Tonsillitis

Description:

Tonsillitis is an inflammatory process in palatine tonsils which can proceed both in acute, and in chronic forms. Acute tonsillitis называбт quinsy.  On a surface of almonds there are about 20 deep tubules called by lacunas. In lacunas not only parts of food, but also causative organisms are late. Also in lacunas purulent, caseous contents can accumulate. Owing to an anatomic structure of lacunas with their gyrose, narrow channels defines a possibility of formation of purulent traffic jams. The process proceeding in lacunas of palatine tonsils till certain time is under control of an organism, i.e. there is a constant active and passive drainage of lacunas of almonds along with activity of macrophages that, preventing an inflammation of a palatine tonsil, promotes development of immunity in relation to many microorganisms coming to an oral cavity and throats together with air and food.

Tonsillitis reasons:

At verification of the causative agent of tonsillitis the group A streptococcus most often comes to light, is more rare – other streptococci and viruses, and sometimes – chlamydias and mycoplasmas. Incidence of tonsillitis has pronounced seasonality which is higher in off-season - in the fall or in the spring. When overcooling, improper feeding, harmful operating conditions protective properties of an organism can decrease that will create premises for development of a disease. It is possible to catch from sick people as the infection is transmitted in the airborne way.

Tonsillitis symptoms:

The symptomatology of tonsillitis depends on its form (an acute or adenoid disease).
The general complaints are morbidity when swallowing, feeling of irritation in a throat, breath difficulty – all this the main symptoms of a disease. Temperature increase, most often to subfibrilny figures is characteristic. The disease most often is followed by a regional limfoadenit, including with interest of hypoglossal lymph nodes. At survey of a throat it is visible that almonds increased in a size and reddened, on them the plaque of yellowish or white color appeared.
Children have a disease heavier. In addition to all listed symptoms, nausea, an abdominal pain, vomiting are characteristic of the children having tonsillitis.

Treatment of Tonsillitis:

Treatment of tonsillitis complex, also has to consider a form, the character of a current and an etiological factor which caused a disease.  An important point is division of tonsillitis into 2 groups: primary tonsillitis which is an independent disease, and secondary when tonsillitis arises against the background of another, often system, diseases. Therefore treatment tactics at different forms is various. For primary tonsillitis the pathogenetic, etiotropic tepariya is shown, at the instruction on the secondary nature of a disease treatment of the main pathology is shown
Treatment of tonsillitis can be conservative and operational.
Conservative treatment of tonsillitis includes first of all systematic sanitation of lacunas of palatine tonsils with preservation of the most adenoid tissue of almonds as immune, to some extent, body. Conservative treatment is shown at an uncomplicated adenoid disease when operation on the general condition of the patient can be delayed; if the patient did not receive any therapy earlier or he is generally disturbed by local displays of tonsillitis - purulent traffic jams in almonds, a fetor from a mouth. Among methods of conservative treatment at chronic tonsillitis the following is most effective: washing of lacunas of almonds and removal of purulent traffic jams. Both at quinsy, and at the pharyngitis accompanying it rinsings of a throat, inhalation, irrigation of a mucous membrane are shown by disinfecting solutions.

At treatment  of tonsillitis phytotherapy is widely used. For increase in immune forces of an organism it is appointed broths and tinctures of a camomile, a mallow and a horsetail as the substances which are their part stimulate protective mechanisms of an organism due to increase in phagocytal activity of macrophages and granulocytes. The positive moment is that side effects at use of drug are noted.

For therapy of uncomplicated forms of tonsillitis purpose of germicides is shown (from the first day of a disease - before obtaining results of a microbiological research). The main requirements to local antibacterial agents are the wide range of antimicrobic action including the most typical activators, lack of absorption from a mucous membrane, a low allergogennost.

Example of antibacterial drug for treatment of uncomplicated tonsillitis is Bioparox. Bioparox - an inhalation antibiotic with antiinflammatory properties. The wide range of antibacterial action of a fyuzafyunzhin, lack of resistant strains of microorganisms, own antiinflammatory properties of drug do it especially effective at treatment of tonsillitis of not streptococcal etiology.  The dosage of drug assumes 4 doses of drug each 4 h within 10 days.

Therapeutic justified drugs for treatment of acute tonsillitis, and also aggravations chronic, are:
Klaritromitsin - on 1 tablet 2 times a day.
Coldrex - on 2 tablets 2 times a day. Children are 6-12 years old - on 1 tablet 4 times a day.
Tonzillotren (tablets for a rassasyvaniye) - on 1 tablet in each hour.

Treatment of such quinsies as agranulocytic and monocytic, demands participation of the hematologist.
Operative measure at tonsillitis assumes removal of the struck almonds which is called a tonsilectomy.
This operation allows to remove the chronic center of an infection in the form of an almond together with the capsule.
Indications to an operative measure:
1. Frequent (2-4 times a year) the aggravations of an adenoid disease which are followed by high temperature of a body; in lacunas the pathological purulent detritis is noted; there is this or that complication connected with a process aggravation (polyarthritis, pyelonephritis and so forth).
2. The frequent quinsies (2-4 times a year and is more often) which are followed by high temperature of a body, are observed local signs of an adenoid disease, without the revealed complications. Often repeating quinsies indicate immunity easing.
3. As a result of one of exceptional cases of a disease of quinsy (1 time in 5-7 years) any complication from heart, joints developed, etc. Local signs of an adenoid disease, an adenitis of lymph nodes in the field of a mandible corner.
4. Cases of quinsy were not, however against the background of the arisen heart diseases, joints, etc. local signs of an adenoid disease, mainly accumulation in lacunas of almonds of purulent contents come to light.
This operation is shown also for children from 2nd year of life. Contraindications are dekompensirovanny somatopathies of cardiovascular,  respiratory, urinary systems, a serious illness of blood.
Local anesthesia provides greasing of a throat of 2% Dicainum solution. At peritonsillites and abscesses when morbidity is increased, the wadded brush moistened with Dicainum solution repeatedly for several seconds is put on site future section. The surgery field is processed  0,25% or 0,5% of solution of novocaine in number of 10 — 20 ml. Adrenaline addition (1: 1000) on 1 drop on 1 ml of novocainic solution promotes desalination of a surgery field, however can strengthen bleedings during the first hours after operation, and at tendency of the patient to vasomotor spasms can provoke them by production of operation. At the choice of drug for anesthesia individual portability of this or that anesthetic is considered. At individual hypersensitivity to novocaine instead of it normal saline solution is injected in bigger quantity, than sufficient anesthesia is reached.
Necessary tools: the small syringe with a long and fine needle, the pallet, is better angular, for a continence for his patients, the special raspatory with pointed, but not too keen edges, curve scissors, mindalikovy or (at its absence) a strong nasal wire loop, several styptic clips (Kokhera and Peana) of different size and a scalpel. More perfect tools as, for example, curve styptic clips, gear peritonsillar abscess forceps, the self-aspirating raspatory connected by a hose to an aspirator are very desirable. Special mindalikovy scissors with the extended manual ends and shortened (bent) cutting are very convenient that allows to make them both a section, and amotio without expense of time for change necessary at the different moments of a scalpel, the raspatory, kuperovsky scissors.
The first injections of small amounts of anesthetic do under mucous front and back handles. Not to puncture a front handle through and not to cause a solution effluence between her and an almond, it is necessary to use not too slantwise the ground needle and to direct it not perpendicularly, and at an acute angle to a mucosal surface. If at sharply increased almonds the back handle is not visible, then the anesthetic injetsirovaniye in her middle part works well only after amotio of an upper pole. It is also necessary to infiltrirovat the field of transition of a front handle in back and a root of language. Administration of solution in the capsule of the lower pole at commissure it with a lingual almond provides painlessness of the last stage of operation. For anesthesia and simplification of amotio of the capsule from a peritonsillar fat if there is no paratonsillar abscess, solution is injected and perikapsulyarno. For this purpose the needle is entered at the level of the middle of a front handle and by several knaruzha from it. The injection site of solution and the direction of a needle are specified by repeated procrastination of the taken almond a kpereda, to the average line that it allows to define lateral border of an almond where enter about 2 ml of novocaine on depth of 1 — 1,5 cm. After an injection within 2 — 3 min. do the break necessary for rest of the patient and explanations of how the patient has to sit and how to hold the angular pallet. It usually calms the worrying patient. The section with a mucous size up to 2 cm is done without almond pulling, on edge of a lobby and partly a back handle, close to an upper pole of an almond. Cut only a mucous membrane. It is better to do a section on both sides prior to the beginning of amotio. Amotio of an almond begin after capture it with special gear nippers or (at their absence) a styptic curved clip. Enter the end of the raspatory into a section of mucous the convex party to an almond only at the first movements, and further — concave. Make the otslaivayushchy short vertical, and then and bending-around an upper pole movements by the raspatory; operating at the same time defines capsule border, bypasses on it an upper pole then removes the raspatory this pole in a throat gleam at a simultaneous pulling its nippers of a kpereda and medially. It allows to see at the first moment the grayish brilliant capsule of an upper pole which is not painted by blood yet and, moving a clip (or nippers), it is obligatory to occupy at the same time the region of an almond together with the capsule without what capture will not be strong. Procrastination of the upper pole which is strongly taken by nippers allows to make almond amotio the raspatory from top to bottom and to the average line from handles and from paratonsillar fabric quicker, with the smallest injury and blood loss. If zamindalikovy cellulose is soldered to the almond capsule as it happens at being ill earlier peritonsillites, then it is useful to inject 1 — 2 ml of the anesthetizing solution into each commissure. If amotio of the capsule is complicated, separate cicatricial tyazh make cuts scissors then stratification is facilitated. When filling a surgery field with blood reasonablly happens to plug zamindalikovy space a gauze napkin and to pass to amotio of an upper pole of other almond. Having entered a tampon for partially otsloyenny second almond, it is necessary to return to continuation of operation on the first. This reception is better, than repeated wipings, dehematizes after operation and allows to carry out release of almonds at the best visual control of all details, and the patient has less often a need to spit out blood. When all middle part of an almond already an otsloyena and an almond does not hang down in a pharyngeal cavity yet, before imposing of a loop it is necessary to make amotio of the lower pole. For this purpose the pallet move from the middle aside, on a side part of language, against the processed almond. It facilitates approach to the lower pole and allows to carry out its amotio under sight control that is important for full removal of an almond. At procrastination of an almond usually it is found so dense connective tissue тяж, connecting the almond capsule with a language root that stratification by its raspatory is complicated. It is facilitated after a partial section of its fibers by scissors. After that the lower pole is allocated in the stupid way so that the almond hangs down down and keeps only on a thin crossing point. Its cutting off can be executed using a loop, and sometimes and without it if blood vessels in it are very small. Sometimes in the course of amotio of the lower pole when developing pains it is useful to inject in addition anesthetizing solution around the lower pole.
The postoperative mode provides bed keeping, observation of personnel, the use of liquid cool food and drink. At pains appoint analginum; narcotic analgetics after operation are not shown as they can cause in the patient somnolence, at which perhaps imperceptible running off of blood from a pharyngeal wound in a stomach. Since 2 days swallowing of liquid food is gradually facilitated and completely recovered by the end of the week after operation. By this time, in the absence of complications, the patient can be transferred to conditions of the house mode with release from work for 10 days.