The tonsils or tonsils (lat. Tonsillae) are clusters in the throat of areas of lymphoid tissue at the border of the nasal cavity and the mouth. They form the so-called lymphoid ring (Valdeyer-Pirogov) and are the central link of immunity. When breathing, this ring becomes the first barrier to microbes, rendering them harmless. In addition, glands produce macrophages and lymphocytes - protective cells of the immune system.
This lymphoid ring also contains paired palatine tonsils, the inflammation of which is called tonsillitis. If such inflammation repeats during the year more than 3 times - the process becomes chronic.
In medicine, purulent tonsillitis is a follicular or lacunar tonsillitis, in which a film appears on the lacunae. The Pirogov ring contains only 6 tonsils: pharyngeal, lingual, a pair of trumpet and palatine. It is fully formed only in 5 years. This is due to the fact that the diagnosis of angina in infants is not made.
The structure of the glands
They have a mesh connective tissue structure, which is penetrated through the ducts (gaps). There are about 20 such gaps in each gland. Follicles open in the gaps, which are engaged in the destruction of pathogenic pathogens. Follicles are accumulations of lymphocytes. Tonsils contain a lot of nerve endings, so with their inflammation the throat hurts.
Causes of inflammation
Infection can be:
- external - contact with a patient or household, alimentary route of infection;
- auto-infection - is associated with a decrease in immunity, when conditionally pathogenic bacteria, which are always and everywhere, wake up and begin to become active, multiply and secrete toxins.
Provoking factors most often include hypothermia, wet feet, acute respiratory viral infections and other inflammations in the nasopharynx, carious teeth, sinusitis, bathing in cold water, overheating with subsequent use of cold water, eating a lot of ice cream, too dry air, damp climate, drafts.
May also contribute to a weakening of immunity, lack of sleep, overwork, smoking, chronic pathologies, hypovitaminosis.
In 90% of cases, the main culprit of angina is considered to be beta-hemolytic streptococcus group A (BHCA). Then comes Staphylococcus aureus, pneumococci, rinaviruses, adenoviruses, fungi, chlamydia, etc.
Angina often occurs in the offseason - in spring and autumn. Children get sick more often and harder.
Chronic tonsillitis
If acute tonsillitis has not been treated correctly and completely, then the process becomes chronic. At the same time, the glands are constantly inflamed, in the gaps, pus plugs can accumulate. Bacteria are always present here and also constantly reduce immunity. Tonsillitis becomes an "uncontrolled" source of infection, constantly giving exacerbations. Moreover, exacerbations of chronic tonsillitis are most often purulent. Often, to avoid the negative effects of the glands, you have to remove.
Symptomatic manifestations
Purulent tonsillitis begins with a sore throat, then intense pain during swallowing, fever and chills join. The temperature reaches 39 degrees and above. There is lymphadenitis of the mandibular nodes with general intoxication with headaches, myalgia, lack of appetite, weakness and ailments. In the throat, swollen red tonsils and the appearance of purulent plugs are visible, which can be removed with pressure. With pus from the mouth there is a putrid odor, cough. Often, rhinitis, otitis media can develop.
Important! Chronic purulent tonsillitis remains contagious from the first day and while there is a purulent process in the tonsils. If a person has suffered a sore throat on his legs, he becomes a bacteriocarrier.
Manifestations in adults and children
In adults, tonsillitis occurs without temperature, even in the presence of purulent plugs. Other symptoms: swelling and hyperemia of the tonsils, sore throat.
Such cases have become more frequent in recent years. Usually this indicates a weakened immune system, which cannot actively fight the infection. Bacteria can die only at high temperatures. In addition, such a course of tonsillitis can be with: autoimmune diseases, heart failure, obesity, frequent use of antibiotics, vasoconstrictors and with exhaustion of the body.
Treatment of purulent tonsillitis in adults without fever is also carried out with antibacterial and anti-inflammatory therapy.
In children, the peculiarity of purulent tonsillitis is in the possibility of starting the process, for example, from otitis media, from cramps in babies, hypersalivation, vomiting, diarrhea and abdominal pain. Children under 3 years of age are subject to hospitalization.
Diagnostic measures
The throat is examined by a pharyngoscope, a picture of the chronic inflammatory process is revealed. A smear on Leffler is required to exclude diphtheria. In the blood test, leukocytosis and acceleration of ESR are detected. It is advisable to take a swab from the throat for culture and identification of the pathogen, as well as to determine its sensitivity to antibiotics. This will take at least 4 days. Therefore, when visiting a doctor, he chooses an antibiotic empirically, based on his experience.
Complications and consequences of purulent chronic tonsillitis
Chronic tonsillitis itself is already a complication of the acute process due to improper treatment or the initiative of parents. The most unpleasant consequence of chronic purulent tonsillitis is rheumatic process with damage to the joints, heart and kidneys.
When streptococci get on the heart valves, they lead to heart defects, infectious-allergic myocarditis, etc. can also develop. The kidneys are silent at first, and then a chronic inflammatory process is detected in them.
The complications of tonsillitis also include:
- collagenoses such as systemic lupus erythematosus;
- vascular pathologies such as Raynaud's disease;
- Meniere's syndrome (pathology of the inner ear);
- pharyngeal abscess;
- otitis media;
- laryngitis;
- sinusitis;
- pharyngitis;
- bronchitis;
- lesions of the nervous system;
- septicemia (rarely, but can be fatal).
Principles of Therapy
Treatment of purulent tonsillitis should always be comprehensive and carried out in a full course without interruption. Antibacterial therapy is required, prescribed not less than 10 days.
It helps to avoid complications and accelerates recovery.
The principles of antibiotic treatment
Antibiotics for purulent tonsillitis should be prescribed and taken only in a continuous course. Admission should always be respected, even if there are clinically improvements. Antibiotics are not prescribed for prophylaxis; they are ineffective with viruses. If there is severe intoxication, the patient may be hospitalized.
In all other cases, treatment is carried out at home. The decision to take antibiotics for the treatment of chronic suppurative tonsillitis is made by the doctor.
A person can independently choose an inadequate dose or the wrong antibiotics, which will lead to a generalization of the infection.
General requirements
The following activities can be attributed to general requirements:
- Compliance with bed rest during the week.
- Drinking a large amount of liquid in a warm form to flush and remove toxins.
- Eating only in warm form.
- It is impossible to squeeze purulent plugs themselves, they will burst during treatment themselves. Why you shouldn’t squeeze the cork yourself: you can damage the protective film of the gaps, and the infection will easily penetrate the blood.
- Do not give analgesics at a temperature of less than 38.5 degrees.
Antibiotics in the treatment of purulent tonsillitis are divided into drugs of the 1st and 2nd row. HBAS are sensitive to cephalosporins penicillins.
First row
These are penicillin drugs. They are valuable in that they treat a sore throat and do not allow complications in the form of rheumatism to develop.
But natural penicillins are now relegated to the background, more often synthetic penicillins are used. These include Ampicillin, Oxacillin, Ampioks.
Inhibitory penicillins lead. They contain clavulanic acid and remain resistant to microbial enzymes. Such funds include: "Clavunate", "Sulbactam", "Augmentin", "Amoksiklav" and others.
Second row
These are macrolides (Azithromycin, Sumamed, etc.) and cephalosporins of 2,3,4 generations (Cephalexin, Ceftriaxone, Cefamisin, etc.).
Macrolides take 5 days, but their concentration in the blood lasts 10 days.
Antibiotics do not interrupt, even if your health is noticeably better. And one more thing: the effectiveness of antibiotics in the treatment of purulent tonsillitis is evaluated after 3 days: if the temperature persists, the antibiotic is changed.
Therefore, the first 3 days, the doctor should visit the patient daily. This is especially true in the treatment of purulent tonsillitis in children.
Symptomatic treatment
So, the systematic treatment includes taking the following groups of drugs:
- Antipyretic drugs - Nurofen, Ibuklin, Paracetamol, Panadol.
- Local treatment of tonsils: irrigation, tonsil lubrication, aerosol application, rinsing, absorbing special tablets, lozenges, lozenges in the mouth - use antiseptics. Local treatment does not replace or exclude the use of antibiotics.
- Rinse and irrigation. They relieve pain and local inflammation. To rinse the throat, prescribe: infusions and decoctions of herbs (calendula, chamomile, etc.), ethacridinal lactate 0.1%, 1% boric acid solution, Gramitsidin, Chlorhexidine, Furacilin. Gargle every 4 hours.
- For irrigation: most often in the treatment of purulent tonsillitis in adults, "Furatsilin", "Iodinol", "Chlorophyllipt", "Miramistin", "Camphomen", "Ingalipt", "Yoks", "Cameton", "Tantumverde, etc."
- Inhalation. For this purpose, Bioparox has been used for over 55 years. It is an antibiotic spray that contains fusafungin. Its advantage was that it did not penetrate the blood and had a pronounced effect on the pathogens locally. But at present, Bioparox is banned in Russia, allegedly due to the side effects of the antibiotic.
- One of the non-pharmacological methods of treating chronic suppurative tonsillitis is the application of compresses to the throat. While purulent plugs persist, inhalations and compresses are not used.
- Resorption tablets - "Falimint", "Strepsils", "Faringosept", "Septolete", "Hexoraltabs" and others.
- Antihistamines. To desensitize the body in severe sore throats, Tavegil, Diazolin, Claritin, etc. are prescribed.
- Necessarily warm drink - herbal teas (chamomile, with rose hips, sage, oregano), heated mineral water without gas, fruit drinks, fruit drinks.
- Mandatory in the treatment of purulent tonsillitis is the appointment of vitamins and immunocorrectors, especially in frequently ill children - IRS-19, Immunal, Ribomunil, etc.
- At the end of the course of antibiotics, probiotics are prescribed to restore the intestinal microflora: Linex, Bifidumbacterin, Lactobacterin.
- In the treatment of purulent tonsillitis, physiotherapy and rinsing are possible only after normalization of temperature. Most often they use UHF, electrophoresis, laser, ultraviolet radiation, quartz tube, ozokerite to lymph nodes, aerosols with ultrasound using lysozyme, hydrocortisone for 10 sessions.
How to remove traffic jams
Treatment of chronic tonsillitis with purulent plugs should be carried out only by a doctor. Use manual washing and a special apparatus. In the manual method, one of the solutions is introduced into the gaps: Miramistin, Furacilin, Iodinol. The course of 7-10 procedures, improvement is noted after 2-3 times.
Treatment of tonsillitis with purulent plugs also involves the removal of plugs by vacuum pumping pus on the Tonsilor apparatus.
Then the tonsils are washed with antiseptics and irradiated with low-frequency ultrasound. Course - 8 procedures.
Glands removal
For the operation, there must be a month period without exacerbations.
Indications for tonsillectomy:
- development of complications;
- the frequency of tonsillitis more than 7 times a year;
- failure of conservative therapy;
- decompensated chronic tonsillitis when it becomes a constant source of infection, etc.
Removal of tonsils is not a guarantee that there will be no further tonsillitis (remember the lymphoid ring).
Removal Methods:
- tonsil removal with ultrasound;
- electrocoagulation - cauterization of tonsils by electric current;
- radiofrequency ablation (coblation);
- excision with a wire loop and scissors is the most common technique.
Another common method is ablation. This is tissue rejection by radiation (tonsils are not completely removed). Ablation can be laser and radio wave. Manipulation takes only half an hour.
Anesthesia with tonsillectomy is local, rarely common. The duration of the operation is 1.5 hours. After the operation, bed rest is 3 days.
The patient should lie on his side, with a low pillow, so that mucus and blood from the wound do not flow into the trachea. Drinking is allowed after 6-8 hours. Eat - only after a day, the food should be warm and soft.
Folk remedies
Treatment of purulent tonsillitis at home is quite acceptable in compliance with all the doctor's recommendations.
To alleviate the throat, warm milk with soda and butter may be recommended.
Other recipes:
- Morning rinse - add 200 tbsp of water to 200 ml of water. l apple cider vinegar.
- It is also good to gargle with fresh beetroot juice, a solution of soda with the addition of salt and iodine. Rinses are performed at least 3-4 times a day.
- Disinfectants - onions and garlic. They need to be crushed, squeezed juice mixed with honey. With honey, you can also mix birch buds, apple cider vinegar.
- Herbal teas - linden with honey, thyme, cranberries. With the severity of intoxication, it is better to drink warm water up to 2 liters per day.
- Tonsils can be lubricated with fir oil, it has a bactericidal effect. Also, fir oil can be added to a gargle solution. With the permission of the attending physician, fir water is first prepared - for 200 ml of warm water 1 tsp. honey + 2 drops of oil. The solution is used to rinse - 3-4 times a day.
Preventive actions
The most important thing in the fight against tonsillitis is hardening of the body and strengthening immunity. This will be facilitated by a balanced diet, preventive intake of vitamins, good sleep and rest. In addition, it is necessary to treat chronic foci of infection in the form of caries, sinusitis and sinusitis, inflammation of the ENT organs. You can not drink ice water from the refrigerator during overheating, hypothermia should be avoided.