Chronic tonsillitis: classification

At the present time, the classification proposed at the VII All-Union Congress of Otorhinolaryngologists (1975), proposed at this congress by IB Soldatov, and also stated in its Methodological Recommendations (1979), according to which numerous pathoanatomical types of chronic tonsillitis are reduced to two clinical forms - compensated and decompensated chronic tonsillitis. Of course, this classification has nothing to do with the principles of scientific classification of diseases of the pharynx and tonsils, and in general, including acute tonsillitis, is only a list of long-known causes and types of pharyngeal diseases, in particular palatine tonsils. Each classification should reveal the essential features of the classified object and contain information about internal processes (etiology and pathogenesis) and external signs (symptoms, dynamics of the clinical state) of a particular nosological form of the disease. On the way to developing such a classification for known reasons, there are great difficulties. Monomodal systems and phenomena delineated by a definite structural-functional complex are correctly classified. Such classifications can meet the truly scientific requirements of systematizing the quantitative and qualitative features of the phenomenon being studied, consisting in fixing regular links between the elements of the system to determine the location of each of them in the system being classified. In this sense, the classification, as a result of a whole layer of research work in the field of a specific medical problem, serves as a "bank" of identified information, and in the field of existing internal links between the elements of the system, a means of searching for new laws, phenomena and objects that develop this problem. Nevertheless, returning to the classification of IB Soldatov, one can not but note its practical importance, since it offers an alternative solution in choosing the method of treatment of chronic tonsillitis.

In 1978, V.T. Palchun "revived" the classification of chronic tonsillitis of B.S. Preobrazhensky (1954), slightly changing it and adding. According to this classification, chronic tonsillitis is divided into a simple and toxic-allergic form.

The author describes the simple form of local signs of chronic tonsillitis and the presence of angina in the anamnesis in 96% of patients. The classification lists all known signs of chronic tonsillitis. With this form, there may be so-called concomitant diseases, which, according to VT Palchun, "do not have a single etiological basis with chronic tonsillitis; pathogenetic communication is effected through general and local resistance ". In the above definition of a simple form there is no key phrase, namely, that this form is characterized by the absence of metatonsillar complications. In the author's interpretation of the "simple form", "additives" such as the list of local signs of chronic tonsillitis and the reference to "concomitant diseases", vaguely hinting at the possibility of potentiating chronic tonsillitis with appropriate risk factors, are identified with the "compensated form" of IBSoldatov. Part of the classification of VT Palchun from the true purpose of this definition as an exhaustive classification definition and brings it closer to the scheme or list of local symptoms of chronic tonsillitis .

The toxic-allergic form of chronic tonsillitis in its descriptive part is even more reminiscent of the student's lecture made at the lecture on the clinical manifestations of chronic tonsillitis. In fact, she details the concept of "decompensated chronic tonsillitis", proposed by IB Soldatov in 1975. According to VT Palchun (1978), this form is divided into I and II degrees. Below are detailed information on tonsillar and general signs characteristic of these forms of chronic tonsillitis. There is no doubt that the classification of chronic tonsillitis of BS Preobrazhensky and VT Palchun has a certain didactic significance that promotes the understanding of chronic tonsillitis as a systemic disease that details its clinical manifestations, however this form of information is more suited to the concept of a scheme or list of symptoms than to the concept of the classification of the pathological process as such.

Many other classifications proposed by different authors, repeat in different terms each other or make minor changes to existing ones, but all of them did not stand the test of time, and today the classification of IB Soldatov remains the most acceptable classification for practical application.

Classification of diseases of palatine tonsils

Acute tonsillitis.

• Primary: catarrhal, lacunar. Follicular, ulcerative-membranous angina.
• Secondary:
  • in acute infectious diseases - diphtheria, scarlet fever, tularemia, typhoid fever;
  • with diseases of the blood system - infectious mononucleosis, agranulocytosis, alimentary-toxic aleukia, leukemia.

Chronic tonsillitis.

• Nonspecific:
  • compensated form;
  • decompensated form.
• Specific: with infectious granulomas - tuberculosis, syphilis, sclera.

Concluding the "problem" of the classification of acad. IB Soldatov, one can not help noticing its brevity and, in contrast to the classification of Preobrazhensky-Palchun, a small amount of information.

According to VI Voyachek: "Chronic forms of amygdala diseases are divided into two main:

1. dystrophy, mainly of the hypertrophic type, and
2. associated with inflammatory and infectious processes. "

Even in this seemingly simple classification, two fundamental concepts already appear: dystrophy and inflammatory-infectious process, the "deciphering" of which with respect to chronic tonsillitis as a nosological form allows, if necessary, to create a harmonious classification of this disease into which such obligate factors would organically enter , such as etiology, pathogenesis, pathomorphology, clinical forms and "integral" - a method of treatment.

Continuing the analysis of V.Voyachek's classification, it is necessary to recall his conceptual approach to the isolated two forms of chronic tonsillitis. According to VI Voyachek, the first form is an expression of the so-called amygdala stereotype - the biological necessity of lymphadenoid tissue to functional (physiological) hypertrophy for certain genetically determined functions. Although V.Voyachek does not speak about this, all subsequent researches in the field of the problem of chronic tonsillitis have shown that the physiological hypertrophy of palatine tonsils is a response tissue immune response to external antigens whose underlying mechanisms are not limited to the replication of "killer" systems but also to education so-called HLA markers with an immense number of their mutual combinations, linking individual human genetic characteristics with the nature of immune response and clinical polymorphism of diseases. The second form is a combination of productive and inflammatory processes that occur against the background of a gradual decompensation of the physiological form in connection with the growth of the virulence of the microbiota and a decrease in the intensity of tissue and systemic immunity. Thus, although in other words, but corresponding to the above meaning, VI Voyachek, in fact, outlined the path, but which should go the development of the theory of chronic tonsillitis and on which the modern concept (theory) of this disease should have developed. How this concept evolved and forms - the subject of special discussions and publications not included in the task of this manual, we note only that some of the information on this issue can be found in the literature recommended by us, and in particular in a very remarkable monograph by V.R. Hoffmann et al. (1998) "Clinical Immunology of Chronic Tonsillitis."

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