Laryngeal sore throat

One of the most common diseases of the nasopharynx is laryngeal tonsillitis. Many of us have known this disease since childhood. The cause of this condition is streptococcal infection. The greatest danger of tonsillitis is its complications. Even if the disease is not very severe, bed rest is required. This is due to the fact that tonsillitis can cause serious complications to the kidneys (in the form of pyelonephritis) and heart (in the form of myocarditis, pericarditis).

Laryngeal tonsillitis refers to acute inflammation of the lymphoid tissue of the larynx (in the area of the aryepiglottic folds, interarytenoid space, in the Morgagni ventricles, in the pyriform sinuses and individual follicles) and can occur in both acute and chronic forms.

Acute laryngitis is often a mild and self-limited illness that typically lasts 3 to 7 days. If the condition lasts longer than 3 weeks, it is called chronic laryngitis.[ 1 ]

Epidemiology

Laryngeal sore throat can affect patients of any age, although it is more common in the adult population, typically affecting people between the ages of 18 and 40, although it can be seen in children as young as three years old. Isolated vocal symptoms in children under three years of age require more thorough evaluation to identify additional pathologies, including vocal cord paralysis, GERD, and neurodevelopmental disorders.[ 2 ] Accurate measurements of the incidence of laryngeal sore throat remain difficult to elucidate, as the condition remains underreported and many patients do not seek medical attention for this often self-limited condition.

Causes laryngeal sore throat

The etiology of laryngeal tonsillitis can be infectious or non-infectious. The infectious form is more common and usually occurs after an upper respiratory tract infection.

Viral agents such as rhinovirus, parainfluenza virus, respiratory syncytial virus, coronavirus, adenovirus, and influenza are potential etiologic agents (listed in order of frequency). Bacterial superinfection is possible in viral sore throat, usually occurring about seven days after symptom onset.

The most common bacterial organisms are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, in that order. Exanthematous febrile illnesses such as measles, chickenpox, and whooping cough are also associated with symptoms of acute laryngitis, so an accurate immunization history is advisable. Laryngeal sore throat due to fungal infection is very rare in immunocompetent individuals and more often presents as chronic laryngitis in immunocompromised individuals or in patients taking inhaled steroids.

At first glance, it may seem that there are many reasons for the development of laryngeal tonsillitis. In one case, the disease was preceded by contact with someone who had tonsillitis, in another case, the cause was hypothermia or overfatigue of the body. But in fact, these are all just predisposing factors, trigger mechanisms that simply provoked the development of diseases. There is only one reason for the development of tonsillitis - streptococcal infection. [ 3 ]

The disease develops if the level of streptococcus in the body exceeds the permissible norm. Thus, normally streptococcus lives in the human body, and its indicators should not exceed 10 ³ CFU / ml. If the level of streptococcal infection exceeds these values, an infectious and inflammatory process develops in the form of laryngeal tonsillitis. Streptococcus belongs to the representatives of opportunistic microflora, that is, it is a normal inhabitant of the human body, and causes an infectious process only if there is a violation of the normal microbiocenosis. This means a violation of the normal qualitative and quantitative states of the mucous membranes, in which the representatives of the normal microflora become fewer, and their place is taken by a pathogenic strain. Or there is a rapid growth of the microorganism that is stronger than the rest. This can be facilitated by a violation of local and general immunity, hypothermia, malnutrition, stress, GERD [ 4 ] and many other factors related to risk factors.

Risk factors

There are quite a large number of risk factors that predispose to the development of laryngeal tonsillitis. For example, the development of laryngeal tonsillitis can be promoted by vitamin deficiency, or bacterial or fungal infection of the body. Tonsillitis is often observed in somatically weakened patients who have reduced immunity, disrupted hormonal background or biochemical cycle. At the same time, patients who have a history of a recent viral, fungal, and less often bacterial infection often get sick. This is explained by the fact that the body's defense mechanisms are sharply reduced against the background of a previous infection. Tonsillitis develops when a person's compensatory and adaptive mechanisms are disrupted, and dysbacteriosis of the mucous membranes develops.

The situation is aggravated by the fact that dysbacteriosis is often accompanied by a general metabolic disorder, the prevalence of dissimilation processes over assimilation. This has a negative effect on the state of the body as a whole, on the state of immunity. The danger of angina is that there is an accumulation of waste metabolites, toxins in the blood. Accordingly, angina is accompanied by intoxication of the body.

Some pharmaceuticals and drugs, such as antibiotics, antifungals, antitumor agents, and antituberculosis drugs, also act as risk factors. They can weaken the body, cause intoxication, reduce immunity, and disrupt hormonal balance. Sometimes the development of angina is facilitated by the development of toxic substances and harmful production factors (in fact, in this case we are talking about laryngeal angina as an occupational disease).

Risk factors include endogenous (internal) causes and exogenous (external) causes. Endogenous causes include an unhealthy lifestyle, poor nutrition, unbalanced diet, and vitamin deficiency. Exogenous factors include the body's condition: dysbacteriosis, immune disorders, and hormonal imbalance.

Frequent laryngeal tonsillitis develops against the background of anti-tuberculosis therapy, in patients who receive radiation therapy or chemotherapy in connection with severe oncological diseases. Laryngeal tonsillitis can develop against the background of acute or chronic intoxication of the body. In some cases, the development of laryngeal tonsillitis can be facilitated by stress, neuropsychic overstrain, physical fatigue, lack of sleep, since all this leads to a decrease in the body's defense mechanisms.

Pathogenesis

Laryngeal tonsillitis is a vulgar inflammation of the lymphoid tissue contained under the mucous membrane of the laryngeal ventricles and pyriform sinuses, as well as scattered in the form of individual follicles throughout the inner surface of the larynx. Inflammation of these follicles is manifested by the formation of whitish or yellowish point formations, in places of greatest accumulation of which they form confluent inflammatory areas of lymphoid tissue. In some cases, significant accumulations of lymphoid tissue occur in the pyriform sinuses, acute inflammation of which is called tonsillitis of the pyriform sinus. As S.N. Khechinashvili (1960) notes, with other forms of laryngeal inflammation, its deeper layers are mainly affected. These diseases constitute a group of submucous laryngitis, which some authors, along with fibrinous and follicular laryngitis, call laryngeal tonsillitis.

Forms

Some authors divide submucous laryngitis into three forms:

1. edematous laryngitis, in which the mucous membrane of the larynx is swollen, edematous-waxy with a grayish-yellowish tint;
2. infiltrative laryngitis, in which the mucous membrane of the larynx is sharply thickened (infiltrated with inflammatory exudate) and hyperemic;
3. phlegmonous laryngitis, characterized by severe inflammation of the soft tissues, and sometimes the internal perichondrium of the larynx with the presence of an abscess in one area or another.

Diagnostics laryngeal sore throat

When the first signs of laryngeal tonsillitis appear, you need to see a doctor as soon as possible. First of all, contact your local therapist (family doctor), after which he determines the course of further diagnostics and further treatment. If necessary, tests and additional specialist consultations may be prescribed. [ 5 ]

As a rule, the diagnosis is based on a routine examination of the patient, collection of anamnesis, and examination. Based on the external signs that are characteristic of angina, one can assume a primary diagnosis. But it must be confirmed during laboratory and other studies. If there is no time to wait for the test results (and this happens in most cases, since angina progresses quickly), standard treatment is prescribed according to the protocol. It usually includes antibacterial therapy, anti-inflammatory drugs, and local agents. To obtain additional information, the doctor may prescribe laboratory tests, instrumental diagnostic methods. Differential diagnostics may be required. Most often, laryngeal angina is differentiated from diseases such as infectious mononucleosis, severe forms of pharyngitis, laryngitis (similar symptoms are noted). [ 6 ]

Tests

In case of laryngeal tonsillitis, a standard set of tests is prescribed: clinical blood and urine tests, stool tests. These tests provide important information about the patient's condition, indicate the severity of the disease, and may indicate the development of an inflammatory or infectious process. These tests can be used to monitor the condition dynamically, in particular, the body's response to the prescribed therapy.

A bacteriological culture is also mandatory from the tests. For this, a swab is taken from the throat and nose, then further culture of the biological material is done in the laboratory. The culture is done in sterile conditions. The cultures are incubated under optimal conditions (in a thermostat). Then a pure culture is isolated, identified (species and genus are determined). An antibiotic sensitivity test is often additionally performed. For this, an antibiotic is selected for each of the isolated microorganisms. Its optimal dosage and mechanism of action are determined. This allows for the most accurate and effective selection of treatment suitable for each individual. [ 7 ]

Virological, immunological, serological research methods can also be used additionally. If necessary, a detailed immunogram is performed, phagocytic activity is determined. This allows us to judge the state of immunity, and, if necessary, to carry out immunocorrection in a timely manner.

Instrumental diagnostics

Instrumental diagnostics are rarely used. Sometimes pharyngoscopy may be required (additional examination of the back wall of the larynx using auxiliary mirrors). However, there is often no need to use this method, since a regular visual examination is sufficient. But instrumental diagnostic methods are often used if there is a risk of complications, such as pyelonephritis, myocardial diseases. In this case, appropriate methods are used.

To diagnose kidney diseases, in particular pyelonephritis, ultrasound of the kidneys, CT, MRI, and other imaging methods may be required. If myocarditis or pericarditis is suspected, ECG, echocardiography, and ultrasound of the heart are used.

Differential diagnosis

Differential diagnostics is based on the need to differentiate one disease from another. So, most often it is necessary to differentiate angina from infectious mononucleosis. It is quite simple to do this. In case of laryngeal angina, bacteriological culture shows a sharp increase in bacterial microflora with a predominance of streptococcus. Whereas in infectious mononucleosis, a viral infection is diagnosed, and the microbiocenosis of the mucous membranes is mainly in a normal state. The cause of mononucleosis is a viral infection, in particular, EBV infection, cytomegalovirus. Accordingly, different treatments are prescribed. [ 8 ]

It is also often necessary to differentiate various forms of pharyngitis, laryngitis, tracheitis from laryngeal tonsillitis. Differentiated diagnosis is also based on various laboratory tests, in particular, biochemical and clinical blood tests, less often - urine tests. The tests can be used to judge the nature of the inflammatory-infectious process.

If the cause of the development of laryngeal tonsillitis is a bacterial or fungal infection, a bacteriological culture is carried out, which allows differentiating the pathogen, up to determining its species and genus. Fungal and bacterial infections require different approaches to treatment. It is also possible to determine the quantitative indicators of pathogenic microflora, and its individual sensitivity to a particular antibiotic.

Treatment laryngeal sore throat

Treatment is often supportive and depends on the severity of the laryngeal tonsillitis.

• Voice rest: This is the most important factor. Using the voice in laryngeal tonsillitis results in incomplete or delayed recovery. Complete voice rest is recommended, although this is almost impossible to achieve. If the patient must speak, he should be instructed to use the "confidential voice"; that is, a normal vocal voice at a low volume without whispering or projection.
• Steam inhalation: Inhaling humidified air increases the moisture in the upper respiratory tract and helps in the removal of secretions and exudates.
• Avoidance of irritants: Smoking and alcohol should be avoided. Smoking delays the rapid resolution of the disease process.
• Diet modification: Dietary restrictions are recommended for patients with gastroesophageal reflux disease. This includes avoiding caffeinated beverages, spicy foods, fatty foods, chocolate, peppermint. Another important lifestyle change is avoiding late meals. The patient should eat at least 3 hours before bedtime. The patient should drink plenty of water. These dietary measures have been shown to be effective in classic GERD, although their effectiveness in LPR is disputed, but they are still used. [ 9 ]
• Medication: Antibiotics are not currently advocated for use in healthy patients with laryngitis; however, high-risk patients and those with severe symptoms may be given antibiotics. Some authors recommend narrow-spectrum antibiotics only if Gram stain and culture are identifiable. Antibiotic therapy is the mainstay of treatment for bacterial laryngitis. Various antibiotics are prescribed that primarily target streptococcal infections or other coccal forms of microorganisms. Anti-inflammatory drugs are also prescribed. Symptomatic therapy, including antipyretics and analgesics, is prescribed if necessary. Bed rest is necessary. This will help avoid complications such as pyelonephritis and myocarditis.

Laryngeal sore throat of fungal origin can be treated with oral antifungals such as fluconazole. Treatment is usually required for three weeks and can be repeated if necessary. This should be done in patients with confirmed fungal infection by laryngeal examination and/or culture.

Mucolytics such as guaifenesin may be used to clear secretions.

In addition to lifestyle and dietary changes, laryngitis associated with LPR is treated with anti-reflux medications. Medications that suppress acid production, such as H2 receptor blockers and proton pump inhibitors, are effective against gastroesophageal reflux, although proton pump inhibitors appear to be most effective against LPR. This may require higher doses or a twice-daily dosing regimen.[ 10 ]

Available data do not support the use of antihistamines or oral corticosteroids for the treatment of laryngeal tonsillitis.

Medicines

Let's look at the main medications used to treat laryngeal tonsillitis.

• Suprastin (antihistamine, anti-inflammatory agent)

Dosage: take 1 tablet 1-2 times a day for a course of 7 days.

Precautions: Not recommended for use during pregnancy and lactation. Should not be used by persons whose activities require increased concentration.

Side effects: drowsiness, lethargy.

• Ciprofloxacin (antibacterial, anti-inflammatory action).

Dosage: one tablet (500 mg) once a day. The course of treatment is no more than 5 days.

Precautions: Do not take if pregnant or breastfeeding, or if you are a child under 6 years of age.

Side effects: nausea, vomiting, diarrhea, headache, dysbacteriosis, loss of appetite, liver pain.

• Sumamed (antibiotic)

Dosage: as a suspension, take a tablespoon, dissolve in a glass of water, drink three times a day. As tablets - 1 tablet 3-4 times a day.

Precautions: not recommended for pregnancy, dysbacteriosis, liver and gastrointestinal pathologies, tendency to bleeding.

Side effects: headache, nausea, vomiting, dystonic disorders, diarrhea, flatulence.

• Anaferon (immunostimulating, antiviral, anti-inflammatory agent).

Dosage: one tablet 2-3 times a day. The course of treatment is 7-14 days.

Precautions: Do not take by children under 6 years of age or pregnant women.

Side effects: nausea, vomiting, intoxication, increased body temperature.

Physiotherapy treatment

Sometimes, various methods of physiotherapy are prescribed for the treatment of laryngeal tonsillitis, in particular, UF (targeted action of ultraviolet light on the larynx, pharynx, nasopharynx). Light procedures and electrical procedures are used. If there is no temperature, heat procedures are indicated, as well as inhalations. Otherwise, bed rest is recommended. Physiotherapy is usually prescribed for severe forms of the disease, with a long course. In other cases, it is advisable to get by with medication.

Herbal treatment

Herbal treatment is often used for laryngeal tonsillitis. But it should be taken into account that this is an auxiliary method of treatment. It is used after a preliminary consultation with a doctor, since even the most harmless herb can have numerous side effects. For tonsillitis, herbs are most often used in the form of decoctions for gargling. Gargle with a warm decoction. Preparing a decoction is quite simple: 1-2 tablespoons of plant material are poured with a glass of boiling water, after which they are allowed to brew for about 30-40 minutes. The remedy should be infused under a tightly closed lid. It is recommended to gargle 5-6 times a day. Below is a description of the herbs that are most effective for tonsillitis.

Alchemilla herb. Has anti-inflammatory, antibacterial effect. Contains many vitamins and minerals: vitamins of group A, B, E, C. The herb has rejuvenating, immunostimulating, hemostatic, wound-healing effect, reduces body temperature. Eliminates allergic, autoimmune reactions, normalizes digestion, relieves swelling. Can be used not only for rinsing, but also taken internally (no more than a glass per day).

Stevia herb. Stevia is a perennial herb, the action of which is aimed at normalizing metabolic processes in the body. It has an immunomodulatory effect: it normalizes the state of the immune system, increases the body's endurance, resistance to infectious diseases. Stevia is characterized by an antiviral effect. It effectively eliminates autoimmune aggression and signs of allergy. In fact, we can say that stevia has a complex effect on the body. An indispensable remedy for laryngeal tonsillitis. It can be taken internally, as well as for gargling, washing the nose.

Goat's rue is a perennial medicinal plant. It normalizes metabolic processes, reduces blood sugar levels, and also improves appetite, increases immunity, activates the body's adaptive potential, and increases resistance to infectious diseases. The herb has a diuretic, choleretic effect, and is a source of vitamin C. This vitamin accelerates recovery and is indispensable in infectious and inflammatory processes.

Amaranth grass is very similar in its properties to rose or rose hips. It contains a large amount of essential oils, flavonoids, resins. It quickly relieves inflammation, sore throat, eliminates cough, nasal congestion. It improves digestion, metabolic processes, has a choleretic and diuretic effect, reduces blood sugar levels. There are practically no contraindications. It is used in the form of decoctions, infusions, leaves and petals are added to tea.

Forecast

In general, with the right treatment and timely diagnosis, laryngeal tonsillitis ends favorably with a full recovery.