The chronic tonsillitis is caused by acute tonsillitis that is not completely cured, and bacteria remain in the tonsillar fossa, while the body’s immune function is poor, and once the body resistance decreases, the acute symptoms recur again, repeatedly. The acute tonsillitis repeatedly leads to scar formation on the surface of the tonsils, further blocking the tonsil crypt, causing poor drainage of the crypt, which is more conducive to the bacterial nest Weiwei. The local pathology of chronic tonsillitis in children is mainly hypertrophy of the tonsils or chronic inflammatory changes of the crypt fossa type. Fibrotic or sexual changes may occur in older children.
Second, how is pediatric tonsillar hypertrophy caused?
The majority of pediatric tonsillar hypertrophy is physiological, and some of these children have chronic tonsillitis.
Inflammatory tonsillar hypertrophy: Because of the uneven surface of the tonsils themselves with grooves and sockets, they are prone to retain viruses and bacteria, and are prone to tonsillitis when the systemic or local immune function is low (child patients are often cold, overheated, and unclean nasal cavity, nasopharynx, and mouth), and the repeated inflammation of the tonsils can easily lead to chronic inflammatory hyperplasia and hypertrophy. If you have chronic inflammatory tonsillar hypertrophy, the basis often exists for physiological tonsillar hypertrophy, that is, on the basis of physiological tonsillar hypertrophy, resulting in chronic tonsillitis.
Third, how to diagnose pediatric chronic tonsillitis and tonsillar hypertrophy?
1, medical history: If it is chronic tonsillitis, there is a previous history of acute tonsillitis, or easily because of tonsillitis and repeated fever, sore throat and other medical history; if only physiological tonsillar hypertrophy, there is generally no history of acute tonsillitis.
2. Symptoms: local symptoms are the main ones, and in a few cases may be accompanied by certain symptoms of the whole body.
(1) Chronic tonsillitis: more pharyngeal pain, frequent discomfort in the pharynx, “uttering” phlegm, paroxysmal irritating cough in severe cases, or bad breath, swollen submandibular lymph nodes; if the tonsils are large, can cause swallowing disorders and affect eating; more prone to colds, colds easily cause acute tonsillitis symptoms (throat The symptoms of acute tonsillitis (increased pain in the throat, fever, pus on the surface of the tonsils). A small number of children with chronic tonsillitis may have certain systemic symptoms, which can cause prolonged low-grade fever, headache, mental discomfort, constipation or indigestion due to the toxic absorption of inflammation; or other symptoms associated with chronic tonsillar complications (tonsillitis can be complicated by heart disease, nephritis, rheumatic fever, etc.).
(2) tonsillar hypertrophy: children with physiological tonsillar hypertrophy can have obstructive symptoms, such as present breathing difficulties, obstructed swallowing (dysphagia), slurred speech, snoring during sleep, and swallowing disorders that affect eating. The symptoms of “uttering” no or little sputum. Patients with chronic inflammatory tonsillar hypertrophy may also show the above symptoms of chronic tonsillar inflammation.
3. Examination.
(1) Tonsillitis.
① Tonsils are generally second degree large or third degree in size, with chronic congestion changes, uneven performance, or pus point embolism at the mouth of the trap, or tonsil performance with scarring changes (caused by the original coal with acute tonsillar suppuration). Sometimes tonsillar manifestations with vasodilatation are seen.
The palatoglossal arch and palatopharyngeal arch are chronically congested, mostly more obvious at the palatoglossal arch.
The tonsils are hard to palpate. Sometimes, when squeezing the tonsils, purulent material can be seen overflowing from the crypt orifice, which is mostly a bacterial infection.
(2) Physiological tonsillar hypertrophy.
(1) The tonsils are mostly three degrees large, or two degrees large, and the surface is smooth.
(2) Physiological tonsillar hypertrophy: ①Tonsils are mostly three degrees large, or two degrees large, with a smooth surface.
When the tonsils are pressed, they are not hard, and no secretions can be squeezed out.
4. What complications can be caused by chronic tonsillitis?
Chronic tonsillitis can cause many complications, commonly heart disease, kidney disease, arthritis, rheumatic fever, as well as appendicitis, cholecystitis, toxicity; goiter; if chronic tonsillitis recurs acutely, it may cause peri-tonsillar abscess; long-term chronic tonsillitis can also cause developmental disorders in children (often associated with the production of more severe snoring). The mechanisms that cause systemic or remote organ complications are related to certain bacterial infections (e.g., type B hemolytic streptococcal infections) and may also be related to metabolic mechanisms.
V. What are the methods of conservative therapy for pediatric chronic tonsillar and pediatric tonsillar hypertrophy?
Any conservative therapy is more difficult to make the enlarged tonsils shrink to normal size in a short period of time. The goal of conservative therapy is not to shrink the tonsils (it is good to be able to shrink them), but to keep tonsillitis from recurring, and to reduce and eliminate the clinical symptoms caused by tonsillitis and tonsillar hypertrophy.
1, Western medicine believes that for patients who are not suitable for surgery, it is most important to strengthen the body’s resistance. For children patients, the way to enhance resistance is to exercise and strengthen the body; secondly, to take some drugs to improve resistance to disease, such as vitamin drugs; patients who are prone to colds can be injected with drugs such as Skincare, Utilis, and Proglobulin.
2, local containing drugs, usually pay attention to keep the mouth and throat area clean, is conducive to reducing the recurrence of tonsillitis.
3, Chinese medicine is the most important conservative treatment, which can enhance the body’s immune function and also reduce or eliminate the symptoms of chronic tonsillitis, so as to prevent or reduce the recurrence of tonsillitis; for those with enlarged tonsils, it can effectively control the obstruction symptoms (mainly snoring) caused by tonsil enlargement.
4. Western anti-inflammatory drugs given orally or intravenously are basically ineffective.
What are the methods of surgical treatment for pediatric chronic tonsillitis and pediatric tonsillar hypertrophy?
1.For older children (more than ten years old), tonsillectomy surgery under non-general anesthesia can be performed to completely remove the tonsils. However, in clinical practice, even adults voluntarily request surgery under general anesthesia for better results and less pain.
2. For younger children, the tonsils can be completely removed by surgical excision under general anesthesia. General anesthesia is generally safe, but there are risks associated with any surgery, some of which are difficult to predict.
3. For pediatric patients over the age of 10 who are able to cooperate with treatment, microwave surgery or plasma surgery or laser surgery (also known clinically as minimally invasive surgery) of the tonsils can be performed to treat the surface of the tonsils so that chronic inflammation is eliminated while preserving the physiological function of the tonsils. However, there is still a possibility of recurrence of tonsillitis in the future, so if the result of one operation is not good, you can consider minimally invasive surgery again (microwave surgery is done 1-3 times, usually no more than 3 times to solve the problem), and often obtain satisfactory results. If minimally invasive surgery is performed on children under 10 years of age, it can only be performed under general anesthesia and requires hospitalization.
How to choose conservative or surgical treatment for pediatric chronic tonsillitis?
The basic idea of how to choose conservative or surgical treatment should be
1. Conservative therapy should be carried out as much as possible to preserve the physiological function of the tonsils. This is because the tonsils in childhood are helpful for the body’s immune function (especially for the local immune defense function).
2.For those who fail in the treatment method of striving to preserve the physiological function of tonsils (conservative therapy system treatment for more than 3 months, the symptom improvement is not obvious, the effect is not ideal, such as tonsillitis still easy to recur, or the symptoms caused by tonsil hypertrophy are still obvious, such as snoring symptom reduction is not ideal), then surgical removal should be considered.
3.When microwave therapy or plasma surgery can be performed, such surgery should be performed as much as possible so that the effect is faster and better than that of simple conservative therapy; when microwave therapy or plasma surgery can be performed, complete removal without surgery should be performed as much as possible so that it is more economical and the physiological function of tonsils can be retained.
4. For those whose tonsillitis has caused complications, surgical removal should be considered as much as possible.
5. Contraindications to surgery: Immediate surgical treatment is contraindicated in the following cases.
If you have not recovered from a cold, if the acute tonsillitis is not yet under control, if you are menstruating, if you have bleeding disorders, if you have congenital heart disease, or if your doctor thinks that you cannot have surgery immediately.
What is the effectiveness of Chinese medicine in the treatment of chronic tonsillitis and tonsillar hypertrophy in children? (Adenoid hypertrophy is also applicable)
Pediatric chronic tonsillitis often has tonsillar hypertrophy, and physiological tonsillar hypertrophy is even more problematic with hypertrophy. According to Chinese medicine, tonsillar hypertrophy belongs to phlegm condensation, which is due to spleen deficiency and phlegm production, long depression into lumps, longer duration of the disease may occur phlegm obstruction, and treatment with blood stasis, so that phlegm and blood stasis each other. If there are recurrent acute attacks of tonsils caused by colds, there is a deficiency of lung qi and a lack of solidity outside the body. If there are also recurrent tonsillar symptoms, they are caused by recurrent external evil on top of this. Therefore, the basic treatment of chronic tonsillitis and physiological hypertrophy of tonsils in children is to benefit Qi, strengthen the spleen, dissolve phlegm and disperse nodules, or to disperse superficial evil and activate blood circulation to remove blood stasis. The basic formula is: Six Junzi Tang combined with Scrofula Pill, with appropriate addition and reduction according to the condition.
Prescription (main formula): Radix Codonopsis pilosulae 3-10g (or Radix prince’s ginseng 3-10g) Atractylodes macrocephala 5-10g Poria 5-15g Glycyrrhiza glabra 2-6g Chen Pi 2-6g Fuxia 3-10g Xuan Shen 3-10g Zhe Bei Mu 10-20g Calcined oyster 10-20g (small values for younger children, large values for older children, same later)
Special Note: 1. Each prescription is generally limited to five doses; 2. The drugs in each prescription are generally controlled at 11-17 flavors; 3. This formula is for reference only; if prescribed, a doctor should be asked to prescribe it, not to prescribe it easily; if prescribed by oneself, an experienced herbalist should also be asked to review whether the prescription is feasible to avoid side effects.
Note on the addition and subtraction of drugs: In the addition and subtraction of drugs, there are two points that need special attention: First, pay attention to the use of drugs that strengthen the spleen and appetite to ensure that the child’s appetite is normal; because drugs such as detoxification will reduce the function of the spleen and stomach, which may lead to poor appetite. Secondly, we should pay attention to keep the stool of children smooth, for those who have dry stool, we need to use Guaou Ren, Huomache Ren, etc. If the stool is thin after taking the medicine, according to Chinese medicine, it can make the fire poison drained down, which is normal, but should not pull watery stool, and should not make the child appear mentally unstable.
The main method of addition and subtraction: (the age of small people with the amount of medicine should be small; children under 3 years old as small as possible; children over 12 years old, the development of better, you can follow a large number)
Easy sweating: Astragalus membranaceus 5-15 grams, Medlar 3-6 grams, Schisandra chinensis 2-5 grams.
Poor appetite: cardamom 3-6 grams, sand kernel 3-6 grams, Shen Qu 3-6 grams, fried malt 5-10 grams, hawthorn 3-6 grams, chicken naijin 3-10 grams, plus 1 -2 flavors will suffice.
Some cough, or a slight chill: 2-6 grams of thorny mustard, 2-6 grams of orris, 3-6 grams of bai qian, 3-6 grams of aster, 1-3 grams of Chuan bai mu, 3-6 grams of almond, 2 -4 flavors; with phlegm, add 3-6 grams of Qian Hu.
Some itching in the throat: Thorax 2-6 grams, Cicada 2-6 grams, 1-2 flavors.
some obvious redness and swelling: 5-10 grams each of honeysuckle, dandelion, wild chrysanthemum, aster, asparagus, etc. (10 grams of such medicines tend to cause abdominal pain and diarrhea), 1 – 3 flavors.
Longer duration of the disease, tonsillar hypertrophy is obvious: 3-5 grams of mountain cichlid, 2-5 grams of eucommia, 3-6 stiff silkworm (phlegm dispersing medicine group); 3-6 grams of peach kernel, 1-3 grams of safflower (blood circulation and stasis dispersing medicine group); three prongs, curcuma 2-6 grams each (group of drugs to resolve blood stasis and disperse nodules); add 1-2 groups; (Note: such drugs tend to cause abdominal pain)
With sinusitis (nasal congestion and turbid discharge): dahurica 3-10 grams, soapberry 3-6 grams, honeysuckle 3-10 grams, mandarin 2-6 grams, winter melon seed 5-10 grams, 3-5 flavors Treatment
Constipation (dry stools, or stools once every 2-3 days): 5-6 grams each of guahua kernel and fire hemp kernel, 1-2 flavors.
loose stools: 10-15 grams of Coix Seed, 3-6 grams of Cardamom, 2-6 grams of Patchouli, 1-2 flavors.
Abdominal pain after taking medicine: xiang (or use: huo xiang) 2-6 grams, sharen 3-6 grams, 2 flavors.
Nine, Chinese medicine treatment of pediatric chronic tonsillitis or tonsillar hypertrophy can be taken to what effect, should achieve the effect to be considered effective?
1.The effect that can be achieved: the effect of eliminating inflammation and tonsillar hypertrophy to a certain extent.
2.The following effects should be achieved in order to be considered good.
(1) Eliminate chronic inflammation of the tonsils, so that tonsillitis rarely recurs acutely (because only the existence of tonsils, there is the possibility of tonsillitis, even if it has not occurred before); no longer appear sore throat, phlegm in the throat, and sometimes want to “utter” clear throat.
(2) The enlarged or hypertrophied tonsils are reduced in size so that symptoms such as snoring and obstruction of swallowing no longer occur.
In most cases, the use of Chinese herbal medicine can reduce recurrence, alleviate symptoms or make symptoms basically disappear. After the child is 10 years old, if chronic inflammation still exists, the child can be further treated with simpler surgical methods (microwave and plasma surgery), which can heal and preserve the physiological function of the tonsils.
Ten, acute recurrence of chronic tonsillitis in children
Acute relapse of chronic tonsillitis in children often results in fever and sore throat, and some pediatric patients are prone to recurrence of this phenomenon. When this phenomenon occurs, it should be treated according to the acute tonsils, and after the acute inflammation has significantly improved, most of them are still not completely cured and should be considered to continue treatment according to chronic tonsillitis.