Chronic tonsillitis
Chronic nonspecific tonsillitis (CNT) is an infectious-allergic disease with local manifestations in the form of persistent inflammation of the tonsils, characterized by a chronic relapsing course, which occurs more often as a complication of an infectious pathology (tonsillitis, scarlet fever, measles) or as a manifestation of allergies. Classification
-
- Compensated and decompensated forms
- Pathological classification
- Lacunar CNT – the inflammatory process is limited to the lacunae of the tonsils
- Lacunar-parenchymal CNT – the inflammatory process is localized both in the lacunae and in the lymphadenoid tissue of the tonsils
- Parenchymal CNT – the inflammatory process is localized mainly in the lymphadenoid tissue of the palatine tonsils
- Sclerotic CNT is an abundant growth of connective tissue in the tonsils and surrounding tissues.
Clinical picture
-
- Hyperemia and ridge-like thickening of the edges of the palatine arches (signs of Gaze, Preobrazhensky)
- Cicatricial adhesions between tonsils and palatine arches
- Loose or scarred, hardened tonsils
- Caseous-purulent plugs or liquid pus in the lacunae of the tonsils
- Regional lymphadenitis – an increase in the behind-maxillary lymph nodes
- Features of the clinical picture depending on the degree of compensation
- Compensated form – only local signs of chronic inflammation of the tonsils, no pronounced general reaction occurs
- Decompensated form – local signs of chronic inflammation of the tonsils in combination with recurrent tonsillitis, paratonsillitis, paratonsillar abscesses, diseases of distant organs.
Diagnosis
-
- The diagnosis of CNT is considered reliable in the presence of 2 or more of the listed local signs.
- In doubtful cases, the diagnosis is confirmed on the basis of the study of the contents of lacunae and smears from the plane of the tonsils.
- Detection of pathological flora
- Decrease in the phagocytic activity of leukocytes, an increase in the number of polymorphonuclear and the appearance of degenerative forms of leukocytes, a decrease in the number of lymphocytes
- Peripheral blood test – hypochromic anemia, neutrophilic leukocytosis, monocytopenia, leukopenia, increased ESR
- Immunogram
- Changes in the content of immunoglobulins, titers of antistreptococcal AT, complement, properdin
- Redistribution in the quantitative content of T-, B-lymphocytes and their subpopulations, the presence of CEC, sensitization of granulocytes to bacterial allergens.
Treatment:
Conservative treatment is carried out 2 r / year in the autumn-spring time, with frequent recurrences of angina – up to 4 r / year. Simultaneous treatment of all family members with identified CNT is recommended. Treatment of exacerbations of CNT – see Angina.
-
- Indications
- Compensated form
- Decompensated form
- Presence of contraindications to surgical treatment.
- General recommendations: the correct regime of the day, a balanced diet with a sufficient number of vitamins, physical exercises.
- Hyposensitizing agents: calcium products, ascorbic acid, antihistamine products, specific hyposensitization to microbial allergens.
- Immunocorrection: autoserotherapy, immunostimulants (for example, levamisole, prodigiosan), irradiation of the tonsils with a helium-neon laser.
- Antibiotic therapy for 10 days
- Penicillins
- Erythromycin 250 mg 4 times a day
- Clindamycin 300 mg 3 times a day (at a dose of 8-25 mg/kg/day in 3-4 doses) is preferred in children with exacerbation of CNT.
- NSAIDs – according to indications.
- Local treatment – means of sanitizing effects
- On the palatine tonsils: suction of the contents of the lacunae, washing the lacunae with antiseptic solutions, their intra- and paratonsillar injections, filling the lacunae with medicinal pastes, inhalations and aerosols of antibiotics, phytoncides, ultraviolet irradiation
- On regional lymph nodes: ultrasound therapy, phonophoresis of interferon, hydrocortisone, laser therapy, UHF, microwave, mud therapy.
- Means of reflex action: all kinds of novocaine blockades, acupuncture, ultraviolet irradiation of the neck.
Surgery
-
- Palliative – galvanocaustics, diathermocoagulation of the tonsils, lacunotomy, curettage of lacunae, cryotherapy on the tonsils, laser destruction. Indications: ineffectiveness of conservative treatment, decompensation of CNT in the form of frequent recurrences of tonsillitis.
- Tonsillotomy – partial removal of the tonsils. Usually produced in children with hypertrophy of the palatine tonsils, combined with signs of CNT.
- Tonsillectomy is the complete removal of the tonsils.
- Indications
- The ineffectiveness of the treatment. Criterion of inefficiency – after 6 courses of conservative therapy, recurrences of tonsillitis continue
- Decompensation of CNT in the form of recurrent paratonsillitis, paratonsillar abscesses, severe tonsillogenic intoxication with the ineffectiveness of the treatment. When CNT decompensation is combined with rheumatism, tonsillectomy is performed after a course of treatment for rheumatism or in the inactive phase of the disease.
- Contraindications for surgery
- Absolute: severe cardiovascular disease with II-III degrees of circulatory failure, uremic stage of chronic renal failure, severe diabetes mellitus with the risk of developing coma, a high degree of arterial hypertension with the likely development of vascular crises, hemophilia (hemorrhagic diathesis) and other diseases of the blood and vascular system (disease Werlhof, Osler’s disease, etc.), accompanied by bleeding and unresponsive to treatment
- Relative: acute diseases and exacerbation of chronic diseases, the presence of carious teeth, the period of menstruation, in the last weeks of pregnancy, pronounced atrophic processes of the mucous membrane of the upper respiratory tract.
- Complications
- Bleeding. By time: early (during the first day), later (after the first day). By
character: vascular (requiring ligation of a bleeding vessel in a niche), parenchymal (requiring tamponade of a niche impregnated with hemostatic drugs; to hold the tampon in the tonsil niche, the palatine arches are sutured over the tampon). With severe bleeding and ineffectiveness of hemostatic measures, the external carotid artery of the corresponding side is ligated
-
- Rare complications: neck phlegmon, subcutaneous emphysema, cranial nerve paresis, pharyngeal hematoma, stomatitis, glossitis, lingual tonsillitis, acute otitis media. Possible exacerbation in the postoperative period of any chronic disease.
Prevention of exacerbations of chronic tonsillitis
-
- General hygiene measures
- hardening
- Balanced diet
- Compliance with the rules of hygiene at home and work premises
- Elimination of dust, air pollution
- Sanitation measures: detection and treatment of diseases of the gums and teeth, sinusitis, otitis media, nasal breathing disorders, chronic tonsillitis
- Low-energy laser exposure with monochromatic red light and a helium-neon laser. The mucous membrane of the nasal cavity, pharynx and palatine tonsils are irradiated (at an radiation intensity of 2.65 mW/cm, exposure time is from 2 to 8 minutes). Course -5-7 exposures every day, spend 2 r / year
- Immunomodulatory drugs – ribomunil 3 tablets orally in the morning on an empty stomach every day for the first 4 days of the week for 3 weeks, then the first 4 days of each month for the next 5 months.
Dispensary registration
-
- Patients with CNT need to be examined by an otorhinolaryngologist 1 r / 3 months, and then, in the absence of exacerbations of the disease for 1 year, 2 r / year
- In the absence of exacerbations for 3 years, after 4-5 courses of conservative treatment, normalization of objective data and the disappearance of local signs of CNT, the patient is removed from the dispensary record
- Patients who have undergone tonsillectomy are removed from the dispensary record after 6 months.
Synonym. Angina chronic
Reduction. CNT – chronic nonspecific tonsillitis
ICD. J35.0 Chronic tonsillitis
Note. Chronic non-anginal tonsillitis – chronic tonsillitis that occurs without exacerbation of the local process, but with