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Chronic tonsillitis: the inflammation of tonsils

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Tonsillitis is one of the most common ENT diseases, especially (but not only) in children.

Tonsilla (colloquially tonsils, from Latin “glandula”, iron) – a pair of relatively large palatine tonsils located on both sides of the entrance to the larynx and are part of the pharyngeal lymphoid (lymphadenoid, lit. “lymph glandular”) Pirogov-Waldeyer ring. To date, apparently, not all the functions of this formation have been identified and studied, but the role of the tonsils as an antiseptic barrier and their active participation in the replenishment of immune resources have been established reliably.

Tonsillitis is called an etiologically heterogeneous group of inflammations that develop and occur mainly in the palatine tonsils. Tonsillitis is one of the most common ENT diseases, especially (but not only) in children. Accordingly, this is one of the permanent problems of modern otorhinolaryngology, although the history of the study and treatment of tonsillitis goes back to ancient times.

Being an infectious and inflammatory process, tonsillitis can occur in acute, subacute and chronic forms . The dividing criterion is the duration of the flow. Acute tonsillitis is also called “tonsillitis” .

In recent years, there has been a trend towards an increase in epidemiological indicators in relation to chronic forms of tonsillitis. To date, the prevalence of this disease by various sources is estimated at 10-35% for adults and 15-60% for children, and these estimates, according to a number of domestic authors, may be underestimated. The incidence does not depend on sex.

The reasons

In the etiological structure of chronic tonsillitis , the leading cause is pyogenic (pyogenic) streptococci , in particular, beta-hemolytic streptococcus A. This is followed by staphylococci, rod-shaped bacteria, fungi of the genus Candida . However, monomicrobial infections are rare today; about 80% of all chronic tonsillitis are polymicrobial or combined(bacterial-fungal symbiosis, say, is found in about 30% of cases). The pathogenesis of chronic tonsillitis, as well as the trend towards an increase in the incidence, are closely related to the problem of weakening and distorting immune responses in modern humans, especially in residents of large cities and other environmentally unfavorable environments. The immune system, unable to completely eradicate the pathogen, enters into a precarious balance with it, either suppressing the activity of harmful microorganisms, or again allowing their activation and, moreover, contributing to inflammatory processes with autoimmune and allergic reactions.

Risk factors include hypothermia, overwork, physical and psycho-emotional overload, deficiency of vitamins and other essential nutrients, smoking, occupational hazards, foci of chronic infections in adjacent and remote areas of the body, as well as problems with nasal breathing due, for example, to the presence of adenoids or deviated nasal septum.

A certain significance of the hereditary factor is being studied and, according to a number of domestic and foreign publications, confirmed.

Symptoms

Chronic tonsillitis may be the result of an untreated or complicated sore throat , however, it can also develop as a primary independent disease, and in some cases it is asymptomatic or asymptomatic in the initial stages.

The classic symptomatology of chronic tonsillitis includes sensations that the throat is “itchy and sore”; pain when swallowing (especially when drinking cold drinks or foods), coughing, bad breath, soreness and enlargement of nearby lymph nodes; swelling and hyperemia of the tonsils, plaque on them . These symptoms are usually aggravated during a night’s sleep. Systemic manifestations include periodic increases in body temperature to a subfebrile level, asthenic “chronic fatigue syndrome”, increased sweating, tachycardia, shortness of breath .

 

In chronic tonsillitis, relatively calm periods of remission alternate with more or less frequent exacerbations in the form of tonsillitis (its clinical type may be different). However, the greatest danger of chronic tonsillitis lies not in this. Since “smoldering” inflammation in the tonsils continues even in remissions, the fibrosing process also continues, i.e. tendency to replace parenchymal tissues with scar, connective tissue. In addition, in the presence of a permanent source of infection, the body is in a state of permanent intoxication, which is the reason for the typical clinic described above. Finally, chronic tonsillitis can become the basis for the development of about a hundred diseases , among which there are very serious and severe ones: glomerulonephritiswith progressive renal insufficiency, arthritis, rheumatic fever and other collagenoses, tonsillogenic pathology of the cardiovascular system and thyroid gland, repeated paratonsillar (peritoneal) and intratonsillar (intratonsillar) abscesses, etc.

Diagnostics

Diagnosis of chronic tonsillitis is usually not difficult . Complaints and anamnesis are studied , an external examination, palpation of the cervical and submandibular lymph nodes, and pharyngoscopy are performed . General clinical and biochemical blood tests are prescribed , a smear is taken from the surface of the tonsils to identify the pathogen(s) and determine sensitivity to antibiotics . Additionally, an ECG and other instrumental studies may be needed to identify and assess the severity of a complicating pathology.

Treatment

The therapeutic strategy for chronic tonsillitis is always individual (determined by the results of the examination) and is complex. Intensive etiopathogenetic treatment is carried out (antibiotics, antimycotics), immunostimulants and immunomodulators, vitamin complexes, local antiseptic and physiotherapeutic procedures (including therapeutic exercises) can be used, a special diet is being developed .

Separately, the issue of surgical removal of the tonsils is considered . In parallel with the increase in the incidence (and regardless of this trend), medicine is increasingly inclined towards conservative, sparing, minimally invasive, organ-preserving methods of treatment. This course naturally follows from the entire history of medicine and will steadily develop, which is manifested, in particular, by a steady trend towards a reduction in the number of tonsillectomy interventions for chronic tonsillitis. Modern alternative methods are no less effective and have a number of undeniable advantages over such an operation.

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