Chronic tonsillitis: an overview of information

Chronic tonsillitis is an active chronic exacerbation of the chronic inflammatory focus of infection in the palatine tonsils with a common infectious allergic reaction. Infectious-allergic reaction is caused by constant intoxication from the tonsillar focus of infection, increases with exacerbation of the process. It disrupts the normal functioning of the whole organism and burdens the course of common diseases, often itself becomes the cause of many common diseases, such as rheumatism, joints, kidney disease, etc.

Chronic tonsillitis with good reason can be called a "disease of the 20th century", "successfully" overstepped the turn of the 21st century. And still constitutes one of the main problems not only of otorhinolaryngology, but also of many other clinical disciplines in the pathogenesis of which the main role is played by allergy, focal infection and deficient states of local and systemic immunity. However, the basic factor that is of particular importance in the onset of this disease, according to many authors, is the genetic regulation of the immune response of palatine tonsils to the effect of specific antigens. On average, according to a survey of different population groups, in the USSR in the second quarter of the 20th century, the incidence of chronic tonsillitis fluctuated within 4-10%, and already in the third quarter of this century, from the report of IB Soldatov at the VII Congress of Otorhinolaryngologists of the USSR (Tbilisi, 1975) it followed that this indicator, depending on the region of the country, increased to 15.8 -31.1%. According to VR Gofman et al. (1984), chronic tonsillitis affects 5-6% of adults and 10-12% of children.

ICD-10 code

J35.0 Chronic tonsillitis.

Epidemiology of chronic tonsillitis

According to domestic and foreign authors, the prevalence of chronic tonsillitis among the population varies widely: in adults it ranges from 5-6 to 37%, in children from 15 to 63%. It must be borne in mind that between the exacerbations, as well as with the bezangina form of chronic tonsillitis, the symptoms of the disease are in many ways habitual and have little or no concern for the patient, which significantly understates the actual prevalence of the disease. Often chronic tonsillitis is revealed only in connection with the examination of the patient for some other disease in the development of which chronic tonsillitis plays a big role. In many cases, chronic tonsillitis, while remaining unrecognized, has all the negative factors of tonsillar focal infection, weakens human health, worsens the quality of life.

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

Causes of chronic tonsillitis

The cause of chronic tonsillitis is a pathological transformation (the development of chronic inflammation) of the physiological process of the formation of immunity in the tissues of the palatine tonsils, where the normally limited inflammation process stimulates the production of antibodies.

Palatine tonsils are part of the immune system, which consists of three barriers: lympho-blood (bone marrow), lympho-interstitial (lymph nodes) and lympho-elithelial (lymphoid aggregations, including tonsils, in the mucous membrane of various organs: pharynx, larynx, trachea and bronchi, intestines). The mass of palatine tonsils constitutes an insignificant part (about 0.01) of the lymphoid apparatus of the immune system.

[7], [8], [9]

Symptoms of chronic tonsillitis

One of the most reliable signs of chronic tonsillitis is the presence of angina and anamnesis. In this case, the patient must always find out how an increase in body temperature is accompanied by pain in the throat and for how long. Angina in chronic tonsillitis can be pronounced (severe pain in the throat during swallowing, significant hyperemia of the mucous membrane of the pharynx, with purulent attributes on the palatine tonsils according to the forms, febrile temperature of the body, etc.), but in adults it often happens that there is no such classic symptomatology of angina. In such cases, exacerbations of chronic tonsillitis occur without severe acuity of all symptoms: the temperature corresponds to low subfebrile values (37.2-37.4 C), sore throat when swallowed insignificant, observe a moderate deterioration in overall health. The duration of the disease is usually 3-4 days.

Screening

It is necessary to conduct screening for chronic tonsillitis in patients with rheumatism, cardiovascular diseases, joint and kidney diseases, it is also advisable to keep in mind that in the case of common chronic diseases, the presence of chronic tonsillitis can, to some extent, activate these diseases as a chronic focal infection, These cases also need an examination for chronic tonsillitis. \

Diagnosis of chronic tonsillitis

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 clinical evaluation, it is necessary to exclude other foci of infection in this region (teeth, gums, sinus nasal passages, etc.).

[10], [11], [12], [13], [14], [15]

Treatment of chronic tonsillitis

With a simple form of the disease, conservative treatment is performed for one to two years with 10-day courses. In those cases when the effectiveness of the local symptoms is inadequate or there is an exacerbation (angina), a decision can be made about a second course of treatment. However, the lack of convincing signs of improvement and the more the occurrence of repeated angina is considered an indication for the removal of palatine tonsils.

With toxic-allergic form I degree, one can still conduct conservative treatment of chronic tonsillitis, but the activity of chronic tonsillar focus of infection is already obvious, and general severe complications are likely at any time. In this regard, conservative treatment with this form of chronic tonsillitis should not be delayed unless a significant improvement is observed. Toxico-allergic form II degree of chronic tonsillitis is dangerous rapid progression and irreversible consequences.