Tonsillitis code in μb 10

Angina (acute tonsillitis) - Overview of information

Angina (acute tonsillitis) is an acute infectious disease caused by streptococci or staphylococci, less frequently by other microorganisms, characterized by inflammatory changes in the lymphadenoid tissue of the pharynx, more often in the palatine tonsils, manifested by pain in the throat and moderate general intoxication.

What is angina, or acute tonsillitis?

Inflammatory diseases of the pharynx are known since ancient times. They have received the general name "angina". In fact, according to B.S. Preobrazhensky (1956), the name "throat angina" unites a group of dissimilar diseases of the pharynx and not only inflammation of the lymphadenoid formations, but also fiber, the clinical manifestations of which are characterized, along with the signs of acute inflammation, the syndrome of compression of the pharyngeal space.

Judging by the fact that Hippocrates (V-IV cc. BC. E.) repeatedly cited information relating to the disease of the pharynx, very similar to angina, we can assume that this disease was the subject of close attention of ancient doctors. The removal of tonsils due to their disease is described by Celsus. The introduction of a bacteriological method into medicine gave rise to the classification of the disease according to the type of pathogen (streptococcal, staphylococcal, pneumococcal). The discovery of the corynebacterium of diphtheria has made it possible to differentiate banal angina from an angina-like disease - diphtheria of throat, and scarlet fever manifestations in pharynx due to the presence of a characteristic of scarlet fever were isolated in an independent symptom, characteristic for this disease, even earlier, in the XVII century.

At the end of XIX century. describes a special form of ulcerative necrotic tonsillitis, the emergence of which is due to Fuso spirochaete symbiosis of Plaut-Vincent, and when introduced into the clinical The practice of hematological studies has highlighted the specific forms of affection of the pharynx, called agranulocyte and monocytic angina. Somewhat later, a special form of the disease that occurs with alimentary-toxic aleukia, similar in its manifestations to agranulocyte angina, was described.

It is possible to defeat not only the palatine, but also the lingual, pharyngeal, guttural tonsils. However, most often the inflammatory process is localized in the palatine tonsils, therefore it is commonly called angina, which means acute inflammation of the palatine tonsils. This is an independent nosological form, but in the modern sense it is essentially not one, but a whole group of diseases, different in etiology and pathogenesis.

ICD-10 code

J03 Acute tonsillitis (tonsillitis).

In everyday medical practice, there is often a combination of tonsillitis and pharyngitis, especially in children. Therefore, the unifying term "tonsillopharyngitis" is widely used in the literature, however, tonsillitis and pharyngitis in ICD-10 are included separately. In view of the exceptional importance of streptococcal etiology, the disease is streptococcal tonsillitis J03.0), as well as acute tonsillitis caused by other specified pathogens (J03.8). If necessary, an additional code is used to identify the infectious agent (B95-B97).

Code for ICD-10 J03 Acute tonsillitis J03.8 Acute tonsillitis caused by other specified pathogens J03.9 Acute tonsillitis, unspecified

Epidemiology of sore throat

In terms of the number of days of incapacity for work, angina ranks third after the flu and acute respiratory diseases. Children and persons are more often ill before 30-40 years of age. The frequency of access to a doctor per year is 50 -60 cases per 1000 population. The incidence depends on the density of the population, household, sanitary-hygienic, geographical and climatic It should be noted that among the urban population the disease is cleaner than in rural areas. According to the literature, rheumatism develops in 3% of patients, and in patients with rheumatic disease, after 20-30% of cases, heart disease is formed. In patients with chronic tonsillitis, angina is observed 10 times more often than in practically healthy people. It should be noted that about one in five, who has suffered tonsillitis, subsequently suffers from chronic tonsillitis.

Causes of sore throat

The anatomical position of the pharynx, which determines the wide access to it of pathogenic environmental factors, as well as the abundance of vascular plexuses and lymphadenoid tissue, turn it into wide entrance gates for various pathogenic microorganisms. Elements, primarily reacting to microorganisms, are solitary clusters of lymphadenoid tissue: palatine tonsils, pharyngeal tonsils, lingual tonsils, tubal tonsils, lateral ridges, as well as numerous follicles scattered in the region of the posterior pharyngeal wall.

The main cause of angina is caused by an epidemic factor - infection from the patient. The greatest danger of infection exists in the first days of the disease, but the person who has suffered the disease is source of infection (although to a lesser extent) during the first 10 days after the angina, and sometimes longer.

In 30-40% of cases in the autumn-winter period, pathogens are represented by viruses (adenovirus types 1-9, coronaviruses, rhinovirus, influenza and parainfluenza viruses, respiratory syncytial virus, etc.). The virus can not only play the role of an independent pathogen, but it can also provoke the activity of the bacterial flora.

Symptoms of angina

Symptoms of angina are typical - a sharp pain in the throat, an increase in body temperature. Among the various clinical forms most common are common angina, and among them - catarrhal, follicular, lacunar. The division of these forms is purely conditional, in essence it is a single pathological process that can quickly progress or stop at one of the stages of its development. Sometimes, catarrhal angina is the first stage of the process, followed by a more severe form or another disease.

Where does it hurt?

Sore throat Sore throat during pregnancy Sore throat in children

Classification of angina

During the foreseeable historical period, numerous attempts have been made to create some sort of scientific classification of throat angina, but every sentence in this direction was fraught with certain shortcomings and not by the "fault" of the authors, but because the creation of such a classification for a number of objective reasons is almost impossible. These reasons, in particular, include the similarity of clinical manifestations not only with different banal microbiota, but also with certain specific angina, the similarity of some common manifestations with different etiological factors, frequent discrepancies between bacteriological data and the clinical picture, etc., so the majority of authors, guided by practical needs in diagnosis and treatment, often simplified their proposed classifications, which, at times, reduced to classical concepts.

These classifications were and still have a pronounced clinical content and, of course, are of great practical importance, however at the true scientific level, these classifications do not reach due to the extreme multifactority of etiology, clinical forms and complications. Therefore, with Practical point of view, angina is expedient to subdivide into nonspecific acute and chronic and specific acute and chronic.

Classification presents certain difficulties due to the variety of disease types. In the basis of classifications V.Y. Voyachek, A.Kh. Minkovsky, V.F. Undrytsa and S.Z. Romma, L.A. Lukozsky, I.B. Soldatova and others. lies one of the criteria: clinical, morphological, pathophysiological, etiological. As a result, none of them fully reflects the polymorphism of this disease.

The most common among practical doctors was the classification of the disease, developed by B.S. Preobrazhensky and later supplemented by V.T. Palchoun. This classification is based on pharyngoscopic signs, supplemented by data obtained in laboratory studies, sometimes with data of an etiological or pathogenetic nature. By origin, the following basic forms are distinguished (according to Preobrazhensky Palchoun):

• episodic form associated with autoinfection, which is activated under unfavorable environmental conditions, most often after local or general cooling;
• epidemic form, which occurs as a result of infection from a patient with angina or bacilli carrier of a virulent infection; usually the infection is transmitted by contact or airborne droplets;
• angina as a regular exacerbation of chronic tonsillitis, in this case the violation of local and general immune reactions is the result of chronic inflammation and tonsils.

The classification includes the following forms.

• Banal:
  • catarrhal;
  • follicular;
  • lacunar;
  • mixed;
  • phlegmonous (intratonsillar abscess).
• Special forms (atypical):
  • ulcerative-necrotic (Simanovsky-Plauta-Vincent);
  • virus;
  • fungal.
• For infectious diseases:
  • with diphtheria of the pharynx;
  • with scarlet fever;
  • measles;
  • syphilitic;
  • with HIV infection;
  • defeat of pharynx with typhoid fever;
  • with tularemia.
• With blood diseases:
  • monocytic;
  • with leukemia:
  • agranulocyte.
• Some forms of localization, respectively:
  • lachrymal tonsils (adenoiditis);
  • lingual tonsil;
  • guttural;
  • lateral ridges of pharynx;
  • tubal tonsils.

By "angina" is understood a group of inflammatory diseases of the pharynx and their complications, which are based on the damage to the anatomical formations of the pharynx and adjacent structures.

J. Portman simplified the classification of angina and presented it in the following form:

1. Catarrhal (banal) nonspecific (catarrhal, follicular), which after localization of inflammation is defined as palatine and lingual amygdalitis, retro-nasal (adenoiditis), uvulitis. These inflammatory processes in the throat were called "red angina."
2. Membrane (diphtheria, pseudomembranous nondiptheria). These inflammatory processes were called "white angina." To clarify the diagnosis, it is necessary to carry out a bacteriological study.
3. Angina, accompanied by loss of structure (ulcerative-necrotic): herpetic, including with Herpes zoster, aphthous, ulcerous Vincent, with scurvy and impetigo, post-traumatic, toxic, gangrenous, etc.

Screening

When a disease is detected, complaints of pain and throat, as well as characteristic local and general symptoms, are guided. It should be borne in mind that in the first days of the disease, with many common and infectious diseases, there may be similar changes in the oropharynx. To clarify the diagnosis, it is necessary to observe the patient dynamically and sometimes carry out laboratory tests (bacteriological, virologic, serological, cytological, etc.).

Diagnosis of angina

Anamnesis should be collected with great care. Great importance is attached to the study of the general condition of the patient and to certain "pharyngeal" symptoms: body temperature, pulse rate, dysphagia, pain syndrome (unilateral, bilateral, with irradiation in or out of the ear, the so-called pharyngeal cough, the sensation of dryness, persecution, burning, hypersalivation - sialorhea, etc.).

Pay attention also to the timbre of the voice, which changes abruptly with abscessed and phlegmonous processes in the pharynx.

Endoscopy of the pharynx in most inflammatory diseases allows you to establish an accurate diagnosis, but the unusual clinical course and endoscopic the pictures force to resort to additional methods of laboratory, bacteriological and, according to indications, histological examination.

To clarify the diagnosis it is necessary to conduct laboratory tests: bacteriological, virologic, serological, cytological, etc.

In particular, microbiological diagnostics of streptococcal angina that is important includes a bovteriological examination of the smear from the surface of the tonsil or the posterior pharyngeal wall. The results of sowing largely depend on the quality of the material obtained. The smear is taken with a sterile swab; the material is delivered to the laboratory within 1 hour (for longer periods it is necessary to use special media). Before taking the material, do not rinse your mouth or use deodorizing agents for at least 6 hours. With the correct technique of sampling, the sensitivity of the method reaches 90%, the specificity is 95-96%.

What it is necessary to survey?

Pharyngeal (adenoid) tonsil Tonsils

How to inspect?

X-ray of the larynx and pharynx

What tests are needed?

Antistreptolysin O in the serum Antibodies to streptococcus A, B, C, D, F, G in the blood Staphylococcal infections: antibodies to staphylococci in the serum

Who to contact?

Otolaryngologist ENT - doctor

Treatment of sore throats

The basis of drug treatment of angina is systemic antibacterial therapy. On an outpatient basis, antibiotic prescribing is usually done empirically, so information about the most common pathogens and their sensitivity to antibiotics is taken into account.

Preference is given to drugs penicillin series, since beta-hemolytic streptococcus has the greatest sensitivity to penicillins. In outpatient settings, preparations should be prescribed for ingestion.

In addition to treatment

Physiotherapy with angina Antibiotics for angina Antibiotics for angina in children Removal of tonsils (tonsillectomy) Tonsillitis: treatment Antibiotics for tonsillitis Than to treat? Dazel Tsebopim Tsedek Thyme Herb Salvia DR. TAYSS Baishitsinge

Prophylaxis of angina

Measures to prevent the disease are based on those principles that are developed for infections transmitted by airborne or alimentary tract, since angina is an infectious disease.

Preventive measures should be aimed at improving the external environment, eliminating factors that reduce protective properties of the organism in relation to pathogens (dustiness, smokeiness, excessive accumulation, etc.). Among the measures of individual prevention - tempering the body, exercise, establishing a reasonable regime of work and rest, staying in the fresh air, food with sufficient vitamins and the like. The most important are therapeutic and prophylactic measures, such as sanation of the oral cavity, timely treatment (if necessary, surgical) chronic tonsillitis, restoration of normal nasal breathing (if necessary, adenotomy, treatment of paranasal sinuses, septoplasty, etc.).

Forecast

The prognosis is lagging with the timely begun and carried out in full volume of treatment. Otherwise, possibly developed local or general complications, the formation of chronic tonsillitis. The average incapacity for work of the patient is 10-12 days.

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Acute tonsillitis (angina) and acute pharyngitis in children

Acute tonsillitis (tonsillitis), tonsillopharyngitis and acute pharyngitis in children are characterized by inflammation of one or more components of the lymphoid pharyngeal ring. For acute tonsillitis (angina), a typical acute inflammation of the lymphoid tissue is mainly palatine tonsils. For tonsillopharyngitis is characterized by a combination of inflammation in the lymphoid pharyngeal ring and pharyngeal mucosa, and Acute pharyngitis is characterized by acute inflammation of the mucous membrane and lymphoid elements of the posterior pharyngeal wall. In children, tonsillopharyngitis is often noted.

ICD-10 code

• J02 Acute pharyngitis.
• J02.0 Streptococcal pharyngitis.
• J02.8 Acute pharyngitis due to other specified pathogens. J03 Acute tonsillitis.
• J03.0 Streptococcal tonsillitis.
• J03.8 Acute tonsillitis caused by other specified pathogens.
• J03.9 Acute tonsillitis, unspecified.

ICD-10 code J02 Acute pharyngitis J03 Acute tonsillitis J03.8 Acute tonsillitis caused by other specified pathogens J03.9 Acute tonsillitis, unspecified J02.8 Acute pharyngitis due to other specified pathogens J02.9 Acute pharyngitis, unspecified

Epidemiology of angina and acute pharyngitis in children

Acute tonsillitis, tonsillopharyngitis and acute pharyngitis develop in children mainly after the age of 1.5 years, which is due to the development of lymphoid tissue of the pharyngeal ring at this age. In the structure of acute respiratory infections, they constitute at least 5-15% of all acute respiratory diseases of the upper respiratory tract.

Causes of angina and acute pharyngitis in children

In the etiology of the disease there are age differences. In the first 4-5 years of life, acute tonsillitis / tonsillopharyngitis and pharyngitis are mostly viral in nature and are caused most often by adenoviruses, In addition, the cause of acute tonsillitis / tonsillopharyngitis and acute pharyngitis can be herpes simplex virus and enterovirus Coxsackie. Since 5 years in the emergence of acute tonsillitis becomes important B-hemolytic streptococcus group A(S. pyogenes),which becomes the leading cause of acute tonsillitis / tonsillopharyngitis (up to 75% of cases) at the age of 5-18 years. Along with this, the causes of acute tonsillitis / tonsillopharyngitis and pharyngitis can be streptococci of group C and G,M. pneumoniae, Ch. pneumoniaeandCh. psittaci,influenza viruses.

Causes of angina and acute pharyngitis in children

Symptoms of angina and acute pharyngitis in children

For acute tonsillitis / tonsillopharyngitis and acute pharyngitis is characterized by an acute onset, accompanied, as a rule, by an increase in body temperature and deterioration of the condition, the appearance of pain in the throat, the refusal of young children from eating, malaise, lethargy, other signs of intoxication. When examined, redness and swelling of the tonsils and mucous membrane of the posterior pharyngeal wall are revealed, its "granularity" and infiltration, the appearance of purulent exudation and raids mainly on the tonsils, the increase and soreness of the regional anterolateral lymph nodes.

Symptoms of angina and acute pharyngitis in children

Where does it hurt?

Sore throat Sore throat with swallowing Sore throat in children

What's bothering you?

Lump in the throat

Classification of angina and acute pharyngitis in children

You can identify the primary tonsillitis / tonsillopharyngitis and pharyngitis and secondary, which develop with such infectious diseases, as diphtheria, scarlet fever, tularemia, infectious mononucleosis, typhoid fever, human immunodeficiency virus (HIV). In addition, they release a mild form of acute tonsillitis, tonsillopharyngitis and acute pharyngitis and severe, uncomplicated and complicated.

Diagnosis of angina and acute pharyngitis in children

Diagnosis is based on a visual assessment of clinical manifestations, including mandatory examination of the otolaryngologist.

In severe acute tonsillitis / tonsillopharyngitis and acute pharyngitis, and in cases of hospitalization, peripheral blood analysis is done, which in uncomplicated cases reveals leukocytosis, neutrophilia and a shift of the formula to the left with streptococcal etiology of the process and normal leukocytosis or a tendency to leukopenia and lymphocytosis in the viral etiology of the disease.

Diagnosis of angina and acute pharyngitis in children

What it is necessary to survey?

Pharynx Swallow (adenoid) tonsil

How to inspect?

X-ray of the larynx and pharynx

What tests are needed?

General blood test Infectious mononucleosis: antibodies to Epstein-Barr virus in blood Antistreptolysin O in serum Antibodies to streptococcus A, B, C, D, F, G in the blood

Who to contact?

Pediatrician ENT - doctor Otolaryngologist

Treatment of angina and acute pharyngitis in children

Treatment varies depending on the etiology of acute tonsillitis and acute pharyngitis. With streptococcal tonsillopharyngitis, antibiotics are shown, they are not shown for viral infection, with mycoplasmal and chlamydial antibiotics are shown only in cases when the process is not limited to tonsillitis or pharyngitis, but descends into the bronchi and lungs.

The patient is shown bed rest in the acute period of the disease on average 5-7 days. Diet is normal. Rinsing of the throat with 1-2% Lugol solution is shown. 1-2% solution of hexathedia (hexoral), etc. warm drink (milk with Borjomi, milk with soda - 1/2 teaspoon of soda for 1 glass of milk, milk with boiled figs, etc.).

Treatment of angina and acute pharyngitis in children

In addition to treatment

Antibiotics for pharyngitis Physiotherapy with angina Antibiotics for angina in children Removal of tonsils (tonsillectomy) Tonsillitis: treatment Antibiotics for tonsillitis Than to treat? Paxeladin Tsebepim Cedex Thymus herb

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Purulent sore throat

Probably everyone is familiar with the condition, when the throat hurts, it becomes difficult to swallow, the tonsils swell and increase in size. This is how purulent angina can manifest itself - an infectious disease that is accompanied by an inflammatory reaction in the palatine tonsils.

The disease can affect both children and adults. The prevalence of purulent sore throat is more than 15% of the inhabitants of our region per year, with the main incidence occurring in the spring-autumn period.

ICD-10 code

According to the international classification of diseases, acute purulent tonsillitis (tonsillitis) takes the following position:

• J03.0 Streptococcal angina;
• J03.8 Acute angina caused by other identified pathogens (additional code B95-B97 may be used). Exception: pharyngotongillitis of herpetic etiology;
• J03.9 Acute angina, unspecified etiology (ulcerative, follicular, gangrenous, infectious, unidentified).

Code for ICD-10 J03 Acute tonsillitis J03.8 Acute tonsillitis caused by other specified pathogens J03.9 Acute tonsillitis, unspecified

Causes of purulent sore throat

The most common cause of purulent tonsillitis is a catarrhal disease. The effect of cold air leads to a reduction in tonsillar mucosa, which becomes an excellent nutrient medium for the activity of pathogenic microorganisms. Thus, the proliferation of pathogens of angina occurs in a short time and is very active.

Often a factor in the development of the disease becomes non-compliance with preventive measures when communicating with an already ill person. Use of common dishes, towels, inhaling air containing infectious agents: the causative agent of angina in everyday life easily passes from sick to healthy people. Microparticles with the pathogen appear in the air at the time of sneezing, coughing, or just breathing. A healthy person, inhaling these particles, may well get sick. Usually, signs of infection appear from the second to the fifth day after infection.

How is purulent angina transmitted? Most often it's an air-drip way, less often - through household items, dishes and other supplies.

Is purulent sore throat? Of course, yes, if you do not adhere to the rules of hygiene and do not wear a protective dressing when you contact the sick person.

Sometimes a person, becoming ill with a cold, infects with the infection "himself": the pathogen can enter the throat from other infectious foci. Such foci can become carious teeth, chronic sinusitis, gum disease, etc.

The danger of getting sick is increased if a person is cold, if his immunity is reduced, and if he has bad habits: smoking and alcohol abuse.

The causative agent of purulent sore throat

Purulent angina in the vast majority of cases is an infectious disease caused by group A beta-hemolytic streptococcus. This pathogen is found in about 60-80% of cases of purulent angina. The assumption that angina can be of viral origin has not been fully confirmed. At the moment, the importance of adenoviruses in the development of angina.

Most specialists still tend to attribute angina to streptococcal infectious diseases. However, the possibility of purulent angina of staphylococcal and pneumococcal origin is not ruled out. There are also descriptions of angina leafereletic etiology.

In addition to the above forms of purulent sore throat, provoked in most cases by streptococcal or staphylococcal infection (less often - pneumococcal), acute damage to palatines tonsils (often - one amygdala) can cause a combined effect of the oral spirochaete and spindle-shaped rod (the so-called ulcerative-membranous form of the disease).

Incubation period of purulent sore throat

The incubation period of purulent sore throat can be from 2 to 5 days. Symptoms of the disease appear quickly enough, and one of the first signs, as a rule, is a chill, followed by a strong fever.

A characteristic feature is that the tenderness in the throat gradually increases, starting bother from a simple feeling of discomfort to severe pain, whether or not associated with swallowing.

The incubation period of purulent sore throat is almost the same in duration, as in other infectious diseases of the nasopharynx.

Through how many passes a purulent sore throat? If the patient turns for help and begins treatment, while still in the incubation period, or at the first signs of the disease, the duration of the disease is significantly reduced. If the patient adheres to the doctor's recommendations, the disease will go to "no" as early as the second day of treatment, and on the fifth (maximum - tenth) days it will be possible to return to the usual way of life. It is inadmissible to carry a purulent sore throat, as they say, "on the feet": bed rest is one of the main conditions for a speedy recovery.

If you do not treat or mis-treat the disease, there can be very adverse effects.

Symptoms of purulent sore throat

Medical specialists identified a number of the most characteristic signs of purulent sore throat:

• chills, fever, fever, fever (39-40 ° C);
• Increasing soreness of the throat, which increases during swallowing movements;
• when palpated, painful and enlarged mandibular lymph nodes;
• increase and reddening of the tonsils;
• areas of pus and white deposits in the tonsils, which can be removed with a medical tool without damaging the mucous membranes;
• bright symptoms of intoxication, with pain in the head, a sense of weakness and loss of appetite.

Symptoms of purulent sore throat can have a different degree of severity, depending on the form and neglect of the infectious process.

Purulent sore throat in adults can take place without significant rise in temperature. In this case, the main and determining signs are pain in the throat, changes in the appearance of the tonsils: redness, swelling of the mucosa, pustules and plaque on the tonsils.

What does purulent angina look like?

The throat with purulent sore throat can have a different appearance: it depends on the type of purulent lesion.

1. Purulent follicular angina is characterized by swelling and hyperemia of the tonsils. Simultaneously, they can clearly see small light or pastel abscesses, similar, at first glance, with millet grains. The abscesses tend to progress, increase: sooner or later they are opened, releasing the purulent contents into the pharyngeal cavity.
2. Purulent lacunar angina - its distinctive feature is the formation of a plaque on the tonsils, especially in the lacunar region. Lacunas are craters of a kind that are especially well seen on the swollen tonsils. Accumulations of a yellowish-white hue can overflow lacunae, occupying the entire surface of the amygdala. They can be easily removed with a medical tool or spoon, but after removal, the plaque soon appears again. If the disease is not treated, then the clusters become dense, forming purulent plugs in a purulent sore throat.
3. Purulent-necrotic tonsillitis - on the surfaces of the tonsils can be found light yellowish-gray films, clearly visible against a healthy mucosa. The films have a soft consistency and are perfectly removed with the help of a cotton swab, exposing a site damaged by the ulcer process. Such a site can bleed, as necrosis spreads into the depths of the tissues. If the process is not stopped, it can go beyond localization, spreading to the gum area and even the tongue.

Frequent purulent angina can easily develop into a chronic form, in which an increase in nearby lymph nodes, such as submandibular or parotid. Lymph nodes become dense and painful when palpated. A strange unpleasant odor appears from the mouth.

Purulent sore throat in adults

Adult patients suffer from purulent sore throat, usually as a result of a decrease in protective immune forces, or with weakening of immunity by other chronic diseases: sinusitis, periodontitis, etc. The provoking factors are also acute cooling of the body, poor sanitary conditions at home or in the workplace, meager or monotonous nutrition, etc.

In adults, much more often acute purulent angina is transformed into a chronic one. This is due to improper or inadequate treatment, since it is adults who, due to many reasons prefer to carry the disease "on their feet", sometimes without thinking about what is dangerous purulent angina.

But in rare cases, chronic purulent angina occurs independently. This situation can happen when the infection passes from other nearby foci: the nasal or oral cavity.

Chronic purulent angina in adults can become a provoking factor in the development of pathologies of autoimmune and allergic etiology: kidney damage, rheumatism, and functional disorders of the central nervous system. If treatment is not initiated on time, or is performed with impairments, the risk of complications increases many times.

Purulent angina in children

Very often purulent angina occurs in children. This is due, first of all, to the peculiarities of the structure of children's tonsils. It is noteworthy that not always purulent angina in children begins with problems in the throat and high fever: often angina can begin with the defeat of another nearby organ, for example, with otitis media.

The complexity of treating children in childhood is that the children's body is much more vulnerable than an adult, so the choice of antibiotics for therapy is not so wide. And the likelihood of developing allergies in children is higher than in older children or in adult patients.

Purulent sore throat in pregnant women

Due to a decrease in immunity in pregnancy, women can develop various infectious pathologies, mostly colds. Depending on the course, such diseases can disappear without a trace, or may adversely affect the course of pregnancy. Such purulent diseases include purulent angina in pregnant women.

According to statistics, more than 60% of women during pregnancy "pick up" ARI, ARVI or flu. And this despite the fact that all doctors constantly indicate that during pregnancy, it is extremely undesirable to care for yourself and the future baby.

If a pregnant woman becomes ill with purulent sore throat, she has a number of risks:

• high temperature, an abundance of toxins in the body, a deficiency of vitamin and nutrients, hypoxia - can lead to spontaneous abortion;
• taking medications and, in particular, antibiotics - can adversely affect the development of the fetus and pregnancy in general.

All these negative consequences can be avoided if one adheres to some rules recommended to pregnant women in case of purulent sore throat.

• Rule I: at the first sign of a cold, keep bed rest, ventilate the room more often, take plenty of liquid (3-4 liters / day).
• Rule II: Do not take any medications without doctor's advice.
• Rule III: rinse the throat with herbal decoctions, but be careful not to take them inside without the doctor's permission.
• Rule IV: Eat more vegetables and fruits, limit the consumption of salt and spicy condiments that irritate the throat.

Without a doctor, you can not do without this: the doctor will determine the most effective and safe for you. child medicine, and also help to understand the herbs that are permitted for use during pregnancy.

Purulent sore throat during breastfeeding

For young mothers breastfeeding, diseases of cold and sore throat often becomes an excuse for stopping breastfeeding. Intoxication of the body, taking medications - all this negatively affects the quality and composition of milk, besides many medications are given with milk to the child, and this is unacceptable.

But if it happened, then purulent angina still have to be treated. But independent treatment here is unacceptable: therapy should be prescribed by a doctor, given the risk to a newborn baby and the benefit for a young mother.

What can the nursing mother do before the doctor arrives:

• drink more warm liquid, tea, milk;
• gargle every hour, you can use a solution of salt with soda and 2-3 drops of iodine;
• drink and gargle with a decoction of chamomile;
• take paracetamol at a temperature;
• hold inhalation with hot steam, boiling water with soda, apply thermal compresses to the neck (with enlarged lymph nodes).

But most importantly - do not worry and turn to the doctor in time. If the doctor decides that you need a course of antibiotic therapy, be prepared for the fact that you may have to give up breastfeeding for a while. If this happens, do not worry, continue to decant milk until you resume feeding, otherwise it may disappear. For this period, transfer the child to the infant formula.

Where does it hurt?

Sore throat Sore throat during pregnancy Sore throat with swallowing Sore throat in children

What's bothering you?

Symptoms of purulent sore throat

Types of purulent sore throat

By the nature of manifestations of the disease purulent sore throat is divided into lacunar, follicular and purulent-necrotic.

• Purulent lacunar tonsillitis - an infectious lesion spreads to the mucous membranes of lacunae where accumulation of purulent secretions that have arisen as a result of inflammatory reaction and necrosis of damaged tissues. The accumulating pus goes beyond the lacunae by separating the yellowish white plugs.
• Purulent follicular angina - an infectious lesion spreads to the almond follicles, which is outwardly manifested by the appearance on the surface of the tonsils of yellow nodules with purulent exudate inside. Nodules can merge, forming an abscess.
• Purulent-necrotic angina - the infectious process is distinguished by an aggressive course with negative dynamics, causing the formation of areas of death of the tissues of the tonsils and ulcerative lesions.

The listed types of purulent sore throat can develop either independently or mixed: for example, purulent angina in adults can occur with simultaneous lesion of follicles and the formation of ulcerative necrotic surfaces on tonsils.

Purulent angina in children can have a peculiar course: one amygdala can be affected by follicular angina, and the other - lacunar.

In addition, distinguish between acute and chronic course of angina:

• acute purulent angina begins suddenly, against a background of absolutely normal state of health, and develops rapidly, with the increase of acute symptoms of the disease;
• chronic purulent angina is a consequence of the already transferred acute angina, which was incorrectly subjected or not treated at all.

The difference between acute purulent angina and chronic disease consists, first of all, in the fact that in chronic course there is no acute signs of inflammation, sudden temperature rises and other symptoms of general intoxication of the body. Chronic purulent angina is characterized, as a rule, by a rather general symptomatology, indicative of a slow inflammatory process: it is pain in the heart, increased sweating, joint soreness, general discomfort and constant fatigue. The throat is dry, perhaps a constant "perspiration" or feeling of a foreign object in the pharynx. During the period of exacerbation, the symptomatology resembles the acute form of angina.

Consequences of purulent sore throat

Now we will tell you about what is dangerous purulent angina, if not to conduct a qualified and timely treatment. The consequences of purulent sore throat can be local and general, that is, develop localized or affect other organs and systems of the body.

Common complications of purulent sore throat:

• Rheumatism is an inflammatory process, exciting, for the most part, heart and joints. Complication affects the valvular heart system and selectively joints;
• myocarditis - an inflammatory reaction in the heart muscle, with the further possible development of thromboembolism;
• endocarditis - an inflammatory disease of the inner shell of the heart, may act as one of the manifestations of rheumatism, or may occur independently;
• pericarditis - inflammation of the pericardial sac and the outer shell of the heart;
• pyelonephritis, glomerulonephritis - a pathology of the renal system, which can be caused by the formation of protein compounds in the blood during a sore throat, which negatively affects the efficiency of the kidneys;
• septic infection of blood is the most complex consequence of purulent sore throat, accompanied by the spread of purulent infection with blood flow through the body.

Local complications of purulent sore throat:

• abscessing of the process - the emergence of one or more purulent cavities inside the amygdala, which in the future may require surgical intervention;
• phlegmonous inflammation is a process involving muscle tissues, tendons and okolomindalnaya fiber;
• defeat of the tympanic membrane, mastoid process or middle ear - the phenomenon of acute otitis. If the complication is not treated properly, the pathology can trigger the appearance of adhesions and loss of auditory function;
• laryngeal edema - the edema of the laryngeal region, if untreated, can quickly become an obstacle to respiratory function, which can result in suffocation and death;
• the discovery of bleeding of the tonsils is a fairly frequent complication of purulent-necrotic sore throat when an ulcer penetrating deep into tissues damages a blood vessel.

Many experts note that purulent angina is not so terrible in itself, how dangerous its consequences are. Therefore, it is necessary to deal with the diagnosis and treatment of purulent sore throat as early as possible.

Diagnosis of purulent sore throat

Diagnosis of purulent sore throat can be divided into several main areas.

1. Clinical researches:

• collection of information about the disease;
• external examination and palpation of the neck, ear and occiput;
• examination of the oral and pharyngeal cavity with a spatula;
• listening to the respiratory system and heart activity.

1. Laboratory research:

• conducting a general blood test (signs of an inflammatory reaction);
• sowing and isolating the culture of the pathogen on nutrient media;
• taking a smear from the pharyngeal and nasal cavity to exclude diphtheria.

Often, a doctor only needs an external examination to establish a diagnosis: inflamed tonsils, characteristic plaque, folds and craters, filled with purulent secretions, as well as purulent plugs in purulent angina - all these are characteristic symptoms of the disease. To the laboratory methods, the doctor often resorts only to identify the pathogen and appoint it is those antibiotics that will best affect a particular type of pathogen. Identification also makes it possible to differentiate purulent angina from other diseases of the pharyngeal region.

What it is necessary to survey?

Pharyngeal (adenoid) tonsil

How to inspect?

Throat examination

Who to contact?

Otolaryngologist ENT - doctor

Treatment of purulent sore throat

Treatment of purulent sore throat should begin with the elimination of the main symptoms, as well as measures to strengthen the defenses of the body. The best help for drug therapy will be the right diet, drinking regimen, sufficient rest and sleep. Bed rest is mandatory in order to prevent the development of complications.

Important are the following rules:

• exclude any physical activity at the time of treatment. Remember about bed rest;
• ventilate the room where the person is ill, three times during the day and at night;
• to eat foods rich in vitamins and trace elements, without sharp seasonings and sour sauces, with a minimum amount of salt;
• apply warming procedures to the area of ​​inflamed lymph nodes, inhalation treatment.

An important link in successful treatment is drug therapy, which the doctor should appoint after diagnosis. Such therapy includes the admission of such groups of drugs:

• sulfonamides;
• antibiotics (for irrigation, as well as in the form of tablets and injections);
• vitamin complexes;
• means for rinsing and lubricating the tonsils.

How quickly to cure purulent sore throat?

It's not a secret that most adult patients want to cure the disease as soon as possible in order to avoid working at a job in order to carry out urgent tasks, etc. But it should be remembered that purulent angina, under no circumstances should not be "on your feet". However hard it may be, work and other worries should be postponed until the moment of full recovery. Do not forget that health is a hundred times more important.

Is it possible to warm purulent sore throat?

Angina at the initial stages of development is quite successfully treated by the method of warming up the throat: staging hot compresses, using dry heat. When the process turns into a purulent form and there is a persistent increase in body temperature, the application of warming procedures in the neck should be significantly reduced.

They can be returned when the body temperature is normalized.

So, in what situations should you not purulent sore throat?

• High body temperature.
• Damage to the skin in places where the compress is supposed to be put (wounds, cuts, boils, allergic rashes, etc.).
• Vascular diseases, including pathology of cerebral vessels.
• Blood clotting disorders, thrombophlebitis.
• Concomitant acute infections.

In all other cases, warming procedures will have a beneficial effect and will help the healing process. It is especially important to resort to warming with increasing cervical and submandibular lymph nodes: this will improve blood and lymph flow and will help to cope with the disease more quickly.

To set up a compress with purulent tonsillitis use all kinds of liquids, most often in the form of alcohol solutions. Compress is prepared in this way:

• prepare gauze or cotton fabric folded several times;
• impregnate the tissue in a solution heated to body temperature;
• squeeze out excess fluid and apply tissue to the necessary area of ​​the skin;
• on top of the fabric apply polyethylene or food film so that the film protrudes beyond the boundaries of the tissue by 3-4 cm;
• compress wrap it with a woolen shawl or warm scarf.

Do not use pure alcohol for setting up a compress: the most optimal is the application of diluted vodka to 25-30 °. Compress on alcohol is often applied at night, or for a period of time not less than 5-6 hours.

If there is no vodka in the house, you can prepare a simple but no less effective saline solution - 2 full st. l. salt on a glass of warm water. The cloth moistened in solution is applied to the neck area, covered with a film and wrapped up warmly. As a rule, in the morning the pain in the throat is much easier.

Remedies for purulent sore throat

For the treatment of follicular or lacunar form of purulent sore throat, medicines are used in the form of rinses, lubrication and irrigation of the pharyngeal region. For internal use use of salicylic agents, sulfonamides and antibiotics, which in some cases (in severe cases) are also prescribed as injections.

Assign desensitizing drugs, vitamin complexes to strengthen the body and raise immunity.

If purulent angina occurs against the background of acute inflammation of the adenoids, then incidentally prescribed antibacterial drops in the nose, interferon.

Funds from purulent sore throat must necessarily be taken in a complex way: treatment with any one drug is not acceptable and will not give the expected positive result. Moreover, in the absence of treatment, recovery is also not expected. Remember that purulent sore throat is not so terrible in itself, how dangerous the complications of the disease can become.

Next, we'll talk in more detail about the drugs used to treat purulent sore throat.

Antibiotics for purulent sore throat

The choice of antibiotic for purulent angina affects the ability of the drug to act on a specific pathogen of infection (etiotropism), the peculiarity of the course of the disease, as well as the individual sensitivity of the patient's body to antibiotic therapy.

When striking streptococcus or pneumococcus often still use medications penicillin series, or semisynthetic penicillins of a wide range of effects (eg, ampicillin).

However, in some cases, among all possible strains of the pathogen, there may be separate forms that do not respond to the action of penicillin-resistant drugs of the penicillin series. In such cases, resort to the use of other drugs: cephalosporins, macrolides, etc.

Consider the most common antibiotics for purulent angina.

1. Sumamed is a macrolide antibiotic with broad antibacterial activity, rapidly creating high concentrations of the active substance in the infectious focus. In medical circles is better known as Azithromycin. It has a harmful effect on streptococci, staphylococci, gram (-) microorganisms, some anaerobes. Does not show activity to some microbes, resistant to the effects of erythromycin. The drug is taken relatively short course, as Sumamed for a long time remains in the blood, continuing to have a disastrous effect on the pathogenic flora. Assign the drug 1 time per day, preferably on an empty stomach, or 2 hours after eating, 0.5 g (2 tablets) for 3 to 5 days. When the drug is prescribed, the patient's sensitivity to antibiotics must be specified.
2. Amoxicillin is a penicillin β-lactam antibiotic that destroys gram (+) and gram (-) coccal flora, rod-like flora. It is acid-fast, perfectly digestible in the digestive tract. Most often, the drug is used 3 times a day for 0.5 g, in some cases, the dosage is increased to 3 g / day. Amoxicillin does not affect bacteria synthesizing penicillinase (a substance with destructive activity against penicillins).
3. Cefazolin is a cephalosporin β-lactam antibiotic that prevents the formation of a bacterial wall. With an injection, for the first hour, it has the most active effect on the microbial cell. The drug is used in the form of IM injections, previously dissolved in saline. On average, the daily dosage can be up to 4 g of cefazolin, with a single amount of 0.25 to 1 g.
4. Erythromycin is a macrolide antibiotic, similar in its nature to penicillin preparations. The drug has a wide spectrum of activity, but it quickly develops resistance to itself. For this reason, erythromycin is often prescribed in combination with other drugs, for example, tetracycline or sulfonamide series. Erythromycin is taken in tableted or encapsulated form, up to 0.25-0.5 g at a time, every 5 hours. The maximum dose of medication per day is 2 g. The drug can not be taken for a long time: bacteria quickly develop resistance to erythromycin.
5. Augmentin is a penicillin β-lactam antibiotic, a combination of amoxicillin and clavulanic acid. Due to the complex composition, the spectrum of activity of the drug increases, which makes it possible to use it for various bacterial infections. Adult patients take 1 tab. three times a day. In case of complications, an increase in the dose to 2 tab. three times a day. The maximum single dose of the drug is 1.2 g. The drug can not be used for more than 2 weeks, as well as during pregnancy and lactation.
6. Suprax is a cephalosporin antibiotic containing the active ingredient cefixime. Has a wide range of activities, including those related to aerobes and anaerobes, gram (+) and gram (-) bacteria. For adult patients, 400 mg of the drug are used per day, for one or two doses. The duration of therapy is determined individually, but not less than 10 days. The drug is not prescribed for pregnant and lactating women, as well as for elderly people and persons with impaired renal function.
7. Flemoxin is a penicillin antibiotic with an active component of amoxicillin. Flemoxin Soluteba with purulent angina is very active, due to rapid absorption in the digestive system and complete digestion. The peak level of the active substance is observed as early as 60 minutes after the drug is used. Tablets have a pleasant citrus flavor, they can be swallowed whole, divided into parts, to prepare from them a syrup or suspension. The daily dosage of the drug for an adult patient is 0.5 to 2 g per day. The duration of therapy is 1 week, but this may depend on the complexity of the patient's condition, as well as on the susceptibility of the bacteria to the active ingredient. Flemoxin necessarily take an additional 2 days after the relief of symptoms of purulent sore throat. The drug is not prescribed with a penchant for allergies to penicillins and cephalosporins. In pregnancy, Flemoxin is approved for use after consultation with a physician.
8. Amoxiclav is a penicillin combined antibiotic, the active components of which are represented by amoxicillin and clavulanic acid. Analogue of drugs Augmentin and Flemoxin. It is produced in the form of tablets, powder for making a suspension, or a powder for making an IV solution. Amoxiclav for adult patients is used in an amount of 1 g twice daily, with the maximum daily dosage of 6 g amoxicillin and 0.6 g clavulanic acid.
9. Ceftriaxone is a third generation cephalosporin antimicrobial agent. Use the drug for in / m and / in the injections. Before carrying out / m injections, ceftriaxone is diluted with sterile water in the proportion: 0.5 g per 2 ml, or 1 g per 3.5 ml. At a time, do not administer more than 1 g of ceftriaxone. For IV infusions dilution is carried out in the proportion: 0.5 g per 5 ml, or 1 g per 10 ml of water. The drug is usually well tolerated if there is no individual hypersensitivity to the drug.

In cases of severe purulent sore throat, adherence or presence of mixed type bacterial damage, and For enhanced exposure, two (or more rarely, more) antibiotic drugs can be prescribed simultaneously.

Remember that prolonged use of antibiotics can provoke intestinal dysbiosis and the development of fungal diseases, so at the same time and after antibiotic therapy it is recommended to take antifungal medications, as well as funds that normalize the intestinal microflora.

Than to rinse a purulent sore throat?

For rinses with purulent angina, a solution of furacilin, 0.1% solution of ethonia, 0.1% rivanol, sodium benzoate, decoction of sage leaf, root of cinquefoil, chamomile are most often used. You can irrigate with interferon, 0.05% levamisole, sodium bicarbonate. Rinsing is recommended to be done every hour, until pain disappears completely and signs of inflammation in the throat.

Rinse the purulent sore throat with the following means:

• solution of salt, soda and iodine - 3-4 drops of iodine, for 1 hour. l. table salt and soda for 200 ml of warm water;
• strong infusion of chamomile color from 1 hour. l. salt per 200 ml;
• a solution of furacilin 1: 5000;
• garlic water - to insist 2 cloves of garlic in 200 ml of boiling water for an hour;
• solution of apple cider vinegar - 1 hour. l. of this vinegar for 200 ml of warm water;
• beet juice with apple cider vinegar (200 ml of juice and 20 ml of vinegar);
• chlorophylliptom, Lugol's solution, Iodinol, Miramistin, Dioxydin, etc.

Consider some of the most popular rinse products.

1. Lugol is an antiseptic and antifungal solution based on molecular iodine. Produced in the form of a liquid or aerosol for the treatment of tonsils. The drug is used up to 6 times a day, optimally - 2-3 times a day. The course of treatment is from 3 to 5 days. Lugol is not used for hypersensitivity of the body to iodine preparations.
2. Peroxide is a known antiseptic, which inhibits the activity of organic clusters: protein, purulent and other secretions. Stops the bleeding of the capillaries. For rinsing of the throat and palatine tonsils apply 0.25% solution of hydrogen peroxide. When rinsing, you should beware of getting the drug on the eye area.
3. Miramistin is an effective antiseptic, it affects gram (-) and gram (+) bacteria, aerobes and anaerobes, microorganisms that form and do not form spores, as well as some fungi and viruses. Miramistin 0.01% solution is used to rinse the throat, up to 6 times a day. The duration of therapy depends on the dynamics of the disease. Sometimes there may be a burning sensation in the throat when using a medication. This is a temporary and normal phenomenon and does not require the withdrawal of the drug.
4. Furacilin is an antimicrobial agent of the nitrofuran series, it destroys the majority of gram (+) and gram (-) microorganisms. With purulent angina, furacilin is used as an aqueous solution in the proportion of 1: 5000.
5. Hexoral is an antiseptic, deodorizing and analgesic medication based on hexaethidine. It destroys fungi, gram (+) and gram (-) bacteria, as well as pseudomonads and protozoa. A 0.1% solution is used to rinse and treat the throat, 15 ml 2 times a day after ingestion. After rinsing it is advisable not to drink or take food for 1.5 hours. With prolonged use of Geksoral, a sensation of taste and a change in the shade of tooth enamel may be disturbed.
6. Streptocide is a proven sulfanilamide agent that destroys streptococci, Escherichia coli, pneumococci, meningococci, gonococci and other microbes. The drug is in the form of tablets that can be used for oral administration or for rinsing. In 200 ml of warm water we pour the crushed streptocid tablet, dissolve, mix. We use it to rinse the throat with purulent sore throat. If there is no possibility to rinse, it is allowed to just hold the streptocid tablet in the mouth until it is completely absorbed (1 tab. 3-4 times a day). This use of the drug is no less effective, but it has its disadvantage: the tablet has a bitter taste, so you will have to suffer. After resorption of the pill, drink and seize the medication can not be, otherwise its effect is canceled.
7. Tantum Verde is a non-steroidal anti-inflammatory and analgesic medication based on indozole. Produced in the form of tablets for resorption and solutions for rinsing the throat, as well as in the form of an aerosol for irrigation. For rinsing use 1 tbsp. l. solution of Tantum Verde every 2 hours. Do not swallow! Aerosol is used in an amount of 5-8 clicks every 2 hours. When using the drug, the appearance of unpleasant sensations in the oral cavity: this is considered normal and is not an excuse for refusing to use the drug.
8. Stopangin - a popular antiseptic, used in the form of an aerosol or a solution for gargling. Contains hexetidine and a number of essential oils: mint, anise, cloves, eucalyptus, etc. Stopangin is used immediately after a meal or 1-1.5 hours before it. For rinsing use 1 tbsp. l. solution, the procedure is repeated about 5 times a day. Duration of treatment - 7 days. The aerosol form of the drug is used to irrigate the pharyngeal region 3 times a day, trying to treat every amygdala. Avoid swallowing the drug and getting it on the eye area.

Tablets with purulent sore throat

If we talk about what tablets are taken with purulent angina, then the medication can be immediately divided into groups of drugs used:

• antibiotic therapy - initially prescribe antibiotics of a wide spectrum of activity. The main task of antibiotic therapy is to eliminate and neutralize the causative agent of the infection, and also to prevent the development of complications. Of the most common drugs are penicillin series (benzylpenicillin, amoxicillin, augmentin), cephalosporin series (ceftriaxone, cefazolin, etc.), macrolide antibiotics (clarithromycin, erythromycin). In some cases, it is recommended that a sample be made for the sensitivity of pathogens to antibiotic therapy: thus, the healing process can be accelerated and the risk of complications may be reduced;
• antihistamine therapy - used in antibiotic therapy in order to reduce the sensitization of the body and reduce the risk of allergic reactions. The drugs of choice for antihistamine treatment are suprastin, diazolin and dimedrol. In this case, suprastin has much fewer side effects, so it is prescribed more often (2-3 tablets each). per day for adults);
• antifungal therapy - is appointed to prevent antibiotic suppression of the beneficial microflora of the digestive tract. It is known that dysbacteriosis, which can occur after a course of antibiotic therapy, provokes not only the appearance of problems with digestion, but can significantly reduce immunity. And the fall of immune defense, in turn, will provoke the development of pathogenic flora and fungal infection in the body. Of the antifungal agents most often prescribed ketoconazole, fluconazole, levorin or nystatin. The most popular are the first two drugs, because they are more convenient to use. For example, fluconazole for prevention is used once a day for 50 mg throughout the course of antibiotic therapy. Nystatin or levorin - very popular drugs even 10-20 years ago - should be used more often: from 4 times a day for 1 tablet;
• immunotherapy - taking pills and funds to strengthen the body's defenses. Such medicines include echinacea, imudon, immunal, levamisole, cycloferon. Means for raising immunity are prescribed individually, given the degree of weakening of the body's defenses. Often appoint multivitamins and complex products, enriched with vitamins and minerals.

Inhalation with purulent sore throat

Inhalation with purulent angina can significantly alleviate the condition of the patient, but only if the inhalation treatment is not independent, but is performed against the background of drug therapy. In general, various solutions of antiseptics are used for inhalation procedures. Of the simplest, but no less effective solutions, use a solution of soda with iodine, chlorhexidine. In general, the list of time-tested solutions for inhalations is quite extensive. It can be infusions and decoctions of medicinal plants (chamomile, sage, eucalyptus, calendula, etc.), as well as a couple of boiled potatoes, turnips, etc. However, there are also special means for inhalations, which can be purchased at pharmacies.

1. Bioparox is an inhalant based on fusafungin - a polypeptide antibiotic. Destroys bacteria, both gram (+) and gram (-), and fungal infection. Effectively removes signs of an inflammatory reaction. Bioparox is used for inhalation treatment. Before use, a special nozzle for oral inhalations is put on the balloon, which should be inserted into the mouth, pressed with the lips and inhaled by pressing the base of the can. After injection, hold the breath for a few seconds so that the product is distributed over the surface of the respiratory tract. For adults, four injections of Bioparox 4 times a day are used. The duration of therapy is 1 week.
2. Ingalipt - an aerosol with essential oils, has an anti-inflammatory and antiseptic effect. Inhalation Ingaliptom is used from 3 to 4 times a day, for 2 seconds. The drug should be retained in the oral cavity as far as possible up to 8 minutes. The effect of the drug is palpable not only in the treatment of purulent sore throat, but also in stomatitis, bronchitis, laryngopharyngitis.

If purulent angina occurs with a strong increase in temperature, then during this period of inhalation it is better not to apply. With the normalization of temperature indicators, you can proceed to inhalation procedures.

Folk treatment of purulent sore throat

There are many folk recipes that speed up recovery with purulent angina. We will present to you the most common and effective recipes, so that everyone can choose the most suitable for themselves.

• Apply a mixture of fir and eucalyptus oil on tonsils (using a pipette or cotton swab) up to 5 times a day. If there is a burning sensation in the throat - not scary, for 15 minutes all is normalized.
• Dried pine needles to be filled up to the top in a glass jar and completely poured with quality vodka with the addition of salt (10 g of salt per 100 ml of vodka). Insist 1 week in a dark closet, stirring occasionally. This tincture is used for inhalation: 100 g of tincture is diluted in 1 liter of water and brought to a boil. Remove from the fire and breathe over couples, covered with a towel, about 15 minutes. The remedy can be stored for a long time and used as needed.
• Green pine cones are poured with honey and left for 2-3 months (1 kg of cones per 0.5 liters of honey). Next, honey consumes 1 tbsp. spoon before each meal.
• Freshly squeezed carrot juice diluted with warm water 1: 1, add 1 tbsp. l. honey. Use for gargling.
• In 200 ml freshly squeezed carrot juice squeeze 2 large or 3 small cloves of garlic and drink half an hour before meals twice a day for 3 days.
• Boil the boiled husks from the onions (2 tbsp. l. husks for 500 ml of water), use to rinse your throat.
• Bake a large onion, breathe over the vapors.
• Prepare a mixture of juice of colanchoe or aloe with warm water (1: 1), use to rinse your throat.
• Prepare the infusion: 2 tbsp. l. St. John's wort, 1 tbsp. l. oak bark to fill in a thermos and pour 700 ml of boiling water. Infuse for 2 hours, then filter and use to rinse your throat (every 2 hours).
• Prepare the infusion of sage (1 tbsp. l. raw materials for 200 ml of boiling water), used for frequent rinsing of the throat, with simultaneous ingestion of 100 ml three times a day for 20 minutes before meals.
• Birch buds are infused in boiling water for 1 hour. Use the infusion inside at 400-600 ml per day.

People's methods of treatment have a positive effect on the process of recovery. However, one should not rely solely on such treatment. Drug therapy should only be supplemented with folk recipes to avoid possible and dangerous complications.

Honey with purulent sore throat

Honey with purulent sore throat helps reduce the duration of the disease. There are facts that honey contains substances that destroy streptococcal flora - the source of pyogenic infection, so when purulent sore throat is simply an indispensable product.

Due to its rich composition, honey accelerates the flow of blood through the capillary network, accelerating the excretion of toxic substances and supplying the inflamed foci with nutrients and oxygen. Honey components strengthen immunity, tone up the body and set it up for recovery.

In the acute period of the disease, a very useful habit is the use of 1 h. l. natural honey after each meal: honey envelops the tonsils, neutralizing the bacterial flora and removing the inflammatory reaction. In addition, honey is recommended to be added to warm tea or milk (up to 40 ° C, at a higher temperature, honey loses its healing properties).

Treatment with honey can be contraindicated in allergies to beekeeping products, as well as children under 1 year of age and lactating women.

Honey can be used as a self-sufficient medicinal product, or in a mixture with other products:

• The honey has an excellent effect in the mixture with the juice from the green peel of the walnut. It is useful to add this mixture to tea or other warm drinks;
• a good effect is observed when gargling with a solution of honey in warm water (1: 3), several times a day;
• 1 tbsp. l. a high-quality butter mix with 1 tbsp. l. honey, add a pinch of baking soda, warm in a water bath until the foam forms. Drink the mixture warm, after or between meals.

Propolis with purulent angina

Propolis is no less effective than the honey. In this case, only propolis will bring benefits, which will cause a tingling in the oral cavity when used. If there is no such sensation, then, perhaps, propolis is not real.

Propolis with purulent angina is chewed after eating. One piece is the size of a fingernail. Qualitative propolis eliminates all the symptoms of purulent sore throat for a couple of days, without fear for the development of consequences.

In order to prepare an alcohol solution, it is necessary to mash 10 g of propolis and pour it 100 g of alcohol. Store in a dark place at room temperature for 7 days. Such a solution can be used for rinsing, for which 10 ml of the tincture is diluted with water (: 0). It is also useful to add tincture to tea (5-10 drops).

An excellent effect has propolis oil: 10 parts of cocoa butter is heated in a water bath, add 1 part propolis (crushed), stir and cool. Take 1 hour. l. three times a day one hour after meals and at night.

The best effect is provided by the integrated use of propolis and honey.

Lemon with purulent sore throat

Lemon with purulent sore throat will help relieve the symptoms of sore throat and stabilize the temperature. However, do not just use tea with lemon. With the initial symptoms of pain in the throat should take a medium-sized lemon, rinse it in boiling water and eat at a time, without sugar. If this is difficult for you, you can limit yourself to using ½ lemon, then after 2 hours - the second half, after which another 1 hour do not eat any food and drinks.

You can also do the following: we clean the lemon from the peel and divide into slices (as a mandarin). For every hour slowly dissolving in the mouth of one lemon slice.

Some people can not eat lemon without sugar. In this case, you can recommend natural honey: we pour a slice of lemon and dissolve in the mouth.

What is the secret of the useful effect of lemon in purulent sore throat? First, the lemon is known to increase immunity. Secondly, the combination of vitamin C and citric acid complicates the existence of pathogenic flora: in such an acidic environment even streptococcal infection dies.

Than to treat a purulent angina at the child?

With the development of purulent sore throat, the child needs adequate help from a doctor and antibiotic therapy. Small children under 3 years old should be treated in a hospital under the supervision of a pediatrician. If the child is older and is treated at home, then he must strictly comply with bed rest.

It is unacceptable to experiment on a child, checking folk methods and means: as a rule, most of these methods are designed for adult patients. The untimely treatment of childhood purulent sore throat is fraught with extremely negative consequences.

Why do not experts advise to resort to independent treatment of purulent sore throat in children? The fact is that many antimicrobial agents are contraindicated in childhood, and even more difficult to calculate the dosage for children, but it is much easier to harm the child with wrong treatment. Use sprays and aerosols for inhalation in small children is contraindicated, as this can cause laryngospasm.

In addition, babies are simply not yet able to rinse their throats, keep a pill or solution in their mouths, and local treatment in children is usually reduced to external processing of the glands.

When purulent angina child should often offer warm tea with honey or raspberry (currant, cranberry) jam. Since swallowing the baby becomes more difficult, it is recommended to feed it with mashed and liquid warm food: first dishes, mashed potatoes, soufflé, porridges. In all other respects, follow the doctor's recommendations and adhere to the prescribed treatment regimen.

What can I eat with a purulent sore throat?

When purulent sore throat is recommended to adhere to easily assimilated, vitamin-enriched diet. Since the disease has sore throat and a problem with ingestion of food, the dishes should be consumed liquid, rubbed and semi-liquid, in a warm state (not cold and not hot). It is necessary to exclude foods that irritate the inflamed mucous: spices and condiments, cold and too hot dishes and drinks, alcohol, rough food.

Priority products for purulent sore throat are:

• dishes from cottage cheese, puddings, eggs, puree from vegetables (potatoes, carrots, pumpkin, cauliflower, celery), mashed boiled meat, yoghurt, oatmeal, semolina and rice porridge;
• broths from meat, chicken and fish;
• warm freshly squeezed juices, compotes, jelly, jelly, fruit mousses, bananas;
• tea with lemon, milk with honey, herbal teas (preferably black currant, raspberry or rosehip tea);
• honey and bee products.

The following products are not recommended:

• bakery products;
• preservation, pickled mushrooms, pickled cucumbers and tomatoes;
• chocolate, cakes and cakes with cream, ice cream;
• alcohol;
• carbonated drinks;
• fried and smoked products.

Take food in small portions, but often. Products for cooking dishes are crushed, wiped, served only in boiled or steam form.

It is recommended to drink more warm liquid.

In addition to treatment

Physiotherapy with angina Antibiotics for angina Antibiotics for angina in children

Prevention of purulent sore throat

Given the possible development of adverse effects of purulent sore throat, it is recommended to prevent the disease. This can be done by observing some simple rules:

• dress according to the weather, not overheating and not supercooling. Do not eat cold food and drinks in the cold season. Do not swim in cold water, avoid drafts;
• accustom yourself to cold conditions gradually - take a contrast shower, go in for sports outdoors;
• regularly visit the dentist, promptly treat caries;
• fully and diversely eat, include vegetables and fruits in the diet;
• Do not smoke or abuse alcohol.

If the patient appears in the house, then it must be isolated from the rest, to allocate individual dishes and utensils for him. It is recommended that households wear gauze dressings and ventilate the room once in 2 hours.

When epidemics of colds in the autumn-spring period are recommended to take complex multivitamin drugs and drugs that activate immune defense (interferon, bronchomunal, immunal, echinacea extract).

Prognosis of purulent sore throat

The prognosis of a purulent sore throat can be favorable under condition of carrying out of appropriate treatment. If such treatment was not available, or if it was performed with impairments, serious general complications such as articular rheumatism, endocarditis, nephritis or sepsis can occur. Therefore, predict the outcome of the disease with caution, especially with repeated angina or chronic course of the process.

Purulent angina is not an excuse to rely on one's own knowledge and conduct experiments on the body: self-medication or an unauthorized change in the treatment schedule prescribed by the doctor will not improve the prognosis of the disease.

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Chronic tonsillitis - Overview of information

Chronic tonsillitis is an active chronic exacerbation of the chronic inflammatory focus of infection in the palatine tonsils with a common infectious allergic reaction. Infectious-allergic reaction is caused by constant intoxication from the tonsillar focus of infection, increases with exacerbation of the process. It disrupts the normal functioning of the whole organism and burdens the course of common diseases, often itself becomes the cause of many common diseases, such as rheumatism, joints, kidney disease, etc.

Chronic tonsillitis with good reason can be called a "disease of the 20th century", "successfully" overstepped the turn of the 21st century. and still constitutes one of the main problems not only of otorhinolaryngology, but also of many other clinical disciplines, in pathogenesis of which the main role is played by allergy, focal infection and deficient states of local and systemic immunity. However, the basic factor that is of particular importance in the occurrence of this disease, according to many authors, is the genetic regulation of the immune response of palatine tonsils to the effect of specific antigens. On average, according to a survey of different population groups, in the USSR in the second quarter of the 20th century, the incidence of chronic tonsillitis fluctuated within 4-10%, and already in the third quarter of this century from the message of IB Soldatov on VII Congress of Otorhinolaryngologists of the USSR (Tbilisi, 1975) it followed that this indicator, depending on the region of the country, increased to 15.8-31.1%. According to VR Gofman et al. (1984), chronic tonsillitis affects 5-6% of adults and 10-12% of children.

ICD-10 code

J35.0 Chronic tonsillitis.

ICD-10 code J35.0 Chronic tonsillitis

Epidemiology of chronic tonsillitis

According to domestic and foreign authors, the prevalence of chronic tonsillitis among the population varies widely: in adults it ranges from 5-6 to 37%, in children from 15 to 63%. It must be borne in mind that between the exacerbations, as well as with the bezangyne form of chronic tonsillitis, the symptoms of the disease are in many respects habitual and little or no concern for the patient, which significantly understates the actual prevalence of the disease. Often chronic tonsillitis is revealed only in connection with the examination of the patient for some other disease in the development of which chronic tonsillitis plays a big role. In many cases, chronic tonsillitis, while remaining unrecognized, has all the negative factors of tonsillar focal infection, weakens human health, worsens the quality of life.

Causes of chronic tonsillitis

The cause of chronic tonsillitis - a pathological transformation (the development of chronic inflammation) of the physiological process the formation of immunity in the tissues of the palatine tonsils, where the normally limited process of inflammation stimulates the production of antibodies.

Palatine tonsils - part of the immune system, which consists of three barriers: lymph-blood (bone marrow), lympho-interstitial (lymph nodes) and lymphoid-elithelial (lymphoid aggregations, including tonsils, in the mucous membrane of various organs: pharynx, larynx, trachea and bronchi, intestines). The mass of palatine tonsils constitutes an insignificant part (about 0.01) of the lymphoid apparatus of the immune system.

Symptoms of chronic tonsillitis

One of the most reliable signs of chronic tonsillitis is the presence of angina and anamnesis. In this case, the patient must always find out how an increase in body temperature is accompanied by pain in the throat and for how long. Angina in chronic tonsillitis can be pronounced (severe sore throat when swallowing, significant hyperemia of the mucous membrane of the pharynx, with purulent attributes on the palatine tonsils according to the forms, febrile temperature of the body, etc.), but in adults it often happens that there is no such classic symptomatology of angina. In such cases, exacerbations of chronic tonsillitis occur without any acute severity of all symptoms: the temperature corresponds to a small subfebrile values ​​(37.2-37.4 C), sore throat when swallowing is insignificant, a moderate deterioration in overall well-being is observed. The duration of the disease is usually 3-4 days.

Where does it hurt?

Sore throat Sore throat with swallowing

Screening

It is necessary to conduct screening for chronic tonsillitis in patients with rheumatism, cardiovascular diseases, joint diseases, kidneys is advisable also bear in mind that with common chronic diseases the presence of chronic tonsillitis in one way or another can activate these diseases as a chronic focal infection, therefore, in these cases, an examination for chronic tonsillitis is also necessary. \

Diagnosis of chronic tonsillitis

The diagnosis of chronic tonsillitis is established on the basis of subjective and objective signs of the disease.

Toxico-allergic form is always accompanied by regional lymphadenitis - an increase in lymph nodes at the corners of the lower jaw and in front of the sternocleidomastoid muscle. Along with the definition of enlarged lymph nodes, it is necessary to note their soreness in palpation, the presence of which indicates involvement in the toxic-allergic process. Of course, that for clinical evaluation it is necessary to exclude other foci of infection in this region (teeth, gums, sinus nasal sinuses, etc.).

What it is necessary to survey?

Tonsils of the palatine tonsil

What tests are needed?

Antistreptolysin O in the serum Antibodies to streptococcus A, B, C, D, F, G in the blood Staphylococcal infections: antibodies to staphylococci in the serum

Who to contact?

ENT - doctor Otolaryngologist

Treatment of 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.

With toxic-allergic form I degree, conservative treatment of chronic tonsillitis can still be carried out, however, the activity 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.

In addition to treatment

Tonsillitis: treatment Antibiotics for tonsillitis Removal of tonsils (tonsillectomy) Physiotherapy with angina Antibiotics for angina Antibiotics for angina in children Than to treat? Tsebopim

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Hypertrophy of palatine tonsils

Hypertrophy of the palatine tonsils (hypertrophic tonsillitis), like hypertrophy of the pharyngeal tonsil often occurs in childhood as a manifestation of the general lymphatic constitution. In hypertrophied tonsils, in most cases, there are no inflammatory changes.

ICD-10 code

Surgical diseases of tonsils and adenoids.

• J31.1 Hypertrophy of the tonsils (enlargement of the tonsils).
• J35.3 Hypertrophy of tonsils with hypertrophy of adenoids.
• J35.8 Other chronic diseases of tonsils and adenoids,
• J35.9 Chronic disease of the tonsils and adenoids, unspecified.

Code for ICD-10 J35.1 Hypertrophy of tonsils J35.3 Hypertrophy of tonsils with hypertrophy of adenoids J35 Chronic diseases of tonsils and adenoids

Epidemiology of hypertrophy of palatine tonsils

Observed mainly in early childhood against the background of age-related physiological immunodeficiency.

Causes of hypertrophy of palatine tonsils

Hypertrophy of palatine tonsils is considered as an immunoreactin state, serving as one of the manifestations of mobilization of compensatory the possibilities of the lymphoid pharyngeal ring in the process of adaptation of the organism to the constantly changing conditions of life. This is facilitated by the constant cooling of the tonsils and the result of oral breathing with hypertrophy of adenoids, especially in winter: Irritating effect on palatine tonsils has an infected mucus from the nasopharynx with a recurrent course of adenoiditis. Hyperplasia is promoted by repeated inflammatory diseases of the nasal and oropharynx, childhood infectious diseases, malnutrition, poor living conditions and other factors that reduce the protective functions of the body. Of known importance are the lymphatic-hypoplastic anomaly of the constitution, endocrine disorders, especially the hypofunction of the cortex of hypocrites, hypovitaminosis, long-term exposure to small doses of radiation. At the heart of hypertrophy of lymphoid tissue of the tonsils is an increase in the number of lymphoid cells, in particular, excessive proliferation of immature T-lymphocytes.

Pathogenesis of hypertrophy of palatine tonsils

A variety of factors leading to hypertrophy of the palatine tonsils are noted.

• In children under 3 years of age, there is a T helper insufficiency that does not allow adequate differentiation of B-lymphocytes into plasmocytes and, accordingly, production of complete antibodies. Infringements in immune system as a result of frequent infectious diseases against the background of physiological immunodeficiency in children of early age, constant antigenic bacterial and viral stimulation lead to compensatory enlargement of the lymphoid tissue. The critical age of the child's immunological reactivity is considered to be 4-6 years old. corresponding to the greatest number of preventive vaccinations in progress.
• Hypertrophy of palatine tonsils is defined as a manifestation of a specific immunopathological predisposition of a child's organism in the form lymphatic diathesis (lymphatics), which is based on a genetic predisposition to insufficiency of the lymphoid system.
• The true hypertrophy of the lymphoid tissue of the tonsils is considered as the main sign of lymphatic diathesis, which causes an increase in the number of lymphatic cells, different in structure and function.
• The main role in the formation of hypertrophy of the palatine tonsils is given to allergic reactions in the lymphoid tissue of the tonsils, which confirms the detection in the removed fragments of hypertrophied tonsils of a large number of mast cells in various stages of degranulation, plasmatization of lymphoid tissue and large clusters of eosinophils.

Hypertrophy of palatine tonsils - reversible process, in adolescents begins the age-related involution of lymphoid tissue.

Symptoms of hypertrophy of palatine tonsils

Hypertrophy of palatine tonsils is often combined with hypertrophy of the entire pharyngeal lymphoid ring, especially with pharyngeal tonsillitis.

The sharply enlarged palatine tonsils look different. They can be on the foot, slightly adjacent to the palatine arch, with a smooth surface, free lacunae. Most enlarged palatine tonsils are densely-elastic consistency; in some cases they are spread out, of a soft consistency, with a developed lower pole, without signs of inflammation and adhesion to the palatine arch, have a pale yellowish or bright pink color, bordered by palatine arch and triangular fold below, lacunae of the usual structure, not widened.

Histologically, the prevalence of lymphoid tissue hyperplasia with an increase in the area of ​​follicles and the number of mitoses in the absence of macrophages and plasma cells.

With pronounced hypertrophy, palatine tonsils serve as a significant obstacle to breathing and swallowing, which leads to severe dysphonia, dysphagia and noisy breathing. Difficult formation of speech, it can be expressed nasal and illegible speech, improper pronunciation of some consonants. The development of dysphonia is explained by the change in the shape of the resonating cavities (the extension tube), and by the restriction of the mobility of the soft palate, especially with intramural hypertrophy of the palatine tonsils, when a significant mass of them is hidden in the depth of the arch. Characterized by restless sleep due to hypoxia, snoring in the sleep, attacks of obstructive sleep apnea due to relaxation of the throat muscles, night cough. Due to tubal dysfunction, hearing is broken, exudative otitis media is formed.

Where does it hurt?

A sore throat

Classification of hypertrophy of palatine tonsils

There are three degrees of hypertrophy of the tonsils. At the first degree of hypertrophy the palatine tonsils occupy the outer third of the distance from the palatine arch to the middle line of the pharynx, with degree II occupy 2/3 of this distance and at the third degree the tonsils touch each other, and sometimes they go for each other,

According to the etiopathogenetic feature, three forms of hypertrophy of palatine tonsils are distinguished: hypertrophic, inflammatory and hypertrophic-allergic.

Screening

Inspection of the oral cavity with pharyngoscopy at any stage of medical care.

Diagnosis of hypertrophy of palatine tonsils

In a history of persistent violation of breathing and swallowing in the absence of angina and repeated respiratory-viral diseases.

Physical examination

Ultrasound of the pharynx.

Laboratory research

Determination of the species composition of microflora with the study of its sensitivity to the drugs used, clinical analyzes of blood, urine, the study of the acid-base composition of the blood.

Instrumental research

Pharyngoscopy, rigid endoscopy and fibrosnapping.

Differential diagnosis of hypertrophy of palatine tonsils

Hypertrophy of palatine tonsils is possible with tuberculosis, infectious granulomas of the pharynx, tumors of the tonsils, leukemia and lymphogranulomatosis.

Indications for consultation of other specialists

When preparing for the operation of partial removal of the tonsils, a check-up with the therapist is necessary.

Indications for hospitalization

No, since the operation of tonsillotomy is usually performed in the outpatient clinic.

What it is necessary to survey?

Tonsils Pharyngeal (adenoid) tonsil

How to inspect?

Throat examination

Who to contact?

ENT - doctor Otolaryngologist

Non-medicamentous treatment of hypertrophy of palatine tonsils

KUF-tube for tonsils, ozonotherapy. Sanatorium treatment - climatotherapy (climatic and balneogryazevye resorts in the warm season), a combination of methods of local treatment of palatine tonsils with a general treatment of natural physical factors of the resort: ultrasound therapy for the projection of palatine tonsils with the help of the ENT-3 device; vacuum hydrotherapy of palatine tonsils with mineral species, herbal preparations and animal origin, possessing antiseptic properties; gargling; Irrigation of the tonsils with sea or mineral water; inhalation with carbonic mineral waters, mud solution, phytoncides, sage broths, chamomile, vegetable oils; peloidotherapy - mud applications on the submandibular and collar area; electrophoresis of the mud solution on the submandibular area; ultraphonophoresis with mud on the projection of palatine tonsils, laser endopharyngeal; oxygenation of the pharynx - oxygen cocktails, UHF and UHF on the submandibular lymph nodes.

Medical treatment of hypertrophy of palatine tonsils

With mildly expressed forms of hypertrophy of the palatine tonsils, astringent and cauterizing agents are used - rinsing with a solution of tannin (1: 1000). antiseptics, lubrication with 2-5% silver nitrate solution. Inside prescribe lymphotropic drugs: umcalor, lymphomyositis, tonzigon, tonsilotren.

Surgical treatment of hypertrophy of palatine tonsils

In most cases, the hypertrophied parts of the palatine tonsils are removed simultaneously with the adenoids. Tonsillotomy is performed with the help of Mathieu's tonsillitis.

For the removal of such tonsils at different times, various methods of mechanical and physical action were developed. A mechanical method for the removal of hypertrophic palatine tonsils is tonsillotomy, for which the use of tonsillitis Mathieu, which is a special device consisting of a ring-shaped knife, a double "harpoon" for fixing the palatine tonsil, one fixed handle for the first finger and two fingers for the II and III fingers, the tension of which drives the tonzillotoma knife that cuts the palatine tonsil.

Tonsillotomy with the help of Mathieu's tonsillitis is performed by the following form. After application anesthesia, any of the clamps with the cremalier is passed into the ring-shaped knife and tightly clamped to the free portion of the amygdala; the knife ring is threaded on the tonsil as deeply as possible, and the "harpoon" is injected into its body, then the amygdala is quickly cut off. If the amygdala is welded to the bow, then they are previously separated from the body of the amygdala, so that they are not damaged during tonsillotomy, and then proceed as described above. Bleeding at this intervention is insignificant and quickly stops by the usual pressing of the cotton ball to the wound surface.

French authors have come up with a way to lump or bite the palatine tonsil, used instead of tonsillotomy, when the last It is impossible to produce because of the small size of the tonsils, and tonsillectomy is undesirable, for example, in young children. The operation consists in the fact that the amygdala is bitten off in parts by a round rump, while special attention is paid to removing the upper pole, so how exactly in it, according to many clinicians, most of the pathological elements that form the basis of a chronic foci of infection are concentrated.

In addition to the methods of tonsillotomy described above, at different times, other methods of destructive treatment of chronic tonsillitis and the removal of "extra" tissue of the tonsils were developed. So, back in the beginning of XX century. the French otorhinolaryngologist E.Escat (1908) developed a technique for electromy of tonsils using an incandescent loop connected to an electric current source. The loop was worn on the body of the amygdala, when the electric current was turned on it was heated to red color and burned it by gradually squeezing the tonsils. Later this method was used in the US with the only difference that the principle of diathermocoagulation was used as a destructive factor, based on the ability of high frequency current to heat tissues to a temperature at which irreversible coagulation of proteins occurs. Gradual compression of the loop led to the burning of the amygdala tissue and its separation from the bulk.

The principle of diathermocoagulation was used to develop deep coagulation of palatine tonsils along its entire surface. Despite the apparent advantages of this method (bloodlessness, the ability to regenerate the remaining lymphoid tissue) before the ones listed above, it is not without a number of significant drawbacks: never the exact depth of coagulation is not known, it is difficult to dose it, the risk of coagulation of large arteries is high, followed by anrrosis bleeding, it is impossible to radically remove all tonsils. Under the cover of the coagulated tissue there are always "operating" lacunae containing microorganisms and products of their activity. Cysts are formed from the arising closed lacunary spaces, and so on. On the same principle, the cryosurgery of palatine tonsils, which was received at the end of the 20th century, was founded. fairly widespread.

Further management

Toilet of the mouth, gargling with antiseptic means, timely sanitation of teeth.

In addition to treatment

Removal of tonsils (tonsillectomy)

Prevention of hypertrophy of the tonsils

Timely removal of adenoids, after which the irritant effect on palatine tonsils of infected mucus from the nasopharynx ceases with a frequently recurring course of adenoiditis, free nasal breathing and the protective mechanisms of the nasal cavity, the child ceases to breathe through the mouth, the tonsils are not subjected to constant cooling and infection, the sensitization of the organism decreases.

Forecast

After tonsillotomy, normal breathing, swallowing and the formation of legible speech in young children are restored. With a moderate hypertrophy of the tonsils, usually after a period of 10 years, these "physiologically hypertrophied tonsils undergo reverse development. Sometimes this involution is delayed, then in adults it is possible to observe relatively large tonsils without inflammatory phenomena. If the tonsillar hypertrophy develops as a consequence of repeated inflammatory processes, the further development and shrinking of the connective tissue lead to a decrease and atrophy of the tonsils.

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Pharyngitis - Overview of Information

Pharyngitis (lat. pharyngitis) (pharyngal catarrh) - acute or chronic inflammation of the lymphoid tissues and pharyngeal mucosa that occurs in a chronic or acute form. The disease of pharyngitis is accompanied by perspiration, severe discomfort and pain when swallowing. Pharyngitis - treatment is carried out both traditional and folk medicine.

ICD-10 code

• J00 Acute pharyngitis.
• J31.2 Chronic pharyngitis

According to the international classification of diseases, pharyngitis is isolated from tonsillitis, however in the literature it is enough often use the unifying term "tonsillopharyngitis", which takes into account a combination of these two pathological conditions.

ICD-10 code J02 Acute pharyngitis J31.2 Chronic pharyngitis

Epidemiology of pharyngitis

Pharyngitis is very common in middle-aged and elderly people. Children, as a rule, suffer from chronic pharyngitis rarely. In men, pharyngitis is observed more often. However, women are dominated by subatrophic forms of the disease.

Screening

Identification of persons with this disease is carried out taking into account the characteristic complaints, anamnesis of the patient and the results of pharyngoscopy.

What causes pharyngitis?

The main factor provoking the appearance of pharyngitis is contaminated and cold air, nicotine, other harmful substances. Pharyngitis often occurs along with tonsillitis (quite simply, angina) and can be caused by penetration into the throat of various infections.

Common causes of the disease are cold or dirty air, the aggressive influence of such irritants as tobacco or alcoholic beverages, pathogenic bacteria: staphylococci, streptococci, influenza virus and fungus "candida". Often inflammation of the mucosa develops in the presence of infection in the oral cavity and nasopharynx: caries, rhinitis.

Often, chronic inflammation is not a separate disease, it is the pathology of other internal diseases: pancreatitis, gastritis, cholecystitis.

Chronic inflammation also often occurs with difficulty breathing of the nose. The reason for this can be frequent and irrational use of nasal drops.

The development of chronic pharyngitis is facilitated by:

• Frequent exposure to mucous factors such as: hot or smoky air, dust, chemical. matter
• Frequent use of decongestants, regular nasal congestion.
• Allergic manifestations
• Vitamin A deficiency in the body
• Smoking and alcohol
• Diseases of the endocrine system
• Cardiac, renal and pulmonary diseases, diabetes

Diagnosis of pharyngitis is carried out by examination, and if necessary, a smear of the mucosa is performed.

Acute pharyngitis is divided into:

• Traumatic
• Virus-bacterial
• Allergic (due to the stimulus)
• Chronic pharyngitis:
• Atrophic
• Catarrhal
• Granuleous

One of the most common forms of pharyngitis is catarrhal, caused by catarrhal diseases. The causative agents of the disease in 70% are rhinoviruses, adenoviruses, parainfluenza viruses and others. According to medical research, the most active agent of inflammation is the rhinovirus, which is especially evident during the autumn and spring epidemics.

Pharyngitis - Causes and pathogenesis

Symptoms of pharyngitis

The clinical form of acute inflammation is increased dryness in the throat, pershenia, tenderness in the pharynx. There may be malaise, fatigue, fever. Cervical lymph nodes are enlarged, which can be determined by palpation.

It should be borne in mind that acute inflammation can cause other, more serious infectious diseases: rubella, measles, scarlet fever.

Symptoms of chronic pharyngitis differ somewhat from the early form of the disease. There is no general malaise, and body temperature often remains normal. The disease is manifested by pain in the throat, dryness and sensation of a lump in the throat, which causes a desire to clear your throat. There is a dry, persistent cough. Chronic pharyngitis disturbs a restful sleep, since the mucus on the back of the throat requires constant swallowing.

With acute pharyngitis and exacerbation of a chronic patient, notes unpleasant sensations in the nasopharynx: burning, dryness, often the accumulation of viscous mucus, perspiration and sometimes mild pain in the throat (especially with an "empty throat"). When the inflammation spreads to the mucous membrane of the auditory tubes, there is congestion and pain in the ears. Often, a headache with localization in the occipital areas disturbs, there is difficulty in nasal breathing and nasal, especially in children. General symptoms are usually not very pronounced. The patient may be troubled by weakness, headache; a slight increase in temperature is possible. Sometimes there is an increase in regional lymph nodes, moderately painful on palpation.

Chronic pharyngitis is not characterized by an increase in temperature and a significant deterioration in the general condition. Catarrhal and hypertrophic forms of inflammation are characterized by a sensation of perspiration, tickling, sadness, awkwardness in the throat swallowing, the sensation of a foreign body that does not interfere with the reception of food, but which often causes swallowing. With hypertrophic pharyngitis, all these phenomena are more pronounced than with the catarrhal form of the disease. Sometimes there are complaints about laying the ears, which disappears after several swallowing movements,

The main complaints with atrophic pharyngitis are a feeling of dryness in the throat, often a difficulty in swallowing, especially in the so-called empty throat, and often unpleasant odors from the mouth. Patients often have a desire to drink a sip of water, especially with prolonged conversation. It should be noted that not always complaints of the patient correspond to the severity of the process: in some cases, with minor pathological changes and even in the presence of a visible absence, a number of unpleasant side effects that cause the patient to be treated for a long time and persistently, while in others, on the contrary, pronounced changes in the mucous membrane proceed almost imperceptibly.

Lateral pharyngitis, or acute inflammation of the lateral pharynx

Lateral pharyngitis is often combined with inflammation of the lymphadenoid granules of the posterior pharyngeal wall (angina pharyngis granulosa). Usually, these lymphoid formations compensate for compensatory hypertrophy after removal of the palatine tonsils, and if the pathogenic microbiota nests in them, then under certain risk factors and provoking causes its virulence to increase, and inflammation of these formations arises, "serving," according to the expression of B.S. Preobrazhensky, "as if equivalent to the tonsillitis of tonsils in non-operated ones."

Most inflammation has a one-sided or predominantly one-sided character, when the lateral roller is involved in the process again.

With pharyngoscopy, the lateral ridges appear enlarged, hyperemic, can be covered with pseudo-film, which can be easily removed by a cotton swab. The general clinical picture resembles that of catarrhal angina.

Treatment: sulfonamides, antiseptic rinses, bed rest for 3-5 days, depending on the severity of the clinical picture.

Pharyngitis - Symptoms

Where does it hurt?

Sore throat Sore throat during pregnancy Sore throat with swallowing Sore throat in children

What's bothering you?

Lump in the throat

Classification of pharyngitis

From the anatomical point of view, the pharynx is divided into three sections - the upper (nasopharynx), the middle (oropharynx), and the lower one (the laryngopharynx). Morphological changes in the mucosa during chronic pharyngitis usually have a predominant localization in one of the anatomical sections of the pharynx, so the inflammatory process developing here can be divided into nasopharyngitis, mesopharyngitis, hypopharyngitis. This division can be conditional, because the inflammatory process often infects the mucous membrane diffusely and has a migratory character.

Acute pharyngitis is divided into viral, bacterial, fungal and allergic. Viral pharyngitis is often a companion of any acute respiratory viral infection. On examination, reddening, loose surface of the pharynx are clearly visible, sometimes an increase in palatine tonsils is observed. Symptoms: dry cough, swallowing in the pharynx, enlarged lymph nodes, temperature can also increase. In more rare cases, bacterial pharyngitis may occur, which causes strepto-, staphylococcus and pneumococci. Fungal pharyngitis, or pharyngicosis, occurs when the mucous pharynx is affected by fungal pathogens. The impetus for the appearance of pharyngicosis can be such pathologies as diabetes, blood diseases, as well as intestinal disorders, etc. Allergic pharyngitis is characterized by frequent sneezing and lacrimation.

Acute pharyngitis can cause uncomfortable sensations in the ears, cervical lymph nodes are often increased.

Chronic pharyngitis can occur without a rise in temperature, the general condition is often normal.

Chronic pharyngitis is usually classified according to the nature of morphological changes developing in the mucous membrane of the pharynx, in connection with which catarrhal (simple), hypertrophic and atrophic (subatrophic) pharyngitis is isolated.

These forms of chronic inflammation often combine. Thus, the presence of diffuse atrophic changes in the mucosa can be combined with focal hyperplasia of the lymphoid tissue of the posterior pharyngeal wall.

Diagnosis of pharyngitis

With pharyngoscopy in a patient with acute pharyngitis and exacerbation of chronic inflammation, the mucous membrane of the pharynx is hyperemic, edematous.

The process can spread to the palatine arches, tonsils: the palatine curtain and the tongue can be swollen, enlarged in volume. Often, on the posterior and lateral walls of the pharynx, separate lymphadenoid follicles are visible in the form of bright red rounded elevations (granules) - granulose pharyngitis.

Pharyngitis - Diagnosis

What it is necessary to survey?

Pharynx Swallow (adenoid) tonsil

How to inspect?

X-ray of the larynx and pharynx

What tests are needed?

Antistreptolysin O in the serum Antibodies to streptococcus A, B, C, D, F, G in the blood Staphylococcal infections: antibodies to staphylococci in the serum

Who to contact?

ENT - doctor Otolaryngologist

Treatment of pharyngitis

If the pharyngitis disease has no pronounced manifestations, then symptomatic treatment is prescribed, which includes an easy diet, warming compresses, inhalations, rinses, foot baths. Any aggressive effect on the mucosa should be discontinued. The list of taboos includes smoking, dry, cold food. The pharyngitis treatment is performed without antibiotics, if the inflammation does not have complications.

The list of antibiotics prescribed for treatment includes several antiseptic drugs: ambazone, chlorhexidine, thymol, iodine preparations, etc. Anesthetics are used: lidocaine and tetracaine. Also natural, natural antiseptics, ascorbic acid, interferon can be prescribed.

Antimicrobials are rinses, inhalations, tablets and lozenges for absorption. Requirements for this category of drugs:

• Absence of toxic effect, low allergenicity
• A broad antimicrobial effect that has antiviral activity
• Absence of mucosal irritants

Most tablets and candies have low activity and are prescribed for mild illness. In addition, many drugs have toxic chlorhexidine, so you should limit the intake of these drugs, especially in children.

Some medications have a high allergenicity and can not be prescribed to allergic patients. Such preparations are propolis, as well as vegetable antiseptics and essential oils.

Folk treatment of pharyngitis

If you do not have allergies to propolis, you can conduct such treatment:

Lubricate the mucosa of the pharynx and nose within 2 weeks. It is necessary to lubricate only the cavity cleared of the mucus, with alcohol impregnated with propolis. Such a prescription has become very popular due to such data: 75% of patients recovered, the others felt a significant improvement.

For treatment, a 10% propolis solution will be needed, 35 drops of which are diluted in a quarter of a glass and drip 4 drops into the nose, drawing in deeply. It should be noted that with such treatment there is soreness, but it quickly goes away.

The effectiveness of this treatment is that, by lubricating such a solution with a throat and dripping the nose, the gastrointestinal tract is simultaneously cured.

Collect the medicinal bouquet: eucalyptus, calendula, sage - each according to a teaspoonful. It is necessary to pour the herbs 300 ml of boiling water and to insist 25 minutes. In hot herbal tea, add half a spoonful of honey and gargle. After 4-5 rinses, the patient marks a significant improvement.

If you are concerned about a dry, painful cough, garlic and honey will help you. Cut the half a cup of garlic, pour it with honey and put on a small fire. It is necessary to simmer, stirring for 30 minutes. Take a dessert spoon after eating.

Pharyngitis - Treatment

In addition to treatment

Antibiotics for pharyngitis Than to treat? Seabuckthorn oil Cepopim Thymus Grass Salvia DR. THISS

How to prevent pharyngitis?

Acute pharyngitis can be prevented if prevention is carried out taking into account the main pathogenetic factors. It is necessary to exclude hypothermia of the body and the effect of drafts, as well as irritation of the mucous membrane of the pharynx by agents of an alimentary nature. Preventative measures are represented by general and local hardening of the organism by cold, timely treatment of purulent-inflammatory diseases of the nasal cavity, paranasal sinuses and nasopharynx. Important is the sanation of the mouth.

Prevention of chronic pharyngitis, first of all, elimination of local and general causes of the disease. It is necessary to exclude the influence of possible irritating factors, such as smoking, dust and gas contamination of the air, irritating food, etc. It should be appropriate treatment of common chronic diseases, including diseases of internal organs (heart, liver, kidneys, gastrointestinal tract, urinary tract), metabolic disorders, since the development and flow of chronic pharyngitis is associated with the general condition of the body.

What is the prognosis of pharyngitis?

Pharyngitis has a favorable prognosis, but chronic atrophic pharyngitis requires the systematic conduct of symptomatic therapy.

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