Chronic tonsillitis
Synonyms
Chronic tonsillitis
definition
Chronic tonsillitis is when the inflammation of the tonsils lasts longer than three months. Chronic tonsillitis can be very variable, sometimes unnoticed, sometimes with severe symptoms of recurring acute tonsillitis.
The complication, rheumatic fever, is a rare but very threatening complication.
The treatment of chronic tonsillitis is surgical tonsillectomy when there are symptoms.
Read more on this topic at: chronic disease
root cause
On the one hand, postponed inflammation can occur after a acute tonsillitis be the cause. This is favorable for worse Defense situation or the early withdrawal of a prescribed one Antibiotic. Also a previous one Tonsillotomy (Partial removal of the tonsils) increases the risk of chronic tonsillitis.
On the other hand, smoldering inflammation can take place in the depths of the tonsils, the so-called crypts. In these crypts there is then detritus, that is a pulpy, crumbly mass of dead cells, leftover food and white blood cells. The detritus can no longer drain off sufficiently and clogs the crypts. The problem is that the detritus is an optimal breeding ground for germs. The bacteria multiply and repeatedly lead to acute inflammation.
Illustration of tonsillitis
A - tonsillitis - Tonsilitis
B - Simple catharrhal angina -
Angina catarrhalis
C - throat findings in diphtheria
D - ulcers in bacterial
Forms of angina
- Palatine almond bay -
Tonsillar fossa - Hard palate -
Palatum durum - Posterior palatal arch -
Arcus palatopharyngeus - Anterior palatal arch -
Arcus palatoglossus - Palatine almond -
Palatine tonsil - Back of tongue -
Dorsum linguae - Uvula + soft palate
(Soft palate) -
Uvula palatina + palatum molle - Meandering -
Isthmus faucium - Throat (back wall) -
Pharynx
You can find an overview of all Dr-Gumpert images at: medical illustrations
Symptoms
The symptoms of chronic tonsillitis also differ from the acute form. Here, the patients mainly complain of a sore throat, severe swallowing difficulties and sometimes a high fever. Chronic tonsillitis is less noticeable in its symptoms. The tonsillitis is called chronic if it does not heal for at least three months or if it recurs several times a year.
The symptoms vary greatly from patient to patient. Some do not even notice their chronic tonsillitis, others suffer from recurring acute tonsillitis.
Most of the time, the symptoms are very discreet because the inflammation is persistent but rather mild. Although slight swallowing difficulties are experienced, these are often dismissed as an atypical sore throat or a feeling of dryness. Often a subjectively bad taste is also felt in the mouth, which is not improved by brushing your teeth. In addition, there is an unpleasant halitosis perceived by fellow human beings. This is due to the fact that in chronic tonsillitis, bacteria permanently nourished by leftover food sit in the small niches of the almonds, whose metabolic products are perceived as having a bad smell. This explains another symptom of chronic tonsillitis, which is described as white spots (which do not represent pus), which are the visible correlate of inflamed tissue, pathogens, leftover food and sometimes dead tissue.
In addition to these symptoms, which are limited to the neck area, very unspecific symptoms relating to the body and overall well-being are often described. These include general decreased performance and drowsiness. Difficulty concentrating can also occur. These symptoms are an expression of the non-healing, latent inflammation of the tonsils.
In addition, an enlargement of the lymph nodes on the neck can be observed in chronic tonsillitis. They show up as light bumps below the lower jaw, but in most cases they are painless. In addition, the most relevant symptom of this disease is that the chronic inflammation repeatedly develops into acute relapses with the typical symptoms of acute tonsillitis. The diagnosis of chronic tonsillitis can be made here at the latest or after carefully observing the above symptoms.
Few patients with chronic tonsillitis even see a doctor.
Read more on the topic: Symptoms of tonsillitis and Pus on tonsils
fatigue
In chronic tonsillitis, tiredness is a part of it Exhaustion and reduced ability to concentrate to the main symptoms.
In the case of chronic tonsillitis, the bacteria have manifested in the throat and pharynx for at least 3 months. If in the first few weeks this was the only source of infestation, then over time they usually have become too spread to other parts of the body. This is done relatively easily via the blood and lymphatic systems Body fluids even to the "the most remote corners“Of the body.
The most common bacterial pathogens are beta-hemolytic streptococci or Streptococcus pyogenes. In addition to tonsillitis, his disease pattern also includes Scarlet fever, and Erysipelas, so sharply defined, painful reddening of the skin. This should make it clear that the body has to struggle with even more "construction sites" after a longer period of infection. The more that immune system has to do, the more energy it needs to do its job and the more drained and tired we feel. Fatigue is therefore a result of the body's constant defense against antibodies.
In the same way, fatigue and poor concentration develop. These symptoms are therefore common side effects of chronic tonsillitis.
Swollen lymph nodes
A typical appearance in the context of chronic tonsillitis are swollen lymph nodes On neck. You are as palpable nodules under the skin be noticed and Expression of inflammation. Usually the lymph nodes are in chronic tonsillitis not painful. The swelling is one natural response on substances and cells that have entered the lymphatic fluid as a result of the inflammatory process. Conspicuous lymph nodes due to chronic tonsillitis are thus harmless and sometimes that only perceived symptom.
Risk of contagion
Acute tonsillitis is known to be one highly contagious, common disease. It also has to be said of chronic tonsillitis contagious works. The infection occurs mainly through Droplet infection. When sneezing or coughing, the pathogens get in tiny water droplets over those of other people inhaled air from human to human.
The likelihood of contagion is however not as high as in acute tonsillitis, because on the one hand the pathogens sit deep in the crypts of the tonsils and are thus harder to cough up and on the other hand in smaller numbers sit in the throat. Does it occur in the context of chronic tonsillitis Onset of acute inflammation, the patient is again highly contagious and should avoid crowds. In acute purulent tonsillitis, the rule applies that one about one day after starting antibiotic therapy the inflammation is no longer contagious. This generally does not apply to chronic tonsillitis, as the pathogens lie deep in indentations in the almonds within leftover food and dead cells and are partially immune to their effects. Contagious is the disease Farther.
diagnosis
The doctor first asks about the symptoms as part of an anamnesis.
Then the physical exam follows. Particular attention is paid to the scanning of the Cervical lymph nodes and looking at the palate region.
The tonsils usually appear reduced in size and scarred (atrophic). They are rarely enlarged and swollen (hypertrophic).
The surface often appears very rugged due to the crater-shaped crypts.
If you put pressure on the tonsils, you can crumbly detritus and pus squeeze out. The tonsils are hardened by the scarring and are difficult to move by the examiner with a spatula.
The palatal arches are usually reddened. The Mandibular angle lymph nodes are usually permanently enlarged, but do not hurt when touching.
Differential diagnoses
Tonsil carcinoma: A malignant tumor starting from the palatine tonsil is rare. However, one must remember that if only one page is affected, the lump spreads outside of the tonsil and looks irregular. The ENT doctor then has to absolutely a sampling with examination under the microscope!
therapy
If the tonsils are only scarred, but do not cause any discomfort, therapy with disinfecting brushes is initiated. Often they are also vegetable or homeopathic remediesthat strengthen the immune system.
With repeated tonsillitis every time Antibiotics prescribed.
However, more than three bacterial occur Tonsillitis per year that are accompanied by a fever and require antibiotic therapy, one should Tonsillectomy (Removal of the tonsils).
Even with chronic tonsillitis with symptoms such as Bad breath If you have difficulty swallowing, your ENT doctor will perform a tonsillectomy.
Home remedies for chronic tonsillitis
There are a number well-known home remediesto fight tonsillitis. Is used frequently, for example Tea made from sage or chamomile extractthat can be used to gargle for pain and inflammation. In addition, you cover that increased water requirements with inflammation. Also known as home remedies warming neck wrapwhich may be placed around the neck together with various preparations made from healing clay or quark.
The use of home remedies for chronic tonsillitis is, however, usually not very promising be: The chronic inflammation persists. The effects emanating from the above or similar home remedies are soothing and supportive in healing, so that they can be useful in the event of a renewed aggravation to acute tonsillitis. If, on the other hand, you have suffered from chronic tonsillitis for months, which causes significant discomfort and repeatedly becomes acute, that's it See a doctor usually the best measure. The risk of dangerous complications from chronic tonsillitis such as Kidney or heart damage as well as the rheumatic fever is not to be underestimated. Hence the home remedies do one Operation to remove the tonsils (Tonsillectomy) not superfluous.
Antibiotic therapy for chronic tonsillitis
In the treatment of chronic tonsillitis play in the case of one Worsening of symptoms Antibiotics a role. Antibiotics are active ingredients that are present in many different places intervene in the metabolism of bacteria and so inhibit their growth or kill them. So they are with infectious diseases like acute tonsillitis Means of choice. Antibiotics work, however not against viruses.
Antibiotics are also used in the treatment of chronic tonsillitis. They are used when the chronic, symptom-free inflammation develops acute tonsillitis with pain and difficulty swallowing developed. Then will Penicillin preparations used or, if these are not sufficient, Erythromycin or clarithromycin. Care must be taken to take the drug continuously for as long as the doctor prescribed, even when the discomfort subsided are. However, antibiotics are not sufficient as a therapy for the actual chronic tonsillitis. The inflammation remains symptom-free and plagues the patient at regular intervals. Then should go to surgical removal of the tonsils are advised.
Homeopathy for chronic tonsillitis
One of the treatment options for some patients is that Use of homeopathy. If there are doubts about antibiotics, surgery or if you are convinced that homeopathic remedies are superior, this alternative is sometimes used first. Homeopathy is considered to be less side effects. One of the preparations that is used for chronic tonsillitis is Potassium sulfuricum (Potassium sulfate), what also with Menstrual cramps or depressive moods is prescribed. The proven dilution potencies are D6 to D12. It's supposed to be against Late-stage inflammation how to help chronic tonsillitis.
Also come from the field of homeopathy various medicinal herbal preparations to use the extracts from Thyme, arnica or sage contain. These plants have been shown to have anti-inflammatory effects. Essential oils for inhalation soothe the throat and relieve symptoms. Overall, however, chronic tonsillitis is to be seen as a disease if left untreated with serious complications can go hand in hand. So using homeopathy to relieve symptoms and as a supplement is not harmful. However, it does not replace the use of antibiotics or removal of the tonsils, which in many cases is the only cure for chronic tonsillitis and certain dangerous secondary diseases prevented.
Naturopathy for chronic tonsillitis
Surgical removal is indicated for recurrent tonsillitis. In a study by the University Medical Center Hamburg-Eppendorf, a third of the affected patients could be cured. In 2/3 at least a slight improvement was achieved. However, the tonsillectomy is one of the most complicated operations with one 5 percent risk of rebleeding on the first and 5th to 8th postoperative day. Many patients therefore wish to have tonsillitis through Natural remedies to heal. The naturopathic approach to this is, among other things, a change in diet and an intestinal rehabilitation, since the origin from a naturopathic point of view is malnutrition or malnutrition. The aim is to strengthen the immune system and help the body to get rid of the pathogen by itself. In addition to proper nutrition, warm or cold compresses, chamomile tea and adequate physical rest can also contribute to healing.
Complications
Hearth infection: The smoldering inflammation associated with chronic tonsillitis can have dangerous effects on the entire body. Starting from the depths of the tonsils, bacteria - especially streptococci - can spread over Blood and lymphatic system sprinkle in all organs of the body. Since the almonds act as a focus here, this is known as a focus infection.
The body makes antibodies against the pathogen. These antibodies clump together with bacterial components and block the smallest vessels in distant organs. Usually the kidneys, skin, joints or heart are affected. It can be dangerous rheumatic fever come. Joint inflammation, kidney inflammation and inflammatory heart disease can be the result.
In the worst case, you can Valvular heart disease or a rapid decline in kidney function. To diagnose, the doctor takes a smear from the tonsils to detect streptococci. There are increased levels of inflammation and in the blood Antistreptolysin as a sign of antibody formation against streptococci. Only that comes as therapy Tonsillectomy in question to eliminate the stove.
Bad breath in chronic tonsillitis
Chronic tonsillitis often goes with one to the chagrin of those affected strong bad breath hand in hand. It arises from the bacterial decomposition of food. Since there are always bacteria in the mouth and throat area in chronic tonsillitis, a strong bad breath can hardly be avoided. During their metabolic processes, the bacteria form hydrogen sulphides, amines and short-chain carboxylic acids.
These create you putrid, very unpleasant bad breath. Unfortunately, this bad breath is very persistent and difficult to cover up. Mouthwashes and teeth brushing are the means of choice. The tongue can also be scraped off to dispel the annoying smell. Hard boiled ones can also chew coffee beans - this is supposed to neutralize the sour odor when belching.
Not recommendable are, however, sugary pastilles. These nourish the bacteria and in the long run worsen the bad breath.
Heart disease from chronic tonsillitis
The danger with a chronic tonsillitis is the development of an inflammatory rheumatic systemic disease, the rheumatic fever.
This disease is usually caused when there is an infection with the pathogen Group A streptococcus.
The reason for this is that the surfaces of the bacteria have certain abnormalities that ours immune system recognizes. This is important in order to guarantee the most targeted defense of our immune system.
The surface structure of certain cells in our body, however, resembles the surface features of the streptococci, which means that when the immune system is activated, not only the streptococci are massively fought, but the immune system as well Wrongly attacks cells in its own body.
This happens when bacteria not only cause problems on the tonsils, but also in the meantime in the case of chronic tonsillitis blood circulation have made it.
Cells that have these similar surface features include the cells of the heart or the pericardium.
Of the Pericardium (medical: pericardium) is like a sack that surrounds the heart.
By fighting the body's own cells through the immune system it comes to a Pericarditis (Endocarditis).
However, heart muscle cells can also be affected Myocarditis speaks.
Children with a rheumatic fever tend to develop endocarditis, whereas adults tend to develop endocarditis more likely to be associated with rheumatic fever arthritis Suffer.
There are some unspecific symptoms that can indicate the presence of a rheumatic fever or endocarditis. These include one increased body temperature such as Joint pain and a increased heartbeat frequency.
The development of rheumatic fever is dangerous because in many cases permanent damage can remain.
Especially acquired heart valve defects can often be associated with a previous streptococcal infection and associated rheumatic fever.
The damage to the heart muscle cells can also Cardiac arrhythmias arise.
Therapy, and thus a reduction in the risk of permanent damage, consists in taking Antibioticsso that the streptococci underlying the disease are eliminated.
If there is a diagnosis of rheumatic fever with accompanying activity in the heart, should also anti-inflammatory substances how Glucocorticoids be taken.
It is also important to prevent a recurring streptococcal infection.
Exercise for chronic tonsillitis
In general, regular sporting activities are one in a healthy state Strengthening the immune system can cause.
However, when a person is sick, the extra stress of exercise may be too much for the body's immune system.
A chronic tonsillitis differs from the acute form, among other things, in that the symptoms and complaints are not permanent, but recurrent, i.e. recurring, are.
Should the immune system, which is caused by the infection of the bacteria If the patient has been weakened and is additionally burdened with physical activity, the symptoms of chronic tonsillitis can become worse.
Before starting sports activities, if you suspect chronic tonsillitis, the Elimination of the bacteria stand in the foreground.
A great risk of chronic tonsillitis are unwanted secondary diseases like this rheumatic fever and an accompanying one bacterial endocarditis. This is another reason why sport should be avoided.
Exercise puts additional strain on the heart, which can be very dangerous if you have bacterial endocarditis, which is easily overlooked due to its rather unspecific symptoms.
It can permanent heart valve damage arise, with the old heart valves need to be replaced by new ones.
With the complaints of a chronic inflammation of the tonsils, sport should not be practiced under any circumstances in view of the health risks. This is especially true when non-specific symptoms of rheumatic fever are perceived as Joint pain, high temperature, a headache, or a increased heartbeat.
If chronic tonsillitis is suspected, medical care must be sought from a general practitioner or ear, nose and throat doctor and the available therapy options discussed with them.
If after using antibacterial therapy Antibiotics No symptoms of chronic tonsillitis occur and blood tests negative for the presence of bacteria may come back with light exercise to be started.
