How do you know if you have tonsillitis and how to treat it?

Tonsillitis is a disease characterized by inflammation of one or more palatine tonsils caused by microorganisms (bacteria or viruses). Angina tonsillaris, or colloquially speaking, sore throat, (streptococcal tonsillitis, tonsillopharyngitis or pharyngitis), is one of the frequently diagnosed pathologies in children. It leads to inflammation of the tonsils, accompanied by fever and intoxication of the body.

Short information about tonsillitis

Classification

Acute tonsillitis is an acute infectious and allergic disease characterized by acute inflammation of the tonsils and other elements of the lymphadenoid pharyngeal ring.

Chronic tonsillitis is a persistent chronic inflammation of the tonsils, the lymphoid apparatus of the pharynx with a general infectious-allergic reaction of the body.

Acute tonsillitis is caused by:

- Primary tonsillitis - lacunar, catarrhal, follicular, ulcerative membranous;
- Secondary sore throats - occur in acute infections (scarlet fever, diphtheria, measles, typhoid fever and tularemia), with blood pathologies (agranulocytosis, infectious mononucleosis, leukemia, etc.).
- Acute tonsillitis with improperly selected treatment or in the absence of it can turn into chronic.
- Chronic tonsillitis can be nonspecific (compensated and decompensated forms) and specific (with infectious diseases: tuberculosis, granuloma, scleroma, syphilis).

Etiology of the disease

The onset and development of the disease is associated with exposure to various infectious agents (microorganisms).

Tonsillitis causes:

- Bacteria - streptococci (hemolytic streptococcus, streptococcus groups C and G), enterobacteria, pneumococcus, staphylococcus, Haemophilus influenzae, etc.;
- Viruses - rhinovirus, coronavirus, adenovirus, herpes simplex virus, cytomegalovirus, Coxsackie virus, etc.;
- Protozoa - amoeba of the oral cavity;
- Fungi - candida, etc.

Very rarely, tonsillitis can cause chlamydia and mycoplasma.

Infection routes

Infection with sore throat occurs by airborne droplets. Getting on the palatine tonsils, microorganisms cause local tissue inflammation, symptoms of intoxication develop, and the temperature rises.

The source of infection is the patient and the carrier of bacteria. Infection occurs during close long-term contact with the patient and the carrier. Patients can be sources of infection in any form of streptococcal infection, but patients with upper respiratory tract damage are most dangerous.

Pathogenesis

The place of introduction of an infectious agent, most often, is the tonsils and lymphoid tissue of the upper respiratory tract, less often damaged skin (wounds, burns, diaper rash), where a primary inflammatory focus appears, in which microorganisms multiply intensively, decay products and toxins accumulate. From a local inflammatory focus, microorganisms spread throughout the body.

In the development of the pathological process, three lines of the syndrome are distinguished:

- Infectious or septic syndrome - changes in the body are directly related to the vital activity of organisms;
- Toxic syndrome - develops as a result of the absorption of toxins of microorganisms and their spread by the blood stream throughout the body;
- Allergic syndrome - caused by the allergenic effects of streptococcus lipopolysaccharides.

Clinical manifestations

Acute tonsillitis develops within 3-4 days. It is characterized by atypical deposits in the area of the tonsils and pharyngeal mucosa. Unlike acute tonsillitis, chronic tonsillitis does not lead to marked changes in the amygdala.

The most typical symptoms of tonsillitis are:

- Sore throat of varying intensity;
- Fever;
- Plaque on the tonsils and in the gaps;
- General malaise;
- Signs of general intoxication (pallor, tachycardia, dyspeptic symptoms).

Signs of tonsillitis can have distinctive symptoms due to the type of disease:

- Catarrhal tonsillitis - slight edema and hyperemia of the tonsil mucosa;
- Follicular tonsillitis - on the tonsils, yellow formations of the size of a pinhead are visible on the tonsils (follicles with accumulation of pus);
- Lacunar angina - pronounced redness, a yellowish purulent plaque is deposited in the gaps, which is easily removed with a spatula.

Features of the disease in children

Most frequent patients with the disease are children. At the slightest suspicion of the development of the disease and the appearance of characteristic symptoms of tonsillitis, it is necessary to urgently seek advice from a pediatric otolaryngologist. In children, angina is much more severe than in adults and is accompanied by high fever, severe intoxication of the body, loss of consciousness, severe dyspeptic symptoms, and more frequent and serious complications.

In children, a transition from one type of angina to another is often observed: catarrhal - into follicular and further into lacunar. Sometimes the disease can proceed under the "mask" of ARVI.

Complications

Incorrectly selected therapy, untimely treatment to a doctor, self-medication can lead to the development of adverse consequences.

Complications and consequences of tonsillitis:

- Perpharyngeal abscess (purulent inflammation of the lymph nodes and tissues of the pharyngeal space);
- Paratonsillitis and paratonsillar abscess (purulent inflammation of the tissues around the tonsils);
- Purulent cervical lymphadenitis;
- Tonsillogenic sepsis;
- Rheumatism;
- Rheumatic endocarditis;
- Glomerulonephritis;
- Serous meningitis;
- Acute sinusitis;
- Acute otitis media, etc.

Diagnostics

Diagnosis of tonsillitis begins with a history and physical examination. The ENT doctor pays special attention to the presence in the history of relapses of tonsillitis (3-4 times a year or more), paratonsillitis and paratonsillar abscesses.

Laboratory tests:

- General blood test;
- Biochemical blood test (determination of the concentration of C-reactive protein in the blood serum);
- General urine analysis;
- Swab from tonsils for flora and antibiotic sensitivity;
- Swab from tonsils and nose for BL (diphtheria bacillus culture);
- Serological and/or molecular biological research for viruses of the herpes group (herpes simplex viruses, cytomegalovirus, Epstein-Barr virus);
- Rapid determination of streptococcal antigen using test strips from the surface of the tonsils.

In chronic tonsillitis, the otolaryngologist may prescribe additional diagnostic methods to assess the functional state of the body and the palatopharyngeal ring.

Instrumental diagnostic methods:

- ECG (electrocardiogram) - shows the work of the heart;
- ENT endoscopy;
- LDF (laser Doppler flowmetry) is a study of blood flow in the tonsils.

Treatment

Treatment of tonsillitis is based on the application of three fundamental principles:

- An integrated approach - treatment is aimed at eliminating not only the symptoms, but also the causes of the disease themselves, includes drug and local therapy. Drug therapy includes antibiotics, for instance, Cefaclor. Preferably, they are chosen based on the susceptibility test that shows the sensitivity of the causative agent to different antibiotics.
- Personal approach - the treatment regimen for tonsillitis is selected strictly individually for each patient, taking into account the age, severity and nature of the pathological process, the presence of concomitant diseases, etc.;
- Continuity - obtaining a stable effect of recovery to exclude recurrences of the disease and achieve stabilization of the patient's condition.

Treatment of tonsillitis includes the following activities:

- Etiotropic therapy (antibiotics, antiviral drugs);
- Antiallergic drugs;
- Antioxidant drugs;
- Antiseptic medicines;
- Symptomatic treatment (with increased pressure, severe pain syndrome).

The modern method of treating tonsillitis is the use of low-intensity laser radiation. The method has an effective anti-inflammatory, analgesic effect, promotes the stimulation of trophism and tissue regeneration, activation of tissue respiration, etc.

Surgical treatments for tonsillitis:

- Traditional tonsillectomy (removal of tonsils);
- Laser tonsillectomy;
- Laser lacunotomy;
- Laser destruction, etc.

As a rule, the treatment of tonsilitis is carried out at home. However, in some cases, hospitalization is not only indicated, but also vital.

Indications for hospitalization for tonsillitis:

- Severe course of the disease (pronounced local changes and severe intoxication);
- Complicated forms;
- Severe concomitant diseases.
- Lack of the necessary sanitary and hygienic standards and conditions to ensure proper care and treatment of the patient at home.

Prevention of tonsillitis

The disease can be prevented if you follow a number of basic rules:

- Observe all the rules of personal hygiene;
- Minimize contact with a sick person;
- Undergo medical examinations on time;
- Strengthen immunity;
- Lead a healthy lifestyle;
- Visit a doctor for the timely elimination of foci of infection (caries, sinusitis, adenoiditis, rhinitis, sinusitis, bronchitis, etc.).

Post by: Samuel Wrangler, M.D., Montgomery, Alabama