Enlarged tonsils in a child

Enlarged tonsils in a child may indicate that the body is fighting some kind of infectious carrier, or some other pathologies. With this symptom, it is necessary to treat the underlying pathology in the body.

Author:

• Oganesyan Tigran Sergeevich

  ENT pathology expert

4.10 (Votes: 10)

Tonsils (tonsils) are a collection of lymphoepithelial tissue, which is the point of contact of the immune system with the external environment. Thanks to this, the body produces protective immunoglobulin proteins in response to bacteria, viruses, fungi and other foreign microorganisms. Thus, the formation and maturation of immunity occurs. Located at the border of the respiratory and digestive tracts, the tonsils promptly intercept viruses and bacteria that enter the body with inhaled air, water and food.

Enlarged tonsils in a child are not a separate disease. They say:

• that the body is fighting some kind of infectious carrier;
• about genetically determined proliferation of lymphoepithelial tissue without an infectious agent;
• about possible blood diseases (oncohematological diseases), autoimmune diseases and diseases of the endocrine system.

The problem is that tonsil hypertrophy progresses quickly, and it is important not to miss the moment when the painful condition begins to cause severe discomfort to the child, but to treat the underlying pathology in a timely manner. Only an experienced doctor, whose specialization is children's ENT diseases, can correctly determine the true factor in the appearance of the symptom and choose competent therapy to eliminate it.

When should you see a doctor?

Even slightly enlarged tonsils in a child are a signal to contact a pediatric otolaryngologist. However, mild hypertrophy of the glands often does not manifest itself in any way, so it cannot be noticed visually. A visit to the doctor is required if the child, in addition to enlarged tonsils, has:

• classic signs of a cold: pain when swallowing, redness of the throat, cough, nasal congestion, fever, uncharacteristic weakness, headache;
• white plaque on the tonsils;
• swollen lymph nodes;
• pustules, ulcers in the larynx;
• swelling of the neck.

Description and symptoms of chronic tonsillitis

Chronic tonsillitis occupies a leading place among inflammatory diseases of the throat. Throat diseases reduce the quality of life and lead to complications. Chronic inflammation of the tonsils is often observed in children starting from 3 years of age and in young people.

Types of tonsillitis

1. Acute tonsillitis (tonsillitis) is an infectious disease with local manifestations of acute inflammation of the components of the lymphatic pharyngeal ring, most often the palatine tonsils, which is caused by streptococci or staphylococci, less often by other microorganisms.
2. Chronic tonsillitis is a long-term inflammation of the pharyngeal and palatine tonsils. Develops after a sore throat and other infectious diseases accompanied by inflammation of the mucous membrane of the pharynx (scarlet fever, measles, diphtheria), or without a previous acute illness.

There are two stages. Compensated and decompensated stages:

1. The compensated stage is a dormant focus of infection. There is no visible reaction from the whole body, no repeated sore throats. The barrier function of the tonsils and the reactivity of the body are not impaired. The edges of the palatine arches thicken, cicatricial adhesions appear between the tonsils, plugs form in the lacunae of the tonsils, liquid purulent discharge forms, and the submandibular and cervical lymph nodes enlarge. One of the problems of the compensated form of tonsillitis is bad breath, which occurs as a result of the formation of plugs in the lacunae.
2. During decompensation, frequent sore throats are a concern; complications of tonsillitis in the form of abscesses, inflammatory diseases of the ear and sinuses, as well as damage to other organs (heart, kidneys) are often observed. Exacerbation of chronic tonsillitis is also called tonsillitis.

Symptoms of chronic tonsillitis

• discomfort and pain when swallowing, especially in the morning;
• dryness, sore throat; sensation of a foreign body in the throat
• cough;
• bad breath;
• increased fatigue, weakness and sweating;
• decreased performance;
• low-grade fever 37.2-37.5°C
• deterioration of sleep;
• decreased appetite;
• pain in the cervical lymph nodes.

Causes that can lead to chronic tonsillitis

The following factors have a particularly strong influence on the chronicity of the process:

• Frequent sore throats, especially in the absence of adequate treatment;
• Impaired nasal breathing, which can be a consequence of both a deviated nasal septum and chronic rhinitis and sinusitis. If rhinitis is of an allergic nature, then it is advisable to do an allergen test and undergo appropriate treatment;
• Low body immunity.

Chronic tonsillitis develops due to a number of factors

• Intoxication - due to the absorption of bacterial toxins and products of chronic inflammation in the tonsils. Intoxication explains symptoms of chronic tonsillitis such as fatigue, weakness, headache, low-grade body temperature, etc.
• The formation of plugs in the tonsils irritates the nerve endings and causes moderate pain in the throat and heart area, cough, and bad breath. Nerve endings undergo degenerative changes, which can cause neurosis and other disorders of the nervous system.
• The body develops sensitivity to bacterial and tissue antigens - an allergy develops. Therefore, chronic tonsillitis is also of an autoimmune nature.

Chronic tonsillitis with complications can lead to functional disorders of cardiac activity, acquired heart defects. Chronic tonsillitis is associated with pathologies such as rheumatism, infectious arthritis, diseases of the urinary system, prostate gland, meninges, etc.

Features of the disease in children

Intensive development of the lymphoid ring begins in infancy - in the second year of life. Immediately after birth, the tonsils are underdeveloped and do not yet function fully. A feature of the tonsils in children 1-3 years old is deep lacunae, as well as narrow, densely branching orifices, which can extend to the capsule. Sometimes the lacunae turn sharply and extend under the integumentary epithelium instead of going deep into the tonsils. At the end of narrow passages there are characteristic expansions that contribute to the development of the inflammatory process.

A feature of younger age is hypertrophy of lymphoid tissue, which, along with an increase in the number of lymphoid follicles, leads to the growth of tonsils. The latter reach their largest size by 5-7 years. At this age, children are most susceptible to infectious diseases and most need protection from infections. Representatives of this age category are recommended to receive preventive vaccinations aimed at mobilizing lymphoid tissue to develop immunity.

The cause of hypertrophy of lymphoid tissue is the intensive formation of active immunity, which is accompanied by local production of antibodies in response to the penetration of an infectious agent. With age, by the age of 9-10, antibodies accumulate in the body, the immune system improves, which leads to age-related involution of lymphoid tissue. Part of it degenerates and is replaced by connective or fibrous.

The causes of childhood respiratory diseases are fungi, bacteria and viruses. If a child gets sick too often, the tonsils are regularly attacked, so the body does not have time to fully defend itself. This becomes the main reason for the development of chronic tonsillitis, along with incorrectly prescribed antibiotic treatment.

Chronic tonsillitis in a child turns into a constant source of infection, depleting the immune system. Quite often, the disease leads to serious complications, especially if timely help is not sought.

Symptoms

Unlike adults, in children the disease develops quickly, occurs in an acute form and is quite obvious. An obvious indication of chronic tonsillitis may be the following local reactions:

• redness of the tonsils;
• their increase, looseness;
• purulent discharge;
• enlarged cervical lymph nodes.

Frequent sore throats, bad breath, and discomfort during swallowing may also indicate the chronic nature of tonsillitis. Some patients experience sleep problems, headaches, and a subfertile temperature (37-37.5 °C).

Chronic tonsillitis in a pregnant woman

Symptoms of the disease in a pregnant woman are fever, general weakness, dry cough, sore throat, which is accompanied by a sensation of a foreign body. This is due to the fact that the tonsils withstand the attack of tonsillitis and respond to it with pain.

Not everyone knows that even a mild sore throat can harm the unborn child, as well as the woman herself. Sometimes the disease causes early miscarriage, and sometimes causes the development of late toxicosis, which negatively affects the development of the fetus. Since the presence of a chronic infection in the body weakens the immune system, a pregnant woman is at risk of developing other diseases.

Clinical studies have confirmed that chronic tonsillitis has repeatedly caused poor labor and premature birth, so women with this diagnosis are often recommended to have a cesarean section. Sometimes a disease that is not treated during pregnancy leads to the development of a heart defect in the child.

Causes of chronic tonsillitis in pregnant women

• sore throat, which has become a latent chronic form;
• hypothermia;
• deficiency of vitamins and nutrients;
• weakened immunity;
• problems with nasal breathing caused, for example, by a deviated nasal septum, polyps or adenoids;
• untreated caries;
• sinusitis.

To avoid undesirable developments, pregnant women are advised to eat well, avoid hypothermia, visit the dentist and generally monitor their health.

Why is chronic tonsillitis dangerous?

Regardless of the form of its occurrence, chronic tonsillitis can cause allergization and infection of the body. In the absence of medical control, the disease can lead to serious complications - frequent exacerbations in the form of a sore throat, recurring up to 6 times a year.

Another serious complication is phlegmon of the neck, which occurs against the background of severe forms of peritonsillar abscess. In addition, weakening of the tonsils leads to the penetration of infection into the underlying respiratory tract and the development of pharyngitis and bronchitis. In general, chronic tonsillitis either itself becomes a source of concomitant diseases or complicates their course.

An infection that has entered the body finds “weak” spots and can cause diseases of any of the systems - bronchopulmonary, urinary, cardiovascular. A chronic focus of infection has a negative effect on the blood coagulation system, metabolic and endocrine processes, the adrenal cortex, and the course of allergic conditions. Inflammation of the palatine tonsils causes epileptic attacks and aggravates the course of encephalitis and cerebral rheumatic vasculitis. The most dangerous is the decompensated form, which provokes changes in internal organs.

Consequences of chronic tonsillitis

1. The disease in a certain way affects the course of collagen diseases - rheumatism, systemic lupus erythematosus, scleroderma, polyarthritis, dermatomyositis, periarthritis nodosa.
2. The cause of frequent sore throats is heart disease - arrhythmias, endocarditis, myocarditis, acquired defects. Since there is a close connection between the lymphatic system of the heart and the ducts of the tonsils, even people under the age of 30 are diagnosed with cardialgia.
3. Chronic intoxication has an adverse effect on blood vessels, especially capillaries. Patients complain of increased fatigue, weather sensitivity, headaches including migraines, and dizziness (Meniere's syndrome).
4. The consequence of the chronic form of tonsillitis can also be diseases of the gastrointestinal tract - gastritis, colitis, duodenitis, stomach and duodenal ulcers.
5. Against the background of chronic tonsillitis, skin pathologies and diseases of the subcutaneous fatty tissue often develop - psoriasis, neurodermatitis, acne, microbial eczema, atopic dermatitis, polymorphic exudative erythema. It makes no sense to treat them until the source of infection is eliminated.
6. Chronic tonsillitis often causes lung diseases - bronchial asthma and chronic bronchitis, and also contributes to the exacerbation of chronic pneumonia. According to pulmonologists, the number of complications with such diagnoses can be reduced by 2-3 times if the source of infection is carried out in a timely manner.
7. The disease also has a negative effect on the accommodative apparatus of the eye. Early sanitation can, according to ophthalmologists, prevent the development of myopia, as well as prevent relapses of conjunctivitis and blepharitis.
8. The liver and the biliary system are also targeted by infection: cholecystitis, cholangitis and cholangiocholecystitis develop against the background of tonsillitis.
9. Weakening of the functions of the pancreas due to focal infection in the tonsils contributes to the formation of diabetes mellitus. The thyroid gland also suffers, and its hormone-forming function is disrupted (thyrotoxicosis).
10. Against the background of tonsillitis, there are disorders in the reproductive sphere: potency in men decreases, and in women of childbearing age, uterine bleeding, endometriosis, uterine fibroids, hypomenstrual syndrome and infertility are observed. Cases of pathological pregnancy - threats of miscarriage and premature birth - are not uncommon.
11. Another serious consequence is kidney damage (pyelonephritis, glomerulonephritis, nephritis, etc.).

Causes of enlarged tonsils in children

The increase is caused by the following infectious agents: pneumococci, staphylococci, herpes, streptococci, chlamydia, Haemophilus influenzae, adenovirus, influenza virus. They can be located in the lacunae of the tonsils without manifesting themselves in any way (for example, remain after treatment for a disease), but at a favorable moment they begin to actively multiply and cause an enlargement of the organ. Such triggers can be:

• decreased immunity;
• allergies;
• bad ecology;
• hormonal disorders;
• severe hypothermia;
• lack of vitamins;
• infections.

The degree of enlargement of the tonsils in a child

There are 4 stages of hypertrophy of the glands:

1. At the first stage, the inflamed tissue of the tonsils covers no more than 30% of the lumen between the pharynx and the sky. In this state, it causes almost no discomfort, so it is difficult to detect at this stage.
2. At the second stage, hypertrophied tissue covers half of the lumen. The child begins to have difficulty swallowing and breathing freely, and a sensation of a foreign body in the throat.
3. At the third stage, there is severe difficulty in breathing and swallowing.
4. On the fourth, the pharynx is almost completely blocked by inflamed tonsil tissue. It is difficult to bring the condition to this stage, since already at the third stage the child’s well-being requires immediate medical attention.

How is inflammation treated?

The tactics for treating enlarged tonsils in a child consists of treating the underlying disease that caused this symptom (taking antibiotics, antiviral or antifungal drugs), and influencing them directly to regenerate the affected tissues. The latter includes:

• washing the tonsils from pathogenic microorganisms and mucus with antiseptic solutions;
• reducing swelling - taking antihistamines and ultraviolet irradiation;
• UHF therapy, which improves blood microcirculation;
• exposure to ultrasound to free the lacunae of the tonsils from pus, which can accumulate in them;
• laser exposure to destroy infection and its pathogens.

Treatment of chronic tonsillitis

Treatment of chronic tonsillitis is traditionally carried out in two directions.

Conservative treatment

This therapy is relevant if pathological changes in the tonsils are compensated. This treatment effectively combines pharmacotherapy with physiotherapeutic methods and pursues the following goals:

• Physical elimination of infection from the surface of the tonsils;
• Relieving swelling and reducing the size of the tonsils;
• Elimination of symptoms of an allergic nature;
• Increasing local immunity, including through the inclusion of the tonsils themselves in the work.

Conservative treatment includes:

• Sanitation of the tonsils using ultrasound, which ensures a deep degree of cleaning of the lymphoid tissue;
• Anti-inflammatory laser therapy;
• Irrigation of the oral cavity with special medicinal solutions that increase local immunity and have bactericidal properties;
• Pharmacotherapy.

Surgical treatment involves complete or partial removal of lymphoid tissue, which can be carried out either traditionally or using a laser. Tonsillectomy has a significant list of contraindications, so the attitude of doctors towards it in recent years has been more wary than in previous decades.

Treatment of chronic tonsillitis in a child

Proper treatment of sore throat in most cases leads to a successful cure, while ignoring symptoms or incorrect actions can lead to the disease becoming chronic. In this case, exacerbations are possible almost once a month.

The treatment regimen for chronic tonsillitis in a child depends on the course of the disease and can be completely different, especially for periods of exacerbations and remission. In a state of remission, it is important to extend this period as long as possible, for which purpose anti-relapse therapy is prescribed at least twice a year, taking into account the individual characteristics of the patient.

General treatment includes non-sedating antihistamines, immunomodulators, vitamin therapy and homeopathy. Local methods include massaging the tonsils, washing the lacunae with medications, rinsing with antiseptics and treating the tonsils with agents that have antiseptic, anti-inflammatory and regenerating properties.

Physiotherapeutic methods are aimed at improving microcirculation in the tissues of the tonsils. These include:

• microwave therapy;
• ultrasound;
• laser therapy;
• Microwave and UHF;
• inductothermy;
• magnetic therapy;
• electrophoresis;
• inhalation;
• ultraviolet irradiation of the tonsils;
• mud therapy, etc.

If the disease has entered a protracted form, the approach to treatment changes radically - bacteriophages are used. We are talking about viruses that destroy streptococci and staphylococci as the main causative agents of the disease. This method has shown excellent results in the treatment of infections of the oral cavity and nasopharynx, which are accompanied by frequent relapses.

Home methods for treating chronic tonsillitis are allowed only under the supervision of a doctor. These include:

• ingestion of herbal tea from medicinal plants - St. John's wort, peony, calendula, chamomile, dill, coltsfoot, thyme, sage, eucalyptus, etc.;
• gargling with the above herbs;
• ingestion of propolis with honey.

Only regular treatment for two years can achieve positive dynamics. If exacerbations have not been observed for five years in a row, they speak of improvement. Compliance with all instructions often leads to a decrease in the number of relapses, however, if this result cannot be obtained, extreme measures are resorted to - tonsillectomy, or complete removal of the tonsils. Surgery has a number of contraindications.

Prevention of chronic tonsillitis

In order to prevent exacerbations, the tonsils need not only protection from adverse factors, but also hardening. To do this, doctors recommend periodically eating ice cream and drinking cold drinks in small portions - only during the period when the person is completely healthy.

It is important to eliminate all factors that can cause a sore throat, that is, take care in advance of the treatment of the nose and oral cavity, as well as the free breathing of the child. Rinsing with antiseptic agents helps clear the tonsils of bacteria. It is useful to gargle twice a day after meals with a solution of furatsilin, a decoction of sage, chamomile or calendula. The course is carried out for a month, then take a break.

Another effective remedy is tonsil massage. Perform it before going outside and before eating cold food. The procedure consists of light stroking in the area under the chin in the direction from the jaw to the chest. If the disease has become protracted, treatment should be more intensive.

Tonsillitis is a rather dangerous disease that can haunt a person throughout his life from early childhood and cause the most unexpected complications. Therefore, it is so important not to let the disease take its course, but to seek help in time.