Tonsillitis: causes, symptoms, treatment, prevention

Causes of tonsillitis

The cause of the disease can be bacteria, viruses, or fungi.

According to ICD-10, when making a diagnosis of tonsillitis, it matters whether the disease is caused by streptococcus or another pathogen. Depending on the duration of the course, acute and chronic tonsillitis are distinguished.

The acute course of the disease is a manifestation of SARS, the causative agents of which in most cases are parainfluenza viruses, coronavirus, respiratory syncytial, and adenovirus infections. The viral etiology of the disease is most common in children under 3 years of age.

Among the bacteria that cause the disease, group A beta-hemolytic streptococcus (GABHS) is important, which is the cause of acute rheumatic fever. According to statistics, streptococcal tonsillitis in children is complicated by rheumatic lesions in the age group of 5-15 years.

The inflammatory process in the tonsils can be a manifestation of diphtheria, gonorrhea, or scarlet fever.

Fungal infection of the tonsils occurs against the background of immunodeficiency states ( HIV infection, drug immunosuppression).

The following can contribute to the development of the disease:

• hypothermia decreased immunity;
• smoking;
• insufficient quality oral care;
• the presence of local chronic infection (sinusitis, caries);
• breathing through the mouth (leads to drying of the mucosa and disruption of its physiological functioning);
• reflux of stomach contents into the oral cavity.

The main route of infection is airborne, infection is less common when eating contaminated food, through household items, and personal hygiene products (toothbrushes).

Symptoms of tonsillitis

Regardless of the causative factor, patients most often complain of:

• violation of the general condition, weakness, weakness;
• perspiration, burning, and discomfort in the throat;
• sore throat, possibly radiating to the ears.

The development of the hyperthermic syndrome and other signs of an acute viral infection (cough, sneezing, runny nose) may be noted. These clinical signs are taken into account when differentiating a viral or bacterial lesion of the tonsils, but their specificity is low.

In babies, the signs of the disease are sleep disturbance, and refusal to eat, even in a liquid state.

The chronic form of the disease manifests itself in the form of frequent exacerbations, clinically manifested by signs of acute tonsillitis.

Diagnosis of tonsillitis

The plan of diagnostic measures is aimed at establishing the cause of the disease (namely, excluding GABHS infection), identifying complications, and conducting differential diagnoses with other diseases.

The doctor listens to the patient's complaints and details them. It turns out whether there was contact with a sick person, how often the patient gets sick during the year, and whether there was an early development of complications.

A physical examination is carried out, and the functional state of all organs and systems is assessed. There may be an increase in regional peripheral lymph nodes.

Examining the throat in patients with tonsillitis, the doctor can observe such changes in the tonsils:

• redness and swelling of their mucosa;
• the presence of whitish spots on them, purulent plaque;
• increase in size.

The following changes are characteristic of the chronic course of the disease:

• plaque or plugs on the tonsils with an unpleasant odor;
• the formation of adhesions between the arches and tonsils;
• the edges of the palatine arches are thickened in a roller-like manner;
• the upper edges of the palatine arches are edematous;
• the edges of the palatine arches are hyperemic;
• enlarged lymph nodes regionally.

Diagnostic measures may include:

• general clinical blood test with the determination of the leukocyte formula, ESR;
• general clinical analysis of urine;
• rapid test for the determination of antigens to GABHS;
• bacteriological examination of the biomaterial, with the definition of the pathogen, and its sensitivity to antibiotics;
• cytological examination;
• pharyngoscopy;
• ECG ;
• biopsy;
• consultations of specialists of a narrow profile (infections, oncologist, rheumatologist, cardiologist ).

In adults with tonsillitis, a bacteriological examination is inappropriate, since the risk of developing a disease associated with GABHS is low.

When sampling biomaterial for bacteriological examination, the following conditions must be met:

• a sampling of material before the start of antibacterial treatment, on an empty stomach, without holding the toilet of the mouth;
• the material is taken from the recesses of the tonsil and the posterior pharyngeal wall;
• a sterile stick should not touch the teeth and tongue.

To differentiate the viral and bacterial etiology of the disease, the Zentner and MacIsaac scales can also be used.

Laboratory and instrumental diagnostics help the doctor exclude scarlet fever, diphtheria, measles, gonorrhea, cancer, and agranulocytosis.

A complete examination plan is drawn up by a doctor based on the patient's complaints, his general condition, and the presence of concomitant pathology.

Treatment of tonsillitis

Therapy of a mild uncomplicated form of the disease is carried out on an outpatient basis.

Hospitalization is indicated for patients with:

• high body temperature, more than three days;
• suspected complication;
• lack of effect from ongoing outpatient treatment;
• development of suffocation, violation of swallowing.

Patients are also hospitalized for elective tonsillectomy.

Therapy of the disease is aimed at eliminating the patient's complaints, and preventing the development of complications:

• acute rheumatic fever;
• abscessing of the tonsils, development of phlegmon;
• post-streptococcal glomerulonephritis;
• joint damage.

Non-drug therapies include:

• compliance with bed rest in the presence of signs of intoxication, an increase in body temperature too high numbers;
• adherence to a diet, the use of easily digestible food of soft consistency, the exclusion of spicy, fatty, fried, salty, and cold;
• drinking enough fluids, breastfed babies need to be breastfed more often.

Pharmacotherapy of tonsillitis involves the use of such drugs:

1. Antibiotics (Azithromycin, Amoxicillin, Cefuroxime). According to clinical guidelines, in the case of a viral etiology of tonsillitis, antibacterial agents are not used.
2. Non-steroidal anti-inflammatory drugs (paracetamol, ibuprofen, acetylsalicylic acid). They have an antipyretic, and analgesic effect, and reduce signs of inflammation.
3. Antiseptics (solution of povidone-iodine, chlorhexidine, nitrofural). Used in the form of gargles and irrigation of the throat, 4-6 times a day, always after a meal. For children, to avoid the development of a gag reflex, antiseptic agents are applied to the mucous membrane of the cheek. Dosage forms in the form of sprays are used after 3-4 years.

In the modern arsenal of pharmacological preparations, there are drugs, which include painkillers and anti-inflammatory components. Plant-based antiseptics and homeopathic preparations are also widely used.

The scheme of taking drugs, and doses depends on the age of the patient, the presence of individual intolerance to drugs, and concomitant diseases.

In a vacuum way, after preliminary local freezing of the tonsils, the lacunae are washed. This method is safer than rinsing with a syringe, as it provides complete removal of pus and plaque, and prevents the penetration of pathological exudate deeper into the tonsil crypts.

Surgical treatment in the form of bilateral tonsillectomy is carried out with:

• ineffective conservative therapy of the chronic course of the disease;
• the transition of the disease to the stage of decompensation;
• development of abscesses, phlegmon;
• development of septic complications of tonsillitis.

The scheme of therapy and further rehabilitation of the patient is developed by the attending physician, taking into account the recommendations of related specialists.

Prevention of tonsillitis

Preventive measures are aimed at eliminating and minimizing risk factors for the development of the disease:

• strengthening immunity;
• rehabilitation of chronic foci of infection;
• compliance with the rules of personal hygiene;
• exclusion of contact with sick people;
• rejection of bad habits;
• treatment of stomach diseases.

With a preventive purpose in the chronic form of the disease, it is recommended to take drugs that contain pidotimod (which increases local immunity).

The irrational use of antibiotics is of great importance in the development of antibiotic resistance. The duration of use and the regimen of antibiotics should be strictly observed by the patient. If these conditions cannot be met, injectable forms of drugs are used. In the case of GABHS-associated tonsillitis, the duration of antibiotic therapy is at least 10 days.

After discharge from the hospital, patients with tonsillitis, which was caused by GABHS, are subject to a medical examination. General clinical examinations of urine and blood are carried out in the first and third weeks after discharge. The doctor examines the patient for signs of heart damage, an ECG is performed. In the absence of pathological changes in the body, the patient is removed from the dispensary.