Chronic tonsillitis is a decompensated form of symptoms. Decompensated tonsillitis, how is the decompensated form of chronic tonsillitis treated? Why therapy is needed

Chronic tonsillitis is understood as a long-term inflammatory process affecting the palatine and pharyngeal tonsils(almond glands). It can be compensated and decompensated. In the first case, these organs are a dormant focus of infections. At the same time, the body's ability to resist diseases is preserved and the tonsils perform a barrier function quite satisfactorily.

Quite another matter is decompensated chronic tonsillitis. With this variant of the disease, the patient often suffers from angina. The tonsils cease to cope with the function of a buffer or barrier between pathogens and internal environment organism and become a permanent source of infection. The disease in this case is often complicated by abscesses, ENT pathology, such as otitis, sinusitis, gives complications to the heart, kidneys and other organs.

Tonsillitis is one of the most characteristic examples of focal infection. The causative agent is most often coccal flora(staphylo- and streptococci), which can normally be present in small quantities in the human body. With the weakening of its general resistance, uncontrolled growth begins pathogenic microflora.

They talk about decompensated tonsillitis if with exacerbation chronic process the patient seeks help more than 3 times a year. The illness is severe, high temperature and damage to the tonsils. The surrounding tissues are also affected. With this form of the pathological process, angina is often accompanied by purulent fusion of the lymphoid tissue, which is represented by the tonsils.

Symptoms

Symptoms of the disease can be divided into two groups. The first one belongs general symptoms diseases that the patient complains about:

Great weakness, lethargy.
Sore throat, comparable to the consequences of a burn.
Throat congestion, discharge of viscous purulent sputum.
Subfebrile body temperature.
Regional lymphadenitis (inflammation of the submandibular, rarely cervical lymph nodes).

At severe course pathological process, there may be difficulty in swallowing and apnea syndrome (stopping breathing, especially during sleep). This is due to a strong increase in the size of the tonsils.

The second group of symptoms of the decompensated form of tonsillitis includes characteristic changes in the region of the pharyngeal ring. They can be evaluated by a pediatrician, therapist and ENT doctor. These signs include:

Severe redness, swelling with the formation of ridge-like thickenings in the region of the edges of the palatine arches.
education purulent exudate in the lacunae of the tonsil-shaped glands or formed abscesses (plugs).
Loosening of the tissues of the tonsil.
Cicatricial changes in the tissues of the tonsils and adhesive processes between the tonsils and adjacent arches.

If there are at least two of these signs, the doctor has the right to ascertain tonsillitis.

Thanks to Russian doctors, today it has become possible to check whether chronic tonsillitis is accompanied by complete decompensation of the tonsils (that is, the loss of their immune function). It also determines whether they are able to fulfill the assigned role, at least partially. The verification technique is to determine a special coefficient. It reflects the quantitative ratio of lymphocytes per unit area of the tonsil to the number of colonies pathogenic microorganisms grown as a result of sowing a smear from the gap.

Why is therapy needed?

Chronic tonsillitis in decompensated form is subject to mandatory treatment. This is due to the established pathogenetic relationship between the pathological process affecting the tonsils and more than a hundred diseases. Some of them are difficult to treat and dangerous to the health and life of the patient. Associated with this disease are:

Collagenosis (SLE/lupus, rheumatism, dermatomyositis, nodular periarteritis, scleroderma).
Nephritis.
Skin diseases (polymorphic erythema, psoriasis, eczema).
Pathology of the organ of vision (Behcet's disease).
Work disruptions thyroid gland(hyperthyroidism).
Purulent complications(para-intratonsillar abscess, phlegmon).
Pathologies affecting the nervous system.

Cardiologists recognize some connection between the described disease and frequent exacerbations of VSD / NCD.

There are cases of improvement in the condition of patients, in terms of reducing the number of exacerbations of vegetovascular disorders after tonsillectomy ( surgical removal tonsils).

Provoking factors

The main cause of tonsillitis in general and in decompensated form, in particular, is the uncontrolled reproduction of pathogenic microorganisms (bacteria) and viruses. In the first place is Staphylococcus aureus and hemolytic streptococcus. But pathological process may be associated with the reproduction of other pathogens:

Various anaerobic bacteria.
Viruses (adeno-, herpesviruses, Coxsani and Epstein-Barr).
Conditionally pathogenic bacteria (moraxella, mycoplasmas).
Chlamydia and fungi.

Provoking factors for the occurrence of a decompensated form chronic tonsillitis insufficient, untimely or illiterate treatment is considered compensated. The development of tonsillitis itself is facilitated by the presence of a chronic focus of infection in oral cavity(caries, stomatitis) or paranasal sinuses (sinusitis, rhinitis). Infection from a sick person/carrier can also lead to this disease.

Exacerbation of chronic tonsillitis is facilitated by any factors that weaken nonspecific resistance body:

Prolonged/severe hypothermia.
Being under the constant influence of stressors or severe stress.
Irritation of the mucous lining of the larynx with toxic or irritating substances, fine particles (smoke, dust).
Allergy, burns of the mucous membrane of the throat.
Environmentally unfavorable area of residence, industrial hazards.
Drinking very cold drinks.
Bad habits (primarily smoking).
Vitamin deficiency and malnutrition.

All these factors contribute to recurring tonsillitis and the loss of the tonsils of their direct functions.

Therapy

Treatment involves taking conservative measures. If they are not effective, it is recommended prompt removal lost immune function tonsil glands.

Conservative measures are considered acceptable if:

Decompensated tonsillitis in chronic form proceeds only in the form of periodically developing angina.
There are contraindications to prompt decision Problems.

Conservative therapy involves regular course treatment, preferably at least 2 times a year, in spring and autumn, before the onset of exacerbation. The number of preventive drug measures can be increased up to 4 times a year. The gold standard in this case is drug therapy. general action, as well as the application antibacterial agents designed for:

Irrigation of tonsils.
Gargle.
Numerous one-time microinjections in the area of the tonsil.

For gargling, an acceptable option is to use local antiseptics and phytochemicals. When choosing an antibiotic, it is important to pay attention to the sensitivity of microorganisms to it. Modern pathogenic microflora has an enviable resistance to many traditional antibacterial agents.

If these measures are ineffective, use radical remedy- removal of the tonsils (complete, partial). New technologies allow the use of laser surgery instead of a scalpel. This is a more gentle and anemic method.

Surgical intervention is not allowed during an exacerbation of the disease, with any infectious disease and in some other cases:

With pathology of the blood coagulation system.
Severe diabetes.
During the period of bearing a baby.
At the time of menstrual bleeding.
At serious injuries heart and kidneys.

Caution in deciding on surgery is justified by the fact that this body participates in immune reactions, is a barrier to the penetration of infection into the gastrointestinal tract and the respiratory system.

It is believed that the tonsils are involved in the processes of hematopoiesis. By removing them, the surgeon strikes at immune system a person, but only if the tonsils retain at least some of the functions.

Prevention

Chronic decompensated tonsillitis requires treatment. But no less obligatory is the prevention of this pathology. She assumes timely treatment acute tonsillitis, balanced diet, physical activity and hardening of the body. In addition, you should:

Timely remediation of foci chronic infection(treat caries, gum disease and inflammation of the paranasal sinuses).
If there is gas and dust in the air in the room where the person is located, it must be eliminated.
When working with manufacturing harmful substances use personal protective equipment.
Do not develop bad habits or abandon existing ones (smoking, drinking alcohol).

It is worth thinking about removing the tonsils only if the doctor insists on it. You must first try all the methods of treatment.

Decompensated chronic tonsillitis appears when palatine tonsils permanently inflamed. This organ, located on both sides of the larynx, prevents the penetration of pathogenic bacteria into the body, which contributes to a significant strengthening of the human immune system. When they become inflamed, this is a signal for lymphocytes that it is time to start fighting the infection. Chronic tonsillitis in decompensated form is the most severe type of this disease.

Severe inflammation of the palatine tonsils indicates that they are actively multiplying on their surface. pathogenic bacteria. If they are constantly inflamed, then this is most likely due to the fact that no one is able to fight with “strangers” and they feel quite comfortable on the tonsils. This clearly indicates that tonsillitis has nothing to do with a cold. This disease is infectious, has other symptoms.

Prolonged exposure of microbes to the tonsils clogs them with their waste products and excludes them from the body's defense system. This process allows bacteria to infect all new internal organs of a person. Chronic tonsillitis can affect the cardiovascular system, the musculoskeletal system and other equally important systems.

Forms of chronic tonsillitis

Chronic tonsillitis occurs in two forms.

If the body is not able to cope with the disease on its own, then this is chronic compensated tonsillitis.

If the immune system is so weakened that it cannot provide adequate resistance to infection and the tonsils themselves are already spreading the virus, then this is chronic decompensated tonsillitis, as mentioned above, the most severe type of tonsillitis. Not only do the tonsils no longer fulfill their direct duty to protect the body from viruses, but they themselves infect neighboring organs.

There is a second variant of the disease - chronic tonsillitis with decompensation of the immune system.

If cases of angina are observed more than three times a year, then tonsillitis is already halfway to the decompensated form of chronic tonsillitis. Tonsils at this stage have already undergone irreversible changes.

Tonsillitis with decompensation of the immune system

The situation described above indicates that the inflammatory process has already spread much further than the pharyngeal tonsils.

At this stage, one can already expect various complications, which is caused by chronic focus inflammation. It is because of chronic decompensated tonsillitis that rheumatism occurs, septic endocarditis, chorea minor, glomerulonephritis, paratonsillar abscess, tonsillogenic sepsis, which can even end in death for the patient.

If the diagnosis of decompensation of chronic tonsillitis is confirmed, then surgical removal of the palatine tonsils affected by the virus is indispensable. If nothing is done at this stage, then subsequent organic changes are no longer amenable to conservative treatment methods.

Treatment of the disease

With the diagnosis of this particular form of chronic tonsillitis, there are only two possible methods treatment:

conservative;
surgical.

When we talk about a conservative method of treating decompensated tonsillitis, we mean whole complex treatment measures.

First of all, we reanimate the affected immune system. This treatment is medication, it is possible to prescribe various forms acupuncture and manual therapy.

We help the palatine tonsils and the pharynx itself in getting rid of the pathogenic microflora. To do this, after a thorough study to determine the type of bacteria, we use antibiotics.

Significant healing effect give washing of the tonsils with a solution of antibiotics, soaking inflamed tonsils propolis tincture or chlorophyllipt, cleaning the tonsils from accumulated waste products of bacteria, direct injections medicines directly into a collection of lymphoid tissue.

All types of physiotherapy are used: ultrasound, UHF, ultraviolet irradiation, inhalation.

A conservative method of treatment often cannot be limited to a one-time course. The success of treatment directly depends on how carefully your family was treated with you. The disease is infectious in nature, so therapy is prescribed to all potential carriers of microbes, that is, to all family members.

Surgical intervention is an extreme case, which is resorted to if conservative treatment has not brought the desired stable results or the disease process is neglected. There are a number of contraindications to surgical treatment: hemophilia, diabetes mellitus, open form tuberculosis, cardiovascular and kidney failure, pregnancy.

Surgical intervention in the case of small tonsils can be reduced to a bloodless version of cryosurgery. Otherwise surgery carried out traditionally. There are options for treatment with a laser that eliminates the focus of inflammation.

The laser beam has a variety of effects on the affected tonsils, reducing them or completely destroying the pathological process. Moreover, the operation in this way is carried out under local anesthesia, which has a beneficial effect on subsequent recovery.

Sometimes the tonsils are affected unevenly, and it makes no sense to remove them completely, then apply partial removal affected areas.

Enough experienced doctor will fight for palatine tonsils to the last, because their absence is a serious blow to the patient's immune system. On the initial stage diseases are always possible methods to avoid their removal. The longer the disease lasts, the less chance the tonsils have.

As practice shows, there is no other treatment for chronic decompensated tonsillitis, except for surgical surgical intervention. The best way to avoid it is not to bring compensated tonsillitis to such a form.

Tonsillitis

Tonsillitis is one of the most common diseases of the throat, in which the tonsils are affected by an infection, their lacunae are filled with purulent contents and cause an inflammatory process. Depending on the incidence of pathology and clinical manifestations distinguish between chronic and acute forms.

Chronic tonsillitis, what is it?

If the disease worsens more often three times per year, it can be attributed to the chronic form. Its symptoms are not as pronounced as in the acute form, but are more detrimental to the body as a whole. It is difficult to cure such a pathology, it requires complex treatment and preventive measures during the period of remission. The sluggish process can continue for years, manifesting itself as sharp outbreaks of exacerbation, especially in the cold season.

Types of chronic tonsillitis

Depending on how far the disease process has gone and whether the tonsils are amenable to therapy, decompensated and compensated tonsillitis are distinguished.

A disease is considered to be a compensated type when chronic exacerbations repeat up to three times a year, and the palatine tonsils, although affected by infection, still perform their function, and slight changes are observed in their structure. In this case, the tonsils are amenable to conservative treatment, which is aimed at destroying the root cause of the disease and the resulting inflammatory focus are bacteria. They are the main cause of the development of tonsillitis. In therapy use:

medications (antibacterial and immunomodulating without fail);
physiotherapy procedures;
carry out a set of measures aimed at washing out the contents from the lacunae of the tonsils and disinfecting them.

Decompensated tonsillitis is the most complex type of disease, characterized by the actual impossibility of conservative treatment, or rather its ineffectiveness. This condition develops as a result of frequently repeated tonsillitis of a compensated type, at least three. At the same time, the tonsils completely lose the ability to normal functioning and they themselves become a carrier of infection throughout the body. Their tissue undergoes irreversible changes, in which it thickens, becomes loose and forms scars. Because of these changes, the gaps are in a kind of trap, since scar tissue blocks the exit from them of the accumulated purulent secret, and he, in turn, gradually poisons the body.

Toxins released from lymphoid formations enter the blood and lymph, and they carry them throughout different bodies, which can lead to a number of other diseases or contribute to the exacerbation of previously diagnosed chronic diseases.

Pathology of the heart (arrhythmia, myocardium, cardialgia);
pyelonephritis and nephritonephrosis of the kidneys;
rheumatism;
polyarthritis;
scleroderma;
pneumonia, bronchitis and asthma;
meningitis;
blockage of blood vessels.

These are just some of the disorders that this type of tonsillitis can contribute to. In this case, conservative methods of treatment become ineffective, and otolaryngologists strongly recommend resorting to radical therapy, performing a tonsillectomy (surgery to remove the tonsils). It is pointless to try to preserve the tonsils at this stage of the disease, since with each exacerbation the situation worsens and harms the body more and more.

Will the operation hurt?

To date, there are a number of modern methods of tonsillectomy, each of them has its own advantages, and based on the specific case, the doctor chooses the most suitable for the patient.

There are the following types of operations:

electrocoagulation;
microdebrider;
excision with an ultrasonic scalpel;
radiofrequency ablation;
laser;
excision with a wire loop (classical method).

In defense of tonsillectomy for decompensated tonsillitis, it is important to say that this operation is the second most popular in the world, about 600 thousand palatine tonsils are removed annually. And in times Soviet Union classic tonsillectomy was performed for every second patient diagnosed with tonsillitis.

The operation is considered simple and in many cases does not even require general anesthesia which for many is an important fact. Also modern methods allow to achieve minimal postoperative, rehabilitation period, and practically reduce pain to zero.

If it so happens that the otolaryngologist has identified you as decompensated, follow the doctor's clear recommendations and do not ignore the surgical treatment he suggested. It’s easier to set yourself up once, albeit not on the most pleasant procedure, but in the future not to have complications and not be subject to constant exacerbations from the sore throat. Of course, the radical method will not completely relieve you of all throat diseases, but it is a fact that they will become less common.

It often happens that after the transferred serious illness there are unpleasant consequences that cannot be ignored. To this kind of labels dangerous diseases refers to tonsillitis. This inflammatory process captures the pharyngeal and palatine tonsils and takes a long time and hard. Both adults and children are susceptible to it (it manifests itself least of all in babies).

Tonsillitis appears after diseases associated with inflammation of the mucous membrane.

These include:

Measles;
Scarlet fever;
Diphtheria;
Severe forms of angina.

It flows next to characteristic features and has two types of treatment, conservative and surgical, which are selected based on its shape. Tonsillitis is a focal disease, that is, it has the most acute manifestation, from which there is an inflammatory process, so everything medical procedures aimed at destroying the "core" of the infection and the subsequent reduction of symptoms.

Tonsillitis has two forms:

Spicy.
Chronic.

Acute tonsillitis occurs directly with the disease, most often - angina. More dangerous chronic. It appears if the first form was not completely cured, and the person has “smoldering” foci of the disease. Any infection or hypothermia will restart the mechanism of the disease, and tonsillitis can not only develop again, but also add serious complications.

Chronic tonsillitis continues its branching. It can be compensated or decompensated. The first option practically does not interfere with human health, except for the fact that it is a launching pad for the development of the disease. Decompensated chronic tonsillitis occurs on a preserved focus. It increases the risk of angina and often leads to inflammation of not only the tonsils, but also the ear and nasal sinuses. It is on him that most of the efforts of doctors are directed.

Causes

Chronic tonsillitis occurs due to the following processes:

Bacterial infections
Weakened immunity
Angina with frequent periodicals;
Frequent use antibiotics that slow down the immune system.

Symptoms of chronic tonsillitis

There are chronic tonsillitis in adults and children.

In the former, it is expressed in a milder form, so its symptoms are often ignored until it is needed. medical intervention. First there is a stabbing pain, which is especially noticeable during swallowing. Over time, the discomfort increases, the pain begins to radiate to the ear.

Gradually, swelling appears on the neck and larynx, and eating becomes more and more difficult, reaching the stage when it is impossible to eat even liquid soups. The danger of tonsillitis in adults is expressed by the fact that at first the disease develops gradually: the temperature rises slightly, only up to 37 degrees, mild intoxication, causing weakness, which is easy to confuse with overwork, slight tinnitus, and occasionally low blood pressure.

Only a doctor with extensive experience in his field will be able to record such disparate deviations from the norm, put them together in a big picture and put correct diagnosis. If the conclusion is put forward late, then you can not even hope for conservative treatment.

In children, chronic decompression tonsillitis manifests itself more clearly. By evening, the temperature will definitely rise, and in the throat there will quickly appear a sensation that prevents swallowing, a lump. Intoxication is expressed much more noticeably, causing severe weakness and sweating, there is a burning sensation around the tonsils. It becomes difficult for the child to swallow, and purulent lumps can be found when coughing. If you do not see a doctor in time, you can wait for heart complications: pain in the chest area, lack of oxygen, rapid pulse.

Treatment of chronic tonsillitis

There are two treatment options for chronic tonsillitis. If the doctor noticed the symptoms in time and made a diagnosis, then it is quite possible to do without conservative treatment. It takes place in several stages, which are combined and intertwined.

First of all, a sick child or adult is prescribed a course of antibiotics. When choosing them, doctors are repelled by the type of bacteria that caused the disease. Most often, drugs based on penicillin are prescribed - they not only affect the focus of the disease, but will also be a good prevention for a weakened body. Pure penicillin is now a thing of the past, its place was taken by semi-synthetic drugs in dosage: amoxicillin, flemoxin. It is important to remember that antibiotics are used only in case of exacerbated chronic tonsillitis, and not as a prophylaxis of the disease.

The next step is to strengthen the immune system so that the body regains the strength to fight stress and illness. To do this, select funds based on herbal ingredients such as chamomile, propolis and echinocea. Polyoxidonium is often prescribed - this medical preparation has properties that stimulate the immune system, as well as reduce the intoxication of the body. With its help, there is an increased production of antibodies that help the body fight infection.

Physiotherapy

Physiotherapy is used to actively influence the focus of the disease. A sick person is prescribed inhalations and ultraviolet radiation. A set of actions aimed at cleaning the tonsils is also connected - they are washed with an antibiotic solution and cleaned of pus with the help of furacilin or sanguirythrin.

For complex treatment, rinsing is also used. From medical preparations Lugol's solution, furatsilin, miramistin and hexoral are suitable. They are easy to breed at home. Dosage - a teaspoon or 40 drops, furatsilin is placed one or two tablets per glass. Must use warm water to reduce discomfort and not worsen the condition of the tonsils.

If chronic tonsillitis has passed into acute stage, you will have to resort to surgical intervention. In the case when the tonsils are small, laser treatment or bloodless removal with the help of cryosurgery can be used. The operation is performed under local anesthesia.

The consequences of surgery - how serious is it?

This question worries many people, but it can be said that pernicious influence sometimes exaggerated. Of course, the tonsils are a barrier to infection trying to enter the body. But this barrier is one of many. If you take care of your health, do not abuse antibiotics and take courses to strengthen immunity from time to time, then you can completely protect yourself.

Prevention of chronic tonsillitis

In order not to expose your body to the danger of deterministic tonsillitis, you must constantly strengthen your immunity. You can spend cold and hot shower or hardening douches - the main thing is not to overdo it with a drop in water temperature, otherwise you can not get tonsillitis, but earn a cold.

It would be nice to have tea from the complex in your kitchen medicinal herbs: it may not be as tasty as usual, but it will be a great help to your body. In the pharmacy for your purposes there is a whole range of various vitamins. They can be used both in fixed courses and daily.

It is very important to make sure that you do not overheat or get cold. Always dress for the weather, in cloudy weather, do not be lazy to take an umbrella with you, and in winter, be sure to wear a scarf and clothes with a high collar.