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 the 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 onset 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 at the VII Congress of Otorhinolaryngologists of the USSR (Tbilisi, 1975) it followed that this indicator, depending on the region of the country, increased to 1, -3,%. 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 tonsillitisEpidemiology 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 bezangina form of chronic tonsillitis, the symptoms of the disease are in many are habitual and have 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 the process of formation of immunity in the tissues of the palatine tonsils, where the normally limited inflammation process stimulates the production antibodies.
Palatine tonsils - part of the immune system, which consists of three barriers: lymphocyte (bone marrow), lympho-interstitial (lymph nodes) and lympho-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, 1) 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 pain in the throat during swallowing, considerable 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 this classic symptomatology of angina is not often it happens. In such cases, exacerbations of chronic tonsillitis occur without any severe acuity of all symptoms: the temperature corresponds to low subfebrile values (3, -3, C), pain in the throat when swallowing is insignificant, there is a moderate deterioration in the total state of health. The duration of the disease is usually 3-4 days.
Where does it hurt?
Sore throat Sore throat with swallowingScreening
It is necessary to conduct screening for chronic tonsillitis in patients with rheumatism, cardiovascular diseases, joint and kidney diseases it is also advisable to bear in mind that, in case of common chronic diseases, the presence of chronic tonsillitis in one way or another may to activate these diseases as a chronic focal infection, therefore, in these cases, a chronic tonsillitis.\
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 tonsilWhat 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 serumWho to contact?
ENT - doctor OtolaryngologistTreatment 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 of the chronic tonsillar focus of infection is already evident, 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? Tsebopimilive.com.ua
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 for acute pharyngitis is characterized by acute inflammation of the mucosa and lymphoid elements of the posterior wall pharynx. 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.
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 adenoviruses, in addition, the cause of acute tonsillitis / tonsillopharyngitis and acute pharyngitis can be herpes simplex virus and enteroviruses 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 a rise in temperature body and deterioration, the appearance of pain in the throat, the refusal of young children from eating, malaise, lethargy, other symptoms intoxication. When examined, redness and swelling of the tonsils and mucous membrane of the posterior pharyngeal wall, its "granularity" and infiltration, the appearance of purulent exudation and raids mainly on the tonsils, the increase and soreness of regional anteroposterior lymphonoduses.
Symptoms of angina and acute pharyngitis in children
Where does it hurt?
Sore throat Sore throat with swallowing Sore throat in childrenWhat's bothering you?
Lump in the throatClassification of angina and acute pharyngitis in children
It is possible to isolate the primary tonsillitis / tonsillopharyngitis and pharyngitis and secondary, which develop with such infectious diseases like 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 shift of formula to the left with streptococcal etiology of the process and normal leukocytosis or a tendency to leukopenia and lymphocytosis in viral etiology disease.
Diagnosis of angina and acute pharyngitis in children
What it is necessary to survey?
Pharynx Swallow (adenoid) tonsilHow to inspect?
X-ray of the larynx and pharynxWhat 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 bloodWho to contact?
Pediatrician ENT - doctor OtolaryngologistTreatment 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 indicated only in cases where 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 herbilive.com.ua
Angina (acute tonsillitis) - Overview of information
Angina (acute tonsillitis) is an acute infectious disease caused by streptococci or staphylococci, less often 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 overall 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 heterogeneous diseases of the pharynx and not only inflammation of the actual lymphadenoid formations, but also cellulose, the clinical manifestations of which are characterized, along with the signs of acute inflammation, a 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 made it possible to differentiate banal angina from an angina-like disease - diphtheria of pharynx, and scarlatination in the throat 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 at.
At the end of XIX century. describes a special form of ulcerative necrotic tonsillitis, the occurrence of which is due to fusospirochete symbiosis of Plaut-Vincent, and when introduced into clinical practice of hematological studies, special forms of lesions of the pharynx have been identified, 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, unspecifiedEpidemiology 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 population density, household, sanitary-hygienic, geographical and climatic conditions, it should be noted that among urban population disease is cleaner than among rural. 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 abundance 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 tonsil, tubal tonsils, lateral ridges, and numerous follicles scattered in the region of the posterior the pharyngeal walls.
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 illnesses, is a source of infection (although to a lesser extent) during the first 10 days after 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 childrenClassification of angina
During the foreseeable historical period, numerous attempts have been made to create some sort of scientific classification of throat angina, however, each sentence in This direction was fraught with certain shortcomings and not by the "fault" of the authors, but due to the fact that the creation of such a classification for a number of objective reasons is practically is impossible. These reasons, in particular, include the similarity of clinical manifestations, not only with different banal microbiota, but also with certain specific angina, similarity some common manifestations with different etiological factors, frequent discrepancies between bacteriological data and the clinical picture, etc., so the majority authors, guided by practical needs in diagnosis and treatment, often simplified the proposed classifications, which, at times, were reduced to classical representations.
These classifications were and still bear a pronounced clinical content and, of course, are of great practical importance, However, these classifications do not reach a truly scientific level due to the extreme multifactority of etiology, clinical forms and complications Therefore, from a practical point of view, it is advisable to divide angina 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:
- 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."
- Membrane (diphtheria, pseudomembranous nondiptheria). These inflammatory processes were called "white angina." To clarify the diagnosis, it is necessary to carry out a bacteriological study.
- Angina, accompanied by a loss of structure (ulcerative-necrotic): herpetic, including Herpes zoster, aphthous, ulcerous Vincent, with scurvy and impetigo, post-traumatic, toxic, gangrenous and and so forth.
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 some "pharyngeal" symptoms: body temperature, heart rate, dysphagia, pain syndrome (one-sided, bilateral, with irradiation in or out of the ear, the so-called pharyngeal cough, a feeling of dryness, perspiration, burning, hypersalivation-sialorhea and other).
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 pictures are forced to resort to additional methods of laboratory, bacteriological and, according to indications, histological survey.
To clarify the diagnosis it is necessary to conduct laboratory tests: bacteriological, virologic, serological, cytological, etc.
In particular, microbiological diagnostics of angina of streptococcal nature is of great importance, which includes a bladder examination of the smear from the surface of the tonsil or back wall pharynx. 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 TonsilsHow to inspect?
X-ray of the larynx and pharynxWhat 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 serumWho to contact?
Otolaryngologist ENT - doctorTreatment 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 BaishitsingeProphylaxis 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 and etc.). Among the measures of individual prevention - tempering the body, exercise, establishing a reasonable mode 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 (with surgical necessity) 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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