Tonsillitis is a long-term inflammatory process in the palatine tonsils. The discharge in the lacunae can be purulent, caseous, accumulate in narrow lacunae, convoluted with spurs, and form the so-called fetid plugs. The process that takes place in the lacunae of the palatine tonsils is under the control of the body until a certain time; there is a constant active and passive drainage of tonsil lacunae along with the activity of macrophages, which, preventing inflammation of the palatine tonsil, contributes to the development of immunity against many microorganisms that enter the oral cavity and pharynx along with air and food.

The balance between the pathogenic active flora and the protective probabilities of the body can be disturbed for many reasons, as a result of which inflammation develops of varying intensity (it captures only the integumentary epithelium of the oral plane of the tonsils without its destruction), passing to the epithelial cover of the tonsil lacunae with its destruction and the formation of necrotic deposits; suppuration of tonsil follicles. Catarrhal, lacunar or follicular tonsillitis develops. Lacunar and follicular tonsillitis have their own well-defined clinical, morphological and microbiological aspects, and they cannot be confused with manifestations of pharyngitis, especially from the point of view of the approach to treatment. According to modern concepts, angina is an acute infectious-allergic disease, and it is necessary to approach the treatment of a patient with angina from these positions.

Symptoms of tonsillitis

The chronic nature of tonsillitis infections is an indication that the body’s immune system is not up to the task. Constant, but insufficient activation of nonspecific defense mechanisms often causes an inflammatory response, but this is not enough to suppress infectious agents.

Undoubtedly, the nature of the pathogenic flora plays an important role in the occurrence of a particular sore throat, but the background on which it occurs also affects the clinic of the disease. Therefore, it is necessary to prescribe and carry out therapy taking into account all the identified features in each case (time since the onset of angina, the age of the patient, the frequency of exacerbations, concomitant diseases: general and from the ENT organs, clinical manifestations, including in the oropharynx, the nature of the flora previous treatment, its effectiveness).

Currently, much attention is paid to the role of group A streptococcus in the occurrence of acute tonsillitis and pharyngitis, although b-hemolytic streptococcus still occupies a leading position among bacterial pathogens. So, it is believed that in late autumn and spring it is group A streptococci that cause illness in 40% of babies and 10% of adults. Along with this, there is an opinion that in the vast majority of cases, the incidence of the lymphadenoid ring of the pharynx in children is determined by a viral infection, the features of which are a protracted and recurrent course, the lack of effectiveness of conservative anti-inflammatory measures, and a tendency to hyperplasia of the palatine and pharyngeal tonsils. Usually, the doctor makes the diagnosis of tonsillitis “by eye”, only on the basis of clinical experience, and prescribes antibacterial treatment without taking into account the appropriateness of antiviral therapy. This not only slows down the healing process, but can also help reduce the protective properties of the pharyngeal mucosa, since under the influence of antibiotics, a-hemolytic streptococcus that produces bactericin, a natural antibiotic, disappears.

It is penicillins, to a greater extent than cephalosporins, that destroy this beneficial flora of the oropharynx and allow pathogenic streptococci to take its place on the epithelium of both the tonsils and the entire pharynx. Therefore, irrational (too early and without taking into account the flora) prescription of antibiotics leads to a decrease in antibacterial immunity and contributes to the recurrence of tonsillitis.

Treatment of tonsillitis

Based on the foregoing, the tactics of treating patients with acute and chronic tonsillitis must consist of an accurate determination of the nature of the inflammatory process (acute, exacerbation of a chronic or its sluggish course), justification of the type of inflammation (catarrhal, purulent, phlegmonous), determining the type of pathogen (streptococcus, spirochete, bacillus , virus, fungus). To this it will be necessary to add that all sore throats can be divided into two groups – primary sore throats, as an independently developing acute inflammatory process in the palatine tonsils, and secondary sore throats, as a symptom of the underlying disease, for example, in blood diseases. Only the correct diagnosis, taking into account the general condition of the patient, determines the choice of treatment tactics. For the doctor, after the diagnosis of “chronic tonsillitis” is made, it is important to choose the tactics of treating the patient and resolve the issue:

Conservative treatment of tonsillitis

Conservative treatment of tonsillitis involves, first of all, the systematic sanitation of the lacunae of the palatine tonsils with the preservation of the lymphoid tissue of the tonsils as an immune, to a certain extent, organ. Conservative treatment is indicated for uncomplicated chronic tonsillitis in cases where the operation can be delayed due to the general condition of the patient; if the patient has not previously received any therapy or he is mainly concerned about local manifestations of tonsillitis – purulent plugs in the tonsils, halitosis. Among the methods of conservative treatment for chronic tonsillitis, the following are most effective: washing the lacunae of the tonsils and removing purulent plugs .. As with angina, and with the accompanying pharyngitis, gargling, inhalation, and irrigation of the mucous membrane with disinfectant solutions are indicated.

An increase in the effectiveness of the treatment of tonsillitis can be achieved by the appointment of immunostimulating plant extracts. In particular, the components of chamomile, marshmallow and horsetail, which are part of it, stimulate the body’s defense mechanisms by increasing the phagocytic activity of macrophages and granulocytes. No side effects were noted when using the product.

Tonsillitis. The appointment of systemic antibiotic therapy for uncomplicated forms of tonsillitis of non-streptococcal etiology is not always justified. In this case, it is more rational to prescribe antimicrobial products locally (from the first day of the disease until the results of the microbiological study are obtained). The main requirements for local antibacterial agents are a wide range of antimicrobial activity, including the most typical pathogens, the absence of absorption from the mucous membrane, and low allergenicity.

Treatment of such angina as agranulocytic and monocytic requires the participation of a hematologist.

Surgical treatment of tonsillitis

Indications for surgery:

1. Frequent (2-4 times a year) tonsillitis, accompanied by high body temperature; pathological purulent detritus is noted in the lacunae; there is one or another complication associated with an exacerbation of the process (polyarthritis, pyelonephritis, etc.).

2. Frequent sore throats (2-4 times a year and more often), accompanied by high body temperature, there are local signs of chronic tonsillitis, without complications. Often recurring sore throats indicate a weakening of the immune system.

3. As a result of one of the rare cases of angina (1 time in 5-7 years), some complication of the heart, joints, etc. developed. Local signs of chronic tonsillitis, adenitis of the lymph nodes in the angle of the lower jaw.

4. There were no cases of angina, however, against the background of diseases of the heart, joints, etc., local signs of chronic tonsillitis are detected, mainly accumulation of purulent contents in the lacunae of the tonsils.

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