When should tonsils be removed? The choice of treatment tactics for chronic tonsillitis

If you go to the mirror and open your mouth wide, you can see two formations that are located on the side surfaces, in the depths of the pharynx, which are shaped like an almond. This is why the tonsils are called tonsils. And since the tonsils are located in the soft palate, they are called palatine tonsils.

Also, in common parlance, the palatine tonsils are also called tonsils. They are one of the important organs of the pharyngeal immune system and form an important part of the Pirogov-Waldeer lymph-epithelial pharyngeal ring.

Palatine tonsil, tonsila palatina. It is located in the tonsillar fossa between the palatoglossus and velopharyngeal arches.

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What other tonsils are there in the pharynx?

Other tonsils that form the lymphoid pharyngeal ring are: adenoid vegetations, or, more simply, adenoids, which are not a paired organ. They are located in the dome of the nasopharynx. It is impossible to see them with the naked eye. In order to recognize the condition of the adenoids, it is necessary to perform an endoscopic examination of the nasopharynx. Inflammation of the adenoids is called adenoiditis and is more common in children.

Also in the pharynx there is a lingual tonsil, located at the root of the tongue, which, like the adenoids, is an unpaired organ.

There are also tubal ridges, which are also called tubal tonsils. They are located at the entrance to the pharyngeal mouth of the auditory tube. The tube ridges are located deep in the nasopharynx, on the lateral (medial) surfaces of the nasopharynx on the right and left. Tubal tonsils perform an important function - they protect against infection entering the auditory tube. Since each of the tonsils of the lymphoepithelial pharyngeal ring deserves separate close attention, in this article we will only talk about the palatine tonsils and chronic tonsillitis. Other tonsils and the pathology they cause will be described in detail separately, in other relevant ENT articles.

Description and symptoms of chronic tonsillitis

Chronic tonsillitis occupies a leading place among inflammatory diseases of the throat. Throat diseases reduce the quality of life and lead to complications. Chronic inflammation of the tonsils is often observed in children starting from 3 years of age and in young people.

Types of tonsillitis

1. Acute tonsillitis (tonsillitis) is an infectious disease with local manifestations of acute inflammation of the components of the lymphatic pharyngeal ring, most often the palatine tonsils, which is caused by streptococci or staphylococci, less often by other microorganisms.
2. Chronic tonsillitis is a long-term inflammation of the pharyngeal and palatine tonsils. Develops after a sore throat and other infectious diseases accompanied by inflammation of the mucous membrane of the pharynx (scarlet fever, measles, diphtheria), or without a previous acute illness.

There are two stages. Compensated and decompensated stages:

1. The compensated stage is a dormant focus of infection. There is no visible reaction from the whole body, no repeated sore throats. The barrier function of the tonsils and the reactivity of the body are not impaired. The edges of the palatine arches thicken, cicatricial adhesions appear between the tonsils, plugs form in the lacunae of the tonsils, liquid purulent discharge forms, and the submandibular and cervical lymph nodes enlarge. One of the problems of the compensated form of tonsillitis is bad breath, which occurs as a result of the formation of plugs in the lacunae.
2. During decompensation, frequent sore throats are a concern; complications of tonsillitis in the form of abscesses, inflammatory diseases of the ear and sinuses, as well as damage to other organs (heart, kidneys) are often observed. Exacerbation of chronic tonsillitis is also called tonsillitis.

Symptoms of chronic tonsillitis

• discomfort and pain when swallowing, especially in the morning;
• dryness, sore throat; sensation of a foreign body in the throat
• cough;
• bad breath;
• increased fatigue, weakness and sweating;
• decreased performance;
• low-grade fever 37.2-37.5°C
• deterioration of sleep;
• decreased appetite;
• pain in the cervical lymph nodes.

Causes that can lead to chronic tonsillitis

The following factors have a particularly strong influence on the chronicity of the process:

• Frequent sore throats, especially in the absence of adequate treatment;
• Impaired nasal breathing, which can be a consequence of both a deviated nasal septum and chronic rhinitis and sinusitis. If rhinitis is of an allergic nature, then it is advisable to do an allergen test and undergo appropriate treatment;
• Low body immunity.

Chronic tonsillitis develops due to a number of factors

• Intoxication - due to the absorption of bacterial toxins and products of chronic inflammation in the tonsils. Intoxication explains symptoms of chronic tonsillitis such as fatigue, weakness, headache, low-grade body temperature, etc.
• The formation of plugs in the tonsils irritates the nerve endings and causes moderate pain in the throat and heart area, cough, and bad breath. Nerve endings undergo degenerative changes, which can cause neurosis and other disorders of the nervous system.
• The body develops sensitivity to bacterial and tissue antigens - an allergy develops. Therefore, chronic tonsillitis is also of an autoimmune nature.

Chronic tonsillitis with complications can lead to functional disorders of cardiac activity, acquired heart defects. Chronic tonsillitis is associated with pathologies such as rheumatism, infectious arthritis, diseases of the urinary system, prostate gland, meninges, etc.

Features of the disease in children

Intensive development of the lymphoid ring begins in infancy - in the second year of life. Immediately after birth, the tonsils are underdeveloped and do not yet function fully. A feature of the tonsils in children 1-3 years old is deep lacunae, as well as narrow, densely branching orifices, which can extend to the capsule. Sometimes the lacunae turn sharply and extend under the integumentary epithelium instead of going deep into the tonsils. At the end of narrow passages there are characteristic expansions that contribute to the development of the inflammatory process.

A feature of younger age is hypertrophy of lymphoid tissue, which, along with an increase in the number of lymphoid follicles, leads to the growth of tonsils. The latter reach their largest size by 5-7 years. At this age, children are most susceptible to infectious diseases and most need protection from infections. Representatives of this age category are recommended to receive preventive vaccinations aimed at mobilizing lymphoid tissue to develop immunity.

The cause of hypertrophy of lymphoid tissue is the intensive formation of active immunity, which is accompanied by local production of antibodies in response to the penetration of an infectious agent. With age, by the age of 9-10, antibodies accumulate in the body, the immune system improves, which leads to age-related involution of lymphoid tissue. Part of it degenerates and is replaced by connective or fibrous.

The causes of childhood respiratory diseases are fungi, bacteria and viruses. If a child gets sick too often, the tonsils are regularly attacked, so the body does not have time to fully defend itself. This becomes the main reason for the development of chronic tonsillitis, along with incorrectly prescribed antibiotic treatment.

Chronic tonsillitis in a child turns into a constant source of infection, depleting the immune system. Quite often, the disease leads to serious complications, especially if timely help is not sought.

Symptoms

Unlike adults, in children the disease develops quickly, occurs in an acute form and is quite obvious. An obvious indication of chronic tonsillitis may be the following local reactions:

• redness of the tonsils;
• their increase, looseness;
• purulent discharge;
• enlarged cervical lymph nodes.

Frequent sore throats, bad breath, and discomfort during swallowing may also indicate the chronic nature of tonsillitis. Some patients experience sleep problems, headaches, and a subfertile temperature (37-37.5 °C).

Chronic tonsillitis in a pregnant woman

Symptoms of the disease in a pregnant woman are fever, general weakness, dry cough, sore throat, which is accompanied by a sensation of a foreign body. This is due to the fact that the tonsils withstand the attack of tonsillitis and respond to it with pain.

Not everyone knows that even a mild sore throat can harm the unborn child, as well as the woman herself. Sometimes the disease causes early miscarriage, and sometimes causes the development of late toxicosis, which negatively affects the development of the fetus. Since the presence of a chronic infection in the body weakens the immune system, a pregnant woman is at risk of developing other diseases.

Clinical studies have confirmed that chronic tonsillitis has repeatedly caused poor labor and premature birth, so women with this diagnosis are often recommended to have a cesarean section. Sometimes a disease that is not treated during pregnancy leads to the development of a heart defect in the child.

Causes of chronic tonsillitis in pregnant women

• sore throat, which has become a latent chronic form;
• hypothermia;
• deficiency of vitamins and nutrients;
• weakened immunity;
• problems with nasal breathing caused, for example, by a deviated nasal septum, polyps or adenoids;
• untreated caries;
• sinusitis.

To avoid undesirable developments, pregnant women are advised to eat well, avoid hypothermia, visit the dentist and generally monitor their health.

Why is chronic tonsillitis dangerous?

Regardless of the form of its occurrence, chronic tonsillitis can cause allergization and infection of the body. In the absence of medical control, the disease can lead to serious complications - frequent exacerbations in the form of a sore throat, recurring up to 6 times a year.

Another serious complication is phlegmon of the neck, which occurs against the background of severe forms of peritonsillar abscess. In addition, weakening of the tonsils leads to the penetration of infection into the underlying respiratory tract and the development of pharyngitis and bronchitis. In general, chronic tonsillitis either itself becomes a source of concomitant diseases or complicates their course.

An infection that has entered the body finds “weak” spots and can cause diseases of any of the systems - bronchopulmonary, urinary, cardiovascular. A chronic focus of infection has a negative effect on the blood coagulation system, metabolic and endocrine processes, the adrenal cortex, and the course of allergic conditions. Inflammation of the palatine tonsils causes epileptic attacks and aggravates the course of encephalitis and cerebral rheumatic vasculitis. The most dangerous is the decompensated form, which provokes changes in internal organs.

Consequences of chronic tonsillitis

1. The disease in a certain way affects the course of collagen diseases - rheumatism, systemic lupus erythematosus, scleroderma, polyarthritis, dermatomyositis, periarthritis nodosa.
2. The cause of frequent sore throats is heart disease - arrhythmias, endocarditis, myocarditis, acquired defects. Since there is a close connection between the lymphatic system of the heart and the ducts of the tonsils, even people under the age of 30 are diagnosed with cardialgia.
3. Chronic intoxication has an adverse effect on blood vessels, especially capillaries. Patients complain of increased fatigue, weather sensitivity, headaches including migraines, and dizziness (Meniere's syndrome).
4. The consequence of the chronic form of tonsillitis can also be diseases of the gastrointestinal tract - gastritis, colitis, duodenitis, stomach and duodenal ulcers.
5. Against the background of chronic tonsillitis, skin pathologies and diseases of the subcutaneous fatty tissue often develop - psoriasis, neurodermatitis, acne, microbial eczema, atopic dermatitis, polymorphic exudative erythema. It makes no sense to treat them until the source of infection is eliminated.
6. Chronic tonsillitis often causes lung diseases - bronchial asthma and chronic bronchitis, and also contributes to the exacerbation of chronic pneumonia. According to pulmonologists, the number of complications with such diagnoses can be reduced by 2-3 times if the source of infection is carried out in a timely manner.
7. The disease also has a negative effect on the accommodative apparatus of the eye. Early sanitation can, according to ophthalmologists, prevent the development of myopia, as well as prevent relapses of conjunctivitis and blepharitis.
8. The liver and the biliary system are also targeted by infection: cholecystitis, cholangitis and cholangiocholecystitis develop against the background of tonsillitis.
9. Weakening of the functions of the pancreas due to focal infection in the tonsils contributes to the formation of diabetes mellitus. The thyroid gland also suffers, and its hormone-forming function is disrupted (thyrotoxicosis).
10. Against the background of tonsillitis, there are disorders in the reproductive sphere: potency in men decreases, and in women of childbearing age, uterine bleeding, endometriosis, uterine fibroids, hypomenstrual syndrome and infertility are observed. Cases of pathological pregnancy - threats of miscarriage and premature birth - are not uncommon.
11. Another serious consequence is kidney damage (pyelonephritis, glomerulonephritis, nephritis, etc.).

Read more about tonsils

It must be said that the palatine tonsils are the largest lymphoid formations of the entire pharyngeal ring, and they play, perhaps, the leading role in the disposal of bacterial and viral infections that enter the pharynx by airborne droplets.

Due to their size, the palatine tonsils are the first to stand in the way of microbes that enter the oral cavity from the external environment, and protect the body from infection by viruses, bacteria, spirochetes, protozoa and other microorganisms.

The palatine tonsils have depressions - lacunae, which in turn are exit holes for deep and sharply convoluted canals - crypts, which are located in the thickness of the palatine tonsil, leading to its root. The number of lacunae and crypts can vary from 1 to 14, but on average, in each amygdala there are from 4 to 7 lacunae. The diameter of the lacunae can also vary, depending on gender, age, individual characteristics of the patient, as well as the duration and severity of the disease and the presence of scar changes in the tonsils themselves.

It is believed that the wider the exit hole - the lacuna - the higher the likelihood of the palatine tonsil to self-cleanse. This statement is true. Accordingly, the smaller the diameter of the lacuna, the more pronounced and severe the tonsillitis. Moreover, if the tonsil produces a large amount of caseous-necrotic detritus (plugs), the severity of the course also noticeably increases.

Normally, on the mucous membrane of the palatine tonsils, as well as in the thickness of the palatine tonsils, in the lacunae and crypts, there is a growth of non-pathogenic and conditionally pathogenic microflora, in normal (permissible) concentrations. If there are more microorganisms (for example, due to intensive growth, or the addition of other pathogenic microflora from the outside), the palatine tonsil immediately destroys and utilizes the dangerous infection and normalizes a dangerous condition for the body. At the same time, the macroorganism, that is, the person, does not notice this in any way.

The tissues of the palatine tonsils produce the following main protective substances: lymphocytes, interferon and gamma globulin.

The palatine tonsils act as a serious infectious and inflammatory barrier and are an important component in creating not only local, but also general immunity in the human body. Therefore, when it comes to removing the palatine tonsils, you first need to think ten times, weigh the pros and cons, and only after that make a decision about removing the tonsils.

Complications of chronic tonsillitis

Chronic tonsillitis has serious complications; they are divided into two groups: local and general. All complications, as a rule, occur during an exacerbation of the process occurring in the form of a sore throat and represent the consequences of untimely treatment of chronic tonsillitis.

With chronic tonsillitis, in the upper respiratory tract of a person, more precisely in the palatine tonsils, there is a focus of chronic inflammation; the problem of focal infection is very acute in modern medicine. Currently, there are about fifty different metatonsillar diseases, which are the result of chronic inflammation in the palatine tonsils. Let's take a closer look at what this can most often threaten.

Peritonsillar abscess

This is the most common local complication. The fact is that between the palatine tonsil and the muscles of the pharynx to which it is attached there is fiber, the so-called paratonsillar fiber. With severe inflammation, the infection can enter this tissue through the hematogenous route, causing its infiltration and purulent melting, and an abscess is formed. Peritonsillar abscess is a very serious disease that requires immediate surgical treatment, usually in a hospital setting, since there is a threat of the purulent process spreading through the cellular spaces of the neck into the mediastinum, which can be fatal.

Diseases of the heart, joints and kidneys

An important role in the inflammatory process in chronic tonsillitis is played by group A beta-hemolytic streptococcus, which often parasitizes the palatine tonsils. The fact is that immune complexes that form in the body as a response to the aggression of this antigen can also attack healthy tissue in the joints, heart and kidneys, which, if not treated in a timely manner, can even lead to disability.

Weakness and decreased ability to work

The parenchyma of the palatine tonsils is densely penetrated by blood and lymphatic vessels, and in the thickness of the organ there are many nerve endings that connect to important autonomic centers. In chronic tonsillitis, inflammatory products enter the circulatory and lymphatic systems, and constant endotoxification occurs. All these factors plus pathological impulses from irritated nerve endings lead to decreased tone, bad mood, and apathy.

Regular colds

With chronic tonsillitis, the body spends a lot of effort to contain inflammation in the tonsils, the immune system is under constant stress, which leads to its significant weakening. Added to this is the not always correct work-rest regime, nutrition, and environmental conditions, as a result of which a person with chronic tonsillitis may literally not “get out” of a cold.

Inflammatory diseases of the respiratory system

The palatine tonsils are anatomically located in the pharynx, close to such organs as the trachea, larynx, and paranasal sinuses. With chronic tonsillitis, microbial contamination of the entire area of ​​the respiratory mucosa occurs, which contributes to the development of diseases such as sinusitis, bronchitis, and laryngitis.

Stomach and intestinal problems

The palatine tonsils are located at the crossroads of the digestive and respiratory systems. Due to certain anatomical features, they represent a rather large conglomerate of the mucous membrane. In chronic tonsillitis, this entire area of ​​the mucosa is involved in the inflammatory process and secretes a pathological secretion in the form of a liquid fraction and caseous masses. This pathological content is evacuated into the pharynx through lacunae and then swallowed with saliva, which often causes disturbances in the functioning of the gastrointestinal tract.

Chronic tonsillitis

Chronic tonsillitis is an autoimmune disease that occurs as a result of frequent sore throats and a decrease in the body’s overall resistance since childhood. With the development of the disease and its exacerbation, a person does not have enough general immunity to keep the palatine tonsils “in working order” and adequately fight the infection.

If harmful microbes get onto the surface of the mucous membrane and into the lacunae of the palatine tonsil, a real battle occurs between the microbes and the human immune system.

The palatine tonsil fights all pathogenic and conditionally pathogenic infections, but not being able to fully resist attacking microbes, it provokes either a new outbreak of sore throat or an exacerbation of chronic tonsillitis (treatment cannot be delayed in any case), thereby triggering an infectious-inflammatory process in palatine tonsils.

As a result of a lost fight, pus accumulates and stagnates in the lacunae of the tonsils, that is, dead leukocytes that come to the aid of the tonsil in the fight against a dangerous infection. The purulent masses irritate and inflame the tonsil tissue from the inside and have a toxic effect on it, thereby causing a sore throat - a severe infectious outbreak of inflammation of the tonsils.

In the absence of quick and adequate treatment, the contents of the lacunae and crypts of the palatine tonsils serve as a breeding ground for pathogenic microbes and a constant source of infection, even after an attack of tonsillitis.

DIAGNOSIS OF CHRONIC TONSILLITIS

For frequently recurrent tonsillitis, consultation with an ENT specialist is necessary. The sooner you make an appointment with a doctor, the faster the specialist will provide qualified assistance. The doctor makes a diagnosis based on medical history, examination and research results. The main method for diagnosing chronic tonsillitis is pharyngoscopy. During the examination, the otolaryngologist identifies characteristic signs of the disease: swelling of the mucous membrane, fusion of the palatine arches with the tonsils, formation of adhesions, loose tissue, accumulation of pus in the lacunae, enlarged lymph nodes.

The toxic-allergic form of chronic tonsillitis is the most severe. Relapses occur several times a year and may be accompanied by infectious and inflammatory processes in internal organs and adjacent tissues, and the formation of abscesses. The patient experiences severe weakness, the body temperature may rise, and a sore throat causes severe anxiety and reduces the quality of life. The simple form of chronic tonsillitis occurs with more sparse symptoms: the patient is bothered by a sore throat, which intensifies when swallowing and chewing, weakness and decreased performance.

A common mistake made by patients with chronic tonsillitis is uncontrolled use of medications, including antibiotics. With antibacterial drugs you only slow down the spread of infection, but over time, pathogenic microorganisms adapt to the action of even the most powerful drugs, which lose their therapeutic effect. While the infectious focus of the tonsils is in the oropharynx, antibiotics will only provide temporary relief, but will not solve the problem.

Forms of the disease

• recurrent form, that is, with frequently recurring sore throats;
• protracted form, when the inflammatory process in the palatine tonsils is characterized by a sluggish and prolonged course;
• compensated form, when episodes of sore throat and exacerbation of tonsillitis are not observed for a long time.

Chronic tonsillitis is the most common disease among all diseases of the pharynx and one of the most common diseases of all ENT organs, along with such a diagnosis as acute sinusitis.

Chronic tonsillitis can affect both adults and children, from the moment the palatine tonsils begin to develop (from 2-3 years). Moreover, the incidence of this disease in childhood is much higher.

Some respiratory diseases can also be classified as social diseases. For example, sinusitis and tonsillitis are among them. Poor environment, stress, lack of sleep, overwork, monotonous and poor nutrition, as well as poor heredity are predisposing factors to the development of the disease.

What is chronic tonsillitis?

Chronic (or recurrent) tonsillitis is a chronic inflammatory disease of the palatine tonsils, the development of which is facilitated by the presence of an infectious focus, insufficiency of local and systemic immunity, as well as a toxic-allergic component. It is necessary to emphasize that chronic tonsillitis cannot simply “go away” - it is a chronic, and therefore permanent, condition of the tonsils. The absence of relapses or pronounced symptoms of the disease is also a stage of the disease, the so-called remission stage, but this is a stage in the development of the disease, and not the final moment.

Causes

The development of the disease is closely related to frequent sore throats (acute tonsillitis). Very often, incompletely cured tonsillitis leads to chronic tonsillitis. Very often, tonsillitis is an exacerbation due to the accumulation of plugs in the tonsils - caseous-necrotic masses, which are often confused with food debris.

Main reasons for development

1. Unfavorable working conditions. The greatest influence is exerted by gas and dust levels in the air at work.
2. Poor environmental conditions, pollution from vehicle exhaust gases, harmful emissions into the atmosphere.
3. Low quality of consumed water.
4. Weak (low) immunity.
5. Severe hypothermia of the body.
6. Stressful situations.
7. The presence of chronic diseases in the nasal cavity, paranasal sinuses and oral cavity - dental caries, purulent sinusitis, etc., which often leads to infection of the tonsils.
8. Irrational or poor nutrition, in which excess amounts of proteins and carbohydrates are consumed.
9. Heredity (mother or father suffers from chronic tonsillitis). It is very important for a woman to undergo one or two courses of treatment for tonsillitis during pregnancy (depending on the severity of the process) in order to minimize the likelihood of the disease developing in the unborn child.
10. Frequent overwork, fatigue syndrome, inability to fully rest.
11. Smoking and alcohol abuse.

How does chronic tonsillitis differ from ordinary sore throat?

If an acute process (tonsillitis) becomes chronic (chronic tonsillitis), then the symptoms change. The main symptoms of chronic tonsillitis are:

• sore throat, sometimes causing coughing. If the cough is severe, then particles of pus may be released;
• bad breath caused by the accumulation of pus (pus plugs in the tonsils);
• enlarged cervical lymph nodes.

Chronic tonsillitis is also characterized by: general weakness (due to constant weakening of the immune system), a slight increase in temperature - usually in the evening. Although sometimes the disease is practically asymptomatic, and only bad breath indicates its presence.

IMPORTANT! The culprits of chronic tonsillitis are not always bacteria or viruses. The disease can be triggered even by advanced caries - carious bacteria enter the throat and attack the tonsils. Also, sooner or later, difficult nasal breathing (for example, due to a deviated nasal septum) can lead to chronic tonsillitis.

Symptoms

How to independently recognize chronic tonsillitis? Symptoms and treatment in adults and children can only be correctly determined by an ENT doctor. Below are characteristic signs - if you find them in yourself, consult a doctor.

The disease is characterized by symptoms such as:

1. Headache.
2. Feeling of something foreign in the throat, as if something was stuck in the throat. In fact, this is nothing more than large accumulations of caseous masses, that is, plugs in the thickness of the palatine tonsils.
3. Increased fatigue, weakness, decreased performance. All this is due to the so-called tonsillogenic intoxication, or in other words, intoxication syndrome.
4. Aching pain in the joints and muscles (with severe illness).
5. Aching pain in the heart, with interruptions in heart function - extrasystole (with severe illness).
6. Pain in the lower back, in the kidney area (with severe disease).
7. Bad mood, and in some cases increased body temperature, and for a long time.
8. Persistent skin rashes, provided that there was no previous skin pathology.

All these symptoms appear due to the entry of waste products of microorganisms into the blood from the palatine tonsils, i.e. staphylococcal and streptococcal infections, poisoning the entire body.

Bad breath appears due to the accumulation of organic substances and the decomposition of bacterial infection in the lacunae (recesses of the tonsils) and crypts (their canals). Tonsils become a source of bacterial infection, which can spread throughout almost the entire body and cause inflammation of the joints, myocardium, kidneys, paranasal sinuses, prostatitis, cystitis, acne and other diseases.

If the tonsils do not cope with their function as an immune organ, then even slight overwork, stress, or mild hypothermia can significantly reduce the immune defense and open the way for microbes and exacerbation of the disease.

Should I have my tonsils removed as an adult?

Tonsillectomy. Should I have my tonsils removed as an adult? Our expert doctor: otorhinolaryngologist of the GVM International clinic Natalya Borisovna Antipina.

Hoarseness, increased fatigue, dryness, sore and sore throat when swallowing, bad breath... Are these symptoms familiar to you?

Don't delay treating your throat. A healthy throat is the key to good health.

Indications for tonsil removal

The doctor decides on a tonsillectomy (removal of the tonsils), when retaining the tonsils will cause more harm to the body than good. A tonsillectomy will allow a person to live a full life. Today, tonsil removal in adults is indicated for serious pathologies:

• enlarged lymph nodes under the jawbone even after treatment with antibiotics;
• frequent exacerbations of chronic tonsillitis;
• abscesses of the paratonsillar region;
• recurrent pustular diseases of the skin and ears;
• difficulty breathing and swallowing due to swelling;
• hoarseness due to enlarged tonsils;
• pathologies of the kidneys and urinary tract, joints, heart due to intoxication by infection;
• chronic, including polypous, sinusitis;
• failure of conservative treatment

Refusal to undergo surgery for such patients has serious consequences.

Before resorting to surgical intervention, it is necessary to undergo an examination prescribed by an otolaryngologist. After receiving the diagnostic results, the doctor makes a decision on the need for surgery and selects a technique (classical, laser, radio wave or ultrasound tonsillectomy).

Anesthesia is used during the operation. After the operation, temporary restrictions are imposed: home regimen, reduced physical activity, diet.

Pros of tonsillectomy

ADVANTAGES OF TONSILLECTOMY: The operation eliminates the source of infection, which prevents the development of secondary ENT diseases (pharyngitis, sinusitis, bronchitis), and reduces the load on the cardiovascular system. Elimination of the pathogen reduces the risk of rheumatism, myocarditis, pyelonephritis, and thyroid diseases.

The disadvantages of the operation include the possibility of postoperative bleeding and allergic reactions.

When deciding on surgical treatment, it is necessary to weigh the risk of complications and the expected benefits of the intervention.

At the GVM International Clinic, diagnosis, treatment and prevention of diseases of the ENT organs is one of the priorities.

Complications

Chronic tonsillitis is very dangerous due to rapidly occurring complications. The most severe of them are heart disease - myocarditis, inflammation of the joints - rheumatism and serious kidney damage - glomerulonephritis.

Some toxins that are produced by microbes in the tonsils and then enter the bloodstream can damage cartilage and ligament tissue. The result is inflammation and pain in the muscles and joints. Other toxins often cause persistent fever, changes in blood tests, fatigue, depression, and severe headaches.

Chronic tonsillitis can affect the functioning of such a vital organ as the heart. The tonsils are often parasitized by group A beta-hemolytic streptococcus, the protein of which is very similar to the protein found in the connective tissue of the heart. Because of this, the immune system can show retaliatory aggression not only to the emerging streptococcus, but also to its own heart. As a result, heart rhythm disturbances, heart valve prolapses, and even the development of severe myocarditis and bacterial endocarditis occur.

For the same reason, articular surfaces and kidney tissue are at great risk. Unfortunately, the development of diseases such as rheumatoid arthritis and glomerulonephritis is extremely high.

Due to the fact that the source of infection remains in the tonsils for a long time, a distortion of the body’s reactivity occurs, resulting in allergic changes. In some cases, just one course prescribed by a doctor can get rid of itching and allergic rashes, and in some cases stop the development of bronchial asthma attacks.

Symptoms of chronic tonsillitis

The main manifestation of chronic tonsillitis is tonsillitis; as a rule, all patients suffering from this disease at least once have had tonsillitis. Sore throat is a fairly serious disease that affects all systems of the body and carries the risk of a number of serious complications, so the choice of treatment tactics for chronic tonsillitis should be related to the frequency of tonsillitis. The main symptoms of the disease can be identified:

Quite a large number of patients do not immediately detect the symptoms of chronic tonsillitis and delay contacting an ENT doctor, which often leads to decompensation of the disease and longer treatment in the future.

Chronic tonsillitis during pregnancy

It is very important to pay attention to the disease during pregnancy. When planning a pregnancy, even in the case of a compensated condition, that is, a condition outside of an exacerbation of tonsillitis, it is highly advisable to carry out a planned course as prescribed by a doctor. This will reduce the bacterial load on the entire body in general and on the palatine tonsils in particular.

It is very encouraging that doctors are now referring pregnant women and women who are just preparing for pregnancy for treatment of tonsillitis. Unfortunately, in some cases one of the reasons for not carrying a pregnancy to term is this disease, although at first glance it is hard to believe, tonsillitis is a traffic jam, the treatment of which and other manifestations may seem in no way related to pregnancy.

Before conceiving a child, it would be correct to examine the future father of the child for the disease and, if necessary, treat it as well. This will significantly reduce the risk of developing chronic tonsillitis in the unborn child. And, on the contrary, the worse the condition of the future father and especially the mother, the risk of developing the disease in the child increases many times over.

Before pregnancy, it is very important to carry out comprehensive treatment of the symptoms of chronic tonsillitis. But even during pregnancy, it is recommended to repeat the course, preferably in the second trimester, when the woman’s condition is perhaps the most comfortable. It is important to note that physiotherapeutic procedures cannot be carried out during pregnancy, but it is highly desirable to wash the palatine tonsils using a vacuum method, followed by treatment with antiseptic solutions.

Consequences of tonsil removal

The high level of metabolic processes in the child's body plays into the hands - children tolerate such procedures more easily. But this does not change the fact that following medical instructions after the procedure is simply vital.

If the rehabilitation program is not followed, the following complications are possible4:

• Severe swelling of the throat;
• Vascular thrombosis;
• Bleeding;
• Inflammation of damaged lymphoid tissue, including septic.

Almost always, after removal of the tonsils, the child feels pain when swallowing; this condition can last a week. A crust forms on the excised surface of the tonsils, which indicates healing processes, but provokes uncomfortable feelings5.

The period of complete recovery takes a long time - three weeks or more. You must follow a special diet for the entire period. It is not recommended for a child to eat excessively salty, sour, spicy or pickled foods. It is also better to avoid hot food. It is better to stop at consuming foods at room temperature.

Some doctors advise eating cold foods, as cold causes blood vessels to constrict. But this technique is only suitable for seasoned children and it is better to clarify this issue with your doctor.

Difficult to chew and coarse foods should also be excluded; preference should be given to pureed dishes. In addition to diet, during the recovery period it is recommended to maintain and increase the child’s immunity5.

The right approach

Sore throat, tonsillitis - treatment in children and adults is important to carry out immediately for all diseases of the oral cavity and nasopharynx that bother you. If breathing through the nose is impaired, and mucus or mucopurulent discharge flows down the back wall of the pharynx, then these symptoms should be given special attention.

Chronic tonsillitis - treatment (effective) can be conservative and surgical. Due to the fact that the removal of tonsils can cause serious harm to the defenses and immunity of the human body, otolaryngologists should try their best to preserve the tonsils and restore their functions without resorting to surgery to remove the tonsils. Modern methods of treating tonsillitis provide a greater chance of recovery without intervention.

Friends! Timely and correct treatment will ensure you a speedy recovery!

Chronic purulent tonsillitis - treatment of a conservative type must always be carried out in an ENT clinic, performing a complex, pathogenetically based course of treatment, as well as using a medicinal approach - medications prescribed by an ENT doctor.

CONSEQUENCES OF TONSILLECTOMY

Tonsil removal surgery is successful in most cases. A huge role is given to the professionalism of the operating doctor, anesthesiologist and other specialists who monitor the patient’s well-being. If you contact a competent otolaryngologist, who has the necessary technical equipment, and follow the doctor’s recommendations before surgery and in the postoperative period, then the risk of complications is minimized.

When the first signs of malaise and deterioration in health appear, you should consult your doctor. Since the pharyngeal tonsils have a rich vascular network, after tonsillectomy there remains a risk of bleeding. Therefore, if the doctor discovers prerequisites for blood loss, the operation is postponed or additional medications are prescribed to prevent bleeding during surgery or in the first days after it.

The first week after surgery is considered the most dangerous. During this period, tissue healing and rejection of fibrin formed at the site of the removed tonsil occurs. Do not take any action on your own. Contact qualified specialists of the Clinic who will provide the necessary amount of medical care and prevent the development of serious complications.

After tonsillectomy, cases of relapse of the disease cannot be excluded. But the high professionalism of our Clinic’s surgeons and the use of innovative technology make it possible to minimize any risks and ensure maximum infectious safety for our patients.

A complex approach

First stage

Viral tonsillitis - treatment with a good and pronounced effect is obtained by washing the lacunae of the palatine tonsils. There are two ways to wash the tonsils.

A very old method is to rinse the tonsils with a syringe. Previously, this method was widely used, but today it is used for lack of a better one or when the patient’s gag reflex is very pronounced.

The disadvantages of this method are that during the process of washing the palatine tonsils, the pressure created by the syringe is not sufficient to effectively wash out caseous masses from the lacunae of the tonsils. Also, this technique is contact and traumatic, since when using a straightened attic needle, its thin and sharp end can prick the inner surface of the palatine tonsil, namely the crypts - the channels into which the needle enters. Also, the tip from the set with a syringe is used for rinsing the tonsils and injecting into the larynx. On the contrary, it is very wide in diameter and injures the tonsil tissue when inserting the tip into the lacuna, or in general, due to the large outer diameter, it cannot always get there.

Practice has shown that today, the best results are achieved by the approach when the ENT uses the Tonsilor attachment.

First, it is necessary to rinse the lacunae of the palatine tonsils with a modified attachment of the Tonsilor apparatus with a transparent antiseptic solution, for example, saline solution (also known as isotonic sodium chloride solution). This is necessary so that the doctor can clearly see what he is washing out of the palatine tonsils.

Second phase.

Since the tonsils are washed from pathological secretions, it is necessary to immediately influence the tissues of the palatine tonsils with low-frequency ultrasound. At the same time, a medicinal solution passes through the ultrasonic tip of the “Tonsilor” apparatus, which, due to the ultrasonic effect of cavitation, turns into a finely dispersed medicinal suspension, which, due to hydraulic shock, hits the tissues of the palatine tonsil and the posterior wall of the pharynx with force and impregnates the medicinal solution into the submucosal layer of the tonsil.

The procedure for exposure to ultrasound is correctly called: Ultrasonic medicinal irrigation. In our clinic we use a 0.01% solution of Miramistin. This drug is good because it does not lose its properties under the influence of ultrasound. Miramistin is a very strong antiseptic drug, and ultrasound exposure further enhances the durability of the physiotherapeutic effect.

Third stage.

It is necessary to treat (lubricate) the palatine tonsils with Lugol's solution, which is also a strong antiseptic based on iodine and glycerin.

Fourth stage.

The otorhinolaryngologist at our clinic conducts a laser therapy session on the tissue of the palatine tonsils and the mucous membrane of the posterior pharyngeal wall. Laser treatment of tonsillitis in adults is very effective. Its action is aimed at reducing swelling and inflammation of the tissues of the palatine tonsils.

The laser radiation source can be installed in the oral cavity and acted in close proximity to the palatine tonsils and the mucous membrane of the posterior pharyngeal wall, thereby achieving the best results.

You can also install the laser emitter on the skin of the anterolateral surface of the neck in the projection of the location of the palatine tonsils and the posterior wall of the pharynx.

Fifth stage.

It is recommended to conduct sessions of vibroacoustic influence. They are carried out with the aim of normalizing microcirculation in the tissues of the palatine tonsils and improving the trophism (nutritional function) of the palatine tonsils themselves.

Sixth stage.

Effectively sanitize the microflora located on the surface of the palatine tonsils using ultraviolet irradiation (UVR).

This method has long been known, has proven itself very well and is still in service in many city (especially children's) clinics.

In this case, it is necessary to approach courses. The number of procedures in each specific case is determined individually at the first consultation with an ENT specialist. But for a lasting effect to occur, at least five sessions must be performed. If, during the fifth procedure, caseous and mucous masses are still washed out of the lacunae of the palatine tonsils, rinsing and other procedures must be continued “until clean rinsing waters”. As a rule, the number of ENT procedures does not exceed 10 treatment sessions.

After a full course, the lacunae of the palatine tonsils restore their ability to cleanse themselves, and the patient feels much better and more energetic.

In order to have a lasting result, it is necessary to carry out conservative treatment 2 to 4 times a year, as well as independently once every 3 months, take homeopathic and antiseptic medications.

In this case, you will most likely be able to avoid exacerbations of this disease and the need to remove the tonsils.

If, 2-4 weeks after the end of the course, caseous detritus again begins to accumulate in the thickness of the palatine tonsils, and the patient’s ENT complaints begin to bother them, as before the start of the course, conservative treatment of chronic tonsillitis in children and adults is considered ineffective. In this case, the patient is asked to consider the option of surgical removal of the tonsils. But fortunately, such an outcome (result) is quite rare.

How to treat this disease?

The choice of treatment tactics for a patient with chronic tonsillitis is largely determined by the form of the disease.

There are several classifications of chronic tonsillitis. According to one version, there are two forms of chronic tonsillitis - compensated and decompensated, according to another version - compensated, subcompensated, decompensated. In practice, otolaryngologists use both classifications.

The compensated form of chronic tonsillitis implies the nature of the course of the disease in which complications do not develop, both local (peritonsillitis, peritonsillar abscess, cervical lymphadenitis, neck phlegmon) and distant (rheumatic heart valve disease, rheumatoid arthritis, kidney parenchyma damage), and exacerbations occur less frequently 5 times a year. This form of the disease is subject to conservative treatment, which involves courses of anti-relapse treatment 1-2 times a year, dynamic observation and evaluation of the effectiveness of such treatment.

The decompensated form of chronic tonsillitis , accordingly, includes the presence of local or distant (metatonsillar) complications listed above, as well as exacerbations of the disease more than 5 times within a year or more than 7 times within 2 years. Surgical tactics for treating patients with decompensated chronic tonsillitis is an option that significantly reduces the risk of complications or aggravation of their course. However, if it is impossible to perform surgical intervention for one reason or another, conservative treatment is justified, which does not solve the problem of decompensated chronic tonsillitis, but helps to achieve a relatively stable remission, which in turn improves the patient’s prognosis.

Drug treatment of chronic tonsillitis

Dear patients! In this article I will describe only general principles and approaches.

More precise treatment will be offered to you at the initial ENT consultation, where an accurate diagnosis, form and degree of the disease will be made, as well as an optimal recovery plan will be proposed and a prognosis for the duration of remission will be given.

So:

1. Antibacterial approach. Antibiotic therapy is important and necessary. But the decision to prescribe antibacterial drugs is made individually and only after a visual examination.

   
   Antibiotics can be either light, prescribed for a short course and have no effect on the mucous membrane of the gastrointestinal tract, or heavy, which must be prescribed under the guise of probiotic medications. The choice of antibiotic depends on the severity of chronic tonsillitis and the microflora that supports this condition.

2. Probiotic treatment is prescribed in case of taking aggressive antibiotics, as well as in the presence of concomitant gastritis, duodenitis, reflux esophagitis.
3. Antiseptic approach. Antiseptic sprays, aerosols, and rinses also give a very good effect and are therefore mandatory in the fight against chronic tonsillitis. I prefer a 0.01% solution of Miramistin, a 1% solution of Dioxidine (1 ampoule diluted - 10 ml + 100 ml of boiled warm water) and Octenisept, which must be diluted with boiled warm water or saline in a dilution of 1:5 , or 1:6.
4. Decongestant (desensitizing) therapy is mandatory. It is needed to relieve swelling of the palatine tonsils and the surrounding tissue, as well as the mucous membrane of the posterior pharyngeal wall. This is also necessary for better absorption of all medications used. Such modern medications as Cetrin, Claritin, Telfast can cope with these tasks. But if a certain desensitizing drug helps you for a long time, you should not change it to another.
5. Immunostimulating therapy. Here I want to draw your attention to the fact that the doctor prescribes drugs that stimulate the immune system. These drugs should not be confused with immunomodulators, which are strictly prescribed by an immunologist based on the results of a blood test. There are not so many drugs that stimulate local immunity at the level of the palatine tonsils and the mucous membrane of the posterior pharyngeal wall. Of the well-known drugs, Imudon comes first. The course must be at least 10 days. You need to take (dissolve) Imudon 1 tablet 4 times a day.
6. Homeopathic treatment. In addition to conventional drug therapy of a chemical nature, it is necessary to take homeopathic medications that improve the trophism and, as a result, the nutritional function of the palatine tonsils. The drugs of choice may be tonsillotren and tonsilgon, as well as rinses, steam and ultrasonic inhalations with infusions and herbs: propolis, string, sage, chamomile and some other herbs.
7. Emollient therapy is used symptomatically, when, against the background of exacerbation of tonsillitis, as well as taking medications, there may be dryness, rawness and soreness in the throat. In such cases, you can use peach oil, which must be instilled a few drops into the nose, throwing back the head. You can rinse your mouth with 3% hydrogen peroxide (VERY IMPORTANT! 6% and 9% hydrogen peroxide CANNOT be used!!!). To do this, you need to pour half a bottle of peroxide (10 ml) into a cup, put it in your mouth and rinse the entire solution once, for as long as possible. Then the solution is spat out and rinsed from foam and bitterness with warm boiled water. After gargling with hydrogen peroxide, you will feel a significant softening and comfort in your throat. You can gargle twice a day, but no more.
8. Analgesic therapy is used if necessary, as symptomatic therapy, depending on the severity of the pain syndrome. Of the tablet forms, it is better to give preference to Nurofen or Ketanal and its derivatives: Ketarol, Ketalar, Ketanof, Ketanal.
9. Diet therapy. Nutrition also plays a significant role in recovery. It is necessary to limit the intake of spicy, fried, sour, salty and peppery foods. During treatment, you should exclude hard foods from your diet. It is also recommended to protect yourself from very hot and very cold foods. Drinking alcohol, especially strong alcohol, is also contraindicated.

FEATURES OF THE POSTOPERATIVE PERIOD

Despite the fact that tonsillectomy is one of the most common operations in modern otolaryngology, the patient’s condition must be monitored by qualified specialists in the postoperative period. The patient is transferred to the ward on a gurney or in a sitting position, depending on the type of anesthesia used. For quick recovery, it is recommended to use dry ice every two hours for 5-15 minutes. This prevents the appearance of swelling and inflammation.

Feeling is restored a few days after the operation. During the first day, you should not swallow saliva - you need to keep your mouth slightly open so that it flows by gravity. In the early postoperative period, you should not talk. If minor sore throat occurs, the doctor will prescribe a pain reliever. He also recommends the use of non-steroidal anti-inflammatory drugs, which, in addition to the analgesic effect, prevent the development of an inflammatory reaction. In general, patients tolerate the operation easily and can return to their usual activities almost immediately.

During the first days after surgery, you can eat mostly soft, pureed foods. Avoid hot drinks. According to indications, specialists can prescribe medications to prevent bleeding. Antibacterial drugs are used to prevent the development of infectious complications.

For two weeks after surgery, physical activity is limited. It is forbidden to visit the bathhouse or actively engage in sports. You should also not actively gargle for the first days after tonsillectomy.

Surgical removal of tonsils

If we talk about the removal of the tonsils, then the operation to completely remove the tonsil tissue is called a bilateral tonsillectomy.

Partial removal of the tonsils is called a bilateral tonsillotomy.

It is extremely rare that the palatine tonsil is removed routinely on one side. There is also a practice of a number of hospitals (they like to do this in the Pirogov City Clinical Hospital No. 1) of removing the palatine tonsil or tonsils in case of a paratosillar abscess. This operation is called abscessonsillectomy. But it must be remembered that against the background of severe pain caused by an abscess, removal of the tonsil is extremely painful. Due to the purulent process, it is impossible to provide adequate anesthesia. Therefore, it is necessary to anesthetize the peri-almond tissue only with strong anesthetics: Ultracaine and Ultracaine DS-forte.

Routinely, palatine tonsils can be removed under local anesthesia or general anesthesia. Previously, this operation was performed only under local anesthesia.

Fortunately, there is now modern equipment that allows removal of palatine tonsils under general anesthesia or under anesthesia using cold plasma coagulation - Coblator.

Treatment of chronic tonsillitis

Treatment of chronic tonsillitis is traditionally carried out in two directions.

Conservative treatment

This therapy is relevant if pathological changes in the tonsils are compensated. This treatment effectively combines pharmacotherapy with physiotherapeutic methods and pursues the following goals:

• Physical elimination of infection from the surface of the tonsils;
• Relieving swelling and reducing the size of the tonsils;
• Elimination of symptoms of an allergic nature;
• Increasing local immunity, including through the inclusion of the tonsils themselves in the work.

Conservative treatment includes:

• Sanitation of the tonsils using ultrasound, which ensures a deep degree of cleaning of the lymphoid tissue;
• Anti-inflammatory laser therapy;
• Irrigation of the oral cavity with special medicinal solutions that increase local immunity and have bactericidal properties;
• Pharmacotherapy.

Surgical treatment involves complete or partial removal of lymphoid tissue, which can be carried out either traditionally or using a laser. Tonsillectomy has a significant list of contraindications, so the attitude of doctors towards it in recent years has been more wary than in previous decades.

Treatment of chronic tonsillitis in a child

Proper treatment of sore throat in most cases leads to a successful cure, while ignoring symptoms or incorrect actions can lead to the disease becoming chronic. In this case, exacerbations are possible almost once a month.

The treatment regimen for chronic tonsillitis in a child depends on the course of the disease and can be completely different, especially for periods of exacerbations and remission. In a state of remission, it is important to extend this period as long as possible, for which purpose anti-relapse therapy is prescribed at least twice a year, taking into account the individual characteristics of the patient.

General treatment includes non-sedating antihistamines, immunomodulators, vitamin therapy and homeopathy. Local methods include massaging the tonsils, washing the lacunae with medications, rinsing with antiseptics and treating the tonsils with agents that have antiseptic, anti-inflammatory and regenerating properties.

Physiotherapeutic methods are aimed at improving microcirculation in the tissues of the tonsils. These include:

• microwave therapy;
• ultrasound;
• laser therapy;
• Microwave and UHF;
• inductothermy;
• magnetic therapy;
• electrophoresis;
• inhalation;
• ultraviolet irradiation of the tonsils;
• mud therapy, etc.

If the disease has entered a protracted form, the approach to treatment changes radically - bacteriophages are used. We are talking about viruses that destroy streptococci and staphylococci as the main causative agents of the disease. This method has shown excellent results in the treatment of infections of the oral cavity and nasopharynx, which are accompanied by frequent relapses.

Home methods for treating chronic tonsillitis are allowed only under the supervision of a doctor. These include:

• ingestion of herbal tea from medicinal plants - St. John's wort, peony, calendula, chamomile, dill, coltsfoot, thyme, sage, eucalyptus, etc.;
• gargling with the above herbs;
• ingestion of propolis with honey.

Only regular treatment for two years can achieve positive dynamics. If exacerbations have not been observed for five years in a row, they speak of improvement. Compliance with all instructions often leads to a decrease in the number of relapses, however, if this result cannot be obtained, extreme measures are resorted to - tonsillectomy, or complete removal of the tonsils. Surgery has a number of contraindications.

Prevention of chronic tonsillitis

In order to prevent exacerbations, the tonsils need not only protection from adverse factors, but also hardening. To do this, doctors recommend periodically eating ice cream and drinking cold drinks in small portions - only during the period when the person is completely healthy.

It is important to eliminate all factors that can cause a sore throat, that is, take care in advance of the treatment of the nose and oral cavity, as well as the free breathing of the child. Rinsing with antiseptic agents helps clear the tonsils of bacteria. It is useful to gargle twice a day after meals with a solution of furatsilin, a decoction of sage, chamomile or calendula. The course is carried out for a month, then take a break.

Another effective remedy is tonsil massage. Perform it before going outside and before eating cold food. The procedure consists of light stroking in the area under the chin in the direction from the jaw to the chest. If the disease has become protracted, treatment should be more intensive.

Tonsillitis is a rather dangerous disease that can haunt a person throughout his life from early childhood and cause the most unexpected complications. Therefore, it is so important not to let the disease take its course, but to seek help in time.

Prevention of chronic tonsillitis

1. Drug therapy
   . If an ENT patient undergoes treatment courses in the clinic once every 6 months, then in addition to six-month procedures, he is recommended to take the drug Tonsilotren, with a frequency of once every 3 months, i.e. 4 times a year. The course of taking (resorption) of the drug is for 2 weeks (more precisely 15 days). It is also possible to instill 0.01% Miramistin solution, 4 pumps 4 times a day for 2 weeks, in courses 4 times a year.
2. Climatotherapy and spa therapy
   . An important point in the prevention of chronic tonsillitis is visiting seaside resorts. Sunbathing, humidified sea air, swimming and, as a result, the inevitable entry of sea water into the mouth have a beneficial effect on the prevention of chronic tonsillitis.
3. Work and rest schedule
   . In order for the periods of remission to be long, it is necessary to fully rest and not expose yourself to stress. It is not without reason that chronic tonsillitis, like sinusitis, is classified as a social disease, in which the more stress and workload there is at work, the higher the likelihood of exacerbation of chronic tonsillitis.
4. Diet
   . It is very important to eat right. Under no circumstances should you get carried away with fried, salty, peppery, sour, bitter, i.e. that food that irritates the mucous membrane of the back of the throat and palatine tonsils. Citrus fruits are contraindicated. The consumption of alcoholic beverages, especially strong ones, is also contraindicated. It is not advisable to eat very hot and very cold and solid foods.

Are large tonsils bad?

A common misconception is the idea that the size of the tonsils indicates their condition - the larger they are, the worse. In fact, small tonsils, as if hidden between the folds of the mucous membrane and sandwiched by arches, are more likely to become infected and are less capable of self-cleaning. The microbes that inhabit the lacunae, as well as the toxic products of their vital activity, are carried throughout the body through the bloodstream and affect almost all internal organs.

Why is chronic tonsillitis dangerous?

As already mentioned, chronic tonsillitis can proceed sluggishly and without sore throats. This form is dangerous precisely because it does not declare itself and does not attract special attention. At this time, the risk of complications increases rapidly. Please know that even a periodic mild sore throat and a low-grade fever that persists for weeks is a serious reason to contact an ENT doctor.

Treatment or removal of tonsils?

Dear patients! If you have visited several specialists in this field, if a course of treatment for chronic tonsillitis has been carried out and none of the methods has brought the expected result, then only in this case should you think about removing the tonsils.

If a conservative approach gives lasting results for 4-6 months or more, then the palatine tonsils are able to fight on their own. Your task is to help the tonsils by regularly sanitizing them and stimulating their work physiotherapeutically.

TREATMENT OF CHRONIC TONSILLITIS: WHY OPERATION?

Medical tactics for chronic tonsillitis are selected based on numerous diagnostic data and examinations. Specialists weigh the pros and cons, assess the risks of complications and make professional forecasts for the future.

In most cases, tonsillectomy is performed when a toxic-allergic form of chronic tonsillitis develops, which, unlike the simple form of the disease, occurs with severe symptoms of intoxication, immunosuppression and a high risk of developing infectious complications.

Radical removal of tonsils for chronic tonsillitis is absolutely justified: if conservative treatment of tonsillitis is ineffective, only surgery can get rid of the source of chronic infection in the pharynx and prevent the spread of infection.

Experts identify more than 100 concomitant diseases that occur with long-term tonsillitis: psoriasis, nephritis, eczema, prostatitis, scleroderma, lupus erythematosus, rheumatism and other pathologies. You should not postpone the operation if the specialist insists on it. The tonsils lose their main protective functions and turn into a dangerous source of infection.

There are certain indications for surgical treatment of chronic tonsillitis, on the basis of which the doctor makes a decision on the need for surgery.

Chronic tonsillitis is a disease of any age

Inflammatory processes in the throat are a big problem for both children and adults. Grigory Aleksandrovich Zhukov, an otolaryngologist at the consultative and diagnostic department of City Clinical Hospital No. 52, talks about their most common cause - chronic inflammation of the palatine tonsils.

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Let's understand the terms.

The most common cause of inflammation in the pharynx is inflammation of the tonsils, or tonsils (these are actually the same thing) - accumulations of lymphoid tissue in the pharynx. These formations are called tonsils because of their external similarity to almond kernels, and tonsils - because tonsils are translated as “small acorn”. In Latin we call them tonsillae - hence the name for inflammation of the organ - tonsillitis.

Why are tonsils needed?

The palatine tonsils are organs of the human body’s immune system. They participate in the formation of the immune response when pathogens of various infections enter the body. Normally, the infectious agent should enter the tonsils, where it will be recognized by cells of the immune system and reactions will develop to combat the infectious agent.

Why does inflammation of the tonsils develop?

If the lymphoid tissue does not have time or is unable to neutralize the “enemy”, inflammation of the tonsils themselves occurs - sore throat. Chronic inflammation (chronic tonsillitis), as a rule, occurs as a result of a sore throat, when a sluggish inflammatory process persists in the tonsils.

So, chronic tonsillitis is a protracted inflammatory process in the tissues of the tonsils. It can occur in both children and adults.

How does the person feel?

Patients feel discomfort and pain in the throat for a long time, so-called “plugs” may be coughed up, there is an increase in temperature to low-grade levels, and general weakness, which forces them to consult a doctor.

What does the doctor see during the examination?

When examining the pharynx, the doctor discovers swelling and redness of the palatine arches, enlargement and redness of the tonsils, their tissue is loose, and plugs form in the lacunae of the tonsils. Plugs on the tonsils represent the accumulation of substances in the lacunae of the tonsils. This substance is a mixture of dead cells and waste products of pathogenic bacteria. If corks are stored for a long time, salts are deposited in their structure, so they become hard. Corks can be multiple or single and vary in structure, size and color. Most often these are small yellowish inclusions visible in the gaps, but the color can vary from gray to brown.

What can a doctor prescribe for an exacerbation of chronic tonsillitis?

The treatment is complex: medication (antibiotics), local (gargling with antiseptic solutions and irrigation with sprays), as well as good old physiotherapeutic procedures; after the exacerbation subsides, you can rinse the lacunae of the tonsils from the plugs (this is done by an ENT doctor). BUT: we do not recommend self-medication, especially not taking antibiotics on your own. “Incorrect” prescriptions can lead to the development of pathogen resistance to the antibiotic, and in the future this drug will not be effective.

Why is chronic tonsillitis dangerous?

The disease occurs with periodic exacerbations in the form of tonsillitis. In a state of chronic inflammation, the tonsils are unable to do their job and become a source of infection. The constant presence of infection in the body causes a decrease in immunity, and therefore a tendency to frequent respiratory diseases. And if joint pain, pain and interruptions in heart function occur, these are signs of serious complications. That is why chronic tonsillitis in advanced cases is an indication for removal of the tonsils. The operation is performed only as prescribed by an ENT doctor.

Tonsil removal: where and how?

Tonsillectomy surgery requires hospitalization in an ENT hospital for several days. It is performed under local or general anesthesia. In our department, we remove tonsils surgically - with a scalpel and a loop.

Since the operation results in a fairly large wound, which in some cases requires suturing, we can leave the patient under observation for up to 5 days - there is a high risk of bleeding in the postoperative period. Some restrictions will be required - such as diet (liquid, non-hot food), lack of exercise for 3-4 weeks and bed rest.

What about ice cream after surgery?

This is a famous story from childhood. You can suck on pieces of food, you can eat ice cream, but the main thing is to treat yourself with care for some time after the operation and, ideally, with attention and care in the future.