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

About palatine tonsils or tonsils for a long time mixed opinions were expressed. Some scientists exaggerated their role, considering the tonsils as endocrine glands. Then a version arose that they were of no particular importance: any lymphoid tissue could play their role. After that, the inflamed tonsils began to be 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 oral cavity. They are located in the upper parts of the digestive and respiratory tract. Here, the Pirogov-Waldeyer lymphatic pharyngeal ring is formed, which includes:

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

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

The size of each of the paired tonsils is equal to the value 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 lacunae or crypts.

Why do we need tonsils

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 that enters the body with air and food is retained.

Functions of the tonsils

The role of small paired organs cannot be underestimated:

1. In the crypts or depressions that line the epithelial tissue, the infectious agent is processed and a specific infection is detected, 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. respiratory tract.
3. Local immunity is formed here, which is part of the general protective barrier of the human body.

Due to the winding passages and "pockets", the surface of the tonsils increases significantly, which means that the contact zone with microorganisms becomes much larger. Lymphoid follicles are located in the thickness of the folds of the tonsil tissue. They form lymphocytes, which play an important role in maintaining the immune status.

Only the tonsils contain a "chemical laboratory" for recognizing 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, chicken pox.

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

Possible diseases

With a weakened immune system, allergic manifestations and the development of general intoxication of the body are possible. The tonsils become inflamed, reddened, swollen and become a dangerous source of infection. The inflammatory process in the tonsils develops for reasons:

• chronic runny nose;
• inflammation of the maxillary sinuses (sinusitis);
• caries or inflammation of the gums;
• hypothermia;
• contact with an infected person.

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

Angina or acute tonsillitis usually develops. Its forms are catarrhal, lacunar, and follicular, which are interchangeable as they are general form inflammatory process.

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

• pain in the throat;
• difficulty during 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 are very similar in their indicators. Different forms of tonsillitis can develop on different tonsils.

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

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

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

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

Delete or not

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

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 on 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 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 gradually heal, and the lymphoid tissue is restored.

If complications begin in the body due to tonsillitis, then the removal of the tonsils (tonsillectomy) is indispensable. With a timely and correctly performed operation, it will not affect the future life and health of the patient.

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

It is not necessary to assume that when the tonsils are removed, local immunity in the throat area will not work. There are 6 tonsils in the peripharyngeal ring, and only 2 are removed. The rest will take on the function of the missing fragments 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.

Being well aware of the important role of the palatine tonsils, a person is not always inclined to surgical intervention. 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 human body's immune system. Their presence is extremely important to ensure the full protection of the body from various harmful external factors. It is they who first begin to contact and fight against microorganisms that carry diseases.

The special arrangement and structure of the tonsils also affects the qualitative performance of their functions. They are among the important organs responsible for protecting the body, but many do not even think about why our body needs them.

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" suggests itself for another simpler and more common name among the people - tonsils. However, it is worth noting that the palatine tonsils are called tonsils, 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;
• tubal - located in the area of ​​​​the pharyngeal opening;
• Lushka's tonsils - they are easy to find above the place of the arch of the pharynx;
• lingual - based on the name, we can say that they are located from the back of the tongue, namely under it.

What are the functions of the palatine tonsils? What is their structure and structure? All these questions can be answered in this article.

Why do you need tonsils

These organs of the oral cavity are needed by the body in order to prevent all kinds of inflammatory processes in the respiratory system. They have the opportunity to be the first to meet the potential threat in the form of microbes, and a great responsibility to fight it. Often, these very microbes lead to the development of a sore throat in a person, in which it is the palatine tonsils, that is, the tonsils, that become inflamed.

The main difference between 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 pathogens that affect the tonsils during the inflammatory process. Lymphoid tissue also includes follicles in its structure.

Appointment of tonsils

Tonsils, including tonsils, are designed to perform certain functions in the human body, such as:

1. Barrier. As soon as various pathogens get inside a person, they begin to contact with these accumulations of tissues of the lymphoid type. At the same time, the tonsils destroy them with the help of cells that are produced by lymphoid tissue.
2. Immunogenic. The tonsils are able to produce T-lymphocytes and B-lymphocytes in human body. These cells are responsible for the immune system of the body as a whole.

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It is worth noting that the tonsils are able to perform 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 occur.

What do 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 folk remedies, avoiding traditional methods as much as possible, although doing this with sore throat, laryngitis, pharyngitis and the like is strictly prohibited.

So, you need to figure out what healthy tonsils look like in order to further diagnose them in yourself:

• tonsils of small size, located within the palatine arches;
• their healthy color is pale pink;
• the complete absence of any raids, redness;
• uneven bumpy surface of the tonsils, you can see small elevations;
• as if separated from the palatine arches;
• no mucosal inflammation rear wall pharynx, uvula, tongue or soft palate;
• absence of caseous plugs or pus when pressed with a spatula;
• the absence of a pattern from the vessels behind the pharynx, the mucous surface without edema, no follicles were found.

If we consider each sign 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 swollen tonsils look like?

Already by pain and discomfort in the oral cavity, it can be understood that the disease process has begun, but this is not at all enough to start the healing process or, conversely, ignore the “frivolous” cold.

So, inflamed tonsils are characterized by the following:

• redness, swelling of the soft part of the palate, pharynx behind - the likely development of pharyngitis in an acute form, provoked by a virus or bacteria;
• swelling, redness in the absence of raids, the appearance of a sore throat - heralds the onset of a sore throat, namely its catarrhal stage;
• redness and inflammation, the appearance of a yellowish-white plaque, sore throat, heat collectively speaks of angina;
• redness, swelling of the tonsils, lack of plaque, covering with small blisters of the tonsils (ulcers in the future) - means a disease of 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 the tonsils are pressed with a spatula, the discharge of pus portends a chronic illness with tonsillitis;
• an increase in follicles behind the pharynx, cough, dryness, sore throat - signs of hypertrophic pharyngitis in a chronic form;
• white coating of the oral cavity (tongue, tonsils, pharynx at the back, gums) indicates a fungal infection that can occur 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 tonsils are considered inflamed or, conversely, healthy. Timely initiation of therapy and the use of necessary medicines will be able to save the patient from many "troubles" in the future and return him to his usual life in a healthy body.

The 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 brief description

This is an accumulation of lymphoid tissue in the pharynx, which begins to form even in the womb. After the birth of a person, 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. Normally, they are small and imperceptible. The circular layout of these formations is called the pharyngeal lymphoepithelial ring. The granules of the posterior pharyngeal wall, its lateral ridges, the 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 peripharyngeal formations in the section have a porous structure, but each of them is characterized by its own characteristics. For example, the pharyngeal is divided into lobules by connective tissue and covered with ciliated epithelium, while the palatine consists of a capsule, stroma, parenchyma, epithelial cover, and also has upper and lower poles. At the top there is an supra-almond fossa, in which it can be located additional slice. The capsule is formed by connective tissue on the lateral surface and mucosa on the medial. Partitions extending from it divide the amygdala into internal lobules, and the stroma into trabeculae. On the outer side there are lacunae, 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.

There is also such a formation near the root of the tongue.

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 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 tonsil, which is called the lingual.

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

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Like all others, it grows up to 15 years, after which it atrophies and divides into the right and left lobes. The bumpy surface has characteristic depressions - the ducts of the salivary glands. The secret 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. The white blood cells that 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-Waldeyer lymphoid ring. About 20 lacunar depressions are responsible for the capture of pathogens in the mouth that enter with 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 measures to eliminate them.

Tubal formations

When a child is at the 7th month of fetal development, such lymphoid formations form in him.

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

pharyngeal lymphoid mass

In everyday life - adenoids. Several rollers of lymphoid tissue and follicles are located in the nasopharyngeal vault. 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 recognizing and capturing pathogenic bacteria and microorganisms.
• Immunogenic. This is where lymphocytes and antibodies are produced.
• Hematopoietic.

Diseases of the tonsils

Many factors can disrupt the function of the tonsils, which will lead to the development of the disease. Among them are hypothermia, viral and bacterial infections against the 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.

The lesions may enlarge at the time of infection.

The tonsils in the throat are most often susceptible to infection. In this case, tonsillitis, 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 tonsils is disturbed, there is a temperature, weakness, headache submandibular lymph nodes are enlarged. A person's tonsils hurt not only when swallowing, but also at rest. To treat this condition, antibiotics, antipyretics and painkillers 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 after 3-5 days or weeks later.

Enlargement of the pharyngeal tonsil is most common in preschool age. Respiratory and hearing disorders, snoring, signs of hypoxia and rhinitis accompany adenoiditis. The severity of 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 tubal tonsils in humans develop against the background of dysfunction of the tonsils 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 lymphoepithelial tissues. Although they are small in size, their significance is enormous. Some people call tonsils tonsils. Both terms are correct, although in the medical literature the patient will mostly encounter the term "tonsil". A doctor who studies and treats the tonsils is an otorhinolaryngologist. Although initially patients seek advice and help not from him, but from 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 location of the tonsils and their physiological features give the 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. In this barrier, the formation and maturation of lymphocytes and the production of antibodies take place. 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 a tight 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-Waldeyer lymphadenoid pharyngeal ring. In total, this complex includes 6 tonsils.

There are six tonsils in the human throat. Paired tonsils: palatine and tubal; unpaired tonsils: lingual and pharyngeal (nasopharyngeal). It is customary to single out 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 tonsil pits (a triangular depression on the side 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. The palatine tonsils have gaps (indentations). The lacunae of the tonsils pass into crypts, which are branches throughout 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 (reduce in size). This process begins in adolescence and continues into old age.

The main role of the palatine tonsils: the formation of lymphocytes and participation in the development of immunity. Especially active is the synthesis of antibodies at a young age (before puberty). It was at this time that a person is widely in contact with various infectious agents and toxins. This is due to the fact that children attend Kindergarten, schools 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 formation is no longer so active.

Another function of the palatine 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 palatine 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 side wall of the nasopharynx near the mouths of the auditory tubes. These tonsils are paired, they lie in depressions (pharyngeal pockets).

With an increase in tubal tonsils, they can become the culprits of frequent otitis media and hearing problems. This will be due to the fact that the enlarged tonsils block 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 has grooves or crevices that do not branch. There are no crypts in the pharyngeal tonsil. The pharyngeal tonsil is not covered by the capsule. The pharyngeal tonsil undergoes involution. This process starts at the age of 14-15.

An excessive increase in 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 impede the process of nasal breathing and disrupt the operation 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 well as in the pharyngeal, there are crevices and furrows, but not crypts. In the photo, this tonsil looks bumpy with a rough surface. By the age of 20-30, the development of the lingual tonsil ends.

Inflammation of the lingual tonsil is accompanied by symptoms such as pain during eating and during a conversation. Chronic inflammation of the lingual tonsil is very rare.

What do tonsils look like in a 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 look at the tonsils in the photo. It is better if the doctor comments on this picture and talks about the norm or pathology.

Healthy tonsils in the photo have the following features: pink color, normal sizes, lack of plaque and "traffic jams". With hypertrophy or inflammation of the tonsils in the photo, you can see their increase in size, discoloration, 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 with other people, enters into different groups, where he inevitably encounters a variety of pathogenic microorganisms. It is the tonsils in children that are the first to take a "blow on themselves" when they meet infectious agents and begin to fight them.

Almost every child encounters inflammatory diseases of the tonsils during his life. Some children suffer from hypertrophy of the palatine 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, growth and developmental delay, deterioration in school performance, and sleep problems will accumulate.

A person 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, follicles that are still forming are found. By the end of the first six months of a child's life (less often by a year), the tonsil follicles complete their development.

The pharyngeal tonsil (adenoid) develops most quickly in children. Even a slight increase in it can cause a violation of 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 subjected to various diseases. The most frequent of them:

• Inflammation of the tonsils (angina, tonsillitis)

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

• Hypertrophy of the tonsils

Hypertrophy is called an increase in the tonsils due to their pathological growth. Hypertrophied tonsils in children, as a rule. There are several stages of this process. The stronger the tonsils are enlarged, the more they interfere with a person (breathing, swallowing, talking normally). Therefore, depending on the degree of the process, appropriate treatment of the tonsils is prescribed.

• Chronic tonsillitis

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

• Tumors of the tonsils

They are benign and malignant.

Angina of 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 of the disease "angina" comes from the Latin word "ago", which means ─ to choke or squeeze. Although in fact, angina is not accompanied by suffocation. Inflammation of the palatine tonsils occurs both acute and chronic. Both forms of the disease have features of the course and treatment.

Acute disease of the palatine 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 other causative agents of angina and their association with each other. Other causative agents of inflammation of the tonsils include: hemolyzing staphylococcus aureus, fungi, Staphylococcus aureus, adenoviruses, spirochetes, enteroviruses, etc.

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

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

That is, inflammation of the tonsils begins when a person is not only affected by harmful or opportunistic microorganisms, but also 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 that lives in the crypts of the tonsils, and the breakdown products of proteins can act as a substance that leads to sensitization of the body. This becomes a trigger 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 palatine tonsils, which is in a state of remission and exacerbation. A person becomes a source of infection for himself (autoinfection) and for others. Exacerbation of the disease can occur due to hypothermia, poor conditions environment(gas contamination, changes in temperature and humidity), reduced immunity.

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

The disease usually occurs after repeated tonsillitis, when there is no complete recovery against the background of inadequate treatment or a decrease in immunity. The tonsils gradually change, pathological contents accumulate in their crypts. Some patients note the constant presence of "plugs" in the tonsils. The crypts are not completely emptied, this is prevented by scars in the tonsils after tonsillitis. Thus, inflammation in the tonsils is constantly maintained and the process is delayed. "Plugs" in the tonsils with purulent or caseous contents in chronic tonsillitis occur 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 themselves with tonsillitis where there is none.

There is another situation: the tonsils are altered, with signs of chronic tonsillitis, but a person does not have exacerbations. Such forms of the disease are called "nonanginal".

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

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

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

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

Pain in the tonsils

With angina, a person feels pain in the tonsils. The pain may be constant, may 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, whether it hurts on one side or on both sides, whether it hurts along the midline of the pharynx, where it gives pain, which helps the patient cope with 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 interferes with normal breathing and swallowing, especially for children. If a person has only enlarged tonsils, then this is not a sign of a sore throat. Most likely, this is hypertrophy of the tonsils. Enlargement of the tonsils varies in degrees. The doctor can find out the cause of the enlarged tonsils and choose a 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, visually, symptoms such as "white" tonsils or purulent tonsils can be noted. "White" tonsils are found in lacunar tonsillitis, 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 clear 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) figures to hyperpyretic values ​​(above 40 ° C). The duration of fever is usually 3 to 5 days, sometimes more. Characterized by a rapid decrease in temperature against the background of adequate treatment of inflamed tonsils.

With inflammation of the tonsils, temperature is only one of the signs of intoxication. In addition to it, 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 inflammation of the tonsils. Some are an independent disease, while others are one of the manifestations of a systemic or infectious disease. Most often, a person falls ill with banal tonsillitis, which include catarrhal, follicular, lacunar and mixed forms.

Less common are atypical forms of tonsillitis: fungal, ulcerative necrotic, phlegmonous, enteroviral tonsillitis 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 (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 angina

This is the least severe tonsillitis, in which the tonsils are affected only from the outside (mucous membrane). Typically, the onset of the disease is acute 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. Headache, feeling of weakness, aches, loss of working capacity, lethargy are characteristic.

With catarrhal angina, the inflamed tonsils look hyperemic, that is, bright red. The palatine arches also become red. Their mucous membrane is swollen with serous discharge. Purulent raids on the tonsils with this form of the disease are not observed. On the epithelium of the tonsils there is a large number of lymphocytes and leukocytes, the epithelium itself is loose.

AT general analysis blood, slight inflammatory changes are noted. Regional lymph nodes often increase in size. The disease lasts, as a rule, not for long, up to 5 days.

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

Follicular angina

This form of angina is much harder 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), there is a sore throat, which often radiates to the ear, vomiting. Signs of intoxication are pronounced, may prevail over local symptoms. This is especially noticeable in children, they even have impaired 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 swollen. 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, look like yellow dots the size of a millet grain (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 on the 2nd-4th day of the disease. They remain erosions that heal quickly.

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

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

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

The disease lasts about one week, with complications, the process may be delayed. Some patients simultaneously have signs of both lacunar and follicular tonsillitis.

Fibrinous angina

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

If we compare the photo of the tonsils with fibrinous angina and with diphtheria, then we 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 remaining symptoms of fibrinous tonsillitis are similar to other symptoms of banal tonsillitis.

This is a severe form of tonsillitis, in which the lacunae of the tonsils are not emptied of their contents. Occurs rarely. The swelling of the inflamed tonsils is determined, their soreness when palpated. An abscess (abscess) is formed inside the tonsil from merged follicles. The process usually happens on one side. This is facilitated by traumatization of the tonsil.

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

Herpangina

With this type of tonsillitis, the tonsils are affected by enteroviruses. The features of the disease are that plaque occurs on the tonsils, and on the mucous membrane of the palatine arches and the palate itself. This plaque is a small reddish vesicles containing serous fluid. Bubbles quickly burst, leaving epithelial defects.

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

Ulcerative necrotic angina

Another name for this type of inflammation of the tonsils is Simanovsky-Plaut-Vincent's angina. The disease is caused by microorganisms that live in the mouth healthy people(fusiform rods and spirochetes). With a pronounced decrease in immunity in conjunction with predisposing local factors (mouth breathing, caries, etc.), this disease may develop.

With this form of tonsillitis, the tonsils undergo necrosis. This applies to both the epithelium and the parenchyma of the tonsils. On them (and sometimes on the arches of the sky, and the wall of the pharynx) defects appear in the form of ulcers. A characteristic plaque on the tonsils is a dirty gray color, sometimes dirty green. A putrid odor appears from the patient's mouth, saliva is separated 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 raids heal without large scars.

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

Fungal angina

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

With a fungal infection of the tonsils, the temperature rises moderately, intoxication is weak. Sore throat, unpleasant sensations of perspiration are disturbing. The patient may complain of "plugs" in the tonsils. On closer examination, it is noticeable that these are white spots (islands) of a curdled nature. They can spread to both the arches and the root of the tongue.

A sick person may mistake fungal tonsillitis for bacterial and start self-medication with antibiotics. This will not only have no effect, but can also lead to a delay in the process and a deterioration in 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: tonsillitis is one of the first signs of various infectious diseases. This is much less common in adults. Therefore, you should pay attention to all other symptoms and fully examine the patient.

Diphtheria is an infectious disease that is now rare, as 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 against the disease. Therefore, it is important to know what diphtheria is and how it manifests itself.

Diphtheria is caused by the bacterium Corynebacterium diphtheriae. The disease can affect the oropharynx, larynx, trachea, bronchi, skin and other organs. The disease is highly contagious, transmitted by airborne droplets and household contact, less often by food. Diphtheria is dangerous with complications: myocarditis, true croup (swelling of the larynx), disruption nervous system. Often, the disease ends in the death of the sick person from complications.

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

A rarer, more common form is characterized by the appearance of raids on the tonsils, spreading to the mucous membrane of the nasopharynx, trachea, and larynx. Respiratory damage can lead to suffocation of the patient.

There is a rule that all patients with "white" tonsils are considered suspicious for diphtheria. Therefore, if a person is diagnosed with angina, the tonsils must be examined carefully. Plaque on the tonsils they are examined for the presence of diphtheria bacilli.

Plaque on the tonsils with scarlet fever

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

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

Zev with 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, and sometimes purulent tonsils, can be noted. Plaque from the tonsils is removed easily, it is not a continuous layer on them. Sometimes plaque extends beyond the tonsils.

Small punctate rashes, peeling of the skin appear on the patient's body. The patient's appearance is remarkable: a pale nasolabial triangle and rosy cheeks. Scarlet fever is dangerous with severe complications. Therefore, with all forms of angina, the child must be shown to the doctor in order to correctly diagnose and begin timely treatment.

Inflamed tonsils in infectious mononucleosis

Infectious mononucleosis refers to infectious diseases with bright 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, swollen lymph nodes (not only submandibular, but all), enlargement of the spleen and liver, and inflammatory changes in the oropharynx.

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

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

Angina is very dangerous complications, which are general and local. Common complications include damage to the heart (rheumatism), joints (arthritis), gastrointestinal tract and etc.

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

Peritonsillar abscess

A person has paratonsillar tissue. This is a fiber that is located between the wall of the pharynx and the capsule of the palatine tonsil. 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 occurs as a complication of angina.

Deep crypts of the tonsils, especially in their upper part, contribute to the penetration of infection into the fiber. 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 contributes to 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 area, high fever, severe intoxication, pain when turning the head, disturbed sleep and food intake, increased salivation, spasm of masticatory muscles, slurred speech, nasal voice. Pain in the tonsil area can radiate to the ear or teeth, regional lymph nodes increase (maybe on one side). In the blood test, inflammatory changes are detected.

When examining the pharynx, there is a noticeable bulging in the region of the spherical tonsil, its swelling, displacement of the tongue 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, opening of the abscess is required. In some cases, the tonsils are removed along with the abscess. In addition, antibiotics, anti-inflammatory treatment are prescribed.

Retropharyngeal abscess

A pharyngeal abscess is also called a retropharyngeal abscess. It refers to severe complications of inflammation of the tonsils. 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 get sick more often, 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 a slight injury), which then affect the fiber. Acute nasopharyngitis and tonsillitis precede the development of complications.

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

Another name for this disease is adenoiditis. Children suffer mainly, as they have an age-related growth of the tissue of the pharyngeal tonsil. Adults rarely get sick. Reduced immunity, hypothermia, concomitant viral diseases predispose to the development of the disease. Under the influence of these factors, the normal flora of the nasopharynx begins to multiply intensively and lead to the development of inflammation of the pharyngeal tonsil.

At the beginning of the disease, intoxication and high body temperature are characteristic. Then join the violation of breathing through the nose and runny nose. Discharge from the nose of a mucopurulent nature. The voice becomes nasal, the lymph nodes increase. Often, tubal tonsils, pharyngeal follicles are involved in the pathological process. In this regard, otitis media, eustachitis (inflammation of the auditory tube), and pharyngeal 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 tools), there is an increase, swelling, mucopurulent film, signs of follicular or lacunar tonsillitis.

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 the treatment.

Banal forms of angina are treated on an outpatient basis, but in severe cases hospitalization is sometimes required. It is important to observe the mode (home), limit physical activity. It is desirable 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-like) food that does not irritate the throat.

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

If bacterial angina is suspected, an appointment is required. Bacterial tonsillitis is the most common, inflamed tonsils have certain signs, so the doctor makes a diagnosis without much difficulty. 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-lactamase) is required: Augmentin, Amoxiclav, Flemoklav.

If a person does not tolerate penicillins, then first-generation cephalosporins (Cefazolin) and second-generation (Zinacef, Mandol) are prescribed; macrolide antibiotics (Azithromycin). In the third place, a choice is made in favor of third-generation cephalosporins (Klaforan), 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 remedies, in addition to systemic ones. Local remedies for the treatment of tonsils are antiseptic sprays, infusions and decoctions of herbs for rinsing, lozenges. Some contain substances that relieve sore throats.

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

Antiseptic and anti-inflammatory lozenges are an addition to the main treatment, not replacing it. These include the following drugs: Faringosept, Grammidin, Falimint, Strepsils, etc. After taking these drugs, 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, Lysobact.

Gargles are prescribed with decoctions 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 (acting on regional lymph nodes) and through the oral cavity (directly on the tonsils). Usually used from 10 to 15 sessions. Procedures improve local immunity, have an antimicrobial effect.

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

Procedures are done every day, 10-12 times for one course of treatment. The effect of the treatment is that the vessels expand, and blood flows to the inflammation of the tonsils.

• Ultrasonic aerosols with medicinal substances.

With the help of a special device, drug particles are deposited on the surface of the tonsils: antibiotics, hormones, enzymes, herbal remedies. Course of treatment: 8-12 procedures.

• Ozokerite and therapeutic mud in the form of applications.

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

Washing the tonsils is a procedure that is most often used to treat chronic tonsillitis. To do this, a special instrument (cannula) is inserted into the gaps, 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 washed, it is enough to wash 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 in a day.

Do not 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.

Tonsil removal

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

The main indication for the removal of the tonsils is chronic tonsillitis, which is not amenable to conservative therapy, as well as the 2nd degree of the toxic-allergic form of chronic tonsillitis.

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

The removed tonsils should be sent for histological examination.

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

They can temporarily postpone the operation if the patient has untreated carious teeth, during pregnancy in recent weeks, with acute inflammation of various localizations.

Removal of the tonsils is usually done under local anesthesia, rarely anesthesia is 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 lymphoepithelial tissues. Although they are small in size, their significance is enormous. Some people call tonsils tonsils. Both terms are correct, although in the medical literature the patient will mostly encounter the term "tonsil". A doctor who studies and treats the tonsils is an otorhinolaryngologist. Although initially patients seek advice and help not from him, but from 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 location of the tonsils and their physiological features give the 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. In this barrier, the formation and maturation of lymphocytes and the production of antibodies take place. 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 a tight 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-Waldeyer lymphadenoid pharyngeal ring. In total, this complex includes 6 tonsils.

There are six tonsils in the human throat. Paired tonsils: palatine and tubal; unpaired tonsils: lingual and pharyngeal (nasopharyngeal). It is customary to single out 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 tonsil pits (a triangular depression on the side 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. The palatine tonsils have gaps (indentations). The lacunae of the tonsils pass into crypts, which are branches throughout 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 (reduce in size). This process begins in adolescence and continues into old age.

The main role of the palatine tonsils: the formation of lymphocytes and participation in the development of immunity. Especially active is the synthesis of antibodies at a young age (before puberty). It was at this time that a person is widely in 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 formation is no longer so active.

Another function of the palatine 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 palatine 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 side wall of the nasopharynx near the mouths of the auditory tubes. These tonsils are paired, they lie in depressions (pharyngeal pockets).

With an increase in tubal tonsils, they can become the culprits of frequent otitis media and hearing problems. This will be due to the fact that the enlarged tonsils block 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 has grooves or crevices that do not branch. There are no crypts in the pharyngeal tonsil. The pharyngeal tonsil is not covered by the capsule. The pharyngeal tonsil undergoes involution. This process starts at the age of 14-15.

An excessive increase in 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 impede the process of nasal breathing and disrupt the operation 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 well as in the pharyngeal, there are crevices and furrows, but not crypts. In the photo, this tonsil looks bumpy with a rough surface. By the age of 20-30, the development of the lingual tonsil ends.

Inflammation of the lingual tonsil is accompanied by symptoms such as pain during eating and during a conversation. Chronic inflammation of the lingual tonsil is very rare.

What do tonsils look like in a 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 look at the tonsils in the photo. It is better if the doctor comments on this picture and talks about the norm or pathology.

Healthy tonsils in the photo have the following features: pink color, normal size, no plaque and “plugs”. With hypertrophy or inflammation of the tonsils in the photo, you can see their increase in size, discoloration, 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 with other people, enters into different groups, where he inevitably encounters a variety of pathogenic microorganisms. It is the tonsils in children that are the first to take a "blow on themselves" when they meet infectious agents and begin to fight them.

Almost every child encounters inflammatory diseases of the tonsils during his life. Some children suffer from hypertrophy of the palatine 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, growth and developmental delay, deterioration in school performance, and sleep problems will accumulate.

A person 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, follicles that are still forming are found. By the end of the first six months of a child's life (less often by a year), the tonsil follicles complete their development.

The pharyngeal tonsil (adenoid) develops most quickly in children. Even a slight increase in it can cause a violation of 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, tonsils can be subject to various diseases. The most frequent of them:

• Inflammation of the tonsils (angina, tonsillitis)

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

• Hypertrophy of the tonsils

Hypertrophy is called an increase in the tonsils due to their pathological growth. Hypertrophied tonsils in children, as a rule. There are several stages of this process. The stronger the tonsils are enlarged, the more they interfere with a person (breathing, swallowing, talking normally). Therefore, depending on the degree of the process, appropriate treatment of the tonsils is prescribed.

• Chronic tonsillitis

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

• Tumors of the tonsils

They are benign and malignant.

Angina of 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 of the disease "angina" comes from the Latin word "ago", which means ─ to choke or squeeze. Although in fact, angina is not accompanied by suffocation. Inflammation of the palatine tonsils occurs both acute and chronic. Both forms of the disease have features of the course and treatment.

Acute disease of the palatine 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 other causative agents of angina and their association with each other. Other causative agents of inflammation of the tonsils include: hemolyzing staphylococcus aureus, fungi, Staphylococcus aureus, adenoviruses, spirochetes, enteroviruses, etc.

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

Most often, people get sick with angina in spring and autumn. The most susceptible to the disease are weakened people, children, persons with reduced immunity (pregnant women, etc.). Contributes to angina poor nutrition of a person with a lack of vitamins B and C, injuries of the tonsils, some features of a person (for example, a 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 also 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 that lives in the crypts of the tonsils, and the breakdown products of proteins can act as a substance that leads to sensitization of the body. This becomes a trigger 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 palatine 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 occur due to hypothermia, poor environmental conditions (gas pollution, changes in temperature and humidity), and a decrease in immunity.

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

The disease usually occurs after repeated tonsillitis, when there is no complete recovery against the background of inadequate treatment or a decrease in immunity. The tonsils gradually change, pathological contents accumulate in their crypts. Some patients note the constant presence of "plugs" in the tonsils. The crypts are not completely emptied, this is prevented by scars in the tonsils after tonsillitis. Thus, inflammation in the tonsils is constantly maintained and the process is delayed. "Plugs" in the tonsils with purulent or caseous contents in chronic tonsillitis occur 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 themselves with tonsillitis where there is none.

There is another situation: the tonsils are altered, with signs of chronic tonsillitis, but a person does not have exacerbations. Such forms of the disease are called "nonanginal".

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

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

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

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

Pain in the tonsils

With angina, a person feels pain in the tonsils. The pain may be constant, may 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, whether it hurts on one side or on both sides, whether it hurts along the midline of the pharynx, where it gives pain, which helps the patient cope with 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 interferes with normal breathing and swallowing, especially for children. If a person has only enlarged tonsils, then this is not a sign of a sore throat. Most likely, this is hypertrophy of the tonsils. Enlargement of the tonsils varies in degrees. The doctor can find out the cause of the enlarged tonsils and choose a 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, visually, symptoms such as "white" tonsils or purulent tonsils can be noted. "White" tonsils are found in lacunar tonsillitis, 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 clear 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 unpleasant sensations in the throat. The severity of the rise in temperature can be different: from subfebrile (up to 38 ° C) figures to hyperpyretic values ​​(above 40 ° C). The duration of fever is usually 3 to 5 days, sometimes more. Characterized by a rapid decrease in temperature against the background of adequate treatment of inflamed tonsils.

With inflammation of the tonsils, temperature is only one of the signs of intoxication. In addition to it, 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 inflammation of the tonsils. Some are an independent disease, while others are one of the manifestations of a systemic or infectious disease. Most often, a person falls ill with banal tonsillitis, which include catarrhal, follicular, lacunar and mixed forms.

Less common are atypical forms of tonsillitis: fungal, ulcerative necrotic, phlegmonous, enteroviral tonsillitis 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 (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 angina

This is the least severe tonsillitis, in which the tonsils are affected only from the outside (mucous membrane). Typically, the onset of the disease is acute 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. Headache, feeling of weakness, aches, loss of working capacity, lethargy are characteristic.

With catarrhal angina, the inflamed tonsils look hyperemic, that is, bright red. The palatine arches also become red. Their mucous membrane is swollen with serous discharge. Purulent raids on the tonsils with this form of the disease are not observed. 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, not for long, up to 5 days.

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

Follicular angina

This form of angina is much harder 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), there is a sore throat, which often radiates to the ear, vomiting. Signs of intoxication are pronounced, may prevail over local symptoms. This is especially noticeable in children, they even have impaired 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 swollen. 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, look like yellow dots the size of a millet grain (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 on the 2nd-4th day of the disease. They remain erosions that heal quickly.

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

General signs of lacunar angina are the same as in follicular, 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, which becomes purulent. This discharge contains many leukocytes, lymphocytes, epithelial cells and fibrin threads.

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

The disease lasts about one week, with complications, the process may be delayed. Some patients simultaneously have signs of both lacunar and follicular tonsillitis.

Fibrinous angina

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

If we compare the photo of the tonsils with fibrinous angina and with diphtheria, then we 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 remaining symptoms of fibrinous tonsillitis are similar to other symptoms of banal tonsillitis.

This is a severe form of tonsillitis, in which the lacunae of the tonsils are not emptied of their contents. Occurs rarely. The swelling of the inflamed tonsils is determined, their soreness when palpated. An abscess (abscess) is formed inside the tonsil from merged follicles. The process usually happens on one side. This is facilitated by traumatization of the tonsil.

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

Herpangina

With this type of tonsillitis, the tonsils are affected by enteroviruses. The features of the disease are that plaque occurs on the tonsils, and on the mucous membrane of the palatine arches and the palate itself. This plaque is a small reddish vesicles containing serous fluid. Bubbles quickly burst, leaving epithelial defects.

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

Ulcerative necrotic angina

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

With this form of tonsillitis, the tonsils undergo necrosis. This applies to both the epithelium and the parenchyma of the tonsils. On them (and sometimes on the arches of the sky, and the wall of the pharynx) defects appear in the form of ulcers. A characteristic plaque on the tonsils is a dirty gray color, sometimes dirty green. A putrid odor appears from the patient's mouth, saliva is separated 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 raids heal without large scars.

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

Fungal angina

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

With a fungal infection of the tonsils, the temperature rises moderately, intoxication is weak. Sore throat, unpleasant sensations of perspiration are disturbing. The patient may complain of "plugs" in the tonsils. On closer examination, it is noticeable that these are white spots (islands) of a curdled nature. They can spread to both the arches and the root of the tongue.

A sick person may mistake fungal tonsillitis for bacterial and start self-medication with antibiotics. This will not only have no effect, but can also lead to a delay in the process and a deterioration in 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: tonsillitis is one of the first signs of various infectious diseases. This is much less common in adults. Therefore, you should pay attention to all other symptoms and fully examine the patient.

Diphtheria is an infectious disease that is now rare, as 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 against the disease. Therefore, it is important to know what diphtheria is and how it manifests itself.

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

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

A rarer, more common form is characterized by the appearance of raids on the tonsils, spreading to the mucous membrane of the nasopharynx, trachea, and larynx. Respiratory damage can lead to suffocation of the patient.

There is a rule that all patients with "white" tonsils are considered suspicious for diphtheria. Therefore, if a person is diagnosed with angina, the tonsils must be examined carefully. Plaque on the tonsils they are examined for the presence of diphtheria bacilli.

Plaque on the tonsils with scarlet fever

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

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

The pharynx in scarlet fever is bright red, the 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, and sometimes purulent tonsils, can be noted. Plaque from the tonsils is removed easily, it is not a continuous layer on them. Sometimes plaque extends beyond the tonsils.

Small punctate rashes, peeling of the skin appear on the patient's body. The patient's appearance is remarkable: a pale nasolabial triangle and rosy cheeks. Scarlet fever is dangerous with severe complications. Therefore, with all forms of angina, the child must be shown to the doctor in order to correctly diagnose and begin timely treatment.

Inflamed tonsils in 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, swollen lymph nodes (not only submandibular, but all), enlargement of the spleen and liver, and inflammatory changes in the oropharynx.

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

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

Angina is very dangerous complications, which are general and local. General complications include damage to the heart (rheumatism), joints (arthritis), gastrointestinal tract, etc.

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

Peritonsillar abscess

A person has paratonsillar tissue. This is a fiber that is located between the wall of the pharynx and the capsule of the palatine tonsil. 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 occurs as a complication of angina.

Deep crypts of the tonsils, especially in their upper part, contribute to the penetration of infection into the fiber. 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 contributes to 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 area, high fever, severe intoxication, pain when turning the head, disturbed sleep and food intake, increased salivation, spasm of masticatory muscles, slurred speech, nasal voice. Pain in the tonsil area can radiate to the ear or teeth, regional lymph nodes increase (maybe on one side). In the blood test, inflammatory changes are detected.

When examining the pharynx, there is a noticeable bulging in the region of the spherical tonsil, its swelling, displacement of the tongue 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, opening of the abscess is required. In some cases, the tonsils are removed along with the abscess. In addition, antibiotics, anti-inflammatory treatment are prescribed.

Retropharyngeal abscess

A pharyngeal abscess is also called a retropharyngeal abscess. It refers to severe complications of inflammation of the tonsils. 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 get sick more often, 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 a slight injury), which then affect the fiber. Acute nasopharyngitis and tonsillitis precede the development of complications.

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

Another name for this disease is adenoiditis. Children suffer mainly, as they have an age-related growth of the tissue of the pharyngeal tonsil. Adults rarely get sick. Reduced immunity, hypothermia, concomitant viral diseases predispose to the development of the disease. Under the influence of these factors, the normal flora of the nasopharynx begins to multiply intensively and lead to the development of inflammation of the pharyngeal tonsil.

At the beginning of the disease, intoxication and high body temperature are characteristic. Then join the violation of breathing through the nose and runny nose. Discharge from the nose of a mucopurulent nature. The voice becomes nasal, the lymph nodes increase. Often, tubal tonsils, pharyngeal follicles are involved in the pathological process. In this regard, otitis media, eustachitis (inflammation of the auditory tube), and pharyngeal 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 tools), there is an increase, swelling, mucopurulent film, signs of follicular or lacunar tonsillitis.

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 the treatment.

Banal forms of angina are treated on an outpatient basis, but in severe cases hospitalization is sometimes required. It is important to observe the mode (home), limit physical activity. It is desirable 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-like) food that does not irritate the throat.

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

If bacterial angina is suspected, antibiotics are required. Bacterial tonsillitis is the most common, inflamed tonsils have certain signs, so the doctor makes a diagnosis without much difficulty. 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-lactamase) is required: Augmentin, Amoxiclav, Flemoklav.

If a person does not tolerate penicillins, then first-generation cephalosporins (Cefazolin) and second-generation (Zinacef, Mandol) are prescribed; macrolide antibiotics (Azithromycin). In the third place, a choice is made in favor of third-generation cephalosporins (Klaforan), 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 remedies, in addition to systemic ones. Local remedies for the treatment of tonsils are antiseptic sprays, infusions and decoctions of herbs for rinsing, lozenges. Some contain substances that relieve sore throats.

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

Antiseptic and anti-inflammatory lozenges are an addition to the main treatment, not replacing it. These include the following drugs: Faringosept, Grammidin, Falimint, Strepsils, etc. After taking these drugs, 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, Lysobact.

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 (acting on regional lymph nodes) and through the oral cavity (directly on the tonsils). Usually used from 10 to 15 sessions. Procedures improve local immunity, have an antimicrobial effect.

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

Procedures are done every day, 10-12 times for one course of treatment. The effect of the treatment is that the vessels expand, and blood flows to the inflammation of the tonsils.

• Ultrasonic aerosols with medicinal substances.

With the help of a special device, drug particles are deposited on the surface of the tonsils: antibiotics, hormones, enzymes, herbal remedies. Course of treatment: 8-12 procedures.

• Ozokerite and therapeutic mud in the form of applications.

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

Washing the tonsils is a procedure that is most often used to treat chronic tonsillitis. To do this, a special instrument (cannula) is inserted into the gaps, 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 washed, it is enough to wash 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 in a day.

Do not 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.

Tonsil removal

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

The main indication for the removal of the tonsils is chronic tonsillitis, which is not amenable to conservative therapy, as well as the 2nd degree of the toxic-allergic form of chronic tonsillitis.

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

The removed tonsils should be sent for histological examination.

Surgery is contraindicated in patients with severe concomitant diseases: heart defects with severe 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.

They can temporarily postpone the operation if the patient has untreated carious teeth, during pregnancy in recent weeks, with acute inflammation of various localizations.

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