Visual examination of the oropharyngeal cavity is a universal primary diagnostic method that is used when pathology is suspected from this anatomical region. Sometimes white layers are visible on the surface of the tonsils, which can be characterized by an observer as spots, plugs or lumps. The detected symptom should be compared with the rest of the symptoms present in the clinical picture. To establish a diagnosis, you need to find out why there are plugs in the throat - the reasons for their occurrence are important for the choice of treatment and preventive measures.
Causes
According to the most relevant statistical indicators, plugs in the tonsils, or palatine tonsils, are found with complaints of sore throat in 5-10% of cases in adult patients and in 12-15% of cases in children. Separately, it is worth looking at the morbidity data in the group of frequently ill children - the number of patients who have white lumps in their throat reaches 40% among the total number of registered patients.
Detection of accumulations of pus indicates a violation of local immune resistance and the presence of an infectious and inflammatory process. Since "tonsil" in Latin is referred to as "tonsillae", the inflammatory lesion within the palatine lymphoid formations is called tonsillitis. Ulcers in the throat can appear in the case of:
- acute inflammation of an infectious nature (acute tonsillitis, or tonsillitis);
- chronic inflammatory process (chronic tonsillitis).
If a patient has pus in the throat, this primarily indicates the presence of inflammation provoked by a bacterial agent - most often streptococcus, staphylococcus. The primary cause could be a viral disease, which led to a weakening of local and systemic immunity, activation of a bacterial infection. The acute course differs from the chronic one in that, with adequate treatment, it ends with recovery, complete or partial restoration of the affected anatomical area. However, this does not exclude the likelihood of complications, both concomitant and distant.
Since pus in the throat is a consequence of the patient having any form of tonsillitis, when discussing the causes of its occurrence, one cannot fail to mention the causes of the development of the disease. It is necessary to start with acute tonsillitis, which are found:
- with exogenous intake of bacteria;
- with autoinfection.
The exogenous intake of bacterial agents suggests infection from the outside - usually by airborne droplets. Autoinfection occurs as a result of the activation of the microflora that is constantly present on the mucous membrane of the oropharynx. This is due to a decrease in immune reactivity (hypothermia, viral diseases, mucosal injury).
At first glance, the mechanism for the development of acute tonsillitis is simple. There is even a kind of "formula" according to which the combination of an etiological factor (bacterial pathogen) and a contributing factor (hypothermia, damage, etc.) leads to the start of an infectious-inflammatory process. However, the general condition of the patient's body is also important (whether he was completely healthy or, conversely, exhausted), the nature of the pathogen.
With streptococcal sore throat, a rapid change in the nature of inflammation is observed - the catarrhal process becomes purulent. This means that purulent points and plugs appear already at the onset of the disease.
Yellowish white dots are sometimes seen as a type of cork; in fact, they are tonsil follicles filled with purulent contents, which, in the classical course of the disease, open themselves up on their own with the formation of ulceration sites.
Chronic tonsillitis
Chronic inflammation of the tonsils should be considered separately. It is chronic tonsillitis that is the most likely reason for the formation and long-term preservation of such a pathological symptom as white plugs in the tonsils. This disease is not only a focal chronic infection; an allergic component is also present in the pathogenesis. Toxic-allergic reactions are caused by the release of toxins by bacteria.
White lumps in the chronic course of tonsillitis can form for a long time, so the visual picture of the lesion does not remain the same and tends to change - especially after a relapse (repeated episode) of angina as a result of an exacerbation. Mechanical elimination of congestion without proper treatment leads only to a temporary and unstable disappearance of plugs. It is impossible to completely remove ulcers in the throat by such actions as squeezing or suction in the absence of additional therapy. In addition, there is a risk of injury, resulting in extensive suppuration.
Among the likely causative agents of chronic tonsillitis:
- Streptococci.
- Staphylococci.
- Haemophilus influenzae, etc.
The main causative agent is group A beta-hemolytic streptococcus - both simple and toxic-allergic forms of the disease are associated with it.
In children of the younger age group, throat plugs can also cause respiratory viruses (influenza, parainfluenza, adenoviruses), Epstein-Barr viruses, etc. The inflammatory process is not caused by them, but a viral infection of the oropharynx and tonsils leads to a violation of local defense mechanisms. This makes the tonsils vulnerable to bacterial agents and also slows down the recovery process.
It should be noted that white lumps are not always visible on a quick examination of the oropharynx. To find them, especially in children, you need to carefully examine the entire tonsil with a medical spatula. Only a specialist can conduct such a study, since knowledge of the anatomical features and accuracy is required to prevent injury to the tissue of the tonsil and other structures of the oropharynx.
Where do traffic jams come from?
Why do purulent plugs form in the throat? There are several main mechanisms:
- The accumulation of purulent exudate (mainly in liquid form) in the dilated lacunae of the tonsils. On examination, bright red tissue of the inflamed tonsil is usually visible - and plugs, which are exudate protruding from the mouths of the lacunae. Sometimes ulcers in the throat are present next to a purulent plaque that covers an area of the tonsil surface.
- There is swelling of the tonsil tissue. Violation of drainage, that is, the process of emptying lacunae, leads to the accumulation of pus. Infiltration with leukocytes occurs, necrosis - subsequently, necrotic foci merge, forming a single purulent focus, or an abscess inside the amygdala.
- The formation of intralacunar adhesions contributes to the violation of the outflow of contents, therefore the lacunas expand. Meanwhile, epithelium, leukocytes, mucus accumulate in them, which, together with tissue subject to necrosis, turn into purulent detritus (a product of tissue decay). The contents of the plugs are detritus rich in pathogenic microorganisms, in which mineral deposits (calcium salts) are often present. It has a semi-liquid, curdled or dense consistency, an unpleasant odor.
In the first case, they speak of the lacunar form of acute banal (classic) tonsillitis. In the second situation, we are talking about phlegmonous sore throat, which is characterized, as a rule, by a one-sided lesion.In the history of the disease with phlegmonous tonsillitis, you can often see the presence of trauma to the tonsil (for example, a fish bone during a meal). The previously mentioned bacteria of the group of streptococci, staphylococci, as well as listeria and other infectious agents can become causative agents.
The third of the described mechanisms is characteristic of chronic tonsillitis, in which the congestion in the throat bothers the patient for many months and even years. When clarifying the question of the main causative agent of the pathological process, monoflora (a specific version of the bacterial agent) is not always detected. Often, patients have microbial associations (communities of microorganisms).
Purulent plugs in the throat should be considered a type of "foreign body". They are not part of the anatomical structure of the amygdala and contain already non-viable tissue. Sores in the throat cannot be “ignored” by the immune system. An inflammatory process occurs around them, during which the epithelium is rejected, wounds are formed, which are ideal "entry gates" for pathogenic microorganisms. The gaps expand significantly, sometimes merging with each other, which is why new adhesions are formed.
Contributing factors
To find out for what reason traffic jams could have formed, contributing factors must also be taken into account:
- frequent respiratory infections;
- the presence of foci of chronic inflammation in the oropharynx;
- chronic diseases accompanied by difficulty in nasal breathing;
- improper diet, constant inhalation of polluted, dusty air;
- performance of professional duties in conditions of exposure to industrial hazards.
In children, hypovitaminosis, a tendency to allergies, and an early start of artificial feeding are also of great importance. Patients who have carious teeth, chronic periodontal disease are much more likely to notice white lumps in the throat. Plugs can also appear in people with immunodeficiencies of any etiology.
Pus in the throat, even if organized in plugs, is a constant source of irritation to the tonsil tissue. They become loose, and in the presence of cicatricial changes, the surface subsequently deforms, looks bumpy. Chronic inflammation of the tonsils leads to the loss of their role as a "barrier" for infection.
The appearance of traffic jams in itself indicates that the body is not able to eliminate the infectious focus. This is a sign of weakening immune reactivity.
White lumps of dense consistency are regarded as one of the main diagnostic signs of chronic tonsillitis. All forms of the disease are associated with the risk of severe complications. When white plugs appear, it is very important to distinguish between acute and chronic inflammatory process, to immediately begin treatment under the supervision of a physician.
