Palatine tonsils: classification of diseases and methods of treatment. Tonsils Where are the tonsils and tonsils in humans

For a long time, ambiguous opinions have been expressed about the tonsils or glands. Some scientists exaggerated their role, considering the tonsils as endocrine glands. Then a version arose that they did not have a special meaning: any lymphoid tissue could play their role. After that, the inflamed tonsils were removed everywhere. Modern medicine considers it a proven fact that a person needs tonsils. Only one question remains open: to delete them or not?

What are tonsils

The tonsils, or tonsils, are a collection of lymphoid tissue that lines most of the nasopharynx and mouth. They are located in the upper digestive and respiratory tract. Here the lymphatic pharyngeal ring of Pirogov-Valdeyer is formed, which includes:

• adenoid;
• two uterine;
• two palatine;
• lingual glands.

But when the term "tonsils" is used, we are most often talking about the palatine tonsils. It is a lymphoid mass of tissue located in pairs on the sides and back of the human throat. The glands grow and reach their normal size by the time of puberty. Then their growth stops, and the tonsils atrophy over time.

The size of each of the paired tonsils is equal to the size of a walnut. When paired, they correspond in size to the throat of a young child. The fabric is located in the form of folds, where there are holes or pockets, which are otherwise called gaps or crypts.

Why are tonsils needed?

The lymphatic pharyngeal ring is an obstacle to the penetration of various foreign agents: bacteria, viruses, fungi. It is here that up to 70% of all pathogenic microflora is retained, which enters the body with air and food.

Functions of the tonsils

The role of small paired organs cannot be underestimated:

1. In the crypts or depressions that lining the epithelial tissue, the infectious agent is processed and a specific infection is identified, for which certain protective proteins are produced.
2. Passing through the tonsils, the air warms up and becomes more humid, which prevents irritation and hypothermia of the respiratory tract.
3. Here, local immunity is formed, which is part of the general protective barrier of the human body.

Due to the winding passages and "pockets", the surface of the tonsils is significantly increased, which means that the contact area with microorganisms becomes much larger. In the thickness of the folds of the tissue of the tonsils are lymphoid follicles. They form lymphocytes, which play an important role in maintaining the immune status.

Only the tonsils contain a "chemical laboratory" for the recognition of the microbe. This information gets into other lymphoid tissues, and an immune response is formed in the form of antibodies that act on a specific infection, for example, measles, scarlet fever, rubella, chickenpox.

As long as the tonsils are healthy, they fulfill their role in full. In chronic inflammation, they not only "open the gates" for infection, but also become a focus of its spread, causing complications and pathologies of other organs.

Possible diseases

With weakened immunity, allergic manifestations and the development of general intoxication of the body are possible. The tonsils become inflamed, redden, swell and become a dangerous source of infection. The inflammatory process in the glands develops for the reasons:

• chronic rhinitis;
• inflammation of the maxillary sinuses (sinusitis);
• tooth decay or inflammation of the gums;
• hypothermia;
• contact with an infected person.

When in contact with the mucous membrane of the palatine tonsils, microbes are activated, begin to multiply actively, creating colonies and spreading throughout the body. Inflammation is possible in the form of separate pathologies, as concomitant with other infections or with blood diseases.

Sore throat or acute tonsillitis usually develops. Its forms are catarrhal, lacunar and follicular, which are interchangeable since this is a common form of the inflammatory process.

The development of acute tonsillitis is accompanied by the following symptoms:

• sore throat;
• difficulty swallowing;
• redness and swelling (plaque) of inflamed tonsils;
• an increase in temperature indicators;
• manifestations associated with the process of intoxication.

Catarrhal angina is expressed by separate symptoms, and lacunar and follicular in their indicators are very similar. Different forms of tonsillitis can develop on different tonsils.

In children under one year old, inflammation of the tonsils practically does not occur. More often, a runny nose or pharyngitis is observed when only the back of the pharynx is irritated. In childhood, angina is extremely difficult. There are signs of general intoxication:

• vomit;
• diarrhea;
• fainting;
• sore throat.

Angina is dangerous for its consequences and complications, in which damage to various organs is possible: heart, joints, kidneys, liver. Against the background of angina, other chronic pathologies are actively developing.

In addition to tonsillitis, there are atypical types of glandular lesions. For example, it is possible to develop herpetic sore throat or angina Vincent-Plaut-Simanovsky, which develops under the influence of two bacteria.

Delete or not

A patient suffering from chronic manifestations of sore throat should not make a decision to remove the tonsils. Advice and recommendations are given by the doctor based on the specific situation and possible health consequences.

If sore throats occur regularly, but not too often (2-3 times a year), then the tonsils are amenable to conservative treatment. One of the methods is sanitation using the Tonsillor apparatus. The essence of its action is that pus is removed from the tonsils and medicines are pumped into the lacunae, freed from pus.

Another method that is intermediate is the laser lacunotomy. With the help of a laser beam, incisions are made on the tonsils, from which pus and other contents flow out. The incisions heal gradually and the lymphoid tissue is restored.

If, due to tonsillitis, complications begin in the body, then you cannot do without removing the tonsils (tonsillectomy). If the operation is done on time and correctly, it will not in any way affect the future life and health of the patient.

If the tonsils are healthy, then they play an important role as a protective barrier. Sore glands are a source of infection. This is a bag filled with pus and pathogenic microflora, it is a "time bomb" that must be defused.

Do not assume that when the tonsils are removed, the local immunity in the throat area will not work. There are 6 glands in the periopharyngeal ring, and only 2 are removed. The rest will take over the function of the missing piece of lymphatic tissue.

The size of the tonsils has nothing to do with the disease. With their large size, a person can be absolutely healthy and vice versa - small tonsils are not evidence of the development of the disease.

Well aware of the important role of the tonsils, a person is not always inclined to surgery. Today this radical method is not popular among doctors either. But in case of emergency, you have to take this difficult step in order to avoid serious complications.

The tonsils (tonsils) are part of the immune system of the human body. Their presence is extremely important to ensure full protection of the body from various harmful external factors. They are the first to begin to contact and fight against microorganisms that carry diseases.

The high-quality performance of its functions is also affected by the special location and structure of the tonsils. They belong to the important organs responsible for the body's defense, but many do not even think about what our body needs them for.

Types of tonsils

Tonsils are some formations of lymphoid tissues, have the shape of an oval. They are located near the mucous membranes in the area where the oral cavity ends and the entrance to the pharynx begins.

The very concept of "tonsils" begs for another simpler and more common name among the people - tonsils. However, it is worth noting that the tonsils are called glands, of which, by the way, there are several types in the human body.

So, tonsils can be:

• palatine - located between the root of the tongue on the left side and the opening of the pharynx in the bays on the right;
• pipe - located in the area of ​​the pharyngeal opening;
• Lushka's tonsils - they are easy to find above the place of the pharyngeal vault;
• lingual - based on the name, we can say that they are from the back of the tongue, namely under it.

What are the functions of the tonsils (tonsils)? What structure and structure do they have? All these questions can be answered in this article.

Why are tonsils needed?

These organs of the oral cavity are needed by the body in order to prevent all kinds of inflammatory processes of the respiratory system. They are entrusted with the ability to be the first to meet the potential threat in the form of microbes, and a great responsibility to fight it. Often, these same microbes lead to the development of angina in humans, in which it is the palatine tonsils, that is, the tonsils, that become inflamed.

The main difference between the tonsils and other types of tonsils is their surface, on which there are special depressions (they are also called lacunae). They are needed in order to keep viruses and bacteria, representing some kind of traps for microorganisms that carry diseases.

There are about 40 lacunae on the tonsils, which hide the pathogens that affect the tonsils during the inflammatory process. Also, the lymphoid tissue includes follicles in its structure.

Purpose of tonsils

The tonsils, including the tonsils, are called upon to perform certain functions in the human body, such as:

1. Barrier. As soon as various causative agents of diseases enter a person, they begin to come into contact with these accumulations of lymphoid-type tissues. At the same time, the glands destroy them with the help of cells that are produced by the lymphoid tissue.
2. Immunogenic. The glands are capable of producing T-lymphocytes and B-lymphocytes in the human body. These cells are responsible for the state of the body's immunity as a whole.

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It is worth noting that the tonsils are capable of performing with full dedication all the functions assigned to them, provided that they are completely healthy. If inflammation occurs in the tissues, the whole body will suffer from this. The protective ability will noticeably decrease, the development of complications may appear.

What healthy tonsils look like

Today it is difficult to meet a person with perfectly healthy tonsils. Infections, weakened immunity, the state of the environment - all this favors the transformation from acute inflammatory processes in the oral cavity into chronic ones. The situation is aggravated by the fact that some people prefer treatment with folk remedies, avoiding traditional methods as much as possible, although doing this with angina, laryngitis, pharyngitis and the like is strictly prohibited.

So, you need to figure out how healthy glands look in order to diagnose them in the future:

• glands are small in size, located within the palatine arches;
• their healthy color is pale pink;
• complete absence of any plaque, redness;
• uneven bumpy surface of the glands, you can see small elevations;
• as if separated from the palatine arches;
• there is no inflammation of the mucous membrane of the posterior pharyngeal wall, uvula, tongue or soft part of the palate;
• absence of caseous plugs or pus when pressed with a spatula;
• the absence of a pattern of vessels behind the pharynx, the mucous surface without edema, follicles were not found.

If we consider each of the signs given here separately, then it cannot be an indicator of a healthy throat. This must be considered, taking into account all the points and the general condition of the person.

What do inflamed glands look like?

Already by the pain and discomfort in the oral cavity, one can understand that the process of the disease has begun, but this is not enough to start the treatment process or, conversely, ignore the "frivolous" cold.

So, the following is inherent in inflamed tonsils:

• redness, swelling of the soft part of the palate, the back of the pharynx - the likely development of acute pharyngitis, provoked by a virus or bacteria;
• swelling, redness in the absence of plaque, the appearance of a sore throat - foreshadows the onset of sore throat, namely its catarrhal stage;
• redness and inflammation, the appearance of a yellowish-white plaque, sore throat, high temperature in aggregate speaks of sore throat;
• redness, swelling of the tonsils, no plaque, small vesicles covering the glands (ulcers in the future) - means a herpetic sore throat;
• runoff from the nasopharynx in children of thick festering mucus is inherent in inflammation of the adenoids, and in adults - inflammation of sinusitis, rhinitis;
• caseous plugs peep out of the lacunae, and when a spatula is pressed on the tonsils, the discharge of pus portends a chronic disease of tonsillitis;
• an increase in follicles behind the pharynx, cough, dryness, sore throat - signs of chronic hypertrophic pharyngitis;
• the coating of the oral cavity with a white coating (tongue, tonsils, back pharynx, gums) indicate a fungal infection, which can appear with prolonged use of antibiotics or a low level of immunity.

It is very important to timely detect the problem in yourself or your relatives and friends in order to be able to cure it with minimal complications and consequences for the body. Therefore, it is very important to familiarize yourself with the points according to which the tonsils are considered inflamed or, conversely, healthy. Timely started therapy and the use of the necessary medications will be able to save the patient from many "troubles" in the future and return him to his usual life in a healthy body.

Palatine tonsils or tonsils in humans are an integral part of the body. They are the first to "get acquainted" with pathogenic factors in the air or food. The further functioning of internal systems and organs depends on how fully they are developed and fulfill their protective role.

What are tonsils: a short description

This is an accumulation of lymphoid tissue in the pharynx, which begins to form in the womb. After a person is born, they actively grow until the age of 15, after which the reverse process begins. They are localized between the oral and nasal cavities and are represented by the palatine, tubal, pharyngeal and lingual tonsils. They are normally small and imperceptible. The circular arrangement of these formations is called the pharyngeal lymphoepithelial ring. Granules of the posterior pharyngeal wall, its lateral ridges, laryngeal tonsils and this ring form the lymphoid apparatus of the pharynx.

Where are they located, what structure do they have, how are the tonsils classified?

All periopharyngeal formations in the section have a porous structure, but each of them is characterized by its own characteristics. For example, the pharyngeal is divided by connective tissue into lobules and is covered with ciliated epithelium, and the palatine consists of a capsule, stroma, parenchyma, epithelial cover, and also has upper and lower poles. In the upper ones, there is a supra-almond fossa, in which an additional lobule can be located. The capsule is formed by connective tissue on the lateral surface and mucous membrane on the medial surface. The partitions extending from it divide the amygdala into internal lobules, and the stroma into trabeculae. On the outside are gaps, which are the mouths of the crypts. The parenchyma is represented by mature lymphocytes and follicles. The anatomical structure of the tonsils is similar, but the existing features are different.

Such a formation also exists near the root of the language.

There are 6 pairs of tonsils in the human body, which are classified into paired, among them palatine and tubal, and unpaired - lingual and pharyngeal. The former are located in the throat between the arches on the sides of the pharynx, and the latter are located near the opening of the Eustachian tube. The pharyngeal formation has the form of transverse folds and is localized on the upper-posterior wall of the pharynx. Under the epithelial membrane of the tongue, in its root part, along the midline is the amygdala, which is called the lingual.

All types of tonsils are composed of lymphoid tissue permeated with lymphatic and blood vessels, as well as nerve fibers.

Language education

Like all others, it grows up to 15 years, after which its atrophy and division into right and left lobes occurs. The bumpy surface has characteristic depressions - the ducts of the salivary glands. The secretion released through them moisturizes the oral mucosa and facilitates the transport of food through the mouth into the esophagus. The air stream inhaled by the mouth is cleared by this lymphoid formation from pathogenic factors. White blood cells, which mature here, are responsible for the body's immune response to their introduction. A good blood supply provides a high potential for fighting bacteria.

Palatine tonsils

The largest paired formations of the Pirogov-Valdeyer lymphoid ring. About 20 lacunar depressions are responsible for the capture of pathogens in the mouth, which enter the air and food. In childhood, as well as in adults with weakened immunity, a large accumulation of pathogenic microflora here provokes the development of the disease. This special anatomy of the tonsils allows them to recognize microorganisms and take action to eliminate them.

Tubular formations

When a child is at the 7th month of intrauterine development, such lymphoid formations are formed in him.

The smallest diffuse accumulations of lymphoid tissue, which consist of a few nodes of the same structure and are located on the lateral walls of the nasopharynx. Outside, they are covered with a mucous membrane with ciliated epithelium. They begin to develop in the fetus in the seventh month of pregnancy and reach a peak of growth by the age of 7 years. Tubular or tubular tonsil protects the organ of hearing from external infection.

Pharyngeal lymphoid formation

In everyday life - adenoids. Several rollers of lymphoid tissue and follicles are located in the fornix of the nasopharynx. Outside, they are covered with ciliated epithelium. In addition to protecting the hearing aid from infection by pathogens, they provide a person with hearing acuity. Localization between the auditory tube, on the one hand, and the pharyngeal cavity, on the other, helps to equalize the pressure in the tympanic cavity.

The main functions of the tonsils

• Barrier. It consists in the recognition and capture of pathogenic bacteria and microorganisms.
• Immunogenic. This is where the formation of lymphocytes and antibodies takes place.
• Hematopoietic.

Diseases of the tonsils

Many factors can impair the function of the tonsils, leading to the development of the disease. Among them are hypothermia, viral and bacterial infections against a background of weakened immunity, exacerbation of chronic diseases, and others. With any inflammatory process in the amygdala, its structure, appearance, size and color are disturbed. The appearance of specific symptoms is influenced by the type of infection and the severity of the pathological process.

Formations can grow at the time of infection.

The tonsils in the throat are most often infected. In this case, angina, scarlet fever, hypertrophy or chronic tonsillitis may occur. Inflammation of the palatine tonsil can be unilateral or bilateral, and also be accompanied by the formation of purulent plaque and plugs on them, the development of intoxication. At the same time, the function of the glands is disrupted, there is a temperature, weakness, headache, submandibular lymph nodes increase. A person's glands hurt not only when swallowing, but also at rest. To treat this condition, antibiotics, antipyretic and pain relievers are given, and it is also recommended to gargle with antiseptic solutions, for example, such as:

• Miramistin;
• "Furacilin".

This disease is dangerous for its complications, which may appear in 3-5 days or after weeks.

The enlargement of the pharyngeal tonsil is most common in preschool age. Breathing and hearing impairment, snoring, signs of hypoxia and rhinitis accompany adenoiditis. The severity of the symptoms will depend on how much it is increased. If the lingual tonsil is inflamed, then the patient feels local pain when talking or eating. Diseases of the tonsils in humans develop against the background of dysfunction of the glands in the body and damage to the adenoids.

The accumulation of lymphoid tissue in the mucous membrane of the upper respiratory tract and the initial sections of the digestive tract. Performs protective and hematopoietic functions.

The tonsils in the human body are referred to as lymphoepithelial tissues. Although they are small in size, their significance is enormous. Some people call the tonsils glands. Both terms are correct, although in the medical literature the patient will mostly come across the term amygdala. A doctor who studies and treats tonsils is an otorhinolaryngologist. Although primarily patients seek advice and help not to him, but to a therapist or pediatrician. Therefore, doctors of these specialties are also well versed in the main diseases of the tonsils.

Anatomy and physiology of the tonsils

The anatomical arrangement of the tonsils and their physiological characteristics provide prerequisites for the development of certain diseases of pathological conditions in them.

What are tonsils?

The tonsils are one of the components of the lymphoepithelial barrier in the human body. This barrier is the formation and maturation of lymphocytes and the production of antibodies. In addition to the tonsils, these functions are performed by lymphoid granules in the pharynx and solitary follicles in the intestine. All these formations have close contact between the internal and external environments of the human body.

The tonsils are located in the throat. Their arrangement resembles a ring. Therefore, the complex of tonsils in the throat is called the Pirogov-Valdeyer lymphadenoid pharyngeal ring. In total, this complex includes 6 tonsils.

There are six tonsils in a person's throat in total. Paired tonsils: palatine and tubal; unpaired tonsils: lingual and pharyngeal (nasopharyngeal). It is customary to highlight their numbering in medical practice: 1 and 2 ─ palatine tonsils, 3 ─ pharyngeal tonsil, 4 ─ lingual, 5 and 6 ─ tubal.

Palatine tonsils

The palatine tonsils are located in the amygdala fossa (a triangular depression on the lateral walls of the pharynx between the palatine arches). These tonsils are the largest.

The palatine tonsils have distinctive features from the rest of the tonsils. This is due to the peculiarities of their structure. There are gaps (grooves) in the tonsils. The lacunae of the tonsils pass into the crypts, representing the ramifications of the entire thickness of the tonsils. A large number of branches are covered with epithelium, which is in contact with the external environment and a huge number of antigens. This stimulates more antibody production in the tonsils. They contain accumulations of lymphoid tissue. They are called follicles. They contain lymphocytes of different maturity.

The palatine tonsils are covered with a sheath of connective tissue. It's called a capsule. In the upper part of the palatine tonsils there are Weber's mucous glands. With age, the palatine tonsils undergo involution (decrease in size). This process begins in adolescence and lasts until old age.

The main role of the palatine tonsils: the formation of lymphocytes and participation in the formation of immunity. The synthesis of antibodies is especially active at a young age (before puberty). It is at this time that a person is in wide contact with various infectious agents and toxins. This is due to the fact that children attend kindergarten, school and other educational institutions.

The location of the tonsils in the body makes them the first barrier to dangerous bacteria and foreign substances. In adults, the tonsils also take part in the immune response, although antibody production is no longer so active.

Another function of the tonsils is elimination, that is, they remove excess lymphocytes from the body to the surface of the tonsils.

Studies have been carried out that prove the role of the tonsils in digestion, namely in the formation of enzymes (lipase, amylase, etc.). After eating, their level in the tonsils increases. This indicates that the tonsils are involved in oral digestion.

Tubal tonsils

Tubal tonsils are small in size, they are accumulations of lymphoid tissue on the lateral wall of the nasopharynx near the mouths of the auditory tubes. These tonsils are paired, they lie in depressions (pharyngeal pockets).

When enlarged, the tubal tonsils can become the culprits of frequent otitis media and hearing problems. This will be due to the fact that the enlarged tonsils overlap the communication between the nasal cavity and the middle ear.

The pharyngeal tonsil is unpaired. It is located along the central line on the wall of the nasopharynx in its upper section. Unlike the palatine tonsils, the pharyngeal tonsil contains grooves or crevices that do not have branches. There is no crypt in the pharyngeal tonsil. The pharyngeal tonsil is not covered with a capsule. The pharyngeal tonsil undergoes involution. This process starts at the age of 14-15.

Excessive enlargement of the pharyngeal tonsil due to its hypertrophy is called adenoid growths (adenoids). This process is observed in childhood. It is dangerous because an enlarged amygdala can hinder the process of nasal breathing and disrupt the work of the auditory tubes.

Lingual tonsil

The lingual tonsil is an unpaired tonsil that does not have a capsule. It is located at the root of the tongue. In it, as in the pharyngeal, there are crevices and grooves, but not crypts. In the photo, this amygdala looks bumpy with a rough surface. By the age of 20-30, the development of the lingual tonsil ends.

Tonsil inflammation is accompanied by symptoms such as pain while eating and talking. Chronic inflammation of the lingual tonsil is very rare.

What do the tonsils look like in the photo?

Of all six tonsils, a person has the opportunity to examine only the palatine tonsils. The rest can only be seen by a specialist using the necessary equipment. Therefore, to find out how they look, you can see the tonsils in the photo. It is better if the doctor comments on this picture and tells about the norm or pathology.

Healthy tonsils in the photo have the following signs: pink color, normal size, absence of plaque and "traffic jams". With hypertrophy or inflammation of the tonsils in the photo, you can see their increase in size, change in color, the presence of pathological plaque and discharge from the lacunae of the tonsils.

Tonsils in children play a huge role in the formation of lymphocytes and the formation of immunity. In childhood, a person actively contacts other people, enters into different groups, where he inevitably meets with a variety of pathogenic microorganisms. It is the tonsils in children that are the first to take the "blow" when they meet with infectious agents and begin to fight them.

Almost every child meets during his life with inflammatory diseases of the tonsils. Some children suffer from hypertrophy of the tonsils or pharyngeal tonsils. Although this process will pass on its own over time, it is dangerous to leave the child without treatment. Because there is a risk that problems such as hearing impairment, speech impairment, delayed growth and development, deterioration in school performance, and sleep problems will build up.

Man is born with tonsils. In the first months after birth, their weak development is noted. They do not actively perform their functions. In the palatine tonsils, only forming follicles are still found. By the end of the first half of a child's life (less often by a year), the tonsil follicles finish their development.

The fastest developing in children is the pharyngeal tonsil (adenoid). Even a small increase in it can cause impaired breathing through the nose, which is due to the peculiarities of the structure of the respiratory tract in a child. In the second year of life, the palatine tonsils fully develop. The special structure of the lacunae of the tonsils contributes to the easy occurrence of inflammatory processes in them.

During life, the tonsils undergo a process of involution, that is, reverse development. As a rule, it begins in adolescence and lasts for many years. Gradually, the lymphoid tissue of the tonsils is replaced by connective tissue.

Diseases of the tonsils

The location of the tonsils in the human body at the intersection of the digestive tract and the respiratory tract, as well as the peculiarities of their structure, make them vulnerable to inflammatory processes. This is especially true of the palatine tonsils, it is there that chronization of processes most often occurs.

Like any other organs, the tonsils can be subject to various diseases. The most common ones are:

• Inflammation of the tonsils (tonsillitis, tonsillitis)

If a person has been diagnosed with tonsillitis, then, probably, we are talking about inflammation of the palatine tonsils. Although inflammation of any tonsils are called sore throats. Simply in this case, it is necessary to indicate the name of the inflamed tonsil when announcing the diagnosis, for example: tonsillitis of the lingual tonsil.

• Hypertrophy of the tonsils

Hypertrophy is an enlargement of the tonsils due to their pathological proliferation. The tonsils in children are hypertrophied, as a rule. There are several degrees of this process. The more the tonsils are enlarged, the more they interfere with the person (breathing, swallowing, talking normally). Therefore, depending on the degree of the process, an appropriate treatment for the tonsils is prescribed.

• Chronic tonsillitis

An inflammatory process in the tissue of the palatine tonsil, which persists in a person for a very long time (sometimes all his life). In this case, there is an exacerbation of the disease and its remission. A chronic sore throat can cause many associated health problems.

• Tonsil tumors

They are both benign and malignant.

Angina of the palatine tonsils

Angina of the palatine tonsils is an acute disease of an infectious-allergic nature, which is manifested by local inflammatory processes in the palatine tonsils.

The term “sore throat” is derived from the Latin word “ago”, which means ─ to choke or squeeze. Although in fact, angina is not accompanied by suffocation. Inflammation of the tonsils occurs both acute and chronic. Both forms of the disease have features of the course and treatment.

An acute disease of the tonsils (tonsillitis), which is characterized by the development of an inflammatory process in them. This disease is very common and at the same time dangerous, because angina can lead to serious complications.

The main causative agent of the disease is group A β-hemolytic streptococcus (up to 80% of cases of the disease). There are also other causative agents of tonsillitis and their association with each other. Other causative agents of tonsil inflammation include: hemolytic staphylococcus, fungi, Staphylococcus aureus, adenoviruses, spirochetes, enteroviruses, etc.

Dangerous microbes enter the body by airborne droplets or alimentary (with food). There is also endogenous infection of a person with a decrease in his immunity. In this case, the inflammatory process can be caused by opportunistic microorganisms that live in the human body constantly.

Most often, people get sick with angina in spring and autumn. Weakened people, children, people with reduced immunity (pregnant women, etc.) are most susceptible to the disease. Sore throats are promoted by poor nutrition of a person with a lack of vitamins B and C, trauma to the tonsils, some features of a person (for example, lymphatic-hyperplastic constitution, chronic diseases of the nasopharynx, problems with nasal breathing).

That is, inflammation of the tonsils begins when a person is not only affected by harmful or opportunistic microorganisms, but other provoking factors of the disease are present.

The development of the disease follows the type of hyperergic reaction. There is an assumption that the microflora inhabiting the crypts of the tonsils and the degradation products of proteins can act as a substance leading to sensitization of the body. This becomes the triggering factor for the development of angina. In addition, the allergic genesis of the disease can explain such consequences of angina as rheumatism, nephritis, polyarthritis and other diseases of an infectious-allergic nature.

Chronic tonsillitis

Chronic tonsillitis is an insidious disease. There is a persistent inflammatory process in the tonsils, which is in a state of remission and exacerbation. A person becomes a source of infection for himself (autoinfection) and for others. An exacerbation of the disease can happen due to hypothermia, poor environmental conditions (gas pollution, changes in temperature and humidity), and a decrease in immunity.

The peculiarities of chronic tonsillitis are such that different microbes live in the tonsils: there is a mixed flora on the epithelium, and one microorganism predominates in the thickness of the tonsils. These include hemolytic streptococcus, staphylococci, adenoviruses, enterococci, and even opportunistic microbes.

The disease usually occurs after repeated sore throats, when complete recovery does not occur against the background of inadequate treatment or a decrease in immunity. Tonsils gradually change, pathological contents accumulate in their crypts. Some patients note the constant presence of "plugs" in the tonsils. Crypts are not emptied completely, this is prevented by scars in the tonsils after tonsillitis. Thus, the inflammation in the tonsils is constantly maintained and the process is delayed. "Plugs" in the tonsils with purulent or caseous contents in chronic tonsillitis happen even during remission.

Exacerbations of chronic inflammation of the tonsils usually occur up to three times a year, sometimes 5-6 times. The diagnosis of chronic tonsillitis can only be made by a doctor, because the patients themselves often diagnose sore throat where it does not exist.

There is another situation: the tonsils are changed, with signs of chronic tonsillitis, but there are no exacerbations in a person. Such forms of the disease are called "angina-free".

There is a chronic inflammation of the tonsils in a simple and toxic-allergic form. The first is characterized by frequent sore throats. The second form includes, in addition to sore throats, other disorders in the body: changes in the blood and in the immune system. It is 1 and 2 degrees in severity.

At grade 1, patients may complain of a slight increase in temperature, fatigue, heart rhythm disturbances, body aches. At grade 2, serious diseases join, which are complications of angina: polyarthritis, rheumatism, endocardial and kidney damage.

The degree of the toxic-allergic form of chronic inflammation of the tonsils is an indication for the removal of the tonsils. Grade 1 of the disease, as well as a simple form of chronic tonsillitis, are first treated conservatively. Necessarily used in the treatment of washing the tonsils. Only with the ineffectiveness of conservative treatment of tonsils is the removal of tonsils used.

Chronic inflammation of the other tonsils is rare. But in children, there are cases of chronic adenoiditis (chronic inflammation of the pharyngeal tonsil).

There are many forms of inflammation of the tonsils (tonsillitis). Depending on the causative agent of the disease, the nature of the course of the disease and the individual characteristics of a person, the symptoms of angina may also differ. Although the main signs of the disease can be noted in almost every clinical case.

Pain in the tonsil area

With angina, a person feels pain in the tonsils. The pain can be constant, it can appear only when swallowing. Usually, the onset of pain is preceded by a feeling of dryness, burning, or sore throat. The intensity of pain varies. In severe forms of angina, sometimes the pain radiates to the ear or teeth.

When examining a patient, the doctor specifies the localization of pain, on one side it hurts or on both sides, whether it hurts along the middle line of the pharynx, where it gives the pain, which helps the patient to cope with the pain. It is important to feel the regional lymph nodes in diseases of the tonsils, they often become enlarged and painful.

Enlarged tonsils

A very important symptom of tonsillitis: the tonsils increase in size. Enlarged tonsils sometimes extend beyond the palatine arches. Sometimes it makes it difficult to breathe and swallow normally, especially for children. If a person has only enlarged tonsils, then this is not a sign of sore throat. Most likely, this is tonsil hypertrophy. The enlargement of the tonsils varies in degrees. The doctor can find out the reason for the enlargement of the tonsils and choose the treatment.

Changes in the lacunae of the tonsils

Changes in the lacunae of the tonsils are characteristic of severe tonsillitis. At the same time, pathological contents accumulate in them. Therefore, you can visually notice symptoms such as "white" tonsils or purulent tonsils. "White" tonsils are found in lacunar angina, diphtheria, and mononucleosis. Purulent tonsils are characteristic of the ulcerative-necrotic form of tonsillitis and phlegmonous tonsillitis. The presence of "plugs" in the tonsils in the absence of vivid symptoms of the disease speaks in favor of chronic tonsillitis.

Very often, in diseases in which the tonsils are affected, fever is the first symptom of the disease or appears along with discomfort in the throat. The severity of the rise in temperature can be different: from subfebrile (up to 38 ° C) numbers to hyperpyretic values ​​(above 40 ° C). The duration of the fever is usually 3 to 5 days, sometimes longer. Characterized by a rapid decrease in temperature against the background of adequate treatment of inflamed tonsils.

With inflammation of the tonsils, the temperature is only one of the signs of intoxication. In addition to her, with tonsillitis, other symptoms are noted. These include headache, weakness, loss of appetite, vomiting, chills.

Common forms of tonsillitis (inflammation of the tonsils)

There are many different forms of tonsil inflammation. Some are independent diseases, while others are one of the manifestations of a systemic or infectious disease. Most often, a person gets sick with banal sore throats, which include catarrhal, follicular, lacunar and mixed forms.

Less common are atypical forms of tonsillitis: fungal, ulcerative necrotic, phlegmonous, enteroviral sore throats and a mixture of these forms.

In a number of infectious diseases, tonsillitis also occurs: the tonsils have their own characteristics of the lesion. Such diseases include scarlet fever, diphtheria, measles, syphilis, HIV infection (infection with the human immunodeficiency virus).

In addition to the above forms of damage to the tonsils, there are tonsillitis in blood diseases: agranulocytic and monocytic tonsillitis, tonsillitis in leukemia.

Catarrhal sore throat

This is the least severe tonsillitis, in which the tonsils are affected only from the outside (mucous membrane). Typically acute onset of the disease with the appearance of unpleasant sensations in the throat: dryness and burning, perspiration and pain. Signs of intoxication are moderate, the temperature does not rise above 38 ° C. Characterized by a headache, a feeling of weakness, aches, loss of working capacity, lethargy.

With catarrhal sore throat, the inflamed tonsils look hyperemic, that is, bright red. The palatine arch also turns red. Their mucous membrane is swollen with serous discharge. Purulent deposits on the tonsils with this form of the disease are not noted. On the epithelium of the tonsils there is a large number of lymphocytes and leukocytes, the epithelium itself is loose.

In the general analysis of blood, minor inflammatory changes are noted. Regional lymph nodes often increase in size. The disease lasts, as a rule, for a short time, up to 5 days.

In order not to confuse catarrhal sore throat with (inflammation of the posterior pharyngeal wall), it is necessary to compare the color of the tonsils and the pharyngeal wall. Enlarged tonsils of bright red color against the background of a relatively pale pink pharynx testify in favor of tonsillitis.

Follicular tonsillitis

This form of angina is much more severe than the previous one: not only the mucous membrane suffers, but also the follicles themselves.

The disease begins acutely, the temperature rises to high numbers (38-39 ° C), a sore throat appears, which often radiates to the ear, and vomiting. Signs of intoxication are pronounced, may prevail over local symptoms. This is especially noticeable in children, they even have a violation of consciousness with follicular angina.

When examining the pharynx, the bright redness of the tonsils and surrounding tissues is clearly visible: the arches, the soft palate. They look edematous. With follicular angina, the tonsils have their own characteristics, since deep pathological processes occur in the thickness of the tonsils. Infiltrates are formed from leukocytes in the follicles. They shine through the epithelium and look like millet-sized yellow dots (1-3 mm). They are clearly visible when examining the pharynx. They are often referred to as "plugs" in the tonsils. Follicles with angina are opened on their own for 2-4 days of the disease. He left them with erosion, which heal quickly.

In the general analysis of blood, pronounced inflammatory changes are noted. Regional lymph nodes are enlarged, which are painful to touch. The illness lasts for about one week.

The general signs of lacunar sore throat are the same as with follicular sore throat, but they are more pronounced. With lacunar angina, significant changes are determined in the lacunae of the tonsils, which then pass to their surface. They contain a serous-mucous secret that becomes purulent. This discharge contains many leukocytes, lymphocytes, epithelial cells and fibrin filaments.

Plaque on the tonsils may appear confluent, making the tonsils appear white or white-yellow. The plaque is easily removed from the tonsils with a spatula, it does not go beyond the boundaries of the tonsils.

The disease lasts for about one week, with complications, the process can be delayed. Some patients have signs of both lacunar and follicular tonsillitis at the same time.

Fibrinous sore throat

Fibrinous tonsillitis develops against the background of follicular or lacunar tonsillitis. In the event that suppurative follicles burst, a fibrinous film may form. It covers the inflamed tonsils and can extend beyond them.

If you compare the photo of the tonsils with fibrinous sore throat and with diphtheria, then you can find the similarity of manifestations, although these are completely different diseases. Bacteriological examination of smears from the pharynx and nose helps to differentiate diseases. The rest of the symptoms of fibrinous sore throat are similar to other symptoms of common sore throats.

This is a severe form of tonsillitis, in which the tonsil lacunae are not emptied from their contents. It is rare. The swelling of the inflamed tonsils is determined, their soreness when palpating. An abscess (abscess) is formed inside the tonsil from the fused follicles. The process often happens on the one hand. This is facilitated by the trauma of the amygdala.

If the abscess is located near the surface of the tonsils, then it can break into the oral cavity or tissue near the tonsils. Otherwise, surgical intervention, opening the abscess will be required.

Herpetic sore throat

With this type of tonsillitis, the tonsils are affected by enteroviruses. The peculiarities of the disease are that plaque occurs both on the tonsils and on the mucous membrane of the palatine arches and the palate itself. This plaque is a small reddish vesicle containing serous fluid. The bubbles quickly burst, leaving defects in the epithelium.

Small children can carry an enterovirus infection hard, up to serous meningitis or myocarditis. Angina with enterovirus infection is only one of the forms of manifestation of this infection, but it can be combined with other symptoms: a rash on the body, abdominal pain, diarrhea, vomiting, etc.

Ulcerative necrotizing tonsillitis

Another name for this type of inflammation of the tonsils is Simanovsky-Plaut-Vincent sore throat. The disease is caused by microorganisms living in the mouth of healthy people (fusiform sticks and spirochetes). With a pronounced decrease in immunity in combination with predisposing local factors (mouth breathing, caries, etc.), this disease can develop.

With this form of tonsillitis, the tonsils undergo necrosis. This applies to both the epithelium and the parenchyma of the tonsils. Defects in the form of ulcers appear on them (and sometimes on the arches of the palate and the wall of the pharynx). Characterized by a coating on the tonsils of a dirty gray color, sometimes dirty green. A putrid odor appears from the patient's mouth, saliva is excreted in an increased amount. The temperature may not rise to high numbers, remaining normal or subfebrile. The disease lasts from several weeks to several months. Ulcers that remain from plaque heal without large scars.

Removed plaque from the tonsils is best examined to identify the causative agent of the disease, if visual diagnosis seems difficult.

Fungal sore throat

Fungal sore throat is caused by fungi of the genus Candida. These fungi are part of normal human flora, but under certain conditions they can multiply strongly, displace normal flora and cause disease. This happens when immunity is weakened and with some concomitant infectious diseases.

With a fungal infection of the tonsils, the temperature rises moderately, intoxication is weak. Are worried about sore throat, unpleasant sensations of perspiration. The patient may complain of "plugs" in the tonsils. Upon closer examination, it is noticeable that these are white specks (islands) of a cheesy character. They can spread to both the arch and the root of the tongue.

A sick person may mistake fungal sore throat for bacterial and self-medicate with antibiotics. This not only will not have an effect, but can also lead to a delay in the process and a worsening of the clinical picture.

Inflammation of the tonsils in other infectious diseases

In the case when the doctor notices inflamed tonsils in children, it must be remembered: angina is one of the first signs of various infectious diseases. In adults, this is much less common. Therefore, attention should be paid to all other symptoms and a complete examination of the patient.

Diphtheria is an infectious disease that is currently rare, since children are vaccinated against diphtheria as early as the first year of life. But not all children are vaccinated, and it does not always guarantee complete protection from the disease. Therefore, it is important to know what diphtheria is and how it manifests itself.

Diphtheria is caused by the bacterium ─ Corynebacterium diphtheriae. With the disease, the oropharynx, larynx, trachea, bronchi, skin and other organs can be affected. The disease is very contagious, transmitted by airborne droplets and contact-household, less often food. Diphtheria is dangerous with complications: myocarditis, true croup (laryngeal edema), disorders of the nervous system. Often, the disease ends with the death of the sick person from complications.

Of all the variety of forms of diphtheria, the most common is the localized form, in which the oropharynx is affected (in particular, the tonsils). They look swollen, slightly red with a bluish tinge. When plaque appears, the tonsils become "white", have a grayish-white or yellowish-gray color. Plaques can only be in gaps or be located on the tonsils with a film. The film is removed with difficulty, it is thick, it forms again in place of the removed one. The removed films from the tonsil are not rubbed on the slide.

A more rare ─ common form is characterized by the appearance of plaque on the tonsils, spreading to the mucous membrane of the nasopharynx, trachea, larynx. Respiratory tract damage can lead to suffocation of the patient.

There is a rule according to which all patients with "white" tonsils are considered suspicious of diphtheria. Therefore, if a person is diagnosed with angina, the tonsils must be examined carefully. The plaque on the tonsils is examined for the presence of diphtheria sticks.

Plaque on the tonsils with scarlet fever

Scarlet fever is a common disease, especially in children's groups. It is caused by streptococcus. With the disease, the tonsils become inflamed, the temperature rises above normal, and a characteristic rash appears on the body.

The inflammatory process in the pharynx begins before the appearance of a rash. Intoxication often occurs from the first days of the disease, it is very pronounced. Some children have seizures and impaired consciousness. Angina proceeds violently.

Pharynx when bright red, redness extends to the hard palate. On the 3-4th day of illness, the tongue becomes crimson, with protruding papillae. Then the process is localized on the tonsils. Angina with scarlet fever can be from catarrhal to necrotic. Therefore, in some cases, only an increase and redness of the tonsils can be noted, and sometimes purulent tonsils. Plaque from the tonsils is removed easily, it is not a continuous layer on them. Sometimes plaque spreads beyond the tonsils.

On the patient's body, small-point rashes, peeling of the skin appear. The patient's appearance is remarkable: a pale nasolabial triangle and ruddy cheeks. Scarlet fever is dangerous with serious complications. Therefore, for all forms of angina, the child must be shown to the doctor in order to correctly diagnose and begin timely treatment.

Inflamed tonsils with infectious mononucleosis

Infectious mononucleosis refers to infectious diseases with a vivid clinical picture, one of the manifestations of which is inflammation of the tonsils. The disease is caused by the Epstein-Barr virus (refers to herpes viruses). There is a theory that the causative agent of the disease is not a virus, but a bacterium of the genus Listeria. A person is infected by airborne droplets.

The disease is characterized by fever, enlarged lymph nodes (not only the submandibular, but all), enlargement of the spleen and liver, and inflammatory changes in the oropharynx.

The palatine tonsils increase in size, sometimes interfere with normal breathing. A dirty gray plaque appears on them, which can go to the arches, uvula and pharynx. You can confuse such a plaque on the tonsils with that of diphtheria. Plaques on the tonsils do not go away for a long time.

The key symptom of the disease is changes in the general blood count, namely the appearance of atypical mononuclear cells (up to 60-80%). The peak of the rise of these blood elements is noted by 6-10 days of illness. In addition, there is an increase in the erythrocyte sedimentation rate (ESR) up to 20-30 mm / hour.

Sore throats are very dangerous complications that are general and local. Complications of a general nature include damage to the heart (rheumatism), joints (arthritis), gastrointestinal tract, etc.

Local complications are as follows: paratonsillar abscess, retropharyngeal and periopharyngeal abscess, inflammation of the cervical lymph nodes, otitis media, laryngeal stenosis.

Paratonsillar abscess

A person has paratonsillar fiber. It is a fiber that is located between the pharyngeal wall and the tonsil capsule. It is most developed at the upper edge of the tonsils. In this place, inflammatory processes can occur when infectious agents from the tonsils enter the fiber. People with chronic tonsillitis usually get sick, aged 15 to 30 years. The disease proceeds as a complication of sore throat.

The deep crypts of the tonsils, especially in their upper part, contribute to the penetration of infection into the tissue. There are Weber's mucous glands involved in the pathological process. There is another feature of the structure of the palatine tonsils ─ an additional lobule, it is located at the top of the tonsil in the thickness of the soft palate. After removal of the tonsils, this lobule sometimes remains and can give impetus to the development of a paratonsillar abscess. Sometimes the development of the disease is promoted by dental caries, trauma to the tonsils and other infectious diseases.

There are three forms of the disease: edematous, with the formation of an infiltrate, with the formation of an abscess (the most common). As a rule, inflammation develops on one side.

Symptoms of the development of an abscess of paratonsillar tissue are bright: intense pain in the tonsil region, high fever, severe intoxication, pain when turning the head, sleep and eating disorders, increased salivation, spasm of the chewing muscles, slurred speech, nasal voice. Pain in the tonsil area can be given to the ear or teeth, regional lymph nodes increase (maybe on one side). A blood test reveals inflammatory changes.

When examining the pharynx, bulging in the area of ​​the amygdala is noticeable, its swelling, displacement of the uvula to the side or forward (depending on the localization of the abscess).

Sometimes the abscess opens itself, this contributes to the rapid improvement of the patient's condition. In other cases, an abscess opening is required. In some cases, the tonsils are removed along with an abscess. In addition, antibiotics and anti-inflammatory treatment are prescribed.

Retropharyngeal abscess

The retropharyngeal abscess is also called retropharyngeal. It refers to severe complications of tonsil inflammation. Purulent inflammation develops between the fascia of the neck, one of which covers the muscles of the pharynx, the other is located near the spine. Children are more likely to get sick, because at an early age they have very developed fiber in this area and lymph nodes. The essence of the disease is that microbes are introduced into the lymph nodes and lymphoid granules of the pharyngeal wall (sometimes with minor trauma), which then affect the fiber. The development of complications is preceded by acute rhinopharyngitis, tonsillitis.

At first there is a sore throat, worse when swallowing. Then signs of intoxication, anxiety, sleep disturbances, high fever join. Asphyxiation may occur, as the abscess interferes with the normal passage of air through the pharynx. The lymph nodes on the affected side are greatly enlarged and painful. The child tilts his head to the sore side. Examination allows you to notice swelling and bulging of the posterior pharyngeal wall, its soreness, and sometimes fluctuation. Treatment for this condition: removal of the tonsil abscess, antibiotics and local anti-inflammatory therapy.

Another name for this disease is adenoiditis. It is mainly children who suffer, since they have an age-related proliferation of the tissue of the pharyngeal tonsil. Adults rarely get sick. Decreased immunity, hypothermia, and concomitant viral diseases predispose to the development of the disease. Under the influence of these factors, the usual flora of the nasopharynx begins to multiply intensively and lead to the development of inflammation of the pharyngeal tonsil.

At the onset of the disease, intoxication and high body temperature are characteristic. Then there is a violation of breathing through the nose and a runny nose. Discharge from the nose of a mucopurulent character. The voice becomes nasal, the lymph nodes enlarge. Often the tubal tonsils and pharyngeal follicles are involved in the pathological process. In this regard, otitis media, eustachitis (inflammation of the auditory tube), and retropharyngeal abscess can join adenoiditis.

When examining the pharynx, redness of the posterior pharyngeal wall is noted, a strip of flowing secretion from the nasopharynx is visible along the midline. When examining the adenoid tonsil (with the help of special instruments), its enlargement, swelling, mucopurulent film, signs of follicular or lacunar tonsillitis are noted.

Treatment of inflammation of the tonsils

Inflamed tonsils are treated by a pediatrician and a therapist. In severe or atypical cases of tonsillitis, an otorhinolaryngologist (ENT doctor) is involved in treatment.

Banal forms of angina are treated on an outpatient basis, but in severe cases, hospitalization is sometimes required. It is important to follow the regime (home), to limit physical activity. It is advisable to isolate the patient in a separate room, especially if there are children at home. He must have individual dishes and a towel.

With a decrease in appetite, the main thing is to drink more water and other liquids (fruit drinks, compotes, weak tea). It is advisable to eat soft (puree) food that does not irritate the throat.

Treatment of inflamed tonsils implies mandatory etiotropic therapy, that is, impact on the cause of the disease.

If you suspect a bacterial sore throat, an appointment is required. Bacterial tonsillitis occurs most often, inflamed tonsils have certain signs, so the doctor makes a diagnosis without much difficulty. The starting drugs are antibiotics from the penicillin group (Penicillin sodium salt, Flemoxin, Amoxicillin).

Bacterial resistance to penicillin is often found, therefore, the appointment of protected penicillins (resistant to beta-lactamases) is required: Augmentin, Amoxiclav, Flemoklav.

If a person does not tolerate penicillins, then first-generation cephalosporins (Cefazolin) and second-generation cephalosporins (Zinacef, Mandol) are prescribed; antibiotics from the macrolide group (Azithromycin). In the third place, a choice is made in favor of third-generation cephalosporins (Claforan) when there is a suspicion that the pathogen belongs to gram-negative microbes.

With viral inflammation of the tonsils, antiviral drugs are prescribed, but this is not a prerequisite for treatment. Tonsillitis of fungal etiology requires the appointment of antifungal drugs.

Given the allergic component in the development of the disease, in addition to antibiotics, it is worth prescribing antihistamines (Suprastin, Claritin).

Local antiseptic treatment of inflamed tonsils

Inflamed tonsils in the throat must be treated with local means, in addition to systemic ones. Local remedies for the treatment of tonsils are antiseptic sprays, herbal infusions and decoctions for rinsing, and lozenges. Some contain substances that relieve sore throat.

Bioparox has proven itself well - a spray that contains the inhaled antibiotic fusafungin. It also has anti-inflammatory effects. Other popular antiseptic sprays: Stopangin, Tantum Verde, Cameton, Hexoral, etc.

Antiseptic and anti-inflammatory lozenges are an adjunct to, and not substitute for, the main treatment. These include the following medications: Faringosept, Grammidin, Falimint, Strepsils, etc. After taking these medications, you should refrain from drinking water and eating.

If the patient has purulent or serous "plugs" on the tonsils, then effective local antiseptic preparations containing enzymes: Laripront, Lizobakt.

Throat gargles are prescribed with decoctions of medicinal herbs (chamomile, calendula, sage), antiseptic solutions (hydrogen peroxide, chlorhexidine).

Physiotherapy

Treatment of tonsils includes physiotherapy procedures:

• Ultraviolet irradiation of the tonsils.

This can be done externally (by acting on the regional lymph nodes) and through the oral cavity (directly on the tonsils). Usually 10 to 15 sessions are used. The procedures improve local immunity and have an antimicrobial effect.

• UHF (method of electrotherapy with an electric field with ultra high frequencies), laser.

The procedures are done every day, 10-12 times per course of treatment. The effect of the treatment is that the vessels dilate, and blood rushes to the focus of inflammation of the tonsils.

• Ultrasonic aerosols with medicinal substances.

With the help of a special device, particles of drugs are deposited on the surface of the tonsils: antibiotics, hormones, enzymes, phytopreparations. Treatment course: 8-12 procedures.

• Ozokerite and therapeutic mud in the form of applications.

They have anti-inflammatory and anti-allergic effects. The course of treatment for tonsils: 10-12 procedures.

Tonsil lavage is the most commonly used procedure to treat chronic tonsillitis. To do this, a special instrument (cannula) is inserted into the lacunae, which is connected to a syringe. Under the influence of pressure, the tonsils are washed with an antiseptic solution. All crypts do not need to be rinsed; it is enough to rinse only 2-3 crypts in the upper part of the tonsils. Due to the communication of these crypts with other crypts, most of the tonsils are washed. Washing the tonsils consists of 10-15 procedures, they are done every other day.

You do not need to use antibiotics to wash the tonsils. In general, the effect of the procedure is due to the mechanical cleansing of the tonsils from pathological contents. After the procedure, the surface of the tonsil is lubricated with antiseptic solutions.

Removal of tonsils

Removal of palatine tonsils is a method of treating chronic tonsillitis, which has its own indications and contraindications.

The main indication for the removal of tonsils is chronic tonsillitis, which does not lend itself to conservative therapy, as well as grade 2 toxic-allergic forms of chronic tonsillitis.

Removal of tonsils is almost always done in case of serious complications of chronic tonsillitis, such as abscess of paratonsillar tissue with the development of parapharyngitis, sepsis, phlegmon of the neck, etc. In such cases, both tonsils are usually removed.

The removed tonsils should be sent for histological examination.

Operation is contraindicated in patients with severe concomitant diseases: heart defects with severity of heart failure, severe diabetes mellitus, kidney disease with significant renal failure, diseases of the blood coagulation system, in which there is a risk of bleeding, pulmonary tuberculosis in the active stage.

The operation can be temporarily postponed if the patient has untreated carious teeth, during pregnancy in the last weeks, with acute inflammations of various localization.

Removal of tonsils is usually done under local anesthesia; anesthesia is rarely used. Good preoperative preparation is very important, including examination of the patient, treatment of concomitant diseases.

The accumulation of lymphoid tissue in the mucous membrane of the upper respiratory tract and the initial sections of the digestive tract. Performs protective and hematopoietic functions.

The tonsils in the human body are referred to as lymphoepithelial tissues. Although they are small in size, their significance is enormous. Some people call the tonsils glands. Both terms are correct, although in the medical literature the patient will mostly come across the term amygdala. A doctor who studies and treats tonsils is an otorhinolaryngologist. Although primarily patients seek advice and help not to him, but to a therapist or pediatrician. Therefore, doctors of these specialties are also well versed in the main diseases of the tonsils.

Anatomy and physiology of the tonsils

The anatomical arrangement of the tonsils and their physiological characteristics provide prerequisites for the development of certain diseases of pathological conditions in them.

What are tonsils?

The tonsils are one of the components of the lymphoepithelial barrier in the human body. This barrier is the formation and maturation of lymphocytes and the production of antibodies. In addition to the tonsils, these functions are performed by lymphoid granules in the pharynx and solitary follicles in the intestine. All these formations have close contact between the internal and external environments of the human body.

The tonsils are located in the throat. Their arrangement resembles a ring. Therefore, the complex of tonsils in the throat is called the Pirogov-Valdeyer lymphadenoid pharyngeal ring. In total, this complex includes 6 tonsils.

There are six tonsils in a person's throat in total. Paired tonsils: palatine and tubal; unpaired tonsils: lingual and pharyngeal (nasopharyngeal). It is customary to highlight their numbering in medical practice: 1 and 2 ─ palatine tonsils, 3 ─ pharyngeal tonsil, 4 ─ lingual, 5 and 6 ─ tubal.

Palatine tonsils

The palatine tonsils are located in the amygdala fossa (a triangular depression on the lateral walls of the pharynx between the palatine arches). These tonsils are the largest.

The palatine tonsils have distinctive features from the rest of the tonsils. This is due to the peculiarities of their structure. There are gaps (grooves) in the tonsils. The lacunae of the tonsils pass into the crypts, representing the ramifications of the entire thickness of the tonsils. A large number of branches are covered with epithelium, which is in contact with the external environment and a huge number of antigens. This stimulates more antibody production in the tonsils. They contain accumulations of lymphoid tissue. They are called follicles. They contain lymphocytes of different maturity.

The palatine tonsils are covered with a sheath of connective tissue. It's called a capsule. In the upper part of the palatine tonsils there are Weber's mucous glands. With age, the palatine tonsils undergo involution (decrease in size). This process begins in adolescence and lasts until old age.

The main role of the palatine tonsils: the formation of lymphocytes and participation in the formation of immunity. The synthesis of antibodies is especially active at a young age (before puberty). It is at this time that a person is in wide contact with various infectious agents and toxins. This is due to the fact that children attend kindergarten, school and other educational institutions.

The location of the tonsils in the body makes them the first barrier to dangerous bacteria and foreign substances. In adults, the tonsils also take part in the immune response, although antibody production is no longer so active.

Another function of the tonsils is elimination, that is, they remove excess lymphocytes from the body to the surface of the tonsils.

Studies have been carried out that prove the role of the tonsils in digestion, namely in the formation of enzymes (lipase, amylase, etc.). After eating, their level in the tonsils increases. This indicates that the tonsils are involved in oral digestion.

Tubal tonsils

Tubal tonsils are small in size, they are accumulations of lymphoid tissue on the lateral wall of the nasopharynx near the mouths of the auditory tubes. These tonsils are paired, they lie in depressions (pharyngeal pockets).

When enlarged, the tubal tonsils can become the culprits of frequent otitis media and hearing problems. This will be due to the fact that the enlarged tonsils overlap the communication between the nasal cavity and the middle ear.

The pharyngeal tonsil is unpaired. It is located along the central line on the wall of the nasopharynx in its upper section. Unlike the palatine tonsils, the pharyngeal tonsil contains grooves or crevices that do not have branches. There is no crypt in the pharyngeal tonsil. The pharyngeal tonsil is not covered with a capsule. The pharyngeal tonsil undergoes involution. This process starts at the age of 14-15.

Excessive enlargement of the pharyngeal tonsil due to its hypertrophy is called adenoid growths (adenoids). This process is observed in childhood. It is dangerous because an enlarged amygdala can hinder the process of nasal breathing and disrupt the work of the auditory tubes.

Lingual tonsil

The lingual tonsil is an unpaired tonsil that does not have a capsule. It is located at the root of the tongue. In it, as in the pharyngeal, there are crevices and grooves, but not crypts. In the photo, this amygdala looks bumpy with a rough surface. By the age of 20-30, the development of the lingual tonsil ends.

Tonsil inflammation is accompanied by symptoms such as pain while eating and talking. Chronic inflammation of the lingual tonsil is very rare.

What do the tonsils look like in the photo?

Of all six tonsils, a person has the opportunity to examine only the palatine tonsils. The rest can only be seen by a specialist using the necessary equipment. Therefore, to find out how they look, you can see the tonsils in the photo. It is better if the doctor comments on this picture and tells about the norm or pathology.

Healthy tonsils in the photo have the following signs: pink color, normal size, absence of plaque and "traffic jams". With hypertrophy or inflammation of the tonsils in the photo, you can see their increase in size, change in color, the presence of pathological plaque and discharge from the lacunae of the tonsils.

Tonsils in children play a huge role in the formation of lymphocytes and the formation of immunity. In childhood, a person actively contacts other people, enters into different groups, where he inevitably meets with a variety of pathogenic microorganisms. It is the tonsils in children that are the first to take the "blow" when they meet with infectious agents and begin to fight them.

Almost every child meets during his life with inflammatory diseases of the tonsils. Some children suffer from hypertrophy of the tonsils or pharyngeal tonsils. Although this process will pass on its own over time, it is dangerous to leave the child without treatment. Because there is a risk that problems such as hearing impairment, speech impairment, delayed growth and development, deterioration in school performance, and sleep problems will build up.

Man is born with tonsils. In the first months after birth, their weak development is noted. They do not actively perform their functions. In the palatine tonsils, only forming follicles are still found. By the end of the first half of a child's life (less often by a year), the tonsil follicles finish their development.

The fastest developing in children is the pharyngeal tonsil (adenoid). Even a small increase in it can cause impaired breathing through the nose, which is due to the peculiarities of the structure of the respiratory tract in a child. In the second year of life, the palatine tonsils fully develop. The special structure of the lacunae of the tonsils contributes to the easy occurrence of inflammatory processes in them.

During life, the tonsils undergo a process of involution, that is, reverse development. As a rule, it begins in adolescence and lasts for many years. Gradually, the lymphoid tissue of the tonsils is replaced by connective tissue.

Diseases of the tonsils

The location of the tonsils in the human body at the intersection of the digestive tract and the respiratory tract, as well as the peculiarities of their structure, make them vulnerable to inflammatory processes. This is especially true of the palatine tonsils, it is there that chronization of processes most often occurs.

Like any other organs, the tonsils can be subject to various diseases. The most common ones are:

• Inflammation of the tonsils (tonsillitis, tonsillitis)

If a person has been diagnosed with tonsillitis, then, probably, we are talking about inflammation of the palatine tonsils. Although inflammation of any tonsils are called sore throats. Simply in this case, it is necessary to indicate the name of the inflamed tonsil when announcing the diagnosis, for example: tonsillitis of the lingual tonsil.

• Hypertrophy of the tonsils

Hypertrophy is an enlargement of the tonsils due to their pathological proliferation. The tonsils in children are hypertrophied, as a rule. There are several degrees of this process. The more the tonsils are enlarged, the more they interfere with the person (breathing, swallowing, talking normally). Therefore, depending on the degree of the process, an appropriate treatment for the tonsils is prescribed.

• Chronic tonsillitis

An inflammatory process in the tissue of the palatine tonsil, which persists in a person for a very long time (sometimes all his life). In this case, there is an exacerbation of the disease and its remission. A chronic sore throat can cause many associated health problems.

• Tonsil tumors

They are both benign and malignant.

Angina of the palatine tonsils

Angina of the palatine tonsils is an acute disease of an infectious-allergic nature, which is manifested by local inflammatory processes in the palatine tonsils.

The term “sore throat” is derived from the Latin word “ago”, which means ─ to choke or squeeze. Although in fact, angina is not accompanied by suffocation. Inflammation of the tonsils occurs both acute and chronic. Both forms of the disease have features of the course and treatment.

An acute disease of the tonsils (tonsillitis), which is characterized by the development of an inflammatory process in them. This disease is very common and at the same time dangerous, because angina can lead to serious complications.

The main causative agent of the disease is group A β-hemolytic streptococcus (up to 80% of cases of the disease). There are also other causative agents of tonsillitis and their association with each other. Other causative agents of tonsil inflammation include: hemolytic staphylococcus, fungi, Staphylococcus aureus, adenoviruses, spirochetes, enteroviruses, etc.

Dangerous microbes enter the body by airborne droplets or alimentary (with food). There is also endogenous infection of a person with a decrease in his immunity. In this case, the inflammatory process can be caused by opportunistic microorganisms that live in the human body constantly.

Most often, people get sick with angina in spring and autumn. Weakened people, children, people with reduced immunity (pregnant women, etc.) are most susceptible to the disease. Sore throats are promoted by poor nutrition of a person with a lack of vitamins B and C, trauma to the tonsils, some features of a person (for example, lymphatic-hyperplastic constitution, chronic diseases of the nasopharynx, problems with nasal breathing).

That is, inflammation of the tonsils begins when a person is not only affected by harmful or opportunistic microorganisms, but other provoking factors of the disease are present.

The development of the disease follows the type of hyperergic reaction. There is an assumption that the microflora inhabiting the crypts of the tonsils and the degradation products of proteins can act as a substance leading to sensitization of the body. This becomes the triggering factor for the development of angina. In addition, the allergic genesis of the disease can explain such consequences of angina as rheumatism, nephritis, polyarthritis and other diseases of an infectious-allergic nature.

Chronic tonsillitis

Chronic tonsillitis is an insidious disease. There is a persistent inflammatory process in the tonsils, which is in a state of remission and exacerbation. A person becomes a source of infection for himself (autoinfection) and for others. An exacerbation of the disease can happen due to hypothermia, poor environmental conditions (gas pollution, changes in temperature and humidity), and a decrease in immunity.

The peculiarities of chronic tonsillitis are such that different microbes live in the tonsils: there is a mixed flora on the epithelium, and one microorganism predominates in the thickness of the tonsils. These include hemolytic streptococcus, staphylococci, adenoviruses, enterococci, and even opportunistic microbes.

The disease usually occurs after repeated sore throats, when complete recovery does not occur against the background of inadequate treatment or a decrease in immunity. Tonsils gradually change, pathological contents accumulate in their crypts. Some patients note the constant presence of "plugs" in the tonsils. Crypts are not emptied completely, this is prevented by scars in the tonsils after tonsillitis. Thus, the inflammation in the tonsils is constantly maintained and the process is delayed. "Plugs" in the tonsils with purulent or caseous contents in chronic tonsillitis happen even during remission.

Exacerbations of chronic inflammation of the tonsils usually occur up to three times a year, sometimes 5-6 times. The diagnosis of chronic tonsillitis can only be made by a doctor, because the patients themselves often diagnose sore throat where it does not exist.

There is another situation: the tonsils are changed, with signs of chronic tonsillitis, but there are no exacerbations in a person. Such forms of the disease are called "angina-free".

There is a chronic inflammation of the tonsils in a simple and toxic-allergic form. The first is characterized by frequent sore throats. The second form includes, in addition to sore throats, other disorders in the body: changes in the blood and in the immune system. It is 1 and 2 degrees in severity.

At grade 1, patients may complain of a slight increase in temperature, fatigue, heart rhythm disturbances, body aches. At grade 2, serious diseases join, which are complications of angina: polyarthritis, rheumatism, endocardial and kidney damage.

The degree of the toxic-allergic form of chronic inflammation of the tonsils is an indication for the removal of the tonsils. Grade 1 of the disease, as well as a simple form of chronic tonsillitis, are first treated conservatively. Necessarily used in the treatment of washing the tonsils. Only with the ineffectiveness of conservative treatment of tonsils is the removal of tonsils used.

Chronic inflammation of the other tonsils is rare. But in children, there are cases of chronic adenoiditis (chronic inflammation of the pharyngeal tonsil).

There are many forms of inflammation of the tonsils (tonsillitis). Depending on the causative agent of the disease, the nature of the course of the disease and the individual characteristics of a person, the symptoms of angina may also differ. Although the main signs of the disease can be noted in almost every clinical case.

Pain in the tonsil area

With angina, a person feels pain in the tonsils. The pain can be constant, it can appear only when swallowing. Usually, the onset of pain is preceded by a feeling of dryness, burning, or sore throat. The intensity of pain varies. In severe forms of angina, sometimes the pain radiates to the ear or teeth.

When examining a patient, the doctor specifies the localization of pain, on one side it hurts or on both sides, whether it hurts along the middle line of the pharynx, where it gives the pain, which helps the patient to cope with the pain. It is important to feel the regional lymph nodes in diseases of the tonsils, they often become enlarged and painful.

Enlarged tonsils

A very important symptom of tonsillitis: the tonsils increase in size. Enlarged tonsils sometimes extend beyond the palatine arches. Sometimes it makes it difficult to breathe and swallow normally, especially for children. If a person has only enlarged tonsils, then this is not a sign of sore throat. Most likely, this is tonsil hypertrophy. The enlargement of the tonsils varies in degrees. The doctor can find out the reason for the enlargement of the tonsils and choose the treatment.

Changes in the lacunae of the tonsils

Changes in the lacunae of the tonsils are characteristic of severe tonsillitis. At the same time, pathological contents accumulate in them. Therefore, you can visually notice symptoms such as "white" tonsils or purulent tonsils. "White" tonsils are found in lacunar angina, diphtheria, and mononucleosis. Purulent tonsils are characteristic of the ulcerative-necrotic form of tonsillitis and phlegmonous tonsillitis. The presence of "plugs" in the tonsils in the absence of vivid symptoms of the disease speaks in favor of chronic tonsillitis.

Very often, in diseases in which the tonsils are affected, fever is the first symptom of the disease or appears along with discomfort in the throat. The severity of the rise in temperature can be different: from subfebrile (up to 38 ° C) numbers to hyperpyretic values ​​(above 40 ° C). The duration of the fever is usually 3 to 5 days, sometimes longer. Characterized by a rapid decrease in temperature against the background of adequate treatment of inflamed tonsils.

With inflammation of the tonsils, the temperature is only one of the signs of intoxication. In addition to her, with tonsillitis, other symptoms are noted. These include headache, weakness, loss of appetite, vomiting, chills.

Common forms of tonsillitis (inflammation of the tonsils)

There are many different forms of tonsil inflammation. Some are independent diseases, while others are one of the manifestations of a systemic or infectious disease. Most often, a person gets sick with banal sore throats, which include catarrhal, follicular, lacunar and mixed forms.

Less common are atypical forms of tonsillitis: fungal, ulcerative necrotic, phlegmonous, enteroviral sore throats and a mixture of these forms.

In a number of infectious diseases, tonsillitis also occurs: the tonsils have their own characteristics of the lesion. Such diseases include scarlet fever, diphtheria, measles, syphilis, HIV infection (infection with the human immunodeficiency virus).

In addition to the above forms of damage to the tonsils, there are tonsillitis in blood diseases: agranulocytic and monocytic tonsillitis, tonsillitis in leukemia.

Catarrhal sore throat

This is the least severe tonsillitis, in which the tonsils are affected only from the outside (mucous membrane). Typically acute onset of the disease with the appearance of unpleasant sensations in the throat: dryness and burning, perspiration and pain. Signs of intoxication are moderate, the temperature does not rise above 38 ° C. Characterized by a headache, a feeling of weakness, aches, loss of working capacity, lethargy.

With catarrhal sore throat, the inflamed tonsils look hyperemic, that is, bright red. The palatine arch also turns red. Their mucous membrane is swollen with serous discharge. Purulent deposits on the tonsils with this form of the disease are not noted. On the epithelium of the tonsils there is a large number of lymphocytes and leukocytes, the epithelium itself is loose.

In the general analysis of blood, minor inflammatory changes are noted. Regional lymph nodes often increase in size. The disease lasts, as a rule, for a short time, up to 5 days.

In order not to confuse catarrhal sore throat with pharyngitis (inflammation of the back of the throat), it is necessary to compare the color of the tonsils and the pharyngeal wall. Enlarged tonsils of bright red color against the background of a relatively pale pink pharynx testify in favor of tonsillitis.

Follicular tonsillitis

This form of angina is much more severe than the previous one: not only the mucous membrane suffers, but also the follicles themselves.

The disease begins acutely, the temperature rises to high numbers (38-39 ° C), a sore throat appears, which often radiates to the ear, and vomiting. Signs of intoxication are pronounced, may prevail over local symptoms. This is especially noticeable in children, they even have a violation of consciousness with follicular angina.

When examining the pharynx, the bright redness of the tonsils and surrounding tissues is clearly visible: the arches, the soft palate. They look edematous. With follicular angina, the tonsils have their own characteristics, since deep pathological processes occur in the thickness of the tonsils. Infiltrates are formed from leukocytes in the follicles. They shine through the epithelium and look like millet-sized yellow dots (1-3 mm). They are clearly visible when examining the pharynx. They are often referred to as "plugs" in the tonsils. Follicles with angina are opened on their own for 2-4 days of the disease. He left them with erosion, which heal quickly.

In the general analysis of blood, pronounced inflammatory changes are noted. Regional lymph nodes are enlarged, which are painful to touch. The illness lasts for about one week.

The general signs of lacunar sore throat are the same as with follicular sore throat, but they are more pronounced. With lacunar angina, significant changes are determined in the lacunae of the tonsils, which then pass to their surface. They contain a serous-mucous secret that becomes purulent. This discharge contains many leukocytes, lymphocytes, epithelial cells and fibrin filaments.

Plaque on the tonsils may appear confluent, making the tonsils appear white or white-yellow. The plaque is easily removed from the tonsils with a spatula, it does not go beyond the boundaries of the tonsils.

The disease lasts for about one week, with complications, the process can be delayed. Some patients have signs of both lacunar and follicular tonsillitis at the same time.

Fibrinous sore throat

Fibrinous tonsillitis develops against the background of follicular or lacunar tonsillitis. In the event that suppurative follicles burst, a fibrinous film may form. It covers the inflamed tonsils and can extend beyond them.

If you compare the photo of the tonsils with fibrinous sore throat and with diphtheria, then you can find the similarity of manifestations, although these are completely different diseases. Bacteriological examination of smears from the pharynx and nose helps to differentiate diseases. The rest of the symptoms of fibrinous sore throat are similar to other symptoms of common sore throats.

This is a severe form of tonsillitis, in which the tonsil lacunae are not emptied from their contents. It is rare. The swelling of the inflamed tonsils is determined, their soreness when palpating. An abscess (abscess) is formed inside the tonsil from the fused follicles. The process often happens on the one hand. This is facilitated by the trauma of the amygdala.

If the abscess is located near the surface of the tonsils, then it can break into the oral cavity or tissue near the tonsils. Otherwise, surgical intervention, opening the abscess will be required.

Herpetic sore throat

With this type of tonsillitis, the tonsils are affected by enteroviruses. The peculiarities of the disease are that plaque occurs both on the tonsils and on the mucous membrane of the palatine arches and the palate itself. This plaque is a small reddish vesicle containing serous fluid. The bubbles quickly burst, leaving defects in the epithelium.

Small children can carry an enterovirus infection hard, up to serous meningitis or myocarditis. Angina with enterovirus infection is only one of the forms of manifestation of this infection, but it can be combined with other symptoms: a rash on the body, abdominal pain, diarrhea, vomiting, etc.

Ulcerative necrotizing tonsillitis

Another name for this type of inflammation of the tonsils is Simanovsky-Plaut-Vincent sore throat. The disease is caused by microorganisms living in the mouth of healthy people (fusiform sticks and spirochetes). With a pronounced decrease in immunity in combination with predisposing local factors (mouth breathing, caries, etc.), this disease can develop.

With this form of tonsillitis, the tonsils undergo necrosis. This applies to both the epithelium and the parenchyma of the tonsils. Defects in the form of ulcers appear on them (and sometimes on the arches of the palate and the wall of the pharynx). Characterized by a coating on the tonsils of a dirty gray color, sometimes dirty green. A putrid odor appears from the patient's mouth, saliva is excreted in an increased amount. The temperature may not rise to high numbers, remaining normal or subfebrile. The disease lasts from several weeks to several months. Ulcers that remain from plaque heal without large scars.

Removed plaque from the tonsils is best examined to identify the causative agent of the disease, if visual diagnosis seems difficult.

Fungal sore throat

Fungal sore throat is caused by fungi of the genus Candida. These fungi are part of normal human flora, but under certain conditions they can multiply strongly, displace normal flora and cause disease. This happens when immunity is weakened and with some concomitant infectious diseases.

With a fungal infection of the tonsils, the temperature rises moderately, intoxication is weak. Are worried about sore throat, unpleasant sensations of perspiration. The patient may complain of "plugs" in the tonsils. Upon closer examination, it is noticeable that these are white specks (islands) of a cheesy character. They can spread to both the arch and the root of the tongue.

A sick person may mistake fungal sore throat for bacterial and self-medicate with antibiotics. This not only will not have an effect, but can also lead to a delay in the process and a worsening of the clinical picture.

Inflammation of the tonsils in other infectious diseases

In the case when the doctor notices inflamed tonsils in children, it must be remembered: angina is one of the first signs of various infectious diseases. In adults, this is much less common. Therefore, attention should be paid to all other symptoms and a complete examination of the patient.

Diphtheria is an infectious disease that is currently rare, since children are vaccinated against diphtheria as early as the first year of life. But not all children are vaccinated, and it does not always guarantee complete protection from the disease. Therefore, it is important to know what diphtheria is and how it manifests itself.

Diphtheria is caused by the bacterium ─ Corynebacterium diphtheriae. With the disease, the oropharynx, larynx, trachea, bronchi, skin and other organs can be affected. The disease is very contagious, transmitted by airborne droplets and contact-household, less often food. Diphtheria is dangerous with complications: myocarditis, true croup (laryngeal edema), disorders of the nervous system. Often, the disease ends with the death of the sick person from complications.

Of all the variety of forms of diphtheria, the most common is the localized form, in which the oropharynx is affected (in particular, the tonsils). They look swollen, slightly red with a bluish tinge. When plaque appears, the tonsils become "white", have a grayish-white or yellowish-gray color. Plaques can only be in gaps or be located on the tonsils with a film. The film is removed with difficulty, it is thick, it forms again in place of the removed one. The removed films from the tonsil are not rubbed on the slide.

A more rare ─ common form is characterized by the appearance of plaque on the tonsils, spreading to the mucous membrane of the nasopharynx, trachea, larynx. Respiratory tract damage can lead to suffocation of the patient.

There is a rule according to which all patients with "white" tonsils are considered suspicious of diphtheria. Therefore, if a person is diagnosed with angina, the tonsils must be examined carefully. The plaque on the tonsils is examined for the presence of diphtheria sticks.

Plaque on the tonsils with scarlet fever

Scarlet fever is a common disease, especially in children's groups. It is caused by streptococcus. With the disease, the tonsils become inflamed, the temperature rises above normal, and a characteristic rash appears on the body.

The inflammatory process in the pharynx begins before the appearance of a rash. Intoxication often occurs from the first days of the disease, it is very pronounced. Some children have seizures and impaired consciousness. Angina proceeds violently.

The pharynx with scarlet fever is bright red, the redness spreads to the hard palate. On the 3-4th day of illness, the tongue becomes crimson, with protruding papillae. Then the process is localized on the tonsils. Angina with scarlet fever can be from catarrhal to necrotic. Therefore, in some cases, only an increase and redness of the tonsils can be noted, and sometimes purulent tonsils. Plaque from the tonsils is removed easily, it is not a continuous layer on them. Sometimes plaque spreads beyond the tonsils.

On the patient's body, small-point rashes, peeling of the skin appear. The patient's appearance is remarkable: a pale nasolabial triangle and ruddy cheeks. Scarlet fever is dangerous with serious complications. Therefore, for all forms of angina, the child must be shown to the doctor in order to correctly diagnose and begin timely treatment.

Inflamed tonsils with infectious mononucleosis

Infectious mononucleosis refers to infectious diseases with a vivid clinical picture, one of the manifestations of which is inflammation of the tonsils. The disease is caused by the Epstein-Barr virus (refers to herpes viruses). There is a theory that the causative agent of the disease is not a virus, but a bacterium of the genus Listeria. A person is infected by airborne droplets.

The disease is characterized by fever, enlarged lymph nodes (not only the submandibular, but all), enlargement of the spleen and liver, and inflammatory changes in the oropharynx.

The palatine tonsils increase in size, sometimes interfere with normal breathing. A dirty gray plaque appears on them, which can go to the arches, uvula and pharynx. You can confuse such a plaque on the tonsils with that of diphtheria. Plaques on the tonsils do not go away for a long time.

The key symptom of the disease is changes in the general blood count, namely the appearance of atypical mononuclear cells (up to 60-80%). The peak of the rise of these blood elements is noted by 6-10 days of illness. In addition, there is an increase in the erythrocyte sedimentation rate (ESR) up to 20-30 mm / hour.

Sore throats are very dangerous complications that are general and local. Complications of a general nature include damage to the heart (rheumatism), joints (arthritis), gastrointestinal tract, etc.

Local complications are as follows: paratonsillar abscess, retropharyngeal and periopharyngeal abscess, inflammation of the cervical lymph nodes, otitis media, laryngeal stenosis.

Paratonsillar abscess

A person has paratonsillar fiber. It is a fiber that is located between the pharyngeal wall and the tonsil capsule. It is most developed at the upper edge of the tonsils. In this place, inflammatory processes can occur when infectious agents from the tonsils enter the fiber. People with chronic tonsillitis usually get sick, aged 15 to 30 years. The disease proceeds as a complication of sore throat.

The deep crypts of the tonsils, especially in their upper part, contribute to the penetration of infection into the tissue. There are Weber's mucous glands involved in the pathological process. There is another feature of the structure of the palatine tonsils ─ an additional lobule, it is located at the top of the tonsil in the thickness of the soft palate. After removal of the tonsils, this lobule sometimes remains and can give impetus to the development of a paratonsillar abscess. Sometimes the development of the disease is promoted by dental caries, trauma to the tonsils and other infectious diseases.

There are three forms of the disease: edematous, with the formation of an infiltrate, with the formation of an abscess (the most common). As a rule, inflammation develops on one side.

Symptoms of the development of an abscess of paratonsillar tissue are bright: intense pain in the tonsil region, high fever, severe intoxication, pain when turning the head, sleep and eating disorders, increased salivation, spasm of the chewing muscles, slurred speech, nasal voice. Pain in the tonsil area can be given to the ear or teeth, regional lymph nodes increase (maybe on one side). A blood test reveals inflammatory changes.

When examining the pharynx, bulging in the area of ​​the amygdala is noticeable, its swelling, displacement of the uvula to the side or forward (depending on the localization of the abscess).

Sometimes the abscess opens itself, this contributes to the rapid improvement of the patient's condition. In other cases, an abscess opening is required. In some cases, the tonsils are removed along with an abscess. In addition, antibiotics and anti-inflammatory treatment are prescribed.

Retropharyngeal abscess

The retropharyngeal abscess is also called retropharyngeal. It refers to severe complications of tonsil inflammation. Purulent inflammation develops between the fascia of the neck, one of which covers the muscles of the pharynx, the other is located near the spine. Children are more likely to get sick, because at an early age they have very developed fiber in this area and lymph nodes. The essence of the disease is that microbes are introduced into the lymph nodes and lymphoid granules of the pharyngeal wall (sometimes with minor trauma), which then affect the fiber. The development of complications is preceded by acute rhinopharyngitis, tonsillitis.

At first there is a sore throat, worse when swallowing. Then signs of intoxication, anxiety, sleep disturbances, high fever join. Asphyxiation may occur, as the abscess interferes with the normal passage of air through the pharynx. The lymph nodes on the affected side are greatly enlarged and painful. The child tilts his head to the sore side. Examination allows you to notice swelling and bulging of the posterior pharyngeal wall, its soreness, and sometimes fluctuation. Treatment for this condition: removal of the tonsil abscess, antibiotics and local anti-inflammatory therapy.

Another name for this disease is adenoiditis. It is mainly children who suffer, since they have an age-related proliferation of the tissue of the pharyngeal tonsil. Adults rarely get sick. Decreased immunity, hypothermia, and concomitant viral diseases predispose to the development of the disease. Under the influence of these factors, the usual flora of the nasopharynx begins to multiply intensively and lead to the development of inflammation of the pharyngeal tonsil.

At the onset of the disease, intoxication and high body temperature are characteristic. Then there is a violation of breathing through the nose and a runny nose. Discharge from the nose of a mucopurulent character. The voice becomes nasal, the lymph nodes enlarge. Often the tubal tonsils and pharyngeal follicles are involved in the pathological process. In this regard, otitis media, eustachitis (inflammation of the auditory tube), and retropharyngeal abscess can join adenoiditis.

When examining the pharynx, redness of the posterior pharyngeal wall is noted, a strip of flowing secretion from the nasopharynx is visible along the midline. When examining the adenoid tonsil (with the help of special instruments), its enlargement, swelling, mucopurulent film, signs of follicular or lacunar tonsillitis are noted.

Treatment of inflammation of the tonsils

Inflamed tonsils are treated by a pediatrician and a therapist. In severe or atypical cases of tonsillitis, an otorhinolaryngologist (ENT doctor) is involved in treatment.

Banal forms of angina are treated on an outpatient basis, but in severe cases, hospitalization is sometimes required. It is important to follow the regime (home), to limit physical activity. It is advisable to isolate the patient in a separate room, especially if there are children at home. He must have individual dishes and a towel.

With a decrease in appetite, the main thing is to drink more water and other liquids (fruit drinks, compotes, weak tea). It is advisable to eat soft (puree) food that does not irritate the throat.

Treatment of inflamed tonsils implies mandatory etiotropic therapy, that is, impact on the cause of the disease.

If you suspect a bacterial sore throat, antibiotics are required. Bacterial tonsillitis occurs most often, inflamed tonsils have certain signs, so the doctor makes a diagnosis without much difficulty. The starting drugs are antibiotics from the penicillin group (Penicillin sodium salt, Flemoxin, Amoxicillin).

Bacterial resistance to penicillin is often found, therefore, the appointment of protected penicillins (resistant to beta-lactamases) is required: Augmentin, Amoxiclav, Flemoklav.

If a person does not tolerate penicillins, then first-generation cephalosporins (Cefazolin) and second-generation cephalosporins (Zinacef, Mandol) are prescribed; antibiotics from the macrolide group (Azithromycin). In the third place, a choice is made in favor of third-generation cephalosporins (Claforan) when there is a suspicion that the pathogen belongs to gram-negative microbes.

With viral inflammation of the tonsils, antiviral drugs are prescribed, but this is not a prerequisite for treatment. Tonsillitis of fungal etiology requires the appointment of antifungal drugs.

Given the allergic component in the development of the disease, in addition to antibiotics, it is worth prescribing antihistamines (Suprastin, Claritin).

Local antiseptic treatment of inflamed tonsils

Inflamed tonsils in the throat must be treated with local means, in addition to systemic ones. Local remedies for the treatment of tonsils are antiseptic sprays, herbal infusions and decoctions for rinsing, and lozenges. Some contain substances that relieve sore throat.

Bioparox has proven itself well - a spray that contains the inhaled antibiotic fusafungin. It also has anti-inflammatory effects. Other popular antiseptic sprays: Stopangin, Tantum Verde, Cameton, Hexoral, etc.

Antiseptic and anti-inflammatory lozenges are an adjunct to, and not substitute for, the main treatment. These include the following medications: Faringosept, Grammidin, Falimint, Strepsils, etc. After taking these medications, you should refrain from drinking water and eating.

If the patient has purulent or serous "plugs" on the tonsils, then effective local antiseptic preparations containing enzymes: Laripront, Lizobakt.

Throat gargles are prescribed with decoctions of medicinal herbs (chamomile, calendula, sage), antiseptic solutions (hydrogen peroxide, chlorhexidine).

Physiotherapy

Treatment of tonsils includes physiotherapy procedures:

• Ultraviolet irradiation of the tonsils.

This can be done externally (by acting on the regional lymph nodes) and through the oral cavity (directly on the tonsils). Usually 10 to 15 sessions are used. The procedures improve local immunity and have an antimicrobial effect.

• UHF (method of electrotherapy with an electric field with ultra high frequencies), laser.

The procedures are done every day, 10-12 times per course of treatment. The effect of the treatment is that the vessels dilate, and blood rushes to the focus of inflammation of the tonsils.

• Ultrasonic aerosols with medicinal substances.

With the help of a special device, particles of drugs are deposited on the surface of the tonsils: antibiotics, hormones, enzymes, phytopreparations. Treatment course: 8-12 procedures.

• Ozokerite and therapeutic mud in the form of applications.

They have anti-inflammatory and anti-allergic effects. The course of treatment for tonsils: 10-12 procedures.

Tonsil lavage is the most commonly used procedure to treat chronic tonsillitis. To do this, a special instrument (cannula) is inserted into the lacunae, which is connected to a syringe. Under the influence of pressure, the tonsils are washed with an antiseptic solution. All crypts do not need to be rinsed; it is enough to rinse only 2-3 crypts in the upper part of the tonsils. Due to the communication of these crypts with other crypts, most of the tonsils are washed. Washing the tonsils consists of 10-15 procedures, they are done every other day.

You do not need to use antibiotics to wash the tonsils. In general, the effect of the procedure is due to the mechanical cleansing of the tonsils from pathological contents. After the procedure, the surface of the tonsil is lubricated with antiseptic solutions.

Removal of tonsils

Removal of palatine tonsils is a method of treating chronic tonsillitis, which has its own indications and contraindications.

The main indication for the removal of tonsils is chronic tonsillitis, which does not lend itself to conservative therapy, as well as grade 2 toxic-allergic forms of chronic tonsillitis.

Removal of tonsils is almost always done in case of serious complications of chronic tonsillitis, such as abscess of paratonsillar tissue with the development of parapharyngitis, sepsis, phlegmon of the neck, etc. In such cases, both tonsils are usually removed.

The removed tonsils should be sent for histological examination.

Operation is contraindicated in patients with severe concomitant diseases: heart defects with severity of heart failure, severe diabetes mellitus, kidney disease with significant renal failure, diseases of the blood coagulation system, in which there is a risk of bleeding, pulmonary tuberculosis in the active stage.

The operation can be temporarily postponed if the patient has untreated carious teeth, during pregnancy in the last weeks, with acute inflammations of various localization.

Removal of tonsils is usually done under local anesthesia; anesthesia is rarely used. Good preoperative preparation is very important, including examination of the patient, treatment of concomitant diseases.