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Chronic tonsillitis: treatment
Last reviewed: 23.04.2024
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[Indications for hospitalization
As a rule, hospitalization is not required.
Treatment of chronic tonsillitis is determined by the stage of development of the inflammatory process and is divided into three types - non-operative, "semi-surgical" and surgical. In addition to special methods directed directly at the amygdala, general methods are used, including elements of etiological, pathogenetic and symptomatic nature that act directly on the focus of chronic inflammation or exacerbation of the process, and on those organs and systems whose diseases are caused by tonsillitis infection . In the latter case, competent specialists are provided by appropriate specialists (cardiologists, rheumatologists, nephrologists, endocrinologists, phthisiatricians, etc.).
Non-surgical treatment is used mainly in uncomplicated forms of chronic tonsillitis. First of all, it consists in the elimination of chronic ectratonsillar foci of infection in the oral cavity (dental caries, pyorrhea, chronic gingivitis, periodontitis, etc.) and only then in a systematic washout from the crypts of caseous masses and pus with various antiseptic solutions using a syringe and a special amygdala cannula with a curved tip. As a washing liquid, solutions of furacilia, iodinol, hypertonic solution of sodium chloride, citral, etc. Are used. An effective agent in the lacunar form of chronic tonsillitis is 0.25-1% solution of carbamide peroxide - a complex of urea with hydrogen peroxide (1-4 tablets per glass of warm water) or a solution of fugentin.
With regard to the method of lacuna washing, it should be noted that with its help it is possible to wash only those crypts into which the tip of the cannula can be inserted, which is no more than 1-2% of all crypts of palatine tonsils emerging on the surface, so a much more effective method of clearing lacunae from pathological contents is a "vacuum suction", in which a special suction device covers most of the surface of the amygdala and a pulsatile aspiration with a simultaneous supply of a wash liquid covering all Propelled by suction gaps and small crypt. Yu.B. Preobrazhensky (1990) recommends that 12-15 washes every other day. We recommend after irrigation of lacunas or vacuum suction to irrigate the tonsils with the drug Strepsils Plus, which is released in vials with a spray dispenser exhibiting pronounced antiseptic activity due to 2,4-dichlorobenzyl alcohol and amylmetacresol, as well as provoking local anesthesia with lidocaine contained in it. The presence of an anesthetic stops the reflex impulse from the tonsils and helps block the tonsillar pathological reflexes. The same drug with various additives (lemon, medicinal herbs, vitamin C, honey, eucalyptus, menthol), released in the form of tablets for resorption, is used for exacerbations of chronic tonsillitis, tonsillitis and chronic tonsillitis without exacerbation.
If it is necessary to stop the tonsillitis-cardiac syndrome, you can use novocainic peripendricular blockades (similar to the paranephric blockade of LV Vishnevsky), which are aimed at weakening the pathological reflex reactions involved in the development of pathological processes. This effect of novocaine, in addition to local anesthetic action on sensitive receptors, is based on a decrease in the formation of acetylcholine and histamine-like substances in pathological tissues, a decrease in peripheral choliporeactive systems, and blocking the pathological reactions of the tonsillar vicious circle. In addition, novocaine has an anti-inflammatory effect. Novocain blockades of the paratonsillar region can be combined with infiltration therapy with drugs of the penicillin series dissolved in novocaine. To prolong the effect of novocaine and antibiotic dissolved in it, it is recommended to add 0.1% solution of epinephrine hydrochloride (1 drop per 2-10 ml of novocaine solution).
Local medical treatment is complemented by physiotherapy: UFO almonds through a special tube, UHF therapy to the region of regional lymph nodes, ultrasound and laser therapy.
In case of decompensated forms of chronic tonsillitis (toxico-allergic, according to BS Perevozhensky and VT Palchun) and the presence of contraindications to radical surgical treatment, along with the above-mentioned methods of local exposure, complex treatment is carried out using methods aimed at eliminating chronic intoxication, strengthening of local and general immunity, strengthening of GHB (reduction for toxins and infection of permeability of capillaries and vessels), control of pathogenic microbiota. For this, a number of methods and medications can be recommended.
With the expressed general intoxication and the phenomena of tonsillogenic chroniosepsis, plasmapheresis is possible, the indications to which are determined by an ENT specialist and specialist in extracorporeal therapy. The effectiveness of plasmapheresis in decompensated forms of chronic tonsillitis is determined by the fact that in this procedure, fragments of proteins, immune complexes with antigenic properties, macroglobulins, antibodies and other factors that determine the development of toxic-allergic metatonsillar tissue and humoral complications are removed from the whole blood, while in the patient's body all normal elements of the blood return. Targeted plasmapheresis significantly improves the immune status, contributes to the correction of blood composition and reduces intoxication, increases the sensitivity to subsequent medication (immunoprotective and antibacterial) therapy, it may optimize patient preparation for radical surgical treatment and a more favorable course of the postoperative period. Plasmapheresis is also used for rheumatoid arthritis - one of the most common metatonsillar complications.
One of the means of complex effect on the body with various humoral metatonsillar complications is the official drug "Wobenzent", which includes 7 biologically active substances, which has immunomodulatory, anti-inflammatory, anti-edematous, fibrinolytic and antiaggregant properties. The drug is indicated for many diseases, including rheumatoid arthritis, extra-articular rheumatism, acute and chronic inflammation of the upper respiratory tract. The drug is available in tablets coated with a dissolving in the intestine shell, applied per os 30 minutes before meals (it should not be bitten) 3-10 tablets 3 times a day, washed down with a glass (150 ml) of water. The drug increases the effectiveness of antibiotic therapy and ensures the prevention of intestinal dysbiosis with it.
Non-drug treatment of chronic tonsillitis
Assign centimeter wave therapy with Luch-2, Luch-3 or ultrasound with the help of the apparatus "LOR-1A", "LOG3", "UET-13-01-L". A separate course is ultraviolet irradiation of the tonsils. At the same time, 10 UHF sessions are prescribed for regional lymph nodes.
The influence on the tonsils by a magnetic field is also applied with the help of the Polyus-1 apparatus, which stimulates the antibody production in the minalines and the factors of nonspecific resistance.
Along with other physical methods, aerosols and electro-aerosols of biologically active preparations are used: Kalanchoe juice, 3% water-alcohol emulsion of propolis, improving the barrier functions of the tonsils showing bactericidal action. Low-energy helium-neon laser installations in the red and infrared ranges and installations of low-intensity incoherent red light (LG-38, LG-52, Yagoda, etc.) are also used.
Medication for 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.
In the toxic-allergic form of the first degree of chronic tonsillitis, conservative treatment can still be carried out, but the activity of the 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.
Treatment should begin with the sanation of the oral cavity, nose and paranasal sinuses, pharynx, etc. According to the indications, it is necessary to conduct a restorative treatment (vitamins, physiotherapeutic procedures, immunostimulating therapy, desensitization).
The most common conservative method of treatment of chronic tonsillitis is the washing of the lacunae of the tonsils by N.V. A whitehead with various solutions (sulfacetamide, potassium permanganate, miramistin, ascorbic acid, etc.), as well as immunostimulating agents with levamisole, interferon, lysozyme, etc. The treatment course consists of 10 washing procedures, usually upper and medium lacunae. It is considered more effective to flush under negative pressure with the help of devices "Cliff" and "Tonsillor". Then the surface of the tonsils is smeared with lute solution or 5% solution of collargol.
With favorable results, conservative therapy courses are conducted 2-3 times per year. The effectiveness of complex conservative treatment is up to 75%, but in the future the symptoms of the disease appear again. According to the research of many authors, even external recovery of palatine tonsils does not indicate the cessation of the influence of the focus of the infection on the body, which is considered a potential threat to the development of rheumatism. Positive results of conservative treatment of chronic tonsillitis have only a temporary healing effect; Cure the disease with conservative methods, as a rule, fails.
Thus, conservative treatment of chronic tonsillitis is considered only as a palliative metol. Cure chronic tonsillitis can only by completely eliminating the chronic focus of infection through bilateral tonsillectomy. Clinical experience and scientific evidence indicate the absence of serious general and local negative consequences of the length of the body after the removal of palatine tonsils.
Surgical treatment of chronic tonsillitis
Surgical treatment (tonsillectomy) is carried out with ineffectiveness of conservative therapy and with toxic-allergic form of the second degree of chronic tonsillitis.
Forecast
The forecast is usually favorable.
Prophylaxis of chronic tonsillitis
Prevention is based on general principles of strengthening general and local immunity, sanitation of the upper respiratory tract and dentoalveolar system. There is a need for a gradual general and local hardening by cold, properly organized contrasting showers of the whole body or baths only for the hands and feet. Vitaminized and rational nutrition, individually selected physical education. However, these measures do not guarantee the prevention of chronic tonsillitis. Nevertheless, preventive measures help to significantly strengthen the body, help in the fight against various infections, including chronic tonsillitis.
In the early detection and treatment of chronic tonsillitis, paramount and rolling have preventive examinations and medical examination. With timely diagnosis of the initial stage (simple form) of chronic tonsillitis in children and adults, when the prescription of the disease is low and the development of the foci of infection has not yet occurred, complete recovery is possible. With increasing prescription of the disease, a foci of infection develops, this increases the danger of developing toxic-allergic reactions, the occurrence of severe general and local complications, so early detection and clinical examination of patients with chronic tonsillitis is extremely necessary. Preventative examinations are needed 2 times a year (in spring and autumn), while simultaneously conducting courses of conservative treatment. From dispensary registration of the patient can be removed only 3 years after the disappearance of all signs of the disease. In cases where after 2-3 courses of conservative treatment with a simple or toxic-allergic (1 degree) forms of chronic tonsillitis, signs of the disease persist, it is advisable to perform tonsillitis in order to avoid serious complications, deterioration of health.