipopolysaccharides of microbial origin: Pyrogenal, Ribomunyl;
- peptides with immunoregulatory, detoxifying, hepatoprotective, antioxidant effects: Imunofan, Polyoxidonium, Likopid.
Natural immunostimulating agents, in particular ginseng, are highly effective.
Judging by the reviews, the treatment of tonsillitis with natural immunostimulating agents is also very effective. These include:
- ginseng;
- echinacea;
- chamomile;
- garlic;
- leuzea;
- propolis;
- pantocrine.
Homeopathic and antihomotoxic agents are often used to correct immunity:
- Lymphomyosot;
- Mucose Compositum;
- Euphorbium;
- Tonsilotren;
- Ubiquinone;
- Angin-Khel.
Phytopreparations are widely used: Tonsilgon, Tonsinal.
In the presence of dysbiosis from immunocorrective therapy or for the purpose of prophylaxis, probiotics are prescribed: Biovestin, Normoflorin B and L.
To improve metabolism and restore the work of enzyme systems, antioxidants are used:
- rutin-containing complexes;
- vitamins of group A, E, C;
- trace elements: zinc, magnesium, calcium, iron, silicon.
Thus, with a simple form of chronic tonsillitis, after a positive result of conservative therapy, the tonsils can be maintained in a satisfactory state without surgical treatment.
Operative treatment
In the absence of positive dynamics in a simple form, subsequent surgical intervention may be required. This is due to the fact that chronic tonsillitis, being a focal infection, depletes the immune system and under the influence of trigger factors (trauma, stress, childbirth, surgery, diabetes mellitus, diseases of the gastrointestinal tract, tumors of various localization) can lead to severe complications.
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In toxic-allergic form I, conservative therapy serves as a preparatory stage for surgical treatment.
In chronic tonsillitis, there is a slow replacement of the amygdala parenchyma with connective tissue. And with frequent exacerbations or ineffectiveness of conservative therapy, one has to make a choice in favor of surgical treatment. Removal of palatine tonsils is carried out by various methods, including electrocautery and surgical laser.
Cryotherapy is a promising method of treating chronic tonsillitis. It is based on the use of low temperatures. Cryophytotherapy treatment, including cryotonsillotomy and herbal medicine, has a good effect.
Cryotonsillotomy is performed on an outpatient basis under local anesthesia. Freezing the tonsils is carried out at a temperature of -180 ° C for 2 minutes.
Oregano tea is used as part of herbal medicine
Frequently used herbal remedies:
- Tonsilgon: 20 drops in the morning on an empty stomach for 3 months;
- oregano herb tea: 1 glass 2 times a day for one month;
- valerian tincture: 5 drops 5-7 times a day for 3 months.
Herbal medicine is practiced not only in the treatment, but also for the prevention of exacerbations of chronic tonsillitis in the fall and spring for several months:
- 20 drops of tincture of Schisandra chinensis or eleutherococcus;
- ½ cup rosehip tincture;
- 20 drops of tincture of golden root or ginseng;
- a glass of vitamin tea made from wild rose berries, chokeberry, raspberry leaves.
Inhalation of eucalyptus leaves infusion in the amount of 7-10 procedures lasting 5-7 minutes has a good therapeutic effect. After inhalation, it is recommended to lubricate the tonsils with Lugol's solution.
Physiotherapy
Physiotherapy methods of treating chronic tonsillitis:
- collar massage or acupressure;
- mud therapy;
- laser therapy;
- paraffin therapy for the area of the submandibular lymph nodes;
- ultraviolet irradiation of the collar zone.
Physiotherapy plays an important role in the treatment of pathology
Ultraviolet irradiation is used not only externally, but also intraductal, which consists in direct exposure to the tonsils using a special tube. The course of treatment is up to 15 sessions. Ultraviolet irradiation helps to improve the barrier function of the tonsils, stimulates local and general immunological processes, and has an antimicrobial effect.
Contraindications to physiotherapeutic treatment are diseases of the cardiovascular system in the stage of decompensation, pregnancy, oncological diseases, purulent complications.
The positive dynamics after the treatment can be traced from the photos taken during pharyngoscopy. Also, patients note a decrease or disappearance of sore throat, an improvement in general well-being.
Features of therapy in elderly patients
In persons of the older age group, concomitant diseases prevent the recovery or long-term remission of chronic tonsillitis. In many patients after 60 years of age, the effectiveness of defense mechanisms decreases, leading to increased sensitivity to infections.
Most often, the latent course of the disease prevails due to the slow development of the pathological process. Physiological systems are quickly depleted and immunity is reduced, which leads to a tendency to relapse, the transition of acute forms to chronic forms, the frequent development of complications and the late onset of the effect of treatment.
Video
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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.
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