Chronic tonsillitis mostly evolves into chronic inflammation from recurrent episodes of acute tonsillitis or from poor drainage of the palatine tonsil crypt, where bacteria and viruses breed and infect the fossa.
Etiology】 Streptococcus and Staphylococcus are the main causative agents of this disease.
1.Recurrent attacks of acute tonsillitis cause epithelial necrosis in the crypt, poor drainage of the crypt, in which bacteria and inflammatory exudates accumulate.
2. Secondary to acute infectious diseases, such as scarlet fever, diphtheria, influenza, measles, etc. It can also be secondary to infection of the nasal cavity and sinuses and other adjacent tissues and organs.
3. In recent years, some scholars believe that chronic tonsillitis is related to autoimmune reaction.
Pathology】 It can be divided into 3 types.
Due to repeated stimulation of inflammation, the lymphatic and connective tissues of the gland proliferate, and the gland is enlarged and soft, protruding beyond the palatal arch, mostly in children. The mouth of the tonsillar crypt is wide, and a collection of secretions or a pus spot is seen. Microscopic examination: proliferation of glandular lymphoid tissue, enlargement of the germinal center, marked division of filiform nuclei, and active phagocytosis.
2. Fibrous type The lymphoid tissue and follicles are degenerated and atrophied, replaced by extensive fibrous tissue. Due to scar contraction, the gland is small and hard, and often adheres to the palatal arch and peri-tonsillar tissue. Focal infections are mostly of this type.
3.Crypt type A large number of exfoliated epithelial cells, lymphocytes, leukocytes and bacteria gather in the crypt of the gland and form pus plugs or the mouth of the crypt is adhered by inflammatory scar and the contents cannot be discharged, forming pus plugs or cysts, which become foci of infection.
Clinical manifestations] There is often a history of recurrent attacks of acute tonsillitis, and there is often sore throat during the attacks; there are few conscious symptoms during the inter-episode period, and there may be mild symptoms such as dryness, itching, foreign body sensation and irritating cough in the pharynx. Halitosis occurs if there is cheese like decay retained in the tonsillar fossa or if there is a large amount of anaerobic bacterial infection. Pediatric patients with excessive tonsillar hypertrophy may have dyspnea, sleep snoring, and dysphagia or speech resonance disorders. Systemic reactions caused by the pus plug of the crypt being swallowed and irritating the stomach and intestines, or the absorption of bacteria and toxins in the crypt, resulting in indigestion, headache, weakness, and low fever.
Examination】 The tonsils and palatoglossal arch are chronically congested, and the mucosa is dark red. When the palatoglossal arch is squeezed, yellow and white cheese-like dots can be seen at the mouth of the crypt. The tonsils are variable in size, and in adults they are mostly reduced in size, but the surface is scarred, uneven, and often adherent to the surrounding tissue. The patient’s lymph nodes in the angle of the jaw are often enlarged.
Diagnosis and differential diagnosis】 The diagnosis is made based on the medical history and combined with local examination. The patient’s history of recurrent acute attacks is the main basis for the diagnosis of this disease. The diagnosis can be confirmed if the local examination reveals chronic congestion of the tonsils and palatoglossal arch, uneven surface of the tonsils, scarring or yellowish-white dots, and secretions spilling out of the crypt by squeezing the palatoglossal arch. The size of the tonsils does not indicate the degree of inflammation, so the diagnosis cannot be made in this way. This disease should be differentiated from the following diseases.
1, physiological hypertrophy of tonsils Most often seen in children and adolescents, no conscious symptoms, smooth, light-colored tonsils, clear crypt opening, no secretion retention, no adhesions with surrounding tissues, soft to touch, no history of repeated inflammatory episodes.
2, tonsillar keratosis is often misdiagnosed as chronic tonsillitis. Keratosis is hyperkeratosis of the epithelium of the tonsillar crypt, appearing as white pointed sand-like material, hard to the touch, firmly attached, and not easy to wipe off. If removed by force, bleeding wounds are left behind. Similar keratinized material can also be seen in the posterior pharyngeal wall and tongue root.
3.Tonsil tumors Benign tumors are mostly unilateral and papilloma is more common. Malignant tumors are squamous cell carcinoma or lymphosarcoma, non-Hodgkin’s lymphoma is more common, in addition to unilateral enlargement is accompanied by ulceration, and invade the soft palate or palatal arch, often accompanied by ipsilateral cervical lymph node enlargement, pathological section is needed to confirm the diagnosis.
Complications] Chronic tonsillitis is prone to various complications such as rheumatoid arthritis, rheumatic fever, heart disease, nephritis, and prolonged hypothermia when the body is exposed to cold and moisture, weakness, endocrine disorders, autonomic dysfunction, or poor living and working environments. Therefore, chronic tonsillitis is often regarded as one of the “foci” of systemic infections.
Treatment
1, non-surgical treatment can be tried the following methods:
(1) immunotherapy, including the use of desensitizing bacterial products (such as desensitization with streptococcal allergens and vaccines), the application of a variety of immunity-enhancing drugs, such as injections of placental globulin, transfer factor, etc.
(2) Local drug application, crypt irrigation, cryotherapy and laser therapy have been tried, but the long-term efficacy is still not satisfactory.
(3) Strengthen physical exercise to enhance physical fitness and resistance to disease.
2.Surgical treatment At present, surgical removal of tonsils is still the main treatment method. However, the indications should be reasonably grasped, and tonsillectomy should be considered only for those irreversible inflammatory lesions.