When should tonsils be removed? The choice of treatment tactics for chronic tonsillitis

Palatine tonsils

Palatine tonsils are small structures that actually look like almond grains and are located between the arches of the palate. In common parlance they are sometimes called “tonsils.” They consist of lymphoid tissue enclosed in a connective tissue capsule. The tonsils have lacunae - slits that greatly increase the surface of the palatine tonsil. They are part of a lymphatic “ring” surrounding the pharynx. Their role is to capture “samples” of microbes entering the body with air, water and food, and report information about them to other immune organs, which produce antibodies - proteins that destroy microbes. The first “acquaintance” with the microbe occurs in the tonsils, which allows the body to fight it. This function of the tonsils is especially important in the first years of life. With age, it becomes less significant, since the same work is performed by lymphoid tissue located in the thickness of the mucous membrane throughout the respiratory tract.

The anatomical features of the tonsils and their constant contact with infection in the oral cavity create the conditions for the development of inflammation of the tonsils - tonsillitis. This inflammation can be acute or chronic.

Acute tonsillitis

Acute tonsillitis - tonsillitis - is most often caused by streptococci. It must be remembered that they are transmitted to others by coughing and sneezing, so a patient with a sore throat needs to be isolated - placed in a separate ventilated room, with separate dishes allocated for him.

Sore throat is an infectious disease accompanied by high fever, general weakness, aching muscles, joints, etc., with local manifestations on the palatine tonsils in the form of swelling, redness, ulcers or plaque. This pus is an accumulation of dead cells that fight the causative agent of sore throat. Often, with a sore throat, an ichorous (putrid) unpleasant odor is felt at a distance from the patient. It is emitted by dead microbes, from which the toxin has been released, placed in the pharynx and absorbed into the body through the vessels, through breathing - into the lungs, through the digestive tract. There is a powerful bacteremia - the body is filled with toxic substances and bacteria.

The danger of sore throat is that the body, fighting the streptococcus that causes sore throat, destroys its own organs. Streptococcus contains a special protein similar to some proteins in the human body. Because of this similarity, the body’s protective antibodies against streptococcus begin to attack its own tissues in the heart, kidneys, and joints. This is a complication of angina.

If a sore throat is not treated correctly, complications may include heart defects, kidney disease - glomerulonephritis, and joint damage. It is believed that the huge number of heart defects in modern 70-80 year old people is due to the fact that in the 30s, when they were children, there were no drugs to combat such microbes. These drugs were invented only in the late 30s and early 40s.

Sore throats can be complicated by a paratonsillar abscess - suppuration of the soft tissue around the tonsil. This is a very serious disease that requires hospital treatment.

It is important to note that many people often mistake any sore throat for a sore throat. Typically, a sore throat, especially a very severe one, is a sign of acute or exacerbation of chronic pharyngitis, and not a sore throat. In any case, the diagnosis of angina should be made by a doctor, preferably an otolaryngologist.

What causes inflammation of the tonsils (tonsillitis)

The tonsils (tonsils) become inflamed when their lymphoid tissue, which is involved in the formation of immunity, is unable to cope with the infectious agent. In this case, adults and children develop acute tonsillitis (tonsillitis), which can develop into chronic.

Other causes of chronic tonsillitis include [2]:

• frequent and untreated pharyngitis;
• prolonged difficulty in nasal breathing due to curvature of the nasal septum, infectious diseases of the nasal mucosa and paranasal sinuses (rhinitis, sinusitis, the occurrence of polyps, etc.);
• diseases of teeth and gums;
• allergic reactions.

As a result of tonsillitis, inflamed tonsils turn into a source of infection, which leads to decreased immunity and frequent respiratory diseases and can cause complications of existing chronic diseases, the development of allergies and serious diseases of the cardiovascular system, liver, kidneys, and joints [2].

Chronic tonsillitis

Chronic tonsillitis is an active chronic inflammatory process in the tonsils with periodic exacerbations and a general infectious-allergic reaction.

If a sore throat occurs with severe sore throat and high fever, then chronic tonsillitis may manifest itself with minor symptoms, and patients do not consult a doctor for a long time. Meanwhile, chronic infection in the tonsils leads to diseases such as rheumatism, kidney disease, heart disease and a number of others. Therefore, chronic tonsillitis must be treated.

Signs of chronic tonsillitis may include:

• Accumulation of “plugs” in the lacunae of the tonsils - whitish cheesy masses with an unpleasant odor, which are sometimes independently released from the tonsils. • A slight increase in body temperature that lasts weeks or months (low-grade fever). • Frequent sore throats. Sore throats that occur more than once a year are considered frequent.

In addition, there are signs of chronic tonsillitis, which are determined by the doctor when examining the pharynx.

Also, there is a method for determining the functional activity of the palatine tonsils, on the basis of which the doctor makes a decision - to treat the tonsils conservatively or to remove them.

Treatment of tonsillitis is aimed at combating infectious inflammation of the tonsils. Antibiotics are prescribed for this. For local effects on the tonsils, gargling with various antiseptic solutions, physiotherapy, lubrication of the tonsils, and washing the lacunae of the tonsils with antibiotics or antiseptics are used.

If conservative treatment is ineffective, surgical intervention (tonsillectomy) is used.

Why doesn't conservative treatment help?

Due to immunodeficiency (congenital or acquired) or concomitant diseases that contribute to prolonged inflammatory processes (diabetes mellitus, chronic infection), conservative treatment of tonsillitis may be ineffective.

Important! Group A beta-hemolytic streptococcus can settle in the tonsils, which causes rheumatic damage to the heart, joints and kidneys. Removing the tonsils avoids these complications.

Other factors that complicate conservative treatment include smoking and alcohol abuse. For teachers, singers and actors, the risk factor is the need to talk long, loudly and a lot.

Tonsillectomy – “removal of tonsils”, “removal of tonsils”.

Indications for this operation are:

• frequent sore throats, severe, with high fever and prolonged low-grade fever; • unsuccessful conservative treatment; • risk of complications (glomerulonephritis, rheumatism, hemorrhagic vasculitis and other infectious and allergic diseases); • recurrent and chronic diseases of the ENT organs; • paratonsillar abscess; • endocrine diseases against the background of chronic tonsillitis; • sleep apnea syndrome caused by enlarged tonsils and adenoids.

There are contraindications for tonsillectomy. It is not recommended to operate during acute or exacerbation of chronic infectious or inflammatory diseases of internal organs and ENT organs; dental caries; hypertension; furunculosis; period of influenza outbreaks; menstruation.

Absolute contraindications are:

• blood diseases (acute and chronic leukemia, hemorrhagic diathesis; immune hemopathy and capillary toxicosis in the acute stage); • vascular anomalies of the pharynx (angiodysplasia, aneurysms, submucosal pulsation of the vessel); • severe neuropsychiatric diseases; • active form of pulmonary tuberculosis; • severe form of diabetes mellitus; • decompensated conditions in diseases of the heart, lungs, liver and kidneys.

The issue of surgical treatment of chronic tonsillitis in patients with concomitant diseases must be approached strictly individually. The final decision is made by the otolaryngologist together with the therapist.

Contraindications

They can be absolute (excluding the possibility of tonsillectomy) and relative, when everything is postponed until the reasons preventing the operation are eliminated.

Absolute contraindications:

• diseases with increased bleeding: hemophilia, hemorrhagic diathesis, Werlhof's disease, agranulocytosis, leukemia;
• heart failure grade 2–3;
• acute infectious diseases and exacerbation of chronic ones;
• active form of tuberculosis;
• cirrhosis of the liver.

Relative contraindications:

• caries (before sanitation - dental prophylaxis of the oral cavity);
• inflammation of the gums;
• pustular diseases of the mouth and skin;
• ARVI and influenza;
• exacerbation (decompensation) of chronic diseases;
• menstruation;
• pregnancy after the 26th week due to the risk of premature birth.

Preparing for tonsillectomy (removal of tonsils)

In preparation for the operation, a clinical examination is carried out to ensure the safety of the surgical intervention: determination of blood group and Rh factor, blood test, urine test, determination of HIV and Australian antigen, sanitation of the oral cavity, in young children - chest x-ray to exclude thymomegaly; a thorough examination to diagnose diseases that may complicate the course of the operation and postoperative period; On the eve of the operation for children, a certificate is obtained from the clinic stating that there is no contact with carriers of childhood infections.

Several weeks before surgery, you should not take aspirin or medications containing it. It impairs blood clotting and increases the risk of bleeding. You need to tell your doctor if you are constantly taking any medications, if you are allergic to anything, if you have had reactions to a blood transfusion, if you have an increased tendency to bleed.

You should not eat or drink anything before the operation. This must be especially monitored if you plan to operate on a child. A light dinner is allowed the night before.

Surgery to remove tonsils

The operation is usually performed under general anesthesia. In extreme cases, tonsillectomy is performed under local anesthesia. For this, a solution of ultracaine is usually used. General anesthesia is usually performed using a combination of inhaled and intravenous anesthetic.

Classic tonsillectomy is as follows: after infiltration of the paratonsillar region, through an arcuate incision along the edge of the anterior arch, the upper pole of the tonsil is bluntly isolated with an elevator and grasped with forceps or a clamp. Then the tonsil is isolated with an elevator to the lower pole. The separated tonsil is removed with a special loop. Bleeding is stopped by tamponade of the niche, coagulation of blood vessels, or application of ligatures. The duration of a tonsillectomy is usually 20-30 minutes.

The numerous methods of tonsillectomy that exist today do not fundamentally change the essence of the operation. The use of lasers, radiofrequency surgery, microdebrider, and ultrasonic scalpel is aimed at reducing tissue bleeding and has virtually no effect on healing time or the severity of pain in the postoperative period.

IF YOU DECIDE TO HAVE AN OPERATION, YOU NEED TO CHOOSE THE TECHNIQUE THAT IS BEST IN THE DOCTOR YOU TRUST.

After removal of tonsils

After the operation, the patient is placed on his side in a bed with a low pillow. Drinking is allowed no earlier than after 6-8 hours.

Constant monitoring is carried out in order to timely diagnose possible bleeding. On the day of surgery, fasting is prescribed. In the following days, a gentle diet (semi-liquid and non-hot food) is prescribed. They are treated with drugs that increase blood clotting, and aerosols with anesthetics are used; in the presence of metatonsillar complications, a short course of antibacterial therapy is carried out. Bed rest is observed for 2-3 days. Fibrinous plaque in the tonsillar niches usually disappears on the 7-10th day.

We care about your health

Palatine tonsils or, as they are also called, tonsils , are located in the nasopharynx. They represent a concentration of lymphoid tissue and perform two important functions. The hematopoietic one is most important at an early age, and the protective one is responsible for immunity - general and local. The tonsils are the first to take the blow that viruses and bacteria inflict on the body. Frequent sore throats and viral infections, as well as decreased immunity, contribute to the development of chronic tonsillitis - inflammation of the tonsils. This disease - tonsillitis, according to statistics, is diagnosed in every 10th adult and in 15% of children. At the initial stage, the pathology often responds to conservative therapy, including physical therapy. If there is no progress in the treatment of chronic tonsillitis, the doctor recommends removing the tonsils using surgery - tonsillectomy. The operation is performed in several ways, but the most effective and safest is the removal of tonsils (tonsils) using a laser.

Tonsillitis - what the disease looks like

What does a healthy throat look like?

What does tonsillitis look like - inflammation of the tonsils (glands)

Preparing for tonsillectomy surgery

Laser tonsillectomy is a highly precise, bloodless operation that uses a laser system. A source of directed laser radiation affects the inflamed tonsils, their tissue is excised. Radical laser tonsillectomy involves removing the entire tonsils to remove a chronic source of infection.

Benefits of tonsillectomy:

1. There is no bleeding, compared to classical surgery, there is no need for electrocoagulation of blood vessels, as well as subsequent antibacterial therapy.
2. A tonsillectomy does not require general anesthesia.
3. Possibility of performing the intervention on an outpatient basis.
4. Long-term recovery is not required, and the patient’s ability to work is not affected.

The procedure does not require special preparation. The patient is prescribed a set of standard tests - urine and blood tests, if necessary - ECG, conclusions of other specialists. The operation itself lasts no more than 30 minutes. Depending on the degree of damage to the tonsils, surgery can be performed using different types of laser:

• holmium;
• fiber optic;
• carbon;
• infrared.

Carrying out a tonsillectomy under anesthesia involves local anesthesia - an anesthetic drug is applied to the mucous membrane. The patient feels only numbness or slight tingling during the operation. The doctor then grasps the tonsil using forceps and uses a laser beam to excise the tissue. Removal occurs in 4 approaches - each on average 15 seconds. There is no bleeding, since under the influence of the laser tissue the vessels instantly coagulate.

Indications for laser tonsil removal

Removal of tonsils is carried out according to strict indications, although several decades ago this operation was prescribed for preventive purposes. But later experts proved that preserving the tonsils is very important for the immune system. Indications for intervention include:

1. Frequent relapses of chronic tonsillitis (more than 4 times a year).
2. Lack of effectiveness of antibacterial treatment.
3. Complications on the kidneys, heart, joint damage (rheumatism).
4. Significant proliferation of tonsil tissue, which causes breathing and swallowing problems.

If there is significant damage to both tonsils and taking into account the client’s wishes, the doctor may prescribe a tonsillectomy under general anesthesia. In the event that there are no contraindications to this.

Inflammation of the tonsils (glands) - photo

Chronic tonsillitis - enlarged tonsils interfere with swallowing

Tonsillitis - inflammation of the tonsils (glands), a chronic form of the disease

How is recovery going after surgery to remove tonsils?

The use of anesthesia during tonsillectomy allows the patient not to experience discomfort during the operation. But 2-3 hours after it, unpleasant sensations may appear in the throat - they are relieved with the help of painkillers. On days 2–3, the postoperative field is covered with a white-yellow film, which disappears after about a week.

The total duration of the rehabilitation period is two to three weeks. It ends when complete epithelization of the wound surface occurs. All this time, the patient must follow the doctor’s recommendations:

• On the day of the operation, you are allowed to drink a little water, but you cannot eat.
• Over the next few days, the diet should consist of pureed food at room temperature - purees, liquid porridge.
• For another 14–16 days, you should avoid sour, spicy and hot foods - they can cause irritation of the mucous membrane that has not completely healed.
• Heavy physical activity, hot baths, visiting a bathhouse or sauna are prohibited.

During the rehabilitation period, difficulty in nasal breathing may occur, caused by swelling of the nasopharynx. The condition will be alleviated by vasoconstrictor drops - they should only be prescribed by a doctor. We treat tonsillitis (remove tonsils/tonsils) with the Medkvadrat ENT clinic.

Tonsillectomy surgery in Moscow is performed in many medical institutions. But contacting the Medkvadrat network of family health clinics guarantees you the following benefits:

• You will be assisted by highly qualified doctors and extensive experience.
• Modern high-tech equipment facilitates accurate diagnosis and increases the efficiency and safety of treatment.
• An individual treatment regimen is selected for each patient, taking into account the severity of the pathology, the characteristics of the body, and the general state of health. Our specialists will select the most effective and safe method.
• You come for a consultation with a specialist who will accompany you from the beginning of treatment to its completion. This approach allows you to achieve maximum results, since the doctor is aware of each stage of therapy.

When prescribing a tonsillectomy, the price of the operation depends on the type of laser that will be used during the operation, the complexity of the manipulations, and the qualifications of the surgeon. The doctor will tell you the exact amount after clarifying the diagnosis and determining the scale of the surgical intervention. He will help you make your choice and carefully explain the importance of timely treatment.

Complications after tonsillectomy

The most common complication is bleeding from the tonsillar niches, mainly in the early postoperative period in the presence of concomitant diseases;
bleeding can be vascular and parenchymal. Vascular bleeding is stopped with hemostatic clamps followed by ligation of the vessel. In case of parenchymal bleeding, the niche is tamponade with hemostatic agents (if it is necessary to hold the tampon for a long time in the niche above it, the palatine arches are sutured). Other complications are extremely rare: subcutaneous emphysema, acute inflammation of the lingual tonsil, stomatitis, glossitis, acute otitis media, exacerbation of chronic diseases of the ENT organs, exacerbation of chronic diseases of the internal organs, phlegmon of the neck, paresis of the cranial nerves, pharyngeal hematoma. [/td]