What Is Recurrent Tonsillitis?

Acute () tonsillitis is a kind of non-specific acute inflammation of the tonsils, often accompanied by acute inflammation of the pharyngeal mucosa and pharyngeal lymph rings of varying degrees. More common in adolescents between the ages of 10 and 30, and often repeated acute attacks based on chronic tonsillitis. Patients older than 50 years and less than 3 to 4 years are rare. It is most common during spring and autumn when temperature changes. It is worth noting that acute tonsillitis is sometimes a precursor to certain diseases, especially certain infectious diseases, such as diphtheria, measles and scarlet fever, and should be detected early.

Basic Information

English name: acute tonsillitis
Visiting department: ENT

Multiple groups: 10 to 30 years old
Common causes: Streptococcus type B
Common symptoms: Chills and high fever, body temperature can reach 39 40 for 3 5 days

Causes of Acute Tonsillitis

Infection factor

The main pathogenic bacteria is type B hemolytic streptococcus. Non-hemolytic streptococcus, staphylococcus, streptococcus pneumoniae, haemophilus influenzae, toxoplasma and some viruses (including adenovirus, influenza virus, parainfluenza virus, EB virus, cytomegalovirus, HIV virus, hepatitis A virus, Rubella virus, etc.) can also cause the disease. Bacterial and viral infections are more common. In recent decades, cases of anaerobic infection have been found. The pathogens of acute tonsillitis can be transmitted through droplets, food, or direct contact and are contagious.

2. Immune factors

The above pathogens do not cause disease in the oral cavity and tonsils of normal people. When certain inducements (such as cold, overwork, excessive tobacco and alcohol, harmful gas stimulation, AIDS, etc.) reduce the overall or local immunity, pathogens invade A large number of in vivo or pre-existing pathogens can cause disease.

3. Acute inflammation of adjacent organs

Such as acute pharyngitis, rhinitis, floor stomatitis, etc. spread and affect the palate tonsils.

Clinical manifestations of acute tonsillitis

Acute tonsillitis occurs in adolescents between the ages of 10 and 30, and it is rare in patients over 50 and under 3 to 4. Symptoms are usually mild in adults and heavier in children.

Systemic symptoms

Acute follicular tonsillitis and acute crypt tonsillitis are more severe. It manifests as acute onset, which can be accompanied by chills and high fever, and the body temperature can reach 39 ° C ~ 40 ° C, which can last for 3 ~ 5 days. Young children can vomit, twitch due to high fever, lethargy, etc. Some patients may have symptoms such as headache, decreased appetite, general weakness, constipation, back and limb pain. The manifestations of systemic symptoms are not specific.

Local symptoms

(1) Sore throat is the most common local symptom. At first it is mostly pain on one side, and then it can develop to both sides. Pain can worsen when swallowing and coughing. Severe pain can cause difficulty swallowing, and speech is ambiguous. Pain can radiate to the ipsilateral ear.

(2) Dyspnea is generally not severe. It often occurs in children. Because children's airways are narrower than adults, swollen tonsils can block the airways, affect children's sleep, and can manifest as snoring or awakening during sleep.

(3) Swelling of the soft palate with swollen tonsils squeezing the soft palate can cause transient soft palate dysfunction and can also cause ambiguity in speech.

(4) Relevant symptoms caused by inflammation spreading to adjacent organs If the inflammation spreads to the throat, it can cause symptoms such as foreign body sensation in the throat, hoarseness, sore throat, sputum, weak vocal strength and even loss of sound; spreading to the nose can cause Symptoms such as nasal congestion, running water or mucus, headache; spread to the nasopharynx, which can spread to the eustachian tube, and cause symptoms such as ear tightness, tinnitus, earache, and hearing loss.

Examination of acute tonsillitis

Hematological examination: The total number of white blood cells increased significantly during bacterial infection, and the neutrophil classification increased significantly. In the early stage of viral infection without bacterial infection, the total number of white blood cells increased, and the lymphocyte classification increased significantly. Infectious mononucleosis caused by EB virus infection is manifested by a significant increase in the total number of white blood cells and lymphocytes during acute tonsillitis, and atypical lymphocytes in blood smears. ESR can be accelerated.

Diagnosis of Acute Tonsillitis

Based on typical medical history, signs, and auxiliary examinations, the diagnosis of acute tonsillitis can basically be established.

Differential diagnosis of acute tonsillitis

Routine must be distinguished from upper respiratory tract infection, acute pharyngitis, acute laryngitis, acute rhinitis, peritonsillar abscess, pericyxitis of wisdom teeth, and secondary infection of tonsil tumors. Special cases, such as acute crypt tonsillitis, must also be distinguished from opharyngitis caused by certain systemic diseases, such as infectious mononucleosis, leukemia, agranulocytosis, scarlet fever, diphtheria, epidemic bleeding Hot etc.

Complications of Acute Tonsillitis

Acute tonsillitis is often more harmful than acute tonsillitis itself. Due to the application of antibiotics, its complications have been significantly reduced in economically developed areas. The dangers of acute tonsillitis can be divided into local (harmful) complications and systemic (harmful) complications.

1. Local complications are more likely to be caused by acute inflammation directly invading adjacent tissues.

(1) Deep neck infections around the tonsil: Abscesses are more common, and chronic acute tonsillitis is more common in authors. Inflammation develops deep into the tonsil due to the obstruction of the tonsil crypts, until it penetrates the tonsil capsule and enters the space around the tonsil, forming cellulitis, and then forming an abscess. Pediatric abscesses are less likely to occur in children because the tonsil crypts are superficial, the capsule is thick and dense. This complication mostly occurs on one side, and rarely occurs on both sides. It can be manifested as 3 to 4 days after suffering from acute tonsillitis, systemic symptoms such as fever continue or continue to worsen, sore throat on one side worsens, especially when swallowing, and pain often radiates to the affected ear or teeth. After another 2 to 3 days, the pain worsened, and saliva retention in the mouth was caused by the intimidation of swallowing. Inflammation of the inner pterygium due to inflammation often results in a significantly restricted mouth opening and inability to eat. The patient's head was biased to the affected side, and the neck was pseudo-rigid. Ipsilateral submandibular lymph nodes are often enlarged and painful. After the abscess was formed, there were obvious localized bulges around the tonsils.

(2) Postpharyngeal abscess and parapharyngeal abscess inflammation spread to the throat or parapharyngeal space, causing the formation of abscesses in the corresponding area. Both can cause serious complications such as laryngeal edema, so once they occur, they should be paid great attention.

(3) The spread of other acute tonsillitis can cause acute otitis media, acute rhinitis and sinusitis; downward can cause acute laryngotracheitis, acute bronchitis, and even pneumonia, internal jugular vein thrombophlebitis, etc.

2. Systemic complications, the occurrence of which is related to the type III allergic reaction of various target organs to streptococcus.

(1) Acute arthritis often invades the shoulder, elbow, and knee joints, and the small joints are less affected. The affected joints feel pain when they move, and joint swelling only occurs when rheumatoid arthritis is complicated.

(2) Renal diseases such as glomerulonephritis and IgA nephropathy after acute streptococcal infection. The former mostly occurs 2 to 3 weeks after the onset of acute tonsillitis, while the latter often occurs 3 to 5 days after the attack. In addition, it can be complicated by acute urethritis, acute orchitis, and epididymitis.

3. Rheumatic fever

Its symptoms often occur 1 to 3 weeks after the onset of acute tonsillitis, and can also occur in the acute inflammatory phase.

4. Circulatory system diseases

Can cause acute pericarditis, acute endocarditis, acute myocarditis, or acute pancarditis. Cardiac complications are particularly common in patients with rheumatic fever after acute tonsillitis.

5. Other

Sepsis, subacute thyroiditis, acute peritonitis, acute appendicitis, or acute cholecystitis.

Acute tonsillitis treatment

General therapy

Patients should rest adequately, stay away from the cause of illness, eat lightly, eat fluids, drink plenty of water, strengthen nutrition and clear the stool. Fast, spicy, barbecue, greasy, quit smoking and drinking. For those with high fever and difficulty in swallowing, fluids and electrolytes should be appropriately supplemented to maintain water and salt balance in the body. Rest areas should be moist and ventilated. Because the disease is contagious, it is best to isolate the patient or instruct the patient to wear a mask.

2. Antibiotic treatment

As the main treatment. For mild cases, penicillin can be given. If the condition is severe or does not relieve after penicillin administration, a second-generation cephalosporin antibiotic that is more sensitive to Gram-positive cocci can be given, and oral or intravenous administration can be selected according to the severity. If local complications have occurred, such as a flattened abscess, in order to prevent the abscess from expanding and causing serious consequences, a third-generation cephalosporin antibiotic can be given concurrently with metronidazole or quinolone antibiotics alone.

3. Symptomatic treatment

For fever patients can be given physical cooling treatment. People with high fever can be given non-steroidal anti-inflammatory drugs, which can relieve pain and subside inflammation to a certain extent. Chlorhexidine acetate solution, compound borax solution, 1: 5000 furacicillin mouthwash all have certain analgesic and anti-inflammatory effects. Glucocorticoids can be used as appropriate.

4. Surgical treatment

For patients who have developed local complications such as a flattened abscess, incision and drainage of the abscess are feasible. In addition, for patients with recurrent acute tonsillitis or perianal abscess incision and drainage two weeks after surgery, you can choose to surgically remove the tonsils after inflammation control.

Prognosis of acute tonsillitis

After active treatment, most patients have a good prognosis.

Acute tonsillitis prevention

Keep fit, pay attention to rest, quit smoking and alcohol, stay away from harmful gases, keep warm when the temperature changes significantly. Pay attention to environmental hygiene in your life. The room should have sufficient light, air circulation, and maintain proper temperature and humidity. Patients with acute tonsillitis should be isolated.