Sore throat is very common in childhood. There are many physiological and age-related reasons for this. However, ailment, ailment - strife, and they require different treatment. After reading this article, you will learn how to recognize tonsillitis in children, what are the symptoms, how to distinguish it from sore throat, pharyngitis and other throat diseases, how treatment is carried out.
What it is?
Tonsillitis is an inflammatory process that occurs in the tonsils. These tonsils are paired, they are located in a small depression between the soft palate and the tongue of the child. In medicine, they are simply called serial numbers - the first and second.
They are composed of lymphoid tissue, like the spleen, and have immune functions. The first and second tonsils form a protective barrier, the task of which is to stop viruses and bacteria that enter the body through the nose (when breathing), through the mouth (with food and water).
The tonsils not only provide protection, but also actively participate in the complex process of hematopoiesis. If a child falls ill, a virus or bacterium enters the throat, then the tonsils react to this with inflammation, thereby creating the most unfavorable conditions for the uninvited "guest" for development and reproduction.
If the child is often sick, the tonsils do not have time to cope with the increased load and begin to grow, hypertrophy. An increase in size temporarily helps them to function according to a program set by nature, but rather quickly such tonsils themselves turn into a source of infection and danger.
With tonsillitis, not only the first and second palatine tonsils suffer, sometimes the inflammation will spread to the unpaired pharyngeal tonsil. That is why among the people such ailments are mistakenly called angina.
Angina in the understanding of doctors is an exacerbation of chronic tonsillitis or acute tonsillitis. But chronic tonsillitis in remission continues to be a disease and angina is not considered.
None of the children are immune from tonsillitis - the ailment can develop in infants and older children. True, at the age of 1 to 3 years, the disease is less common - in 3% of children. At 3 years of age and older, the incidence doubles - about 6% of children under the age of 7 have such a diagnosis in their personal medical history. The highest incidence is in children over 7 years of age (it is approximately 15%).
Classification
Tonsillitis can be acute or chronic. Acute (angina), in turn, is catarrhal, follicular, lacunar, fibrinous and herpetic. As the name of each subspecies suggests, the difference lies in the causes and progression of the disease.
Acute tonsillitis is most often bacterial in nature, it can be streptococcal, staphylococcal, pneumococcal - depending on which microbe attacked the child. The inflammation of the tonsils caused by microbes is always accompanied by purulent phenomena - abscesses, plaque on the tonsils.
In second place are viral acute tonsillitis, they are caused by viruses that have got on the lymphoid tissue. The fungal nature of the disease is not excluded - candidal tonsillitis is a rather dangerous disease.
However, once transferred tonsillitis is not a reason to diagnose a child with tonsillitis. The chronic form of this disease usually appears in children who have had a sore throat at least 4 times a year, as well as in babies whose acute form of the disease has not been properly treated.
Chronic tonsillitis is also not as simple as it might seem. He has a lot of manifestations and guises. So, the disease is compensated and decompensated. In the first case, the child's body, which has a high ability to compensate, “smooths out” the ailment, preventing it from developing, and nothing bothers the baby. The infection "slumbers" peacefully for the time being. With the decompensated stage, inflammation becomes frequent, they are complicated by ailments of neighboring organs - the ear, nose.
The simplest is considered to be lacunar chronic tonsillitis, with it the inflammation spreads only to the lacunae. In more serious cases, the inflammatory process also covers the tissues of the entire amygdala, and this is already lacunar-parenchymal tonsillitis.
Phlegmonous is called such an ailment in which mainly the palatine tonsils are affected. The most difficult form is sclerotic tonsillitis, with it not only the tonsils are affected, but also the neighboring areas, and there is also a strong proliferation of connective tissue.
Causes
It is not so difficult to establish the true origin of tonsillitis, the disease is well studied, and the most common causes of its occurrence are known to doctors literally "by sight":
- Bacteria... These are staphylococci, streptococci, haemophilus influenzae, moraxella, pneumococci, widespread in the environment.
- Viruses... This is a whole family of adenoviruses that are very common among humans, some herpes viruses - for example, the Epstein-Barr virus, Coxsackie viruses, influenza viruses.
- Fungi, chlamydia and mycoplasma.
- Allergens.
Pathogens entering the child's body do not always act destructively. In some children, they cause tonsillitis, while in others they do not.
It is believed that the development of the disease is most likely in immunocompromised children who have recently suffered an infectious disease or are currently suffering from it.
Other risk factors:
- Sources of infection in the mouth or throat. These are sick unhealed teeth, and stomatitis.
- Prolonged rhinitis and diseases of the nasopharynx. If the child's nasal breathing is difficult, but he begins to reflexively breathe through his mouth, as a result of which he inhales practically untreated, unheated air, often too dry. The mucous membranes of the oropharynx dry out and cease to perform immune functions, which contributes to the multiplication of bacterial microflora.
Often the development of tonsillitis by all means is "helped" by the adenoids that the child suffers from, chronic rhinitis, sinusitis.
- Unfavorable climate... If a child breathes in too dry or too humid, too gassed, polluted air, the risk of developing tonsillitis increases significantly.
- Hypothermia or overheating.
- Improper nutrition, which led to metabolic disorders.
- Constant stress... If a child is in an atmosphere of constant scandals or in a situation of parental divorce, if he has difficulties in communicating with peers in a children's team, the likelihood of developing tonsillitis increases. This is a well-founded medical opinion, which is based on the experience of observing and treating hundreds of thousands of children with tonsillitis.
Symptoms and Signs
Acute tonsillitis (tonsillitis) and attacks of chronic tonsillitis always occur with an increase in temperature. Moreover, the fever can be very pronounced, the temperature can rise to 39.0-40.0 degrees - with some forms of angina. The temperature usually lasts 3-5 days - depending on how quickly and how correctly the throat was treated.
Sore throat is intense, the child sometimes cannot eat, drink or even swallow his own saliva. With catarrhal angina, most often the tonsils just turn red and look swollen. With follicular, yellowish purulent points appear on the tonsils, which increase in size, merge and turn into rather large purulent formations.
With lacunar sore throat with the naked eye, you can see the accumulation of liquid purulent contents in the lacunae, as well as the appearance of purulent-caseous plugs on the tonsils.
A very unpleasant odor comes from the child's mouth with any sore throat. The stronger the purulent manifestations, the stronger it is. Regional lymph nodes (under the jaw, in the occipital region, behind the ear) become inflamed and increase in size.
If the child is allergic, during this period he may have an aggravated allergy, if there are problems with the joints, then there is an increase in joint pain.
Chronic tonsillitis in the remission stage does not give any special symptoms, the child leads a normal life, does not complain about anything, he is not contagious. However, in the exacerbation stage, the symptoms become very similar to the classic sore throat, except that the course of the disease is slightly less acute.
Parents can suspect chronic tonsillitis in a child for a number of signs:
- Temporary discomfort in the throat after eating cold food or drinksassociated with sensations of perspiration, difficulty swallowing, minor pain.
- Body temperature rises to 37.0-37.9 and lasts for a long time... Most often, she rises in the evenings, before bedtime.
- Bad breath appears, which is especially strongly felt in the morning - after a night's sleep.
- The child's sleep is disturbed, he sleeps restlessly, often wakes up.
- Fatigue increases, the child becomes distracted and inattentive.
- Exacerbations can be up to 10-12 times a year - almost every month.
Danger of disease
Tonsillitis cannot be considered a harmless disease, because in the absence of treatment or inadequate treatment, it can cause severe complications:
- Paratonsillar abscess. It manifests itself as a one-sided severe sore throat when swallowing, when viewed from a child, pronounced asymmetry is noticeable - one amygdala is much larger than the other.
- Myocarditis. This is a lesion of the heart muscle, which is manifested by shortness of breath, edema, pain in the heart, irregular heartbeat. Requires long-term and serious treatment.
- Rheumatism. With such a complication, systemic damage to the connective tissue occurs, most often in the region of the heart.
- Glomerulonephritis. This is a complication that is associated with the destruction of renal cells - glomeruli. Requires long and difficult treatment.
In severe form, it can lead to severe intoxication and death of the child. In case of severe damage, it requires a donor kidney transplant, as well as lifelong supportive therapy on an artificial kidney apparatus.
- Skin diseases. It has been established that long-term chronic tonsillitis is one of the main reasons for the development of neurodermatitis and dermatoses of various etiologies in a child.
- Other diseases. In chronic tonsillitis, the focus of infection is permanent; this can cause some diseases of the lungs, metabolism, and joints.
Diagnostics
The diagnosis of the disease is carried out by a pediatric otolaryngologist. Other specialists can also join the treatment - a nephrologist (if complications arise from the kidneys), a cardiologist (if there are complications in the heart), an allergist (if the disease progresses with an exacerbation of allergies or is caused by allergens), a surgeon (if surgical treatment of tonsils is required).
The doctor begins the diagnosis with an external examination of the condition of the tonsils. The clinical picture of tonsillitis is characterized by a variety of specific signs with enlarged tonsils. This is a rash on the first and second tonsils, a purulent or non-purulent lesion of the pharyngeal tonsil, as well as inflamed follicles that look like small or medium-sized abscesses.
A swab is always taken from the surface of the tonsils. It is examined in the laboratory - for the content of bacteria, fungi. If they are detected, then the laboratory assistant gives an answer to another question - which particular microbe caused the disease.
This is important in order to carry out the correct treatment. After all, some antibiotics are active against staphylococcus, while others are best suited to fight pneumococcus. Fungal lesions are treated with antifungal drugs, this is another story altogether.
A general blood test, which is done to all children with tonsillitis, shows how strong the inflammatory process is in the body, whether it is systemic. And virological analysis allows you to establish whether the disease is caused by certain types of viruses. Indeed, with this origin, tonsillitis will be treated without the use of antibiotics.
If the child has advanced and severe tonsillitis, the ENT doctor may give referrals to a nephrologist and cardiologist. The first one will have to go with ready-made urine results on hand in order to exclude possible complications on the kidneys. The cardiologist will conduct an ECG and ultrasound of the heart (if necessary) to see if the inflamed tonsils are complicated by heart ailments.
Treatment
Acute (and chronic) tonsillitis is treated using different techniques and schemes.
Acute form
Treatment of acute tonsillitis (depending on the pathogen that caused it) is carried out with drugs that are active against a specific microorganism.
That is why a sore throat should in no case be treated on its own at home. Such "treatment" in 90% of cases leads to the fact that tonsillitis becomes a persistent chronic form.
For bacterial angina, your doctor may prescribe antibiotics. It is best if the drug is most effective against a specific microbe. But in small towns and villages, where hospitals often do not have bacteriological laboratories at all, it is sometimes very difficult to establish whether staphylococcus or streptococcus is to blame for the disease. The doctor determines the bacterial infection literally "by eye" - and in this case he prescribes broad-spectrum antibiotics.
As a rule, treatment begins with the penicillin group of antibacterial drugs. "Amoxicillin" and "Amosin" have proven themselves well. For small children, it is permissible to take drugs in the form of syrups.
In parallel with this, the child is prescribed local therapy - washing of the tonsils with a special apparatus "Tonsilor", rinsing with a furatsilin solution, treatment with antiseptics.
For this, the most often prescribed spray "Miramistin", herbal antiseptic "Tonsilgon".
With a viral infection of the tonsils, antibiotics are completely and categorically contraindicated. Taking them in this case cannot reduce the risks of complications. Moreover, these risks increase 6-8 times.
Sometimes doctors recommend taking antiviral drugs. It is up to parents to decide whether to buy them or not, since the clinical effectiveness of most of these funds has not been officially proven. "Anaferon" or "Ergoferon" in no way affect the speed of the child's recovery.
More hope for local treatment. Affected tonsils are treated with Vinilin balm, rinsing the throat with a furatsilin solution, and antiseptic treatment are prescribed.
Fungal sore throats are considered one of the most difficult to treat. With them, a course of antifungal therapy is prescribed, which includes both taking the appropriate drugs inside and local treatment with antifungal sprays and ointments. The course is quite long - from 14 days, after a short break it is repeated.
To reduce fever in acute tonsillitis, antipyretic drugs are allowed - "Paracetamol", "Tsefekon" (suppositories for children), anti-inflammatory nonsteroidal drug "Ibuprofen". They allow not only to relieve fever, but also moderately relieve pain.
Do not treat the throat with a sore throat solution "Lugol". This preparation contains a large amount of iodine, which is perfectly absorbed and absorbed by the child's body. The more extensively the lymphoid tissue of the tonsils is affected, the faster and more aggressively iodine acts. This is fraught with serious overdose and iodine poisoning.
At the stage of recovery, the child is prescribed physiotherapeutic treatment - warming up, procedures for treating tonsils with ultrasound, phototherapy.
Chronic form
Treatment of chronic tonsillitis is a whole range of measures aimed at neutralizing the focus of inflammation and increasing immunity, including local. Parents are advised to review the child's daily routine, diet and physical activity. Long walks, a sufficient amount of vitamins in food, sports are excellent help for simple forms of the disease, periods of remission become long and persistent.
If the child's disease does not cause serious complications and manifests itself mainly only by frequent episodes of tonsillitis, then conservative treatment is indicated for him. It includes local treatment - washing the glands, treatment with antiseptics (with the exception of iodine and alcohol solutions). In the acute stage, antibiotics are prescribed (for bacterial disease) or antifungal agents (for fungal disease).
Such courses are usually prescribed twice a year (in spring and autumn, when the immunity of children is weakened). On an individual basis, the doctor can increase the number of courses to 3-4 per year, if the child is often sick, he has exacerbations of tonsillitis.
Today, the treatment of tonsillitis with low-frequency ultrasound is considered a fairly effective method. During the procedure, the sound is first applied to the tonsils, then the pus is sucked out in a vacuum way, and only then the tonsils are irrigated with antiseptics, and, if necessary, with antibiotics. Such procedures are carried out by an ENT doctor, the average course of treatment is 10-15 days.
If conservative treatment does not help, the frequency of exacerbations does not decrease or some complication is detected, the child is recommended a surgical method for treating tonsillitis.
The operation called "tonsillectomy" involves the complete removal of the tonsils - along with the connective tissue capsule. This operation is the only effective way to cope with the problem, there are no alternatives, but it is she who is most often criticized by opponents of the surgical method of treating tonsillitis.
The essence of the criticism is that an organ, important for the immune system, is removed - the tonsils. As a result of such intervention, immunity is weakened, especially local, and children after tonsillectomy are more likely to suffer from diseases of the throat, bronchi, lungs, and nasopharynx.
However, official medicine has ample evidence that the benefits of surgery significantly outweigh the harm, since sometimes only it can stop the dangerous process of developing complications from the kidneys, heart and joints.
It should be noted that this operation is not indicated for all children, there are diseases and conditions in which the complete excision of the tonsils is unacceptable. Then the child can be assigned to another operation - tonsillotomy. It consists in removing not the entire tonsil, but only part of it, especially an overgrown and damaged infection. Most often, it is carried out for children aged 5 to 10 years, since before, without special need, there was no point at all in surgical treatment.
Both operations are performed under both local and general anesthesia. Both tonsillotomy and tonsillectomy can be performed not with a special surgical knife (tonsillotomy), but with the use of modern laser technologies.
The recovery period does not last long, after 8 hours the child can eat and drink, and in a day he is sent home from the hospital. In the near future, he will have to eat on a sparing diet, excluding spicy and spicy, salty, sour and fried, and every time after eating, rinse his throat and mouth, first with ordinary boiled water, and then with antiseptic solutions.
General recommendations for treatment:
- Treatment of acute tonsillitis (or exacerbation of a chronic illness) always requires an abundant warm drink. This is important to maintain moisture in the mucous membranes and to prevent dehydration at elevated temperatures.
- For gargling, you can use herbal decoctions (chamomile or sage), but only if the tonsillitis is not allergic.
- Walking in the fresh air helps to strengthen the immune system. This can be done immediately after the body temperature drops. Hardening is useful, as well as active games on the street.
- Do not interrupt the course of treatment at the first sign of improvement. An untreated infection becomes chronic, and then it will be even more difficult to treat it, since the microbe will develop resistance to previously used types of antibiotics.
- After a sore throat or during remission of chronic tonsillitis (when the child is not worried about anything) parents should be engaged in strengthening the local immunity - to harden the throat. To do this, the child is given ice cream, cool drinks, cold gargling is practiced with a gradual decrease in the temperature of the gargle.
Prevention
Preventive measures that can help keep your child from tonsillitis are pretty simple.
They do not require the use of expensive drugs or time consuming:
- During a massive increase in the incidence of ARVI, it is better not to drive a child to crowded places, you should avoid traveling on public transport. Instead, it is better to walk a few stops or take a walk in the park.
- If you have a sore throat, redness, enlargement of the tonsils, you should immediately call a doctor... Only correct, urgent and complete treatment of throat diseases (including sore throat) will help to avoid the occurrence of such an unpleasant ailment as chronic tonsillitis.
- The child needs to be tempered, take him to sports sections, do not overfeed or entangle... Only under such conditions a normal, strong, strong immunity is formed.
- It is important to do everything according to age compulsory vaccinations.
For the reasons for the development of chronic tonsillitis, the conditions under which the removal of the tonsils is indicated, and how to treat the enlarged palatine tonsils, see the following video.
