Tonsillitis: Symptoms and Treatment
Tonsillitis is an inflammatory process that occurs in the area of palatine tonsils and is characterized by the duration of its own course. Tonsillitis, whose symptoms are also defined as the more common name for the disease «angina», consists in pathological changes in the oropharynx, similar to each other, but differing in their own etiology and flow.
About the angina is known since ancient times of ancient medicine, and most often this term indicates the relevance of various types of disease states, concentrated in the throat and have similar characteristics. Meanwhile, the causes that provoked tonsillitis, in essence determine for the disease an absolute difference in the varieties of its forms. Given this fact, all the current variants of this disease can be divided into three separate categories: primary sore throats, specific sore throats, secondary sore throats (or symptomatic ones).
Primary sore throats
Primary angina is an infectious acute disease characterized mainly by its own streptococcal etiology, as well as a relatively short course of fever, intoxication and inflammatory changes occurring in the pharynx tissues (mainly in the tonsils and lymph nodes Near them located).
The danger of this form of ailment lies in the fact that it starts the development of autoimmune processes, the lack of treatment of which can lead to the development of acute forms of rheumatism and glomerulonephritis, which in turn lead to serious damage to the heart and kidneys.
Most often, tonsillitis occurs as a result of the pathogen, beta-hemolytic streptococcus, with a similar course of the disease observed in more than 90% of cases. In 8% of cases, the incidence of tonsillitis is associated with exposure to Staphylococcus aureus, in some cases combined with streptococcus.
Extremely rare as a pathogen is a hemophilic rod, corynebacterium or streptococcus pneumonia. As a source of the pathogen in case of tonsillitis, the patient with a disease in the acute form of its course and a carrier of microorganisms of the pathogenic flora appears.
The main way of infection is the air-drop path, which is extremely common in large groups, as well as through close contact with a sick person. The infection can also occur as a result of the use of products pre-infected with staphylococcal infection (compote, milk, minced meat, salad, etc.).
As to the susceptibility to the disease, it can be noted that it is not the same for each patient, being determined to a large extent by the condition inherent in the local immunity of the tonsil area. So, than the immunity is lower, so, respectively, the higher the risk of the probability of the disease.
This risk also increases as a result of fatigue, hypothermia, exposure to other factors of an unfavorable type. For the incidence of primary angina, compliance with certain seasons, namely spring and autumn, is characteristic. Tonsillitis is noted in both children and adults.
Secondary sore throat
Secondary angina is an acute type of inflammation, centered in the region of the components of the pharyngeal lymphatic ring, which mainly affects the palatine tonsils. A disease of this type is determined by a specific systemic disease.
The development of secondary angina occurs as a result of a number of infectious diseases, including measles, diphtheria, syphilis, infectious mononucleosis, scarlet fever, herpetic and adenoviral infection, etc.
An isolated group of such anginas that develop against a background of actual for the patients leukemia and agranulocytosis.
Acute tonsillitis: the main features and forms of the disease
The lymphoid tissue of the oropharynx region acts as an entrance gate for the disease, it is in it that the primary focus of the inflammatory process is formed. As predisposing factors to the development of acute tonsillitis, local hypothermia, increased dryness in the air, gas contamination and dustiness of the atmosphere, reduced immunity, nasal breathing disorders, hypovitaminosis, etc., are distinguished.
In many cases, the development of angina occurs as a result of the transfer of patients with acute respiratory viral infection, whose pathogens are directed at reducing the protective functions characteristic of the epithelial cover, which in turn facilitates the process of invading streptococci.
Based on the nature of the lesion and its depth, the following types of tonsillitis are defined:
- catarrhal angina
- Follicular sore throat;
- lacunar angina
- necrotic sore throat.
Of the listed forms of tonsillitis, the easiest course is noted in the catarrhal form of the disease, and the most severe — with its necrotic form.
Based on the characteristic degree of severity, tonsillitis can be of light, medium and heavy form. The severity of this disease is determined by the degree of manifestation of changes in the general and local scale, while the general manifestations in determining this criterion are decisive.
Acute tonsillitis: symptoms
The total duration of the incubation period, relevant for this disease, is on the order of 10 hours to three days. The onset of the manifestations of the disease is characterized by acuity, the main ones being high fever and chills, as well as severe pain experienced during swallowing. In addition, there is an increase in lymph nodes, their soreness. The nature of the severity of the fever accompanying tonsillitis, as well as the nature of the pharyngoscopic picture in combination with intoxication, is determined on the basis of the form of the course of the disease.
Symptoms of catarrhal tonsillitis
For this form of the disease, a characteristic feature is the superficiality of the affected area of the tonsils. Intoxication manifests itself moderately, the temperature in patients subfebrile.
When analyzing blood, it is determined that there is no change in it, or that this phenomenon is insignificant. Pharyngoscopy reveals diffuse and sufficiently bright hyperemia, which captures the hard and soft palate, as well as the capture of the pharynx (posterior wall of the pharynx). Somewhat less often, hyperemia in tonsillitis is limited only by palatines and amygdala. A characteristic increase in tonsils occurs due to swelling and infiltration.
The duration of the course of the disease is of the order of up to two days, followed by a gradual remission of inflammatory processes of the pharynx, or, conversely, another form of tonsillitis (follicular or lacunary) begins to develop.
The flow of follicular and lacunar tonsillitis is characterized by a much more pronounced clinical picture. Thus, the temperature in these cases rises to 40 degrees, a pronounced character acquires and peculiar manifestations of intoxication (headache, weakness, joint pain, in the muscles and in the heart).
A general blood test determines an increase in ESR of the order of up to 50 mm / h, and leukocytosis is also detected (in this case a neutrophil shift to the left is determined). Urinalysis in some cases allows the identification of red blood cells and traces of protein.
Symptoms of lacunar tonsillitis
For the disease in this form, the actual damage to the tonsils, as one can determine from the name, within the lacunae region, while simultaneously spreading to the free surface of the tonsils purulent plaque. Pharyngoscopy reveals pronounced puffiness and flushing, widening of lacunae and infiltration of the tonsils. The contents of the lacunae have a fibrinous-purulent consistency of a yellowish white color, it forms a loose coating in the region of the surface of the tonsils, this film has the appearance of a film or small foci. The release of the raid beyond the borders of the tonsils does not occur, it is also easily eliminated, leaving no bleeding after it.
Symptoms of follicular tonsillitis
A characteristic feature of this form of the disease is the predominant concentration of the lesion within the follicular apparatus of the tonsil area. Pharyngoscopy reveals the following: hypertrophy of the tonsils and their sharp puffiness, translucence of suppurated follicles through the epithelial layer. The follicles in particular are comparable in size to the pinhead, the color is whitish-yellow. Subsequently, the follicles, exposed to the corresponding suppuration, are opened, resulting in a purulent deposit, the spread of which does not occur outside the tonsils.
Symptoms of necrotic tonsillitis
For the disease in this form, there is a strong manifestation of manifestations of general and local scale (in comparison with the forms noted above).
The blood test in the analysis determines the expressed form of leukocytosis and neutrophilia, the sharp shift to the left of the leukocyte formula is actual, the parameters of the ESR are also significantly increased. With pharyngoscopy, there is a presence on the mucosa of the plaque in the area of the lesions of the tonsils, its surface is rugged and uneven, the color is gray or greenish-yellow. Primarily, fibrin impregnation of affected areas occurs, as a result of which they acquire a pronounced density, their removal is accompanied by the appearance of a bleeding surface.
The rejection of the areas subjected to necrosis leads to the formation of a deep tissue defect, the transverse dimensions of it are of the order of 1-2 cm, the bottom is tuberous and uneven. There may also occur a proliferation of necrosis to the tongue, arches or to the posterior wall of the pharynx, that is, beyond the tonsils.
Sharpening of the acute form
Acute tonsillitis can also be accompanied by certain complications. In particular, early complications and complications are distinguished among these.
- Early complications of tonsillitis. They appear during the course of the disease, and, as a rule, are caused by the actual spread of the inflammation formed to nearby organs and tissues. It can appear in the form of peritonsillitis, sinusitis, otitis, purulent lymphadenitis, tonsillogenic mediastinitis, parathonsillar abscess.
- Late complications of tonsillitis. The development of these complications occurs in a few weeks (3-4), as a rule, they are characterized by an infectious-allergic etiology. There are complications of this type in the form of post-streptococcal glomerulonephritis, rheumatic carditis and articular rheumatism
Chronic tonsillitis can occur in two ways:
- recurring form
- bezanginose form
The recurrent form of chronic tonsillitis, as can be understood directly from the definition of this disease, is primarily characterized by its own relapses. Accordingly, a patient with this form of the disease every year (or several times a year), regardless of the peculiarities of pharyngoscopy during examination, has an actual diagnosis of recurrent chronic tonsillitis &, whose symptoms we will consider below.
It is noteworthy that, outside the recurrent stage of the disease, patients can create the impression of absolutely healthy people, and such a conclusion can be drawn from the absence of complaints about their own condition. Objective examination of the tonsils (including mucous and lymph nodes) for pathology, as we have already noted, may not reveal this at all. Meanwhile, this kind of well-being, noted in the inter-religious period, is rare. Therefore, mainly the period of remission indicates the presence in patients both objective and subjective symptoms of the disease.
Subjective symptoms are as follows: sore throat when swallowing, which is especially pronounced in the morning; Increased pain or their appearance after cold fluid or food; A feeling of awkwardness that occurs during swallowing, as well as a feeling of fullness in the throat or the presence of a foreign body in it.
It is often noted and the attachment of complaints that occur against the background of secondary pharyngolaringitis: laryngic cough, pershenia and throat sore, etc. In some cases, these complaints are predominant in the general condition of the patient.
The listed complaints of «local» scale are often combined and with complaints common, arising under the influence of tonsilogenous intoxication. The manifestations are the following: rapid fatigue and general malaise, irritability and headaches, sweating, evening low-grade fever, discomfort (sometimes reaching pain) in the heart, shortness of breath, rapid heartbeat.
The listed disorders of the subjective type are often expressed so much that the pains in the throat, which are topical for the main relapsing disease, are relegated to the background, or even insignificant, against the background of the general picture of the patient’s condition.
Objective study of chronic tonsillitis in the recurrent stage may not distinguish it significantly from non-relapsing primary tonsillitis, as a result, excluding from the history of the patient with frequent angina in it, it is possible to incorrectly establish the diagnosis.
The signs found in the inter-religious period of the disease can be divided into signs that are reliable and relative.
Reliable Features are as follows:
- the presence in the gaps of purulent contents or purulent-caseous contents
- presence of purulent cysts or microabscesses of chronic type in tonsils
- enlarged lymph nodes located near the tonsils, as well as their soreness
- congestive hyperemia, thickening of the palatine anterior arch.
Relative characteristics (that is, the signs used to diagnose the disease only as relative in value) are manifested as follows:
- enlargement of the tonsils, their atrophy
- the appearance of cicatricial changes in them
- the appearance of adhesions between the tonsils and the front arms.
Specific sore throats
Diphtheria of throat
Often has a similar to the primary form of tonsillitis symptomatology. Diphtheria of throat can manifest itself in one of three forms:
- localized (there is no escape of the raid beyond the tonsils to the soft palate);
- common (there is a flight out of the framework of the tonsils to the soft palate and to the back wall of the pharynx);
- toxic (the edema concentrates in the area of throat, the neck is focused subcutaneous tissue).
The first two of these forms of diphtheria occur with the formation of a dense type of raids, it is difficult to eliminate them from the tonsils. After eliminating the raids, bleeding of the underlying tissues is noted, but the film itself is not to be dissolved in liquid or rubbed. Elimination of the use of antidiphtheria serum leads to the progression of the disease, which results in a transition from its mild form to a form much more severe or toxic.
Fungal sore throat
They are provoked by yeast-like fungi, which appear as a result of prolonged use in the treatment of antibiotics, as well as with reduced reactivity of the organism as a whole. The difference between this type of angina and angina primary is the insignificant increase in temperature, as well as in mild intoxication. The surface of the tonsils contains «curdled» and loose plaque, easily eliminated. As a result of its disappearance, the inflamed, but smooth mucosa («varnished mucosa», as it is also customary to define) opens.
The disease is provoked by a certain symbiosis of microorganisms (that is, their cohabitation), the habitat of which is concentrated in the oral cavity. Such microorganisms include, in particular, spindle-shaped sticks and spirochetes. Poor quality of oral care, as well as smoking leads to the appearance of pathogenic features. Thus, as a result of a slightly expressed form of intoxication, on the one hand, a ulcerative necrotic process develops. Already the next two days, the amygdala is covered with a touch of grayish-white color, and by the fourth or fifth day the plaque area already has a deep ulcer (its bottom has a dirty gray shade, the edges are uneven). Distribution of plaque is possible both along the entire amygdala and beyond, but there is no transition to the other side. Duration of the disease is about two weeks and no more.
Secondary sore throats: features and symptoms
Many types of infectious and non-infectious diseases, in addition to the fact that the features of their course involve the defeat of a number of systems and organs, also lead to secondary anginas. This type of angina is a whole complex of clinical manifestations, as a result of which there are also characteristic anginal changes. This type of change is observed in ARVI and influenza, tularemia and scarlet fever, with syphilis and tuberculosis, as well as measles, infectious mononucleosis, agranulocytosis and leukemia.
Sore throat with scarlet fever
If it is a question of follicular-lacunar form or about the form of catarrhal, then the disease manifests itself on the first day. Its difference from the primary form consists in a more pronounced coloration of the affected mucous membranes (which is defined as «glowing pharynx»), as well as in disappearance to the fourth or fifth day of the disease. The difference from the primary type of sore throat is the presence of symptoms typical for the underlying disease (that is, for scarlet fever), which is manifested in the bright staining of the mucous throat, as well as in the expression of the papillae of bright red color («crimson tongue»), pale nasolabial triangle and bright- Red cheeks. In addition to this, there is also a pinpoint eruption, actual for scarlet fever, which is concentrated in the region of the hips (their inner surface), in the lower abdomen, on the folds of the legs and hands.
Syphilitic sore throat
Development of it occurs with oral lesion. After a period of 3-4 weeks from the time of infection, one of the tonsils grows, and the temperature also increases insignificantly. Already after a few days on the tonsil you can see a characteristic chancre. Predominantly in practice erosive lesions of the amygdala are noted, in which the erosion formed has a regular shape and diameter up to 1 cm, smooth and distinct edges, and also a brilliant bottom. In the case of secondary syphilis, angina is accompanied by the appearance on the tonsils of whitish plaques (about 0.5 cm in diameter) slightly elevated above their surface and surrounded by a rim of red color. It is noteworthy that secondary syphilis is accompanied by the defeat of both tonsils at once.
Angina with tularemia
As a rule, it manifests itself one-sidedly, being filthy, necrotic or catarrhal. The surface of the tonsils is plaque in the form of yellow-white islets, subsequently they merge with each other, which forms a coarse and thick film resembling a film in diphtheria. In addition, there is a significant increase in cervical lymph nodes with their simultaneous soreness, as well as their suppuration and fusion with the formation of conglomerates. Tularemia is also accompanied by an increase in the spleen and liver.
Angina with leukemia
Symptoms in this case are manifested as a rise in temperature (up to 40 degrees), chills and headaches. Often there are nosebleeds, hemorrhages develop in the mucous and skin areas. Initially, the catarrhal sinus is transformed into a necrotic, which is accompanied by the formation of a dirty gray plaque, as a result of which reflection occurs bleeding blemishes on the surface, characterized by special features of the process unevenness. Clarification of the diagnosis occurs after a blood test, which often determines a twenty-fold increase in the norm of white blood cells.
Angina with agranulocytosis
It appears in a ulcerative-necrotic form, has a similarity to the course of angina in leukemia. Blood as a result of the analysis determines the almost complete absence of leukocytes.
Sore throat with enterovirus infection (herpwagin)
Symptoms are manifested as a rise in temperature to 40 degrees, there is a bubble rash on the tonsils. The opening of this rash determines the subsequent appearance of superficial sores with a white thin coating. The duration of the disease is about a week.
Sore throat with infectious mononucleosis
As a rule, it is noted in the early days of the disease, but it is possible to develop it by the fifth or sixth day. In the area of the lacunae of the tonsils, an easily removed rough and loose plaque appears. The difference of this type of angina is a symptom actual for the mononucleosis, which consists in the defeat of lymph nodes (cervical, axillary, inguinal, subclavian, etc.). In addition, the spleen and liver are subject to increase.
The diagnosis of streptococcal angina is usually made on the basis of data that includes in general the clinical course of the disease, as well as data obtained by pharyngoscopy (that is, by visual examination of the pharynx), for which a frontal reflector mirror). Also, the data of laboratory studies are used.
Treatment of tonsillitis
Tonsillitis is treated, as a rule, on an outpatient basis. Heavy it requires hospitalization. A sparing diet is prescribed, saturated with vitamins B and C, as well as an abundant drink for detoxification.
Given the occurrence of angina against a background of streptococcal infection (in the vast majority of cases of morbidity), the treatment of tonsillitis (tonsillitis) is the use of penicillin containing antibiotics. In the case of an allergy in the patient to penicillin, he is prescribed antibiotics included in the group of macrolides (azithromycin, erythromycin). Severe course of the disease may require intravenous administration of solutions of sodium chloride and glucose.
A heavily tolerated high temperature requires the use of analgesics (aspirin, paracetamol).
In case of repeated tonsillitis immunostimulants are prescribed, from general health-improving medications — vitamins (simple multivitamins, ascorbic acid, vitamin B). To ensure hygienic effect, it is necessary to rinse the throat. Pain relief in the throat is facilitated by the use of sprays, pastilles based on mint oil, menthol and local anesthetics, which reduce the sensitivity of the mucosa.
Pronounced inflammation of the lymph nodes involves performing warming procedures in the form of physiotherapy and dry heat.
Secondary tonsillitis, whose treatment is performed in any of its variants with an effect on the underlying cause of the disease, is often significantly different from the treatment of angina in its primary form. The effect is directed to the elimination of certain manifestations of symptoms, for which a therapy similar to that of primary angina can be used.
If you have symptoms of tonsillitis, you need to contact an otolaryngologist (LOR) to diagnose the disease and prescribe appropriate treatment.