Chronic tonsillitis in children

Once on the amygdala, the infection lingers in the lacunae - the internal crypts of the lymphoid tissue. In a healthy tonsil, the lacunae are always clean, and healthy lymphoid tissue captures the incoming infectious agent and disinfects it by passing on air or food. A chronically ill amygdala cannot do this. The amygdala captures the infection, but is unable to neutralize it, so it accumulates in the lacunae. In the lacunae, which in chronic tonsillitis change (expand and deform), food residues, bacteria, fungi enter, white blood cells also tend to enter, calcium salts fall out, which form the so-called purulent-caseous plugs and become an even greater source of infection. Therefore, chronic tonsillitis is usually accompanied by a concomitant violation of any body functions.

Symptoms of acute and chronic tonsillitis

• Sore throat: sore throat, significant fever, deterioration of well-being, malaise, enlargement of regional lymph nodes. With fungal or bacterial sore throat, plaque may appear on the tonsils, viral sore throat is manifested by blistering rashes and swelling of the tonsils.

• Chronic tonsillitis is often asymptomatic and is manifested only by exacerbations in the form of sore throats. Symptoms may include periodic discomfort or sore throat, bad breath, general weakness, malaise, excessive sweating, prolonged increases in body temperature to 37.1 - 37.3 degrees Celsius, and enlargement of regional lymph nodes.

With chronic tonsillitis, the functions of the "target organs" (heart, kidneys, joints) may be impaired. This is often manifested by joint pain, arthritis, osteoarthritis, endocarditis, pericarditis, myocarditis and other diseases. Therefore, chronic tonsillitis can be classified as a systemic disease. If chronic tonsillitis occurs with complications (the so-called decompensated form of tonsillitis), surgery (removal of the tonsil) is recommended.

With angina, a dangerous local complication is peritonsillar abscess, when pus from the tonsils enters the surrounding tissues and an abscess forms. This is an acute and very painful condition in which self-medication is contraindicated, and you should immediately consult a doctor. Peritonsillar abscess is an indication for the removal of tonsils to avoid recurrence.

Diagnosis of chronic tonsillitis

Visual inspection. Signs of chronic tonsillitis are adhesions of the tonsils with arches, the presence of discharge (purulent, caseous) in the lacunae, a change in the shape and size of the anterior and posterior arches of the tonsils (Preobrazhensky's symptom), redness of the arches (Giza's symptom), their swelling (Zak's symptom), an increase in regional lymph nodes.

Laboratory blood tests: ESR values, leukocyte formula, streptococcal infection markers (C-reactive protein, antistreptolysin O).

Diagnosis of angina

Visual inspection. Redness and swelling of the tonsils, the presence of plaque, enlargement and soreness of the regional lymph nodes.

Laboratory tests: seeding from the surface of tonsillar plaque on flora and antibiotic sensitivity, smear for diphtheria (to exclude or confirm its presence), clinical blood test.

Chronic tonsillitis in children: treatment

In acute tonsillitis, antibacterial therapy is prescribed. This way, not only the treatment of tonsils is carried out, but also the complications that often occur with angina are eliminated. Local anti-inflammatory antibacterial or antiseptic therapy, analgesic treatment, and antihistamines are recommended.

In chronic tonsillitis, conservative treatment consists in removing the contents from the tonsillar lacunae (for example, gargling with antiseptic solutions, saline solutions; the use of local antiseptics in the form of tablets for resorption and sprays). Conservative treatment is usually applied in courses. In addition, rinses with anti-inflammatory drugs and herbal infusions are prescribed. Physiotherapy is also used - ultraviolet radiation and ultrasound to the submandibular area with anti-inflammatory drugs.

If conservative treatment has no effect, sore throats recur or signs of tonsillitis remain unchanged, surgical treatment is prescribed. If chronic tonsillitis is diagnosed, the tonsils are completely removed.

At the European Medical Center, the tonsils are removed to the child in a state of safe drug-induced sleep, which relieves psychological discomfort and negative impressions from visiting the clinic. Coagulation of the niche is performed simultaneously with the removal, thereby eliminating the risk of bleeding by 90%. About a day after the operation, a small patient can leave the clinic.

Surgical treatment of pediatric tonsillitis at the EMC Children's Clinic is carried out using modern methods and protocols that have proven their effectiveness. To remove the tonsils, a radio-wave knife, laser or high-frequency coagulation, and bipolar tweezers are used. They can significantly reduce the length of hospital stay, significantly reduce the risk of postoperative bleeding and significantly shorten the period of full recovery of the child after the intervention.

For medical reasons, less radical methods are used in EMC: tonsillotomy, lacunotomy, ablation or fulguration of the tonsils, laser exposure. The decision on the most optimal method is made by the attending physician individually in each specific case, depending on the stage of the disease and the degree of prevalence of the pathological process. If several options are suitable, the advantages of each of them are discussed with the parents of the small patient, and the most optimal method is jointly selected.