Angina without pain in the throat and temperature: is it

In everyday life, any reddening of the throat, especially with whitish dots or a touch on the tonsils is called angina. Aesculapius of Ancient Greece, too, was called so all inflammatory diseases of the pharynx, and from their light hand this name in the same understanding is used in everyday life even today.

The clinical picture is enlarged and hyperemic tonsils, covered with dots similar to pustules, but there are no painful sensations. So is angina without pain in the throat? Can not be. This is an acute infectious disease, one of the main signs of which is the pain in the throat. It may not appear right away, first the temperature rises, but the next day there will be a strong pain in the pharynx, aggravated by swallowing.

[1], [2], [3], [4], [5], [6]

Epidemiology

Medical statistics indicate that in the second half of the last century, diseases caused by fungal infections were widely spread, which is associated with the discovery and introduction of antibiotics into broad medical practice. Today, the prevalence of mycotic lesions among the adult population of the planet is estimated at 5-20%. In the structure of mycoses, the first place is caused by nail lesions, the second is due to fungal infection of mucous membranes (in 90% or more cases of candidiasis), about 40% of patients have oropharyngeal mucous membranes. Much less often with fungal infections (5-6%), aspergillas, penicillas, white mold and others are sown, as well as leptotrichia bacteria. All of them are present in insignificant quantities in the biocoenosis of the healthy oral cavity and provoke a pathological process with a decrease in immunity.

The prevalence of chronic tonsillitis is estimated by different authors among children - from 12 to 15%. The incidence of this pathology among adults is 4-10%.

[7], [8], [9], [10], [11]

Causes of the sore throats without sore throat

So, we found out that such an angina does not happen. However, some inflammatory processes in the pharynx are not always accompanied by pain. For example, a fungal affection of the tonsils (tonsillomycosis) or pharyngeal mucosa (pharyngomycosis). These lesions are still incorrectly called fungal angina.

[12], [13],

Risk factors

Risk factors for the development of chronic tonsillitis: angina, violation of nasal breathing due to curvature of the nasal septum, polyposis growths, infectious foci in neighboring organs, smoking. Anatomical features in the form of deep, narrow and densely branched crypts, complicating drainage from lacunar areas located in the depth of the amygdala.

Risk factors for the development of oropharyngemicosis - diseases of the gastrointestinal tract, especially accompanied by a violation of the balance of microorganisms in the intestine. The lack of bifido-, lacto- and other beneficial bacteria causes insufficient production of B vitamins, reproduction and spread of fungal flora in the intestine and up the esophageal canal, reaching the mucous ENT organs up to the oral cavity.

Fungal microflora develops well in diabetics, in persons with hematopoiesis, malignant tumors and other diseases that disrupt the processes of digestion and assimilation of vitamins, fats, proteins and carbohydrates, and thereby cause immunodeficiency. Especially prone to fungal infections are people with acquired immunodeficiency syndrome, in which mycosis takes a generalized form and leads to death. Pharyngo- and tonsillomycosis often develops as a side effect of prolonged treatment with high doses of glucocorticosteroids.

[14], [15], [16],

Pathogenesis

Angina is sometimes called chronic tonsillitis (prolonged sustained inflammation of the tonsils, often palatine) or its combination with pharyngitis in remission. Sometimes the expression "chronic angina" can be heard even from the lips of doctors. This disease is not an angina, although it can be a complication. And periodic relapse is very similar to angina symptomatology. They are distinguished from each other, first of all, by the frequency of occurrence in the same patient. If angina-like disease occurs once a year and more often, then it is an exacerbation of chronic tonsillitis. A real angina is not all sick, but the same person - no more than three times throughout life with large time intervals.

Most often in patients with chronic tonsillitis streptococci (hemolytic, green), enterococcus, staphylococcus, adenoviruses are sown. The cause of the disease can be the growth and multiplication of non-pathogenic microorganisms-saprophytes of the upper respiratory tract due to decreased immunity, that is, a chronic inflammatory process develops as a pathology caused by endogenous autoinfection.

The pathogenesis of chronic tonsillitis trigger many components. Most often it occurs as a consequence of angina (acute tonsillitis), when the reverse development of the disease leads to its chronicization. Pathogenetic links in the development of this chronic disease are histological features of the palatine tonsils (anatomy, topography); presence of favorable conditions for vegetation of conditionally pathogenic and pathogenic microorganisms in crypts (branching crevices) of palatine tonsils; deterioration of drainage in these cracks after inflammation due to strictures; chronic inflammatory processes in ENT organs, caries.

In the pathogenesis of mycosis of the pharynx, the main role is played by cumulation and circulation in the blood of antibodies to the causative agent of infection (fungi), which causes instantaneous and delayed reactions, and the transformation of immunity at the cellular level is taken into account. A rather important pathogenetic link is allergy and specific (nonspecific) sensitivity of the organism. Considered the transferred injuries of the mucous membrane of the pharynx (burns, injections, surgical operations).

[17], [18]

Symptoms of the sore throats without sore throat

Fungal infections localized in the pharynx may be acute. Symptoms correspond to an acute condition - high temperature and pain are mandatory attributes. The lesion seizes the mucous membrane of the oral cavity and pharynx, including the tonsils. This condition can also be confused with sore throat, however, in our case, the interest is a chronic sluggish mycosis, which, for visual reasons, can be treated as a sore throat without fever and sore throat. Defeat - redness and whitish small islets or plaque at this stage of the disease are often limited. Tonsillomycosis - hyperemic and covered with a touch of only the palatine tonsils, pharyngomycosis - the posterior wall of the pharynx. These types of chronic disease are represented by a recurrent and persistent form.

Mycotic foci, which look like whitish dots merging into islets, are localized on palatine tonsils and curtains, lateral arches, back wall and tongue. Appearance of the pharynx to an unsophisticated view resembles a purulent sore throat without pain in the throat. Over time, fungal infection, which persists with traditional antibiotic therapy, acquires stability and occupies an increasingly vast space. Necrotic areas of the mucosa form, during a period of exacerbation, the temperature may rise, however, necrosis leads to the absence of painful sensations. During this period, a condition determined only by the clinical picture can be interpreted as a sore throat without a sore throat with a high fever.

Mycosis of the pharynx have various forms and stages - from superficial to ulcerative necrotic. With prolonged chronic disease begins hypertrophy of the mucous membrane of the pharynx, which is covered with tubercles, cracks, polypous growths. Slightly increased lymph nodes (sub- and maxillary), they are usually not painful, as in true angina. However, an incompetent doctor may well diagnose: a follicular sore throat without sore throat.

In chronic mycoses, exacerbations occur at intervals of two to three weeks. Acute pharyngomycosis usually lasts from seven days to two weeks, the chronic process is characterized by a wave-like course, the recurrent form develops in approximately 22% of patients. Pharyngeal mycosis often spreads to the corners or to the red border of the lips and the mucous membrane of the tongue.

For actinomycosis, lymphadenopathy is not typical. Appear slowly growing dark red tubercles (granulomas), occasionally the pathology acquires a phlegmonous form. Phlegmon is mostly located in the mouth or neck area, sometimes on the tonsils, in the nose, the larynx or in the tongue. Education is suppressed, an abscess that can break through with the formation of a fistula begins.

With leptotrichiasis on the unchanged surface of the epithelium of the pharynx, tonsils, lateral archways, spike-shaped outgrowths are grayish and yellowish. Symptomatics erased, inflammatory transformations and an increase in body temperature are not observed, with the development of the disease there are complaints that the pharynx senses a foreign body.

Chronic inflammation of the tonsils, in particular, in the acute stage, can often be confused with sore throat. Visual symptoms of this disease include:

• hyperemic and thickened as rollers of the edge of the palatine arches;
• loose or abnormally dense tonsils, the presence of cicatricial changes in them;
• festering plugs in the tonsils or the presence of pus in their lacunae;
• proliferation of connective tissue between the tonsils and palatines;
• increased lymph nodes on the neck.

The presence of any two or more symptoms is the first signs of chronic tonsillitis. Types of chronic tosillitis - follicular and lacunar. It can flow without pain in the throat and without fever. Angina without sore throat in a child is most often a chronic tonsillitis, among children this pathology is more common than among adults. The appearance of this chronic disease in children is caused by the pathology of bioprocesses in the palatine tonsils, since there are natural anatomical conditions for their occurrence.

Chronic tonsillitis often can cause subfebrile temperature, tinnitus, vasomotor rhinitis, vegetative-vascular dystonia and other symptoms.

Chronic inflammation of the tonsils can be combined with pharyngitis, which inflames the posterior wall of the pharynx. The chronic form of this disease is not characterized by an increase in temperature and a significant deterioration in the general condition. Usually, the Pershit is in the throat, which is connected with the slime located on the back wall of the pharynx and the need to get rid of it.

However, neither mycoses nor chronic inflammations of the pharynx are an angina, although the visual picture of the pharynx resembles it very much.

Complications and consequences

Self-diagnosis or incompetent medical advice can be costly for the patient. If the patient is confident that he has a mild form of sore throat, not accompanied by pain and high fever, he will almost certainly try to get by with alternative means and relatively harmless medicines. However, a chronic inflammatory process in the pharynx, and, especially, fungi in such ways can not be eliminated. The disease will progress.

In the case of chronic tonsillitis, the most likely final is surgical intervention for the removal of palatine tonsils.

Continued disregard of chronic tonsillitis can lead to a variety of complications, especially ENT organs. In particular, persistent nasal edema causes labored breathing. Exacerbation or angina may be complicated by a parathonsillar abscess, and it, in turn, can lead to a phlegmon of the neck (a very serious disease that does not always lead to a patient's recovery).

During the night sleep in the gastrointestinal tract gets almost a glass of pus, crawling with bacteria.

Prolonged tonsillogenic intoxication can provoke the development of collagenoses, skin pathologies, inflammation of the kidneys, neuritis, Verlhof disease. It can suffer from the cardiovascular system and the genital area. In total, specialists identify more than 50 diseases that arise as consequences of chronic tonsillitis.

Fungal infection will gradually spread to other organs, the worst in this case - its generalization. This can not only seriously worsen the quality of life, but also take away life itself.

Incorrect diagnosis and, accordingly, treatment can only complicate the course of the disease. For example, antibacterial drugs in mycosis of the pharynx can lead to an exacerbation of the disease and the spread of the colony of fungi by destroying bacteria that compete with fungi and at least somehow restraining their spread.

Fungicides for inflammation of the pharynx also will not produce any effect, the disease will progress, allergies to the drugs used may occur. The clinical picture is smeared and makes further diagnosis more difficult.

Therefore, even if the doctor diagnosed "angina" and the patient does not have a sore throat, one must go to another specialist, make appropriate tests, identify the pathogen and establish an accurate diagnosis.

[19], [20], [21]

Diagnostics of the sore throats without sore throat

Since the tonsils and pharynx are superficial organs, they can be examined using a light diagnostic procedure - pharyngoscopy (visual examination of the mucous membrane of the throat).

The main pharyngoscopic symptom of chronic inflammation of the almond is the presence of pus, which is detectable when the spatula is pressed against the amygdala.

To resolve the question of the causative agent of the pharynx, bacteriological culture on the microorganism culture (culture analysis) will help. This is an absolutely accurate and not traumatic method. At the patient take soskob from tonsils or a back wall of a pharynx. Then the material is placed on a nutrient medium for growth of microorganisms, after a few days it is possible to accurately determine not only the type of microorganism (fungi or bacteria), but also accurately identify the pathogen and differentiate saprophytic from mycosis. When saprophytic (multiplication of endogenous conditionally pathogenic microorganisms), microscopy distinguishes only individual non-perceptible cells, when infected with fungi, all of their components, blastospores and mycelium, are determined.

With oropharyngeal mycosis, immunodiagnostics can be used - blood tests are performed to identify the pathogen antigens. Its variety is serological tests that detect antibodies to the cells of the source of the infection. Immunological analysis is not very informative, but in the process of treatment it is possible to trace its effectiveness in reducing the titers of antigens or antibodies.

Instrumental diagnostics is used to detect complications, for example, radiography of the paranasal sinuses, larynx and pharynx, electrocardiography and other methods as needed.

Differential diagnosis of oropharyngeal mycosis is carried out with diphtheria, ulcerative necrotic gingivitis, throat lesions in blood diseases, chronic tonsillitis, tuberculosis of the tonsils, hyperkeratosis of the tonsils and pharynx, syphilis, neoplasms.

[22], [23], [24], [25]

Treatment of the sore throats without sore throat

Therapy of fungal infections of the pharynx  involves solving three problems: the destruction of pathogens (if before the patient took antibacterial drugs, they are canceled); normalization of the balance of microorganisms in the intestine and indices of the interferon status.

Treatment of mycotic infections of the throat begins primarily with the use of local antiseptic or antimycotic drugs. The duration of the course of treatment of acute mycoses with local antifungal agents is usually from two to three weeks, antiseptic - more prolonged. Therapeutic measures are carried out until the visual symptomatology disappears and then another seven to ten days.

Antiseptic means lubricate the previously dried infected surface. In this case, aqueous solutions (1% or 2%) of conventional  greens  or  methylene blue are used. These agents cause irritation of the mucous membrane, and the fungi quickly become resistant to them. Lugol's solution is more effective  , they can be lubricated by the throat and tonsils. More convenient form of spray. This solution contains iodine, can cause burns, irritation, allergies. It is not recommended for pregnant women, children 0-4 years old, persons with hyperthyroidism.

For lubrication, a  solution of borax in glycerine  (10-15%) is also used, the old tested product, however, inferior in effectiveness to modern antifungal agents.

Antiseptic, a solution of  Manganese-potassium hydroxide  or  Boric acid  (1%) is used for rinsing. The throat is rinsed every time after a meal, for greater effectiveness antiseptic drugs are used alternately, changing them in a week.

Modern antiseptics are more effective. For rinses, a solution of  Hexetidine  (0.1%) is used. The throat is rinsed for about half a minute in the morning and at night after a meal. The solution is also available in aerosol form. Irrigation of the throat is performed for one or two seconds twice a day.

Antifungal topical preparations belong to the group of polyene antibiotics (nystatin, amphotericin, levorin and others) or to imidazole derivatives (nizoral, clotrimazole, fluconazole). They are produced in various forms - solutions, sprays, tablets. When using any form of the drug, the main condition for treatment is the need to delay the drug as much as possible in the mouth. For example,  Nystatin tablets   with oropharyngeal lesions slowly resolve to the cheek and try to hold in the mouth as long as possible. This drug has activity against yeast fungi and aspergillas, it is low in toxicity, but can cause allergic reactions.

If the local therapy is ineffective, systemic treatment is connected, for example, with  Nizoral. It has the ability to destroy yeast fungi that cause candidiasis, destroying the membranes of their cells. It can cause side effects from the nervous system, digestive organs, the genital area, disrupt blood coagulability. The daily dosage is 0.2 g and can be increased to 0.4 g. Taking the drug is desirable during meals for two or three weeks. Sometimes the treatment is repeated.

Correction of the balance of the intestinal microbiocenosis is multitasking. Reduction of the number of pathogenic and conditionally pathogenic microorganisms is carried out with the help of antibacterial drugs, such as Intestopan, and also by the inclusion of products with bactericidal properties in the diet.

Intestopan is  active against bacteria and protozoa. Contraindicated in case of sensitization to oxyquinoline derivatives, nervous disorders, severe hepatic and renal pathologies. May cause side effects - digestive disorders, peripheral nerve damage, tachycardia and headache. Adults take one or two tablets three times a day for not more than a decade. To children - the doctor appoints, proceeding from a status and weight of a body.

Required reconstitution microbiocenosis via microbial preparations such  kolibakterin  - lyophilizate live bacteria E. Coli or  Lactobacterin,  containing Lactobacillus acidophilus. Live bacteria, entering the intestines, multiply, creating a favorable environment for digestion, metabolism, strengthening immunity and displacing representatives of pathogenic microorganisms. Side effects and contraindications for probiotics are not fixed. Treatment lasts from three weeks to three months, it is recommended to be carried out against a background of vitamin therapy.

Substitution therapy, for example,  Viferon, is performed with the aim of correcting the indices of the interferon status. This drug contains reaferon (artificial α-2b-interferon, identical to human), antitumor and cell membrane stabilizing ingredients. In the form of rectal suppositories is administered per unit twice a day every 12 hours for a month. Then, within two or three months, the suppository is applied thrice a week (for example, Tuesday, Thursday, Saturday). The dosage remains the same. After the end of therapy, a control immunoassay is given.

In the case of extensive involvement of the pharynx with Candida fungi, operations on the lymphatic pharyngeal ring, heat and steam procedures, washing of the lacunae of the tonsils are counter-indicative, penicillin and tetracycline antibacterial drugs are not recommended.

With leptotrichosis infection, removal operations are performed, laser or cryodestruction of sites with pathological changes of exclusively palatine tonsils.

Treatment of actinomycosis involves a complex of antibacterial and antifungal measures; oral intake of funds containing iodine. Operative treatment, including a wide opening of the suppuration area, ensuring a constant outflow of pus and washing antiseptics of inflammatory infiltrates.

Immunotherapy consists in intramuscular injection of 20-25 injections of  Actinolizate  (stimulant phagocytic process). The drug is not used to administer sensitized patients, with acute viral infections and cancerous tumors. It is not prescribed to lactating women. In extreme cases, it is used to treat pregnant women and people with autoimmune diseases. At the initial stage of treatment is very likely an exacerbation of the underlying disease.

In severe forms of actinomycosis, treatment with X-rays is indicated.

In the  treatment of chronic tonsillitis  various methods are used. Therapeutic regimens are used for compensated (local) form of the disease, when signs of systemic reactions of the organism are not yet observed; when decompensated, manifestations of which consist in repeated angina, and in cases of patient's contraindications to the conduct of surgical treatment.

The patient is guided by the observance of the correct daily routine, which includes moderate exercise, walking outdoors, balanced nutrition, containing the necessary amount of natural vitamins and trace elements.

The drugs that reduce the hypersensitivity of the body - containing calcium, hypo-sensitizing agents: calcium preparations, vitamin C, antiallergic drugs and minimum dosages of allergens, aminocaproic acid and others for symptomatology.

Immunocorrective medications are prescribed, for example,  Broncho-munal.  It is an oral combined stimulant of immunity, lyophilizate of eight bacteria - the most common pathogens of diseases of the upper respiratory tract. Has a vaccine-like effect. The effect of the application is a decrease in the frequency and severity of the course of infectious diseases of the respiratory tract. Accordingly, drug therapy, especially antibacterial therapy, is minimized. With the introduction of destroyed cells of bacilli, the body responds by producing antibodies to them, which leads to the development of resistance of the organism to these pathogens, preventing exacerbation or greatly facilitating its course. The drug activates the activity of phagocytes, the cleavage of oxygen, its metabolites, superoxide and nitric oxide, have a destructive effect on pathogenic microorganisms found in the body. Increased production of immune cytokines and stimulated their functional qualities, immunoglobulins in plasma, saliva, gastric juice, secretion of the lungs and bronchi, thereby increasing the humoral immunity.

Contraindicated in infants up to six months, pregnant in the first three months and lactating women, as well as with allergies.

Side effects are extremely rare, however, there are allergic reactions, dyspeptic disorders and increased fatigue.

Capsules are taken in the morning on an empty stomach one piece per day. The preventive course consists of three ten-day receptions with intals in 20 days.

Broncho-munal is not recommended to be taken concomitantly with immunosuppressors, combinations with antibiotics are possible.

Manipulations are carried out for the sanation of the tonsils and the pharyngeal cavity by washing or sucking off the lacunar contents and introducing medicines into the lacunae. Solutions for these manipulations of rinsing are selected by the doctor. It can be: antiseptic and antibacterial, enzymatic, anhistamine and other drugs. Properly performed procedures contribute to reducing the inflammatory process and the size of the tonsils themselves.

With these manipulations enough often used  Ekteritsid  -  antibacterial natural product based on fish oil. Antagonist of pyogenic microflora. Has no contraindications and side effects.

Drugs are injected directly into the tonsils, sometimes using a nozzle with multiple thin needles for a quality penetration of the amygdala tissue.

As before, lubrication of the tonsils with Lugol solution, chlorophyllipt (oil solution), collargol and other means is practiced.

Patients are prescribed rinsing with medicine or herbal infusions, prepared at home, vitamins and vitamin-mineral complexes.

Physiotherapy is widely used. The most common application of ultrasound, laser, micro- and magnetic waves, induction currents, microwave radiation, UHF-therapy, ultraviolet irradiation, mud therapy. Practice and other methods.

For example, reflexotherapy - acupuncture, novocain blockades and manual therapy, since it is established that chronic tonsillitis is often combined with blocking mobility in the occipital region (it is localized most often between the occiput and the atlas).

Alternative treatment

It is impossible to rely entirely on alternative medicine, these pathologies of the throat should not be underestimated. However, physicians themselves often resort to alternative means in a complex of medical measures. The lights of alternative medicine can significantly alleviate the condition of both children and adults, but necessarily after a medical consultation, since independence in this matter should not be shown. It can slow down recovery and complicate the course of the disease. Especially  orofaringomycosis, as the fungi are quite persistent and resistant pathogens, especially their spores.

The simplest advice - every time after a meal is recommended to eat one small slice of garlic, thoroughly chewing and holding the gruel in your mouth. The therapeutic effect of eating garlic appears in a week. The smell can be repulsed by chewing the leaves of parsley, which is also used as an alternative remedy for the fungus - fresh parsley, finely chopped, measure two tablespoons, pour a glass of cold water and make a broth, boiling for five minutes. Insist for an hour, gargle each time after eating.

The root of horseradish has antifungal activity, rub it with ½ cup and mix with three lemons juice. After meals, eat one teaspoon of this mixture.

It is recommended to treat the throat and tonsils right after rinsing with sea buckthorn oil twice a day, in the morning and in the evening. It should be noted that after lubrication you can not eat or drink anything for two hours.

Rinse is prepared from herbs that have antifungal properties. These are marigolds, sage, oak bark, chamomile. Such treatment with herbs should be performed no less than three times a day, or better - after each meal.

Infusions for rinsing with mycosis of the throat:

• flowers of marigold and leaves of peppermint (one tablespoon) brew with boiling water 200ml, insist 30 minutes;
• shoots of a birch and flowers of a bird cherry (on one table spoon) to make boiled water 200мл, to insist 30 minutes.

Alternative treatment of  chronic tosillitis  mainly consists of active rinsing of the throat with herbal infusions and the use of herbal teas.

Infusions are prepared from marigold, chamomile, peppermint, sage, oak bark (as with mycosis), you can use the leaves of blackberries, plantain, raspberries, burdock, as well as its roots, herb wormwood and thyme.

You can rinse yourself with "sea water" of your own preparation - in 200ml of water (≈37 ° C) add ½ teaspoon of soda and salt, stir and drip five drops of iodine;

• juice of red beet with apple cider vinegar in the proportion of a teaspoon of vinegar to 200ml juice;
• garlic infusions: cut three-four slices and brew with boiling water (200ml), insist 2/3 hours.

Herbal teas are brewed with leaves, dried berries and young shoots of currants, raspberries, blackberries, dog rose, chamomile, elecampane. You can add a teaspoon of honey, a slice of lemon, a half teaspoon of turmeric or cloves. In general, you need to drink a lot of warm drinks.

At night, it is recommended to drink a glass of hot milk with the addition of a pinch of pepper and turmeric. To relieve exacerbations, this procedure is done three times in succession.

Healing tea: for 500ml of water add a piece (≈5cm) of ground ginger root, two crushed lemons and cloves of garlic. This mixture is boiled for 20 minutes. When the mixture cools down halfway, you can add a little honey. Drink such tea three times a day in the intervals between meals, after eating must pass at least an hour.

Yoga is recommended for the treatment of chronic tonsillitis to practice asanas: the pose of a lion (simhasana) and a stand on the shoulders (sarvangasana). They cause blood flow to the head and neck. At the beginning of training it is not necessary to perform both poses at once, one by one, better - one at a time. Before performing asanas, you need to clear the tonsils from the plugs and rinse your throat, otherwise there may be an exacerbation.

[26], [27], [28]

Homeopathy

This direction of medicine can give good results in the treatment of chronic inflammation of the tonsils and help to avoid their removal. Homeopathic treatment should appoint a qualified homeopath, the choice of means for treating this pathology is extensive.

At first glance, sore throat without pain in the throat should be cured by Baptisia or Mercurius solubilis, which is more suitable for female patients, however, other factors besides these will be taken into account when appointing a doctor. At the initial stages of the disease, Ferrum phosphoricum is recommended, with purulent plugs Potassium muratikum. Correctly and individually selected means faster and more effective will help get rid of frequent exacerbations of the disease, and perhaps achieve a complete cure.

From drugstore homeopathic preparations can be appointed  Tonsilotren.  The drug intake helps to eliminate purulent plugs, relieves inflammation and reduces the size of the tonsils, restores the structure of their tissues and impaired activity. Contraindicated in case of sensitization to chromium. Pregnant women and people with high thyroid function should only take the doctor's prescription.

In chronic tonsillitis and hyperplasia of tonsils, individuals over 12 years of age can resolve one or two tablets under the tongue, at the age of 1-12 years - one tablet. The number of receptions for all age categories of patients is three per day. The medication is taken at an interval of 30 minutes before or after a meal.

Fungal diseases of the throat are also treatable by homeopathy, however, in this case the treatment is prescribed by a doctor. With candidiasis of the throat, Apis, Lahiesis, Belladonna can be selected, there is information about the successful treatment with Kali Carboconum.

Surgery

At present, indications for tonsillectomy are:

• frequent exacerbations (at least seven registered appeals for exacerbations throughout the year, or five for each year for two years, or at least three every year for three years);
• decompensated chronic inflammation of the tonsils;
• toxic-allergic phenomena accompanying this disease and increasing the likelihood of complications from the heart, joints, urinary or other organs, or already developed pathologies;
• stopping breathing in a dream, a breathing disorder and swallowing, which are a consequence of an increase in the volume of palatine tonsils;
• relapsing inflammations of the peripendritive cellulose.

Usually tonsillectomy is performed in the remission stage, but with purulent complications the operation is performed urgently in the acute stage under the barrier of antibacterial drugs in high doses.

In pediatrics indications for tonsillectomy are most often decompensated, non-conservative therapy, a form of chronic tonsillitis, or any form of the disease, accompanied by a violation of the function of breathing during sleep. Also indications for surgery for the removal of tonsils is the presence of serious diseases that have developed against their chronic inflammation. Nowadays, age is no longer a contraindication to this operative intervention, it can be carried out to children from the age of two and to older people as needed.

Removal of palatine tonsils is contraindicated in patients with the following pathologies:

• severe forms of nervous and mental disorders, diabetes;
• blood diseases;
• vascular anomalies in the pharynx;
• decompensated diseases of vital organs (heart, kidney, liver, lungs);
• open tubercular process in the lungs.

Tonsillectomy is not performed during the period:

• acute inflammatory, infectious and exacerbations of chronic diseases;
• with the symptomatology preceding the disease;
• menstruation in women;
• caries lesions of the teeth (mandatory sanation before the operation);
• presence of pustular skin lesions;
• intoxication, bronchoadenitis of tuberculous etiology;
• epidemics of influenza and poliomyelitis.

Preparation for surgery includes blood tests (clinical, biochemical, for clotting), a general urine test.

Currently, various methods are used to remove palatine tonsils, characterized by removal technology, bleeding intensity and pain syndrome after surgery. The duration of the recovery period also differs somewhat for different types of surgical interventions.

Extracapsular tonsillectomy (removal with surgical scissors and a wire loop) is the most common method performed under local and under general anesthesia. With this method it is possible to perform a resection of the amygdala together with its capsule and to open the infiltrates (abscesses) of the peripendritive cellulose.

Electrocoagulation method (use of high-frequency current) - a small loss of blood is a plus, but postoperative complications are possible in connection with the exposure of thermal radiation to the near-modal tissues.

The use of an ultrasonic scalpel minimizes damage to the paramagnetic fiber and bleeding.

Laser methods - used infrared, which allows not only to dissect, but also to "weld" tissues, or a carbon dioxide laser, which performs evaporation of the tonsil tissue and the elimination of foci of infection. Carried out under local anesthesia. In both cases, bleeding, puffiness are minimized, and postoperative soreness is practically absent. A short recovery period is typical.

Radiofrequency ablation (the use of radio waves) - most often used for tonsillotomy. Anesthesia is local, the removal of tonsils with the help of radio wave energy causes minimal postoperative discomfort. A short recovery period is typical.

Coblation (bipolar radiofrequency ablation) - complete or partial resection of the tonsils by disengaging molecular bonds in an ionized layer created by radio frequency vibrations. Anesthesia is common, bleeding is minimized, post-operation pains, complications and time for rehabilitation are minimized. It is considered a promising direction in surgery.

Prevention

The main measures that prevent the development and relapse of oropharyngeal mycosis are:

• the duration of treatment with antibacterial medicines was sufficient to kill the pathogen, but not longer;
• prescribing antibiotics for preventive purposes with influenza, ARVI and other diseases that do not require them, was unacceptable;
• with prolonged or repeated prescriptions of antibacterial treatment, antimycotics should be administered;
• monitor the condition of oropharyngeal mucosa in the treatment of local and systemic hormonal drugs;
• after each meal, rinse the oral cavity with boiled water or a solution of baking soda;
• use toothpastes containing antimicrobial additives;
• timely treatment of infectious and inflammatory diseases of the oral cavity and pharynx;
• to observe hygienic norms, in small children regularly to steam toys and utensils.

General recommendations for the prevention of angina-like diseases: a healthy lifestyle that promotes an increase in immunity, including the correct mode of work and rest, nutrition, feasible exercise, hardening; timely diagnosis and treatment of acute and chronic diseases.

[29], [30], [31]

Forecast

With timely diagnosis and adequate treatment, the prospects are quite favorable. Even surgical treatment usually does not lead to disability, loss of ability to work and a significant deterioration in the quality of life.

[32], [33], [34], [35]