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Chronic tonsillitis

Chronic tonsillitis is a chronic inflammation of the tonsils, with damage to other tonsils, localization is indicated - chronic adenoiditis, tonsillitis of the lingual tonsil. There are many classifications of chronic tonsillitis. At present, the classification of IB Soldatov, approved by the VII All-Union Congress of Otolaryngologists, is the most recognized. According to this classification, two forms of chronic tonsillitis are distinguished: compensated and decompensated, although V.I. Voyachek believed that the terms "compensated" and "decompensated" tonsillitis do not reveal the mechanisms of the clinic and the pathogenesis of the disease. The diagnosis of chronic tonsillitis is quite difficult, since its malignancy is not determined by the frequency of tonsillitis per year (1-2 times per year). The patient can suffer 2-3 tonsillitis over a lifetime and have metatonsillar diseases leading to disability. Objective symptoms are also intermittent: the cohesion of the arches with tonsils, their swelling, thickening, hyperemia. Two symptoms are more reliable - the presence of caseous plugs in the gaps and an increase in regional (anterior cervical) lymph nodes. Exacerbation of chronic tonsillitis always occurs in the form of a sore throat. Chronic tonsillitis and tonsillitis are still different diseases, with different pathogenesis, pathomorphological picture and often metatonsillar diseases occur in patients with rare tonsillitis, moreover, the non-angina form of chronic tonsillitis is recognized. Therefore, it is a mistake to call angina an exacerbation of chronic tonsillitis, especially since the treatment of these diseases is also different. The age of patients with chronic tonsillitis is practically unlimited, the same number of men and women is sick, the number of patients is 2.5% in the Russian Federation, and in large cities up to 4.4%. From 13 to 24% of patients with chronic tonsillitis are almost stable in ENT hospitals, 98% of them are operated on (tonsillectomy), which indicates poor effectiveness of conservative treatment: antibiotics, sulfonamides, desensitizing drugs, inhalation, hormonal therapy, special mixtures (mefiditis, angina ), dozens of drugs were ineffective. Some authors also recommend inhalation of formalin vapor, X-ray and radiotherapy, cryotherapy, galvanic caustics of the tonsils. However, these methods are not widely used in ENT practice. More encouraging were: washing the tonsil lacunae with a thin cannula on the syringe with saline or antibiotic, irradiating the tonsils with ultraviolet rays (the so-called “tube quartz”), phonophoresis on the skin of the side surfaces of the neck with hydrocortisone, and laser irradiating the tonsils. However, these methods do not give a lasting effect, so the main method of treating chronic tonsillitis is surgical - tonsillectomy. Since the diagnosis of chronic tonsillitis is difficult, the decision about surgery is also difficult. According to the formula, when in doubt, the decision is made in favor of the patient, especially with paratonsillitis and metatonsillar diseases, even with rare tonsillitis in the anamnesis, or in the case of frequent tonsillitis, the patient’s subfebrile condition, with frequent malaise, weakness, decreased performance (ENT indications of tonsillectomy )
Since metatonzillar diseases are called by various authors from 15 to 50, the question of their number remains controversial, nevertheless it cannot be reliably stated that rheumatic and other etiologies of heart and joint lesions, nephritis and pyelonephritis, cholecystitis, gastritis, diseases of the bronchi and lungs, toxic goiter , diencephalic syndrome is pathogenetically associated with chronic tonsillitis. Therefore, in such cases, they speak of mixed indications - otolaryngological and therapeutic. The follow-up history in such patients after surgery shows its beneficial effect on the course of a therapeutic disease in 60% of patients. Much more carefully, you need to approach tonsillectomy in children, since they have tonsils, as you know, have a more active function and serve as a powerful protective organ. A tonsillectomy is performed mainly under local, less often under general anesthesia. The arches of one of the tonsils, the posterior pharyngeal wall, and the root of the tongue are smeared with a solution of 2% dicaine or 5% cocaine, then three injections of 1% novocaine at the poles of the tonsils and in the middle between them, lateral to the capsule of the tonsil in the paratonsillar space, are made in the region of the front arch along the transitional fold. Under this condition, further separation of the tonsil will take place with the least difficulty. A cut with a scalpel along the transitional fold at the upper pole, then with a special raspor, the upper pole is peeled off, separated from the arches and separated with a capsule (important!) In the paratonsillar space. The lower pole is cut off with a special loop (Bohon). Bleeding during the detachment of the tonsil and the field successfully stops with gauze and cotton balls, pressing them to the tonsil niche with a clamp (Mikulich). After stopping the bleeding, another tonsil is also removed. After the operation, during the day, strict bed rest, hunger, then the regimen is expanded, a sparing diet is prescribed, after 5-7 days the patient is discharged from the hospital for outpatient monitoring and dismissal for 7-10 days. Complications of tonsillectomy are rare, except for bleeding from the tonsil niche - from 1.5 to 5%. They are stopped by pressing a cotton-gauze ball in the almond niche, by applying a catgut suture to the vessel in the niche, or by stitching the arches over the ball with a special needle G.G. Kulikovsky, or balls with hydrogen peroxide, aminocaproic acid, hemostatic sponge, etc. Of the rare complications, mention should be made of damage to the carotid arteries, entrapment of the spatula or removed tonsil into the larynx, which leads to asphyxiation. These complications require emergency care - ligation of the main vessels of the neck or laryngoscopy with the removal of the foreign body of the larynx. Collapse and fainting of the patient are frequent during tonsillectomy, so patients should be examined by a general practitioner and anesthetist before surgery. In some cases, the operation has to be performed under endotracheal anesthesia. The technique of surgery (except for anesthesia) is the same. Finally, it is necessary to recall the statement of experienced doctors that tonsillectomy is "an operation in which the patient is present," that is, takes an active part in it, which is certainly accompanied by a great deal of neuropsychic stress.
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Chronic tonsillitis

  1. Chronic inflammation of the tonsils - chronic tonsillitis
    Chronic tonsillitis (tonsillitis chronica) is a common infectious disease with the localization of a chronic focus of infection in the tonsils with periodic exacerbations of tonsillitis. It is characterized by a violation of the general reactivity of the body, due to the ingestion of toxic infectious agents from the tonsils. Exacerbations of chronic tonsillitis (sore throat) when contagious
  2. Chronic inflammation of the tonsils (chronic tonsillitis)
    In children, this disease is common. Prerequisites for the development of chronic tonsillitis are anatomical, physiological and histological features, the presence of microflora in the gaps, and the violation of protective and adaptive mechanisms in the almond tissue. Most often, chronic tonsillitis begins after a sore throat. The inflammatory process in the tissues of the tonsils at the same time becomes chronic
  3. Chronic tonsillitis
    The clinical picture Chronic tonsillitis (chronic inflammation of the tonsils). Frequent disease in adults and children. It develops as a result of repeated sore throats or acute infections. There are unpleasant sensations, pain in the throat, radiating to the ears, sometimes a bad breath. Often prolonged low-grade fever in the evenings, weakness, headache, decreased ability to work. In most patients -
  4. Chronic tonsillitis. U-35.0
    {foto8} Treatment outcome: Clinical criteria for improving the patient's condition: 1. Normalization of temperature. 2. Normalization of laboratory parameters. 3. Improving the clinical symptoms of the disease (bad breath, difficulty swallowing, pain in the joints and areas
  5. Chronic tonsillitis. Classification, clinic, complications
    Chronic inflammation of the tonsils is a common disease that occurs mainly as a result of repeated tonsillitis. The development of the disease is facilitated by persistent obstruction of nasal breathing, inflammatory diseases of the nose and paranasal sinuses, carious teeth, and other chronic sources of infection. Reduced reactivity is important in the development and course of chronic tonsillitis.
  6. Acute tonsillitis
    Inflammation of the tonsils is usually caused by viruses. From the age of 5 years, the bacterial process caused by the p-hemolytic streptococcus of group A is becoming more frequent. ¦ Streptococcal tonsillitis (unlike viral) is not accompanied by cough and catarrh. Complications characteristic of streptococcal tonsillitis: purulent lymphadenitis,
  7. Streptococcal Tonsillitis and Pharyngitis
    Classification Pharyngitis is an acute inflammation of the mucous membrane of the pharynx, usually of viral, less often bacterial origin. Tonsillitis is an acute inflammation of the tonsils, usually as a result of streptococcal, rarely viral, infection. Streptococcal tonsillitis (tonsillitis) - tonsillitis or pharyngitis caused by HBSA (S.pyogenes). Recurrent streptococcal tonsillitis should be
  8. Angina (acute tonsillitis)
    Angina - a common acute infectious and allergic inflammation of the tonsils, often palatine, other tonsils are involved in the inflammatory process much less often. Forms of tonsillitis differ in etiology, mechanisms of disease development and clinical course. Among the various microbial pathogens of angina, which include cocci, rods, viruses, spirochetes, mushrooms, Klebsiella, in the first place
  9. Streptococcal tonsillitis. U-03.0
    {foto7} Treatment outcome: Clinical criteria for improving the patient's condition: 1. Normalization of temperature. 2. Normalization of laboratory parameters. 3. Improving the clinical symptoms of the disease (pain, difficulty swallowing, purulent discharge from
  10. Acute tonsillitis (tonsillitis). U-03.
    {foto6} Treatment outcome: Clinical criteria for improving the patient's condition: 1. Normalization of temperature. 2. Normalization of laboratory parameters. 3. Improving the clinical symptoms of the disease (pain, difficulty swallowing, purulent discharge from
  11. Acute tonsillitis, unspecified. U-03.9
    {foto12} Treatment outcome: Clinical criteria for improving the patient's condition: 1. Normalization of temperature. 2. Normalization of laboratory parameters. 3. Improving the clinical symptoms of the disease (pain, difficulty swallowing, purulent
  12. Acute tonsillitis caused by other specified pathogens. U-03.8
    {foto11} Treatment outcome: Clinical criteria for improving the patient's condition: 1. Normalization of temperature. 2. Normalization of laboratory parameters. 3. Improving the clinical symptoms of the disease (pain, difficulty swallowing, purulent
  13. Chronic glomerulonephritis in children. Acute and chronic renal failure
    Questions for repetition: 1. Samples used to study the functional state of the kidneys. Test questions: 1. Definition, etiopathogenesis of chronic glomerulonephritis. 2. Classification of chronic glomerulonephritis. 3. The clinical picture and laboratory diagnosis of various forms of chronic glomerulonephritis. 4. Differential diagnosis of chronic glomerulonephritis. 5. A kidney biopsy,
  14. CHRONICAL BRONCHITIS. CHRONIC PULMONARY HEART.
    In recent years, due to the deteriorating environmental situation, the prevalence of smoking, and a change in the reactivity of the human body, there has been a significant increase in the incidence of chronic non-specific lung diseases (COPD). The term KNZL was adopted in 1958 in London at a symposium convened by the pharmaceutical group Ciba. He combined such diffuse diseases
  15. Chronic duodenitis. Chronic gastroduodenitis
    Chronic duodenitis (gastroduodenitis) is a disease characterized by a chronic inflammatory process in the mucous membrane of the duodenum (and stomach). ETIOLOGY. In the etiology of the disease, impairment of diet and lifestyle, disorders of the neuro-endocrine regulation of the function of the stomach and duodenum are important, as a result of which motor function is impaired
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