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Chronic tonsillitis: diagnosis
Last reviewed: 23.04.2024
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Physical examination
The diagnosis of chronic tonsillitis is established on the basis of subjective and objective signs of the disease.
Toxico-allergic form is always accompanied by regional lymphadenitis - an increase in lymph nodes at the corners of the lower jaw and in front of the sternocleidomastoid muscle. Along with the definition of enlarged lymph nodes, it is necessary to note their soreness in palpation, the presence of which indicates involvement in the toxic-allergic process. Of course, that for the clinical evaluation it is necessary to exclude other foci of infection in this region (teeth, gums, sinus nasal sinuses, etc.)
Chronic focal infection in the tonsils, due to its localization, lymphogenous and other connections with organs and life support systems, the nature of the infection (beta-hemolytic streptococcus, etc.) always has a toxic-allergic effect on the whole organism and constantly creates a threat of complications in the form of local and common diseases. In order to establish the diagnosis of chronic tonsillitis, it is necessary to identify and assess the general conjugate diseases present in the patient.
Laboratory research
It is necessary to make a clinical blood test, a smear from the surface of the tonsils to determine the microflora.
Instrumental research
Pharyngoscopic signs of chronic tonsillitis include inflammatory changes in the palatine arch. A reliable sign of chronic tonsillitis is purulent contents in the crypts of the tonsils, which is released when the spatula is pressed against the amygdala through the anterior palatine arch. Normally, there are no contents in the lacunae. With chronic inflammation in the crypts of the tonsils, a purulent discharge is formed: it can be more or less liquid, sometimes mushy, in the form of stoppers, cloudy, yellowish, plentiful or lean. The fact of the presence of purulent contents {and not its quantity) objectively indicates chronic inflammation in the tonsils. Palatine tonsils in chronic tonsillitis in children are usually large pink or red with a loose surface, in adults they are often of medium size or small (even hidden behind the meadows) with a smooth pale or cyanotic surface and enlarged upper lacunae.
The remaining pharyngoscopic signs of chronic tonsillitis are more or less expressed, they are secondary and can be detected not only in chronic tonsillitis, but also in other inflammatory processes in the oral cavity, pharynx and paranasal sinuses. From these positions, they must be evaluated.
In some cases, ECG, radiography of the paranasal sinuses may be required.
Differential diagnostics
In differential diagnosis it should be borne in mind that some local and general signs characteristic of chronic tonsillitis can be caused by other foci of infection, for example, pharyngitis, gingival inflammation, tooth decay. In these diseases, inflammation of the palatine arch and regional lymphadenitis can also be observed: the processes of said localization can be etiologically associated with rheumatism, nonspecific polyarthritis, etc.
Differential diagnosis of chronic tonsillitis is carried out:
- first of all with acute primary tonsillitis (vulgar angina), after which (if it was not an exacerbation of chronic tonsillitis) after 2-3 weeks of any organic signs of chronic tonsillitis is not detected;
- with hypertrophic amygdala form of secondary syphilis, which is manifested by a sudden and rapid increase in the volume of all solitary lymphadenoid formations of the lymphadenoid pharyngeal ring, accompanied by cutaneous manifestations of this stage of the disease;
- with a simple hypertrophic form of tuberculosis of the tonsils (usually one of them) with a characteristic plaque and cervical and mediastinal lymphadenitis;
- with hyperkeratosis of the pharynx and palatine tonsils, in which the isolated "keratinous plugs" appear as microscopic examination in the form of stratified depleted epithelium;
- with pharyngomycosis, in which the fungal colonies are on the surface of the amygdala and stand in the form of white small conical formations;
- with a sluggishly flowing amygdala abscess creating an impression of hypertrophy of the tonsils; the process is one-sided, revealed by the puncture of the tonsils and its subsequent removal;
- with amygdala petrification, which is formed as a result of impregnation with the calcium salts of the above-mentioned amygdala abscess and defined by touch or by touch with a sharp object (lancet-shaped scalpel or needle);
- with infiltrative form of cancer or amygdala sarcoma at the initial stages of their development; as a rule, these malignant tumors affect one amygdala; the final diagnosis is established by biopsy;
- with malignant lymphogranulomatosis (Hodgkin's disease), in which, along with an increase in the palatine and other tonsil tonsils, there is an increase in the lymph nodes of the neck, lesion of the spleen and other lymphoid formations;
- with lymphatic leukemia, the first manifestation of which is hyperplasia of the lymphadenoid ring of the pharynx, especially the palatine tonsils, which increase until mutual contact; their appearance is cyanotic, tuberous; the systemic defeat of lymphocytic formations of the body is rapidly occurring, in the blood the expressed lymphocytosis (2-3) x10 9 / l);
- with a giant cervical spine, pressing inside the capsule of palatine tonsils, causing soreness when swallowing and turning the head toward an enlarged process. If the apophyses of the giant styloid process come into contact with the lingopharyngeal and lingual nerves, then there are various paresthesias and pain sensations in the tongue, throat and regions innervated by these nerves. The diagnosis of the giant cervical spine is established with the help of bimanual palpation from the side of the amygdala and the submandibular region, as well as X-ray examination.
Indications for consultation of other specialists
In chronic tonsillitis, consultations between a therapist and a cardiologist are necessary, and with appropriate complaints, a nephrologist, a neurologist, an oculist, etc.
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