Angina without sore throat and fever: does it happen

In everyday life, any redness of the throat, especially with whitish spots or plaque on the tonsils, is called angina. The Aesculapians of Ancient Greece also called all inflammatory diseases of the pharynx this way, and thanks to them, this name in the same sense is used in everyday life today.

The clinical picture is enlarged and hyperemic tonsils covered with dots that look like pustules, and there is no pain. So, is there a sore throat without a sore throat? It doesn't. It is an acute infectious disease, one of the main symptoms of which is a sore throat. It may not appear immediately, first the temperature will rise, but the next day at most there will be severe pain in the throat, which worsens when swallowing.

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Epidemiology

Medical statistics show that in the second half of the last century, diseases caused by fungal infections became widespread, which is associated with the discovery and introduction of antibiotics into widespread medical practice. Nowadays, 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 for nail lesions, the second - for fungal infection of the mucous membranes (in 90% or more cases - candidiasis), in about 40% of patients, the oropharyngeal mucous membranes are affected. Much less often in mycoses (5-6%), aspergilli, penicillium, white mold and others are sown, as well as leptotrichia bacteria. All of them are present in negligible quantities in the biocenosis of a healthy oral cavity and provoke a pathological process with a decrease in immunity.

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

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Causes sore throats without a sore throat

So, we have found out that such a sore throat does not exist. However, some inflammatory processes in the throat area are not always accompanied by pain. For example, fungal infection of the tonsils (tonsillomycosis) or the mucous membrane of the throat (pharyngomycosis). These lesions are also incorrectly called fungal sore throat.

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Risk factors

Risk factors for the development of chronic tonsillitis: previous tonsillitis, impaired nasal breathing due to a deviated nasal septum, polypous growths, infectious foci in adjacent organs, smoking. Anatomical features in the form of deep, narrow and densely branched crypts, complicating drainage from the lacunar areas located deep in the tonsil.

Risk factors for the development of oropharyngomycosis are diseases of the gastrointestinal tract, especially those accompanied by an imbalance of microorganisms in the intestine. A deficiency of bifido-, lacto- and other beneficial bacteria causes insufficient production of B vitamins, proliferation and spread of fungal flora in the intestine and up the esophagus, reaching the mucous membranes of the ENT organs right up to the oral cavity.

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

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Pathogenesis

Angina is sometimes called chronic tonsillitis (long-term persistent inflammation of the tonsils, most often the palatine tonsils) or its combination with pharyngitis in the remission stage. Sometimes the expression "chronic tonsillitis" can be heard even from the lips of doctors. This disease is not tonsillitis, although it can be its complication. And periodic relapses are very similar to tonsillitis in symptoms. They are distinguished from each other, first of all, by the frequency of occurrence in the same patient. If a angina-like disease occurs once a year or more often, then we are talking about exacerbations of chronic tonsillitis. Not everyone suffers from real tonsillitis, and the same person - no more than three times during life with large time intervals.

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

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

In the pathogenesis of pharyngeal mycoses, the main role is given to the accumulation and circulation in the blood of antibodies to the infectious agent (fungi), causing immediate and delayed reactions, and the transformation of immunity at the cellular level is also taken into account. A fairly important pathogenetic link is allergy and specific (non-specific) sensitivity of the body. Past injuries to the mucous membrane of the pharynx (burns, injections, surgeries) are taken into account.

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Symptoms sore throats without a sore throat

Fungal infections localized in the throat can be acute. The symptoms correspond to an acute condition - high temperature and pain are mandatory attributes. The lesion affects the mucous membrane of the oral cavity and pharynx, including the tonsils. This condition can also be confused with tonsillitis, however, in our case, chronic sluggish mycosis is of interest, which can be interpreted as tonsillitis without fever and sore throat based on visual signs. The lesion - redness and whitish small islands or plaque at this stage of the disease is often limited. Tonsillomycosis - only the palatine tonsils are hyperemic and covered with plaque, pharyngomycosis - the back 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 islands, are localized on the palatine tonsils and the curtain, lateral arches, the back wall and the tongue. The appearance of the pharynx to the untrained eye resembles purulent tonsillitis without a sore throat. Over time, the fungal infection, which persists with traditional antibiotic therapy, becomes resistant and occupies an increasingly large area. Necrotic areas of the mucous membrane are formed, during an exacerbation, the temperature may rise, however, necrosis leads to the absence of painful sensations. During this period, the condition, determined only by the clinical picture, can be interpreted as tonsillitis without a sore throat with a high temperature.

Mycoses of the pharynx have various forms and stages - from superficial to ulcerative-necrotic. With a long-term chronic disease, hypertrophy of the mucous membrane of the pharynx begins, which is covered with tubercles, cracks, polypous growths. The lymph nodes (sub- and retromandibular) increase slightly, usually they are not painful as with true tonsillitis. However, an incompetent doctor may well make a diagnosis: follicular tonsillitis without a 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.

Lymph nodes are not typical for actinomycosis. Slowly growing dark red tubercles (granulomas) appear, and occasionally the pathology takes on a phlegmonous form. Phlegmon is located mostly in the oral cavity or neck area, sometimes on the tonsils, in the nasal area, larynx, or on the tongue. The formation suppurates, an abscess begins, which can break through on its own with the formation of a fistula.

In leptotrichosis, spiny growths of grayish and yellowish color form on the remaining unchanged surface of the pharyngeal epithelium, tonsils, and lateral arches. Symptoms are vague, inflammatory transformations and an increase in body temperature are not observed, as the disease develops, there are complaints that a foreign body is felt in the throat.

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

• the edges of the palatine arches are hyperemic and thickened like ridges;
• loose or abnormally dense tonsils, the presence of cicatricial changes in them;
• purulent plugs in the tonsils or the presence of pus in their lacunae;
• proliferation of connective tissue between the tonsils and palatine arches;
• enlargement of the lymph nodes on the neck.

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

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

Chronic inflammation of the tonsils can be combined with pharyngitis, in which the back wall of the pharynx becomes inflamed. The chronic form of this disease is not characterized by an increase in temperature and a significant deterioration in the general condition. Usually there is a sore throat, which is associated with mucus on the back wall of the pharynx and the need to get rid of it.

However, neither mycosis nor chronic inflammation of the pharynx are angina, although the visual picture of the pharynx is very similar to it.

Complications and consequences

Self-diagnosis or incompetent medical advice can cost the patient dearly. If the patient is sure that he has a mild form of angina, not accompanied by pain and high temperature, then he will almost certainly try to get by with folk remedies and relatively harmless medications. However, it will not be possible to eliminate a chronic inflammatory process in the throat, and, especially, fungi, in such ways. The disease will progress.

In the case of chronic tonsillitis, the most likely outcome is surgical intervention to remove the tonsils.

Long-term neglect of chronic tonsillitis can lead to various complications, primarily ENT organs. In particular, constant nasal edema causes difficulty breathing. Exacerbation or tonsillitis can be complicated by a peritonsillar abscess, which in turn can lead to phlegmon of the neck (a very serious disease that does not always lead to the patient's recovery).

During a night's sleep, almost a glass of pus teeming with bacteria enters the gastrointestinal tract.

Long-term tonsillogenic intoxication can provoke the development of collagenoses, skin pathologies, kidney inflammation, neuritis, Werlhof's disease. The cardiovascular system and the genital area can suffer from it. In total, specialists identify more than 50 diseases that arise as consequences of chronic tonsillitis.

The fungal infection will gradually spread to other organs, the worst thing in this case is 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 for mycosis of the pharynx can lead to an exacerbation of the disease and the spread of a colony of fungi by destroying bacteria that compete with fungi and somehow restrain their spread.

Fungicidal agents for inflammation of the pharynx will also not give an effect, the disease will progress, an allergy to the drugs used may occur. The clinical picture will be blurred and further diagnostics will be difficult.

Therefore, even if the doctor diagnosed “tonsillitis,” and the patient does not have a sore throat, you need to go to another specialist, do the appropriate tests, identify the pathogen and establish an accurate diagnosis.

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Diagnostics sore throats without a sore throat

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

The main pharyngoscopic symptom of chronic inflammation of the tonsil is the presence of pus, which is detected when pressing a spatula on the tonsil.

A bacteriological culture of the microorganism (cultural analysis) will help to resolve the issue of the causative agent of the pharyngeal lesion. This is an absolutely accurate and non-traumatic method. A scraping is taken from the patient's tonsils or the back wall of the pharynx. Then the material is placed on a nutrient medium for the 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 saprophytosis from mycosis. In saprophytosis (reproduction of endogenous opportunistic microorganisms), microscopy distinguishes only individual non-budding cells; in case of infection with fungi, all their components are determined - blastospores and mycelium.

In case of oropharyngeal mycosis, immunodiagnostics can be used - blood tests are taken to identify the pathogen's antigens. Its variety is serological tests that detect antibodies to the elements of the cell of the source of infection. Immunological tests are not informative enough, but during the treatment process they allow tracking its effectiveness by reducing the titers of antigens or antibodies.

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

Differential diagnostics 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.

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Treatment sore throats without a sore throat

Therapy for fungal infections of the throat involves solving three problems: destroying pathogens (if the patient has previously taken antibacterial drugs, they are discontinued); normalizing the balance of microorganisms in the intestine and interferon status indicators.

Treatment of mycotic throat infections begins mainly 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, with antiseptics - longer. Treatment measures are carried out until the visual symptoms disappear and then for another seven to ten days.

Antiseptics are applied to the previously dried infected surface. Aqueous solutions (1% or 2%) of ordinary brilliant green or methylene blue are used. These agents irritate the mucous membrane, and fungi quickly become resistant to them. Lugol's solution is more effective; it can be used to lubricate the throat and tonsils. A spray form is more convenient. This solution contains iodine and can cause burns, irritation, and allergies. It is not recommended for pregnant women, children aged 0-4 years, and people with hyperthyroidism.

For lubrication, a solution of borax in glycerin (10-15%) is also used, an old, tried and tested remedy, however, inferior in effectiveness to modern antifungal drugs.

Antiseptics, potassium permanganate solution or boric acid (1%), are used for gargling. The throat is gargled every time after eating, for greater effectiveness, antiseptic preparations are used alternately, changing them every week.

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

Antifungal drugs for local use belong to the group of polyene antibiotics (nystatin, amphotericin, levorin, etc.) or to imidazole derivatives (nizoral, clotrimazole, fluconazole). They are available in different forms - solutions, sprays, tablets. When using any form of the drug, the main condition of treatment is the need to keep the drug in the oral cavity for as long as possible. For example, Nystatin tablets for oropharyngeal lesions are slowly dissolved behind the cheek and kept in the mouth as long as possible. This drug has activity against yeast fungi and aspergilli, is low-toxic, but can cause allergic reactions.

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

Correction of the intestinal microbiocenosis balance is multi-tasking. The number of pathogenic and opportunistic microorganisms is reduced using antibacterial drugs such as Intestopan, as well as by including foods with bactericidal properties in the diet.

Intestopan is active against bacteria and protozoa. Contraindicated in case of sensitization to oxyquinoline derivatives, nervous disorders, severe liver and kidney pathologies. May cause side effects - digestive disorders, peripheral nerve damage, tachycardia and headache. Adults take one or two tablets three times a day for no more than ten days. For children - prescribed by a doctor, based on the condition and body weight.

It is necessary to restore the microbiocenosis using microbial preparations, for example, Colibacterin - a lyophilisate of live E. coli bacteria or Lactobacterin, which contains acidophilic lactobacilli. Live bacteria, getting into the intestine, multiply, creating a favorable environment for digestion, metabolism, strengthening the immune system and displacing pathogenic microorganisms. There are no side effects or contraindications for probiotics. Treatment lasts from three weeks to three months, it is recommended to carry out it against the background of vitamin therapy.

Replacement therapy, for example, Viferon, is carried out to correct interferon status indicators. This drug contains reaferon (artificial α-2b-interferon identical to human), antitumor and cell membrane stabilizing ingredients. In the form of rectal suppositories, one is administered twice a day every 12 hours for a month. Then, for two or three months, suppositories are used three times a week (for example, Tuesday, Thursday, Saturday). The dosage remains the same. After the end of therapy, a control immunological analysis is taken.

In case of extensive damage to the pharynx by Candida fungi, operations on the lymphatic pharyngeal ring, heat and steam procedures, rinsing of the lacunae of the tonsils are contraindicated; it is not recommended to use penicillin and tetracycline antibacterial drugs.

In case of leptotrichosis infection, operations are performed to remove, laser or cryodestruct areas with pathological changes exclusively in the palatine tonsils.

Treatment of actinomycosis involves a complex of antibacterial and antifungal measures; oral administration of iodine-containing agents. Surgical treatment, including wide opening of the suppuration area, ensuring constant drainage of pus and washing inflammatory infiltrates with antiseptics.

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

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

Various methods are used in the treatment of chronic tonsillitis. Therapeutic treatment regimens are used in the compensated (local) form of the disease, when there are no signs of systemic reactions of the body; in the decompensated form, the manifestations of which consist of repeated sore throats, and in cases where the patient has contraindications to surgical treatment.

The patient is guided to follow a correct daily routine, including moderate physical activity, walks in the fresh air, and a balanced diet containing the necessary amount of natural vitamins and microelements.

Medicines are used that reduce the body's hypersensitivity - containing calcium, hyposensitizing agents: calcium preparations, vitamin C, antiallergic drugs and minimal doses of allergens, aminocaproic acid and others according to the symptoms.

Immunocorrective drugs are prescribed, for example, Broncho-munal. This is an oral combined immune stimulant, a lyophilisate of eight bacteria - the most common pathogens of the upper respiratory tract. It has a vaccine-like effect. The effect of use is a decrease in the frequency and severity of infectious diseases of the respiratory tract. Accordingly, drug therapy is minimized, especially antibacterial. When destroyed bacilli cells are introduced, the body responds by producing antibodies to them, which leads to the development of resistance to these pathogens, preventing exacerbation or significantly alleviating its course. The drug activates the activity of phagocytes, the breakdown of oxygen, its metabolites superoxide and nitric oxide, have a destructive effect on pathogenic microorganisms that have found themselves in the body. The production of immune cytokines increases and their functional qualities are stimulated, as well as immunoglobulins in plasma, saliva, gastric juice, pulmonary and bronchial secretions, thus increasing humoral immunity.

Contraindicated for infants under six months, pregnant women in the first three months, nursing women, and those with allergies.

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

The capsules are taken in the morning on an empty stomach, one per day. The preventive course consists of three ten-day doses with 20-day intervals.

Broncho-munal is not recommended to be taken simultaneously with immunosuppressants; combinations with antibiotics are possible.

Manipulations are performed to sanitize the tonsils and pharyngeal cavity using rinsing or suction of lacunar contents and introduction of drugs into the lacunae. Solutions for these rinsing manipulations are selected by the doctor. These can be: antiseptic and antibacterial, enzymatic, antihistamine and other drugs. Correctly performed procedures help to reduce the inflammatory process and the size of the tonsils themselves.

In these manipulations, Ectericide is often used - an antibacterial natural preparation based on fish oil. Antagonist of pyogenic microflora. Has no contraindications and side effects.

Injections of medications are made directly into the tonsils; sometimes a nozzle with multiple thin needles is used to ensure high-quality impregnation of the tonsil tissue with the drug.

Lubricating the tonsils with Lugol's solution, chlorophyllipt (oil solution), collargol and other agents is still practiced.

Patients are prescribed gargles with pharmaceutical preparations or herbal infusions prepared at home, vitamins and vitamin-mineral complexes.

Physiotherapeutic treatment is widely used. The most common are ultrasound, laser, micro- and magnetic waves, induction currents, ultra-high-frequency radiation, UHF therapy, ultraviolet irradiation, mud therapy. Other methods are also practiced.

For example, reflexology – acupuncture, novocaine blockades and manual therapy, since it has been established that chronic tonsillitis is often combined with a blockage of mobility in the occipital region (located most often between the back of the head and the atlas).

Folk remedies

You can't rely entirely on folk medicine, these throat pathologies should not be underestimated. However, doctors themselves often resort to folk remedies in a complex of treatment measures. Folk medicine can significantly alleviate the condition of both children and adults, but always after a doctor's consultation, since you should not be independent in this matter. This can slow down recovery and complicate the course of the disease. Especially oropharyngomycosis, since fungi are quite persistent and resistant pathogens, especially their spores.

The simplest advice is to eat one small clove of garlic after each meal, chewing it thoroughly and holding the pulp in your mouth. The therapeutic effect of eating garlic appears after a week. The smell can be beaten off by chewing parsley leaves, which is also used as a folk remedy for fungus - finely chop fresh parsley, measure out two tablespoons, pour a glass of cold water and make a decoction, boiling for five minutes. Infuse for an hour, gargle every time after eating.

Horseradish root has antifungal activity, grate ½ cup and mix with juice from three lemons. After meals eat one teaspoon of this mixture.

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

The rinse is prepared from herbs that have antifungal properties. These are marigolds, sage, oak bark, chamomile. This herbal treatment should be done at least three times a day, and preferably after each meal.

Infusions for gargling for throat mycosis:

• calendula flowers and peppermint leaves (one tablespoon each) brew with 200 ml of boiling water, leave for 30 minutes;
• Brew birch shoots and bird cherry flowers (one tablespoon each) with 200 ml of boiling water and leave for 30 minutes.

Traditional treatment of chronic tonsillitis mainly consists of actively gargling with herbal infusions and drinking herbal teas.

Infusions are prepared from calendula, chamomile, peppermint, sage, oak bark (as with mycosis), you can use blackberry leaves, plantain, raspberry, burdock, as well as its roots, wormwood and thyme.

You can rinse with homemade “sea water” – add ½ teaspoon of soda and salt to 200 ml of water (≈37°C), stir and add five drops of iodine;

• red beet juice with apple cider vinegar in proportions of one teaspoon of vinegar per 200 ml of juice;
• garlic infusion: cut three or four cloves and brew with boiling water (200 ml), leave for 2/3 hours.

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

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

Medicinal tea: add a piece (≈5 cm) of chopped ginger root, two chopped lemons and garlic cloves to 500 ml of water. Boil this mixture for 20 minutes. When the mixture has cooled halfway, you can add a little honey. Drink this tea three times a day between meals, at least an hour should pass after eating.

Yogis recommend practicing asanas to cure chronic tonsillitis: lion pose (simhasana) and shoulder stand (sarvangasana). They cause blood flow to the head and neck. At the beginning of training, do not do both poses one after the other, it is better to do one at a time. Before doing asanas, you need to clear the tonsils of plugs and gargle, otherwise an exacerbation may occur.

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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 be prescribed by a qualified homeopath, the choice of means for the treatment of this pathology is quite extensive.

At first glance, a sore throat without a sore throat should be cured by the drug Baptisia or Mercurius solubilis, which is more suitable for female patients, however, when prescribing, the doctor will take into account other factors besides these. At the initial stages of the disease, Ferrum phosphoricum is recommended, with purulent plugs, Potassium muratikum. A correctly and individually selected remedy will help get rid of frequent exacerbations of the disease faster and more effectively, and possibly achieve a complete cure.

Of the homeopathic pharmaceuticals, Tonsilotren may be prescribed. Taking the drug helps eliminate purulent plugs, relieves inflammation and reduces the size of the tonsils, restores the structure of their tissue and impaired activity. Contraindicated in case of chromium sensitization. Pregnant women and people with increased thyroid function should take it only as prescribed by a doctor.

For chronic tonsillitis and tonsil hyperplasia, persons over 12 years of age should dissolve one or two tablets under the tongue, and 1-12 years of age should dissolve one tablet. The number of doses for all age categories of patients is three per day. The medicine is taken at intervals of 30 minutes before or after meals.

Fungal diseases of the throat can also be treated with homeopathy, however, in this case, the treatment is prescribed by a doctor. For throat candidiasis, Apis, Lachesis, Belladonna can be chosen, there is information about successful treatment with Kali carbonicum.

Surgical treatment

Currently, indications for tonsillectomy are:

• frequent exacerbations (at least seven registered requests for exacerbations during the year, or five each year for two years, or at least three each year for three years);
• decompensated chronic inflammation of the palatine 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;
• sleep apnea, difficulty breathing and swallowing, which are a consequence of an increase in the volume of the palatine tonsils;
• recurrent inflammation of the peritonsillar tissue.

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

In pediatrics, indications for tonsillectomy are most often decompensated, non-responsive to conservative therapy, form of chronic tonsillitis, or any form of the disease accompanied by impaired respiratory function during sleep. Also, indications for tonsillectomy surgery are the presence of serious diseases that have developed against the background of their chronic inflammation. Nowadays, age is no longer a contraindication to this surgical intervention; it can be performed on children from the age of two and on elderly people if necessary.

Removal of the tonsils is contraindicated for patients with the following pathologies:

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

Tonsillectomy is not performed during the period:

• acute inflammatory, infectious and exacerbation of chronic diseases;
• in case of symptoms preceding the disease;
• menstruation in women;
• dental caries (mandatory sanitation before surgery);
• the presence of pustular skin lesions;
• intoxication, bronchoadenitis of tuberculous etiology;
• epidemics of influenza and polio.

Preparation for surgery includes blood tests (clinical, biochemical, coagulation), general urine analysis.

Currently, various methods of tonsil removal are used, differing in the technology of removal, intensity of bleeding 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 general anesthesia. This method allows for resection of the tonsil together with its capsule and opening of infiltrates (abscesses) of the peritonsillar tissue.

Electrocoagulation method (using high-frequency current) – the advantage is low blood loss, but postoperative complications cannot be ruled out due to the effect of high-frequency thermal radiation on the peritonsillar tissues.

The use of an ultrasonic scalpel minimizes damage to the paratonsillar tissue and bleeding.

Laser methods – infrared is used, which allows not only to cut but also to “weld” tissue, or a carbon dioxide laser, which evaporates the tonsil tissue and eliminates foci of infection. It is performed under local anesthesia. In both cases, bleeding and swelling are minimized, and postoperative pain is virtually absent. A short recovery period is typical.

Radiofrequency ablation (using radio waves) – most often used for tonsillotomy. Local anesthesia, removal of tonsils using radio wave energy causes minimal postoperative discomfort. A short recovery period is typical.

Coblation (bipolar radiofrequency ablation) is a complete or partial resection of the tonsils by breaking molecular bonds in an ionized layer created using radiofrequency oscillations. General anesthesia minimizes bleeding, postoperative pain, complications and rehabilitation time. It is considered a promising direction in surgery.

Prevention

The main measures to prevent the development and recurrence of oropharyngeal mycosis are:

• the duration of treatment with antibacterial drugs was sufficient to destroy the pathogen, but not longer;
• the prescription of antibiotics for prophylactic purposes for influenza, acute respiratory viral infections and other diseases that do not require them was unacceptable;
• in case of long-term or repeated prescriptions of antibacterial treatment, it is necessary to carry out therapy with antimycotics;
• monitor the condition of the oropharyngeal mucosa during treatment with local and systemic hormonal drugs;
• After each meal, rinse your mouth with boiled water or a solution of baking soda;
• use toothpastes containing antimicrobial additives;
• treatment of infectious and inflammatory diseases of the oral cavity and pharynx was carried out in a timely manner;
• Observe hygiene standards; regularly steam toys and dishes for small children.

General recommendations for the prevention of angina-like diseases: a healthy lifestyle that helps to improve immunity, including a proper work and rest regime, nutrition, feasible physical activity, hardening; timely diagnosis and treatment of acute and chronic diseases.

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Forecast

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

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