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Chronic tonsillitis - Treatment
Last reviewed: 04.07.2025
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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-surgical, "semi-surgical" and surgical. In addition to special methods aimed directly at the tonsils, general-purpose methods are also used, including elements of an etiological, pathogenetic and symptomatic nature, affecting both directly the focus of chronic inflammation or exacerbation of the process, and those organs and systems whose diseases are caused by tonsillogenic infection. In the latter case, competent treatment is provided by the relevant specialists (cardiologists, rheumatologists, nephrologists, endocrinologists, phthisiologists, etc.).
Non-surgical treatment is used mainly for uncomplicated forms of chronic tonsillitis. It primarily consists of eliminating chronic extratonsillar foci of infection located in the oral cavity (dental caries, pyorrhea, chronic gingivitis, periodontitis, etc.) and only then systematically washing out caseous masses and pus from the crypts with various antiseptic solutions using a syringe and a special tonsillar cannula with a curved end. Furacilium, iodinol, hypertonic sodium chloride solution, citral, etc. are used as a washing liquid. An effective remedy for the lacunar form of chronic tonsillitis is a 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 lacunae washing, it should be noted that 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 the crypts of the palatine tonsils that come to the surface, therefore a much more effective method of cleaning the lacunae from pathological contents is "vacuum suction", in which a special suction device covers most of the surface of the tonsil and, with pulsed suction and simultaneous supply of washing fluid, covers all the lacunae and small crypts under suction. Yu.B.Preobrazhensky (1990) recommends performing 12-15 washes every other day. We recommend irrigating the tonsils with Strepsils Plus after washing the lacunae or performing vacuum aspiration. The drug is available in spray bottles and has a pronounced antiseptic effect due to 2,4-dichlorobenzyl alcohol and amylmetacresol, as well as lidocaine, which causes local anesthesia. The presence of an anesthetic substance interrupts the reflex impulses from the tonsils and helps block tonsillar pathological reflexes. The same drug with various additives (lemon, medicinal herbs, vitamin C, honey, eucalyptus, menthol), available in the form of lozenges, is used for exacerbations of chronic tonsillitis, sore throats, and chronic tonsillitis outside of an exacerbation.
If it is necessary to relieve tonsillocardial syndrome, novocaine peritonsillar blockades can be used (similar to the paranephric blockade according to L.V. Vishnevsky), which are aimed at weakening pathological reflex reactions involved in the development of pathological processes. This effect of novocaine, in addition to the local anesthetic effect 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 pathological reactions of the tonsillar vicious circle. In addition, novocaine has an anti-inflammatory effect. Novocaine blockades of the paratonsillar region can be combined with infiltration therapy with penicillin-type drugs dissolved in novocaine. To prolong the effect of novocaine and the antibiotic dissolved in it, it is recommended to add a 0.1% solution of adrenaline hydrochloride (1 drop per 2-10 ml of novocaine solution).
Local drug treatment is supplemented by physiotherapy: ultraviolet irradiation of the tonsils through a special tube, UHF therapy on the area of regional lymph nodes, ultrasound and laser therapy.
In decompensated forms of chronic tonsillitis (toxic-allergic, according to B.S. Preobrazhensky and V.T. Palchun) and the presence of contraindications to radical surgical treatment, along with the above methods of local action, complex treatment is carried out using methods aimed at eliminating chronic intoxication, strengthening local and general immunity, strengthening the GHB (reducing the permeability of capillaries and blood vessels for toxins and infections), and combating pathogenic microbiota. A number of methods and medications can be recommended for this.
In cases of severe general intoxication and manifestations of tonsillogenic chronic sepsis, plasmapheresis may be used, the indications for which are determined by an ENT specialist and a specialist in extracorporeal therapy. The effectiveness of plasmapheresis in decompensated forms of chronic tonsillitis is determined by the fact that this procedure removes protein fragments, immune complexes with antigenic properties, macroglobulins, antibodies and other factors that cause the development of toxic-allergic metatonsillar tissue and humoral complications from whole blood, while all normal blood elements return to the patient's body. Targeted plasmapheresis significantly improves the immune status, helps correct blood composition and reduces intoxication, increases sensitivity to subsequent drug (immunoprotective and antibacterial) therapy, and possibly optimizes the patient's 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 action on the body in various humoral metatonsillar complications is the official drug "Wobferment", which includes 7 biologically active substances, possessing immunomodulatory, anti-inflammatory, anti-edematous, fibrinolytic and antiplatelet 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 an enteric coating, applied per os 30 minutes before meals (it should not be chewed) 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 dysbacteriosis during it.
Non-drug treatment of chronic tonsillitis
Prescribed are centimeter wave therapy with the Luch-2, Luch-3 devices or ultrasound exposure with the LOR-1A, LOG3, UET-13-01-L devices. Ultraviolet irradiation of the tonsils is carried out as a separate course. At the same time, 10 UHF sessions are prescribed for the regional lymph nodes.
They also use magnetic field exposure to the tonsils using the “Pole-1” device, which helps stimulate antibody production in the tonsils and non-specific resistance factors.
Along with other physical methods, aerosols and electroaerosols of biologically active preparations are used: Kalanchoe juice, 3% water-alcohol emulsion of propolis, which improve the barrier functions of the tonsils and exhibit 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.
Drug treatment of chronic tonsillitis
In the simple form of the disease, conservative treatment is carried out and the course is 1-2 years in 10-day courses. In cases where, according to the assessment of local symptoms, the effectiveness is insufficient or an exacerbation occurs (tonsillitis), a decision may be made to repeat the course of treatment. However, the absence of convincing signs of improvement and especially the occurrence of repeated tonsillitis is considered an indication for the removal of the 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 possible at any time. In this regard, conservative treatment for this form of chronic tonsillitis should not be delayed if significant improvement is not observed. The toxic-allergic form of the second degree of chronic tonsillitis is dangerous due to rapid progression and irreversible consequences.
Treatment should begin with sanitization of the oral cavity, nose and paranasal sinuses, pharynx, etc. According to indications, general strengthening treatment should be carried out (vitamins, physiotherapy procedures, immunostimulating therapy, desensitization).
The most common conservative method of treating chronic tonsillitis is considered to be rinsing the lacunae of the tonsils according to N.V. Belogolovin with various solutions (sulfacetamide, potassium permanganate, miramistin, ascorbic acid, etc.), as well as immunostimulants levamisole, interferon, lysozyme, etc. The course of treatment consists of 10 rinsing procedures, usually of the upper and middle lacunae. Rinsing under negative pressure using the Utes and Tonsillor devices is considered more effective. Then the surface of the tonsils is lubricated with a lute solution or a 5% collargol solution.
With favorable results, conservative therapy courses are conducted 2-3 times a year. The effectiveness of complex conservative treatment is up to 75%, but subsequently the symptoms of the disease reappear. According to research by many authors, even the external recovery of the palatine tonsils does not indicate the cessation of the influence of the source of 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; as a rule, it is not possible to cure the disease with conservative methods.
Thus, conservative treatment of chronic tonsillitis is considered only as a palliative method. Chronic tonsillitis can be cured only by complete elimination of the chronic source of infection through bilateral tonsillectomy. Clinical experience and scientific data indicate the absence of serious general and local negative consequences for the body after removal of the palatine tonsils.
Surgical treatment of chronic tonsillitis
Surgical treatment (tonsillectomy) is performed when conservative therapy is ineffective and in the toxic-allergic form of grade II chronic tonsillitis.
Forecast
The prognosis is generally favorable.
Prevention of chronic tonsillitis
Prevention is based on the general principles of strengthening general and local immunity, sanitation of the upper respiratory tract and the dental system. Gradual general and local hardening with cold, properly organized contrast showers of the whole body or baths only for hands and feet, vitamin-rich and rational nutrition, individually selected physical education are necessary. 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, preventive examinations and medical examinations are of primary importance. With timely diagnosis of the initial stage (simple form) of chronic tonsillitis in children and adults, when the disease has not been around for long and the development of the infection has not yet occurred, a complete recovery is possible. As the disease progresses, the infection focus is formed, and the risk of developing toxic-allergic reactions, the occurrence of severe general and local complications increases, so early detection and medical examination of patients with chronic tonsillitis is extremely necessary. Preventive examinations are necessary 2 times a year (in spring and autumn), and conservative treatment courses are simultaneously carried out. A patient can be removed from the dispensary register only 3 years after all signs of the disease have disappeared. In cases where, after 2-3 courses of conservative treatment for simple or toxic-allergic (1st degree) forms of chronic tonsillitis, signs of the disease persist, it is advisable to perform tonsillectomy to avoid severe complications and deterioration of health.