I. Overview of tonsillitis Tonsillitis is one of the most common clinical diseases and is classified as acute or chronic. Acute tonsillitis is an acute nonspecific inflammation of the palatine tonsils, often accompanied by varying degrees of inflammation of the pharyngeal mucosa and other lymphoid tissues, and is often an acute episode of chronic tonsillitis; it occurs mostly in children and young adults. It tends to develop during the change of seasons and temperature changes. Chronic tonsillitis mostly evolves from repeated episodes of acute tonsillitis or poor drainage of the crypt and bacterial and viral breeding infections in the fossa.
The main causative agent of acute tonsillitis is Streptococcus haemolyticus type B. The main causative agent of acute tonsillitis is Streptococcus haemolyticus. Non-hemolytic streptococci, staphylococci, bacillus pneumoniae, bacillus influenzae and adenovirus or rhinovirus, herpes simplex virus, etc. can also cause. Mixed infections of bacteria and viruses are not uncommon. In recent years, anaerobic bacterial infections have been found, and Gram-negative bacillus infections are on the rise. When human resistance is reduced, cold, humidity, overexertion, excessive smoking and alcohol, stimulation by harmful gases, and the presence of chronic lesions in the upper respiratory tract are all causative factors. The pathogen can be transmitted by droplet or direct contact. It is usually sporadic, occasionally regional, and is most often seen in people living in groups, such as troops, factories, and schools.
The main causative agents of chronic tonsillitis are streptococci and staphylococci. Repeated acute tonsillitis causes epithelial necrosis in the crypt, in which bacteria and inflammatory exudates gather, and poor drainage of the crypt leads to its occurrence and development, also secondary to scarlet fever, diphtheria, influenza, measles, and nasal and sinus infections. The mechanism of its occurrence is not clear, but in recent years it is believed that chronic tonsillitis is related to auto-adaptive reactions.
The clinical manifestations of tonsillitis are often divided into two categories of acute palatal tonsillitis, namely catarrhal and septic tonsillitis. The basic performance is generally similar. The main symptoms are: (1) systemic symptoms The onset of the disease is rapid, and may include chills, high fever, headache, decreased appetite, fatigue, body discomfort, constipation, etc. (2) local symptoms
(2) Local symptoms Sore throat is the main symptom, with severe sore throat, difficulty in swallowing and pain often radiating to the ear. The lymph nodes in the jaw angle are enlarged, and sometimes it is difficult to turn the head.
(3) Examination The patient has an acute appearance. The mucosa of the pharynx is diffusely congested, with the tonsils and the two palatal arches being the most severe. The palatine tonsils are enlarged and yellow-white pus spots can be seen on their surface or yellow-white or gray-white pulp-like exudate at the mouth of the crypt, which can be connected into a pseudomembrane.
The clinical characteristics of chronic tonsillitis are often a history of acute attacks, but usually there are no obvious conscious symptoms, and patients sometimes complain of minor symptoms such as dry and itchy throat, foreign body sensation, irritating cough, and bad breath. If the tonsils are excessively enlarged, disorders of breathing, swallowing or speech resonance may occur. Systemic reactions due to irritation of the stomach and intestines by swallowing of crypt pus plugs or absorption of bacteria and toxins in the crypt cause indigestion, headache, malaise, and hypothermia. On examination, the tonsils and palatoglossal arch are chronically congested, and yellow and white cheese-like spots can be seen at the mouth of the saphenous fossa; the size of the tonsils is variable. In adults, the tonsils are mostly shrunken, but the surface is scarred and uneven, often with adhesions to the surrounding tissue. The lymph nodes in the jaw angle of the patient are often enlarged.
The diagnosis and differential diagnosis of tonsillitis Acute tonsillitis generally has typical clinical manifestations, so it is not difficult to diagnose. However, attention should be paid to differentiate it from pharyngeal diphtheria, Fanshang’s pharyngitis and pharyngitis caused by certain blood diseases.
The main basis for the diagnosis of chronic tonsillitis is the patient’s history of recurrent acute attacks. The diagnosis should be made on the basis of the medical history, combined with local examination. The size of the tonsils does not indicate the degree of inflammation and therefore cannot be used to make a diagnosis. Chronic tonsillitis should be differentiated from physiological hypertrophy of the tonsils, tonsillar keratosis, and tonsillar tumors.
The most common local complication of acute tonsillitis is peri-tonsillar abscess, which can also cause acute otitis media, acute rhinitis and sinusitis, acute lymphadenitis, parapharyngeal abscess, etc. Acute tonsillitis can cause many diseases in various systems of the body, including rheumatic fever, acute arthritis, myocarditis and acute nephritis.
Chronic tonsillitis is easily formed when the body is exposed to cold and humidity, general debility, endocrine disorders, autonomic dysfunction or poor living and working environment, and metamorphosis occurs, resulting in various complications such as rheumatoid arthritis, rheumatic fever, heart disease, nephritis, and prolonged hypothermia. Chronic tonsillitis is often regarded as one of the “foci” of systemic infection.
The treatment of tonsillitis 1, acute tonsillitis treatment (1) general therapy The disease is contagious, so patients should be isolated. Bed rest, a liquid diet and more water, to enhance nutrition and loose stool, sore throat or high fever, oral antipyretics and analgesics.
(2) Antibiotic application is the main treatment method. Penicillin should be the first choice of antibiotics, and the route of administration should be decided according to the severity of the disease. If the condition does not improve after 2~3d of treatment, the reason must be analyzed and other kinds of antibiotics should be used instead. Hormone can be used as appropriate.
(3) Local treatment Commonly used compound borax solution, oral tide (compound chlorhexidine gargle) or 1:5000 furacilin solution gargle.
(4) Traditional Chinese medicine According to the theory of traditional Chinese medicine, the disease is caused by internal phlegm-heat, unclear lung and stomach, and external wind and fire, so the wind and heat should be cleared, swelling and toxicity should be eliminated. Yin Qiao Gan Tang or Qing Pharynx Antiseptic Soup is commonly used. Acupuncture therapy is effective in relieving pain and fever, taking the points Hegu and Quchi. For severe pain and high fever, Shaoshang can be pricked.
(5) Surgical treatment If there are many recurrent episodes of acute tonsillitis, especially those with complications, tonsillectomy should be performed after the acute inflammation has subsided.
2, the treatment of chronic tonsillitis (1) non-surgical treatment can try the following methods: ① based on the view that chronic tonsillitis is an infection – allergic state, the treatment of this disease should not be limited to antibacterial drugs and surgery, but should take into account immunotherapy or anti-allergic measures, including the use of desensitizing bacterial products (such as desensitization with streptococcal allergens and vaccines), as well as a variety of immune-enhancing drugs. and various immunity-enhancing drugs such as placental globulin injections, transfer factors, etc. ②Local drug application, crypt irrigation, cryotherapy and laser therapy have been tried, but the long-term effect is still not satisfactory. ③Strengthen 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 cases where the inflammation has become irreversible.
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