Tonsillopharyngitis is an infectious disease that occurs with inflammation of the pharynx and tonsils. However, in the existing ICD system, this pathology, depending on the localization of the pathological process, is divided into two diseases, tonsillitis and pharyngitis, the course of which can be both acute and chronic.
Chronic tonsillopharyngitis is caused by the influence of various adverse factors:
- the presence of foci of chronic infection in the body, sinusitis, caries;
- decreased immunity, which is due to concomitant severe pathology, hypothermia;
- ecologically unfavorable environmental factors;
- allergies.
In the development of such a pathological process in the pharynx and glands, various microorganisms are also involved, mainly viruses, bacteria, less often fungi. The main cause of the development of an inflammatory process in the throat is viruses. About 90% of cases of the disease are due precisely to the effect of these pathogens. However, among all the causes of tonsillopharyngitis, the greatest attention is paid to the beta-hemolytic streptococcus group A.
This is due to the fact that the impact of this pathogenic organism can cause the development in the body of not only local, but also severe systemic complications, rheumatism with the formation of heart defects, as well as kidney damage, glomerulonephritis. The approaches to the treatment of such a pathology may be somewhat different. Therefore, in order to prescribe the correct treatment for a patient, it is necessary to clarify the nature of the pathogen.
Diagnostics
When diagnosing chronic tonsillopharyngitis, they rely on the following factors:
- patient complaints;
- the results of an objective examination, allowing to clarify the localization and form of the lesion;
- anamnesis data indicating previously transferred tonsillitis and pharyngitis;
- results of laboratory diagnostics.
The chronic process is characterized by periods of remission and exacerbation, which is reflected in the development of the clinical picture of the disease.
The most common complaint with exacerbation of chronic tonsillopharyngitis is a sore throat, which increases with swallowing, eating, and radiating to the ear or neck.
Putrid odor from the mouth is also troubling to patients. It is caused by the accumulation of pathological secretions in the crypts of the tonsils. These cheesy masses consist of dead cells, food debris. With the development of inflammation and a violation of the drainage function of the tonsils, these masses are evacuated into the oral cavity, which causes the development of certain symptoms in the form of an unpleasant odor.
An important factor indicating the development of an exacerbation of the disease is an increase in temperature. Subfebrile indicators in the range of 37.3-37.3 degrees can be observed for a long time. Hyperthermia of about 38 degrees indicates a period of exacerbation of the disease.
The symptom confirming the development of the inflammatory process is the increase and soreness of the regional lymph nodes. Typically an increase in the anterior cervical, mandibular lymph nodes. On palpation, they are soft, easily displaceable.
The involvement of the pharyngeal mucosa in the process is evidenced by the presence of a cough. It can be dry or with a small amount of hard-to-separate whitish phlegm.
Instrumental diagnostics of chronic tonsillopharyngitis is most reliable during the period of remission. In this case, the main signs are as follows:
- thickening of the palatine arches;
- the presence of cicatricial adhesions between the arches and directly the tonsils;
- tonsils are loose or hardened lymphoid formations;
- when pressing on the tonsils with a spatula, pus appears.
With an exacerbation of the process, the pharyngoscopic picture will correspond to the acute period and be characterized by the presence of a hyperemic and edematous mucous membrane of the pharynx, which may look like a varnish surface.
A mandatory symptom of the acute period is the presence of purulent plugs or liquid pus in the lacunae of the tonsils.
Anamnesis data play an important role in the diagnosis of the condition. Confirmation of the chronic course of the disease is a history of frequent sore throats and a constant sensation of discomfort in the throat. The clinical picture changes significantly depending on what form of tonsillitis is present, compensated or decompensated.
The compensated form of chronic tonsillopharyngitis can manifest itself only by the presence of purulent plugs and periodic coughing.
In this case, the exacerbation and development of angina occurs no more than once a year. With decompensated tonsillopharyngitis, not only subfebrile condition, purulent plugs in the throat are noted, but there may be symptoms indicating the development of local and systemic complications, fatigue, swelling and tenderness of the joints, shortness of breath during exertion, discomfort in the heart. With the spread of the process, the development of sinusitis, bronchitis, laryngitis, signs of involvement of the digestive tract in the process is noted.
Treatment measures in remission
Treatment for chronic tonsillopharyngitis depends on the stage of the disease, remission or exacerbation. The main measures without exacerbation are aimed at strengthening immunity, preventing exacerbations. They are as follows:
- The need to rehabilitate foci of chronic infection, as well as treatment of chronic diseases, which are accompanied by a decrease in immunity;
- Conducting restorative procedures that stimulate protective reactions in the body. These include the normalization of work and rest, hardening, fortified food, spa treatment, etc.;
- The use of immunomodulatory drugs;
- Providing an adequate diet that is free from coarse, spicy, hot, or overly cold foods.
An important role is given to measures to improve the drainage function of the tonsils. The easiest way to get results is by regularly flushing the throat and tonsils. They are carried out in order to wash out dried crusts, mucus. The presence of these formations on the back of the pharynx contributes to pain in the throat, forcing you to constantly cough up. Rinsing the tonsils, especially those performed using a jet under pressure, helps to flush out pathological secretions and cleanse them. Furacilin solutions, potassium permanganate, salt and soda solutions are used for this.
However, there are downsides to washing the tonsils with a syringe. First of all, the diameter of the cannula used does not allow flushing all the lacunae, which significantly reduces the effectiveness of the procedure. In addition, there is a risk that the use of a jet of solution under pressure contributes to the flow of pathological secretions into the deeper parts of the tonsils. Another disadvantage of this method is the possible trauma of the lacunae, which means their scarring.
In this regard, the hardware techniques used to wash the lacunae are considered the most effective and safe. The priority positions are taken by the use of the Tonsillor apparatus. Its use is possible for carrying out ultrasonic cleansing of the tonsils, which is more effective than the procedure using a solution stream. In addition, this apparatus can also use an ozonized solution, which has a more pronounced pharmacological effect. Experts believe that carrying out such preventive courses twice a year contributes to long-term remission of patients.
For over 20 years, many medical centers have been using intravenous laser blood irradiation (IVLB). By introducing the light guide and passing through it the radiation of a certain wave, it is possible to activate the formed elements of the blood, to increase immunity. Photodynamic therapy also belongs to modern techniques aimed at improving the recovery processes in the mucous membrane. It is based on the selective absorption of special waves by inflamed tissue areas, which contributes to their repair.
Operative treatment
Surgery is a radical method of treating chronic tonsillitis.
Tonsillectomy is a surgical procedure that removes the affected tonsil.
Tonsils play a barrier role in the body, they are an important organ in maintaining human immunity, therefore, the use of this method of treatment is always a balanced decision of the otolaryngologist. Having removed the lymphoid formations, an easier access is opened for the penetration of pathogenic pathogens into the oropharynx. This leads to frequent respiratory diseases, aggravates the course of chronic pharyngitis, laryngitis.
Surgical methods of treatment also include lacunotomy, carried out using radio wave methods, laser vaporization of the amygdala parenchyma. The task of such interventions is to improve the drainage function of the tonsils by expanding the lacunae. However, turning to such techniques, specialists are forced to investigate possible complications. The result of such interventions can be the activation of the cicatricial process, and, as a consequence, the receipt of the effect opposite to the expected one.
Treatment in the acute period
As for antibiotics for the treatment of chronic tonsillopharyngitis, their use is of limited use. This is due to the fact that drugs have a negative effect on the immune system, reducing the protective functions of the body. In the development of chronic diseases, the state of immunity plays a key role. The use of antibiotics is advisable during an exacerbation, as well as a short course before surgery.
In connection with the sensitivity of pathogens, drugs of the penicillin group, cephalosporins, macrolides have found the greatest use. Used "Bioparox" - a topical drug produced in the form of an aerosol. In case of exacerbation, other local agents are also used, which have anti-inflammatory, antiseptic effects. The development of hyperthermia exceeding 38 degrees is an indication for the appointment of antipyretic drugs.
An important part of effective treatment in the acute period is adherence to bed rest, sparing food and drinking plenty of fluids. Such activities contribute to the detoxification of the body, a decrease in body temperature, and the speedy normalization of the condition.
