Chronic tonsillitis - Diagnosis

Physical examination

The diagnosis of chronic tonsillitis is established on the basis of subjective and objective signs of the disease.

The toxic-allergic form is always accompanied by regional lymphadenitis - enlargement of the lymph nodes at the angles of the lower jaw and in front of the sternocleidomastoid muscle. Along with determining the enlargement of the lymph nodes, it is necessary to note their pain upon palpation, the presence of which indicates their involvement in the toxic-allergic process. Of course, for clinical evaluation it is necessary to exclude other foci of infection in this region (teeth, gums, ocholaparesis 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 entire body and constantly creates a threat of complications in the form of local and general diseases. In this regard, to establish a diagnosis of chronic tonsillitis, it is necessary to identify and evaluate the patient's general associated diseases.

Laboratory research

It is necessary to do a clinical blood test and 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 arches. A reliable sign of chronic tonsillitis is purulent contents in the crypts of the tonsils, released when pressing a spatula on the tonsil through the anterior palatine arch. Normally, there is no content in the lacunae. With chronic inflammation, purulent discharge forms in the crypts of the tonsils: it can be more or less liquid, sometimes mushy, in the form of plugs, cloudy, yellowish, abundant or scanty. The very fact of the presence of purulent contents (and not its quantity) objectively indicates chronic inflammation in the tonsils. In children with chronic tonsillitis, the palatine tonsils are usually large, pink or red with a loose surface; in adults, they are often medium-sized or small (even hidden behind the puddles) with a smooth, pale or cyanotic surface and widened upper lacunae.

The remaining pharyngoscopic signs of chronic tonsillitis are expressed to a greater or lesser degree, 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. They should be assessed from this position.

In some cases, an ECG and X-ray of the paranasal sinuses may be required.

Differential diagnostics

In differential diagnostics, it is necessary to keep in mind that some local and general signs characteristic of chronic tonsillitis may be caused by other foci of infection, such as pharyngitis, inflammation of the gums, dental caries. Inflammation of the palatine arches and regional lymphadenitis can also be observed with these diseases: the processes of the named localization can be etiologically associated with rheumatism, nonspecific polyarthritis, etc.

Differential diagnosis of chronic tonsillitis is carried out:

1. primarily with acute primary tonsillitis (vulgar angina), after which (if this was not an exacerbation of chronic tonsillitis) after 2-3 weeks no organic signs of chronic tonsillitis are detected;
2. with the hypertrophic tonsillar 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;
3. with a simple hypertrophic form of tuberculosis of the tonsils (usually one of them) with a characteristic plaque and cervical and mediastinal lymphadenitis;
4. with hyperkeratosis of the pharynx and palatine tonsils, in which the isolated “keratin plugs” appear under microscopic examination as layers of desquamated epithelium;
5. with pharyngomycosis, in which colonies of the fungus are located on the surface of the tonsil and appear as small white cone-shaped formations;
6. with a sluggish tonsil abscess, creating the impression of hypertrophy of the palatine tonsils; the process is unilateral, revealed by puncture of the palatine tonsils with its subsequent removal;
7. with tonsillar petrification, formed as a result of the impregnation of the above-mentioned tonsillar abscess with calcium salts and determined by touch or by palpation with a sharp object (lancet scalpel or needle);
8. with infiltrative cancer or sarcoma of the tonsil in the initial stages of their development; as a rule, these malignant tumors affect one tonsil; the final diagnosis is established by biopsy;
9. with malignant lymphogranulomatosis (Hodgkin's disease), in which, along with an increase in the palatine and other tonsils of the pharynx, there is an increase in the lymph nodes of the neck, damage to the spleen and other lymphoid formations;
10. with lymphocytic leukemia, the first manifestation of which is hyperplasia of the lymphadenoid ring of the pharynx, especially the palatine tonsils, which increase in size to the point of mutual contact; their appearance is bluish, bumpy; systemic damage to the lymphocytic formations of the body quickly occurs, with pronounced lymphocytosis in the blood (2-3) x 10 ⁹ /l);
11. with a giant cervical process that presses from the inside on the capsule of the palatine tonsils, causing pain when swallowing and turning the head towards the enlarged process. If the apophysis of the giant styloid process comes into contact with the glossopharyngeal and lingual nerves, various paresthesias and pain sensations occur in the tongue, pharynx and areas innervated by these nerves. The diagnosis of a giant cervical process is established using bimanual palpation from the tonsil and submandibular region, as well as X-ray examination.

Indications for consultation with other specialists

In case of chronic tonsillitis, consultations with a therapist, cardiologist, and in case of corresponding complaints - a nephrologist, neurologist, ophthalmologist, etc. are necessary.

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