Symptoms of chronic tonsillitis

One of the most reliable signs of the disease is considered to be the presence of angina and a history. At the same time, it is imperative for the patient to find out how the fever in the throat is accompanied by a rise in body temperature and for how long.

Angina in chronic tonsillitis can be pronounced (severe pain in the throat when swallowing, significant hyperemia of the pharyngeal mucosa, with purulent attributes on the tonsils, respectively, forms, febrile body temperature, etc.), but in adults often such classic symptoms of angina do not occur. In such cases, exacerbations of chronic tonsillitis occur without severe severity of all symptoms: the temperature corresponds to low subfebrile values (37.2-37.4 C), sore throat when swallowing is insignificant, a moderate deterioration in general well-being is observed. The duration of the disease is usually 3-4 days. This picture of angina is typical for patients with rheumatism. In other cases, the patient notes only a slight sore throat with a feeling of well-being for several days. However, the unexpressed manifestation of exacerbations of chronic tonsillitis does not in any way diminish the aggressiveness of the pathological process with respect to the onset of toxic-allergic complications. After such “soft” sore throats, the number of exacerbations of rheumatism increases several times, the development of re-deformation of the mitral valve often occurs.

The clinical picture of chronic tonsillitis is characterized by recurrence of angina, usually 2-3 times a year, often 1 time in several years and only 3-4% of patients with angina do not exist at all. For angina of another etiology (not as an exacerbation of chronic tonsillitis) is characterized by the absence of their recurrence.

In chronic tonsillitis, moderate symptoms of general intoxication are observed, such as recurrent or persistent low-grade body temperature, sweating, fatigue, including mental, sleep disturbance, moderate dizziness and headache, loss of appetite, etc.

Chronic tonsillitis often causes other diseases or makes them worse. Numerous studies conducted in recent decades confirm the association of chronic tonsillitis with rheumatism, polyarthritis, acute and chronic glomerulonephritis, sepsis, systemic diseases, dysfunction of the pituitary and adrenal cortex, neurological diseases, acute and chronic diseases of the bronchopulmonary system, etc.

The main feature of the symptoms of chronic tonsillitis is non-specificity of some of them. Thus, the subjective symptoms largely coincide with those in various forms of chronic pharyngitis. According to their size, the tonsils are classified in three grades, however, the size and appearance of the tonsils also do not reflect their true state: there are tonsils of absolutely normal appearance and yet they may contain a source of chronic infection causing various metatonsillar complications. Removal of such tonsils often confirms this position. And yet, in most cases of chronic tonsillitis, a number of subjective (from anamnesis) and objective symptoms come to light, which give a basis to establish the diagnosis of chronic tonsillitis and differentiate it into two clinical forms - compensated and decompensated chronic tonsillitis and, depending on this, determine the tactics and treatment strategy of the patient.

With compensated chronic tonsillitis, some signs of chronic inflammation are macroscopically revealed, but this process is limited to the territory of the tonsils, does not extend beyond its limits, does not manifest anginal exacerbations and especially paratonsillar complications. This state of the tonsils is due to the existing balance between local tissue immunity and the general reactivity of the body, on the one hand, and the inflammatory process occurring in the tonsils. With decompensated chronic tonsillitis, local symptoms of chronic tonsillitis are usually clearly pronounced, some of them are typical only for this form and are absent with compensated chronic tonsillitis, with this form often aggravations occur in the form of sore throats, peritonsillitis, paratonsillar abscesses, regional lymphadenitis, and clinically advanced cases - metatonsillar complications at a distance (according to BS Preobrazhensky, anaginosis-free course of chronic tonsillitis occurs only in 2% of cases in this disease).

Subjective symptoms of chronic tonsillitis

The subjective symptoms of chronic tonsillitis are characterized by recurring pain in the tonsils during swallowing and talking, tingling, burning, dryness, discomfort and feeling in the throat of a foreign body. As a rule, these symptoms with compensated chronic tonsillitis are not accompanied by an increase in body temperature, but in some cases, especially with decompensated forms, there may be a persistent or recurring subfebrile. During this period, there are weakness, malaise, fatigue, which are often accompanied by aching pain in the joints and in the region of the heart. The appearance of subjective symptoms at a distance indicates the transition of a compensated form of chronic tonsillitis to decompensated. In other cases, patients feel a marked burning and soreness in the pharynx, causing them to have bouts of severe coughing (irritation of the pharyngeal branches of the vagus nerve) - one of the symptoms of the lacunar form of chronic tonsillitis, during which caseous masses stand out from the enlarged lacunas into the oral cavity. Often, the patients themselves squeeze them out of the tonsils with a finger or a teaspoon. The smell of these “purulent plugs” is extremely unpleasant; its putrid nature indicates the presence in the crypts of the palatine tonsils fuzospiroheleznyh microorganisms. A number of patients observe a symptom of reflex pain in the ear — tingling and “post-arresting” in it.

[1], [2], [3]

Objective symptoms of chronic tonsillitis

Objective symptoms of chronic tonsillitis are detected by endoscopic examination of the pharynx and external examination of the region of regional lymph nodes. At the same time, an examination, palpation, a sample with “dislocation” of the amygdala, a sample with extrusion of caseous masses from lacunae, sensing of lacunae, taking material for bacteriological research, including aspiration of the tonsil, are used.

On examination, first of all, they pay attention to the size of the tonsils, the color of the mucous membrane, the state of its surface and surrounding tissues. Objective signs of actual XT are determined not earlier than 3-4 weeks after the completion of the process of exacerbation or angina. According to the descriptions of B.S. Preobrazhensky (1963), with the follicular form of chronic parenchymal tonsillitis on the surface of the tonsils under the epithelium, there are "yellowish vesicles" indicating the rebirth of the follicles and their replacement with small cyst-like formations filled with "dead" leukocytes and dead microbial bodies. In the lacunary form, the expanded outlets of the lacunae are determined, which contain caseous white masses. When pressing with a spatula, caseous masses or liquid pus stand out on the lateral part of the anterior palatine arch and on the area of the upper pole of the tonsil from it, as mince from a meat grinder.

When examining the region of the tonsils, it is often possible to detect a number of signs of chronic tonsillitis, reflecting involvement in the inflammatory process of the surrounding anatomical structures:

1. Giza's symptom [Guisez, 1920] - hyperemia of the front arches;
2. Zack symptom [Zak VN, 1933] - swelling of the mucous membrane over the upper pole of the palatine tonsils and upper palatal arches;
3. the symptom of Preobrazhensky [Preobrazhensky B.S., 1938] - arcuate infiltration and hyperemia of the upper halves of the arches and the angle of the joint.

In chronic tonsillitis, regional lymphadenitis usually develops, which is determined by palpation behind the angle of the lower jaw and along the anterior edge of the sternocleidomastoid muscle. Lymphatic nodes can be painful on palpation, and on palpation of the retromandibular nodes, pain radiates to the corresponding ear.

Important diagnostic importance is the reception of palpation and dislocation of the tonsils. When finger palpation (there is also a palpation instrument) assess the elasticity, compliance (softness) of the tonsil or, on the contrary, its density, rigidity, the contents of the parenchyma. In addition, in case of finger palpation, it is possible to determine the presence of a tonsil in the parenchyma or in the immediate vicinity of its niche of a large pulsating arterial vessel, which must be considered as a risk factor for bleeding in tonsillotomy and tonsillectomy. If, with an accentuated pressure with a spatula, the amygdala does not protrude from its niche, but under the spatula there is dense tissue, this indicates cohesion of the amygdala with the tissues of its bed, i.e., chronic sclerotic tonsillitis, as well as difficulties extirpation of the tonsil during c extracapsular removal.

Crypt sounding carried out using a special curved bell-shaped probe G.G. Kulikovsky (with a handle or separate, inserted into a special holder, fixing the probe with a screw), allows you to determine the depth of the crypts, their contents, the presence of strictures, etc.

Thus, the basis of the clinical picture of chronic tonsillitis is considered to be a symptom complex associated with the formation of a foci of chronic infection in the tonsils. This process has certain patterns of local development and distribution in the body. The focus of chronic infection in the tonsils affects the functioning of all organs and functional systems, disrupting their livelihoods, on the one hand, and on the other, it often becomes the etiological factor of a new, usually serious illness and in all cases aggravates any diseases occurring in the body.

[4], [5]

Classification of chronic tonsillitis

Many authors offer various options for the classification of chronic tonsillitis. According to these classifications, the disease is mainly considered from the standpoint of the degree of protection of the body from tonsillar intoxication, using the terms "compensated" and "decompensated" inflammatory infectious process in the tonsils in relation to the whole organism. Based on the previous classifications and new data, the classification of K.S. Preobrazhensky and V.T. Palchuna, according to which the clinical forms of the disease that determine the medical tactics are differentiated and from modern scientific and practical positions.

In most cases, the patient will observe all the signs of chronic tonsillitis. Characteristic of a particular form, but in some cases reveal only a few or even one sign. According to this classification, the assessment of one or another sign or signs of an infectious focus in the tonsils and in the general condition of the body is of diagnostic value.

There are 2 clinical forms of chronic tonsillitis: simple and toxic-allergic two degrees of severity.

[6], [7], [8], [9], [10], [11]

Simple form of chronic tonsillitis

It is characterized only by local signs and in 96% of patients - the presence of angina in history.

Local signs:

• liquid pus or caseous-purulent congestion in the gaps of the tonsils (may be with smell);
• tonsils in adults more often small, may be smooth or with a loosened surface;
• persistent hyperemia of the edges of the palatine arches (sign Giee);
• swelling of the edges of the upper portions of the palatine arches (Zack sign);
• valiform thickening of the edges of the apron of the palatine arches (a sign of Preobrazhensky);
• fusion and adhesions of the tonsils with arches and a triangular fold;
• enlarged individual lymph nodes, sometimes painful on palpation (in the absence of other foci of infection in the region).

Concomitant diseases include those that do not have a single infectious base with chronic tonsillitis, the pathogenetic relationship of common and local reactivity traits.

The treatment is conservative. The presence of purulent contents in the gaps after 2-3 courses of treatment is an indication for tonsilllomy.

[12]

Toxic-allergic form of I degree

It is characterized by local signs of a simple form and general toxic-allergic reactions.

Signs:

• periodic episodes of subfebrile body temperature;
• episodes of weakness, weakness, malaise;
• fatigue, reduced working capacity, poor health;
• recurrent joint pain;
• increased and painful palpation of regional lymph nodes (in the absence of other foci of infection);
• functional impairment of cardiac activity is not constant, may occur during exercise and at rest, during the exacerbation of chronic tonsillitis;
• abnormal laboratory data may be unstable and non-permanent.

Concomitant diseases are the same as in the simple form. They do not have a single infectious base with chronic tonsillitis.

The treatment is conservative. The lack of improvement (pus in the lacunae, toxic-allergic reactions) after 1-2 courses of treatment is an indication for tonsillectomy.

Toxic-allergic form II degree

It is characterized by local signs of a simple form and general toxic-allergic reactions.

Signs:

• periodic functional disorders of cardiac activity (the patient complains, violations are recorded on the ECG);
• heartbeat, heart rhythm disturbances;
• pains in the heart or joints occur both during a sore throat and outside of exacerbation of chronic tonsillitis;
• low-grade body temperature (may be prolonged);
• functional disorders of infectious nature in the kidneys, heart, vascular system, joints, liver and other organs and systems, recorded clinically and using laboratory methods.

Concomitant diseases may be the same as in the simple form (not associated with infection).

Concomitant diseases have common infectious causes with chronic tonsillitis.

Local diseases:

• paratonsillar abscess;
• parafaringite.

Common diseases:

• acute and chronic (often with veiled symptoms) tonsillogenic sepsis;
• rheumatism:
• arthritis;
• acquired heart defects:
• infectious-allergic nature of diseases of the urinary system, joints and other organs and systems.

Surgical treatment (tonsillectomy).

Pharyngoscopic signs appear for the second time: the purulent contents released from the crypts on the tonsil surface, being a strong irritant, cause local inflammation, therefore the edges of the palatine arches are hyperemic, infiltrated and edematous. For the same reason, chronic tonsillitis, as a rule, is catarrhal or granular pharyngitis. Regional lymphadenitis in the form of an increase in lymph nodes at the corners of the mandible and along the sternocleidomastoid muscle also indicates an infection in the overlying regions, most often in the tonsils. Of course, in all these cases, the infection can proceed not only from the tonsils, but also sick teeth, gums, pharynx, etc. In this connection, all possible causes of pharyngoscopic signs of inflammation should be taken into account in the differential diagnosis.