Necrotizing ulcerative tonsillitis: causes, symptoms and treatment, photo folk remedies. Symptoms of ulcerative necrotic tonsillitis. Diagnostics and therapy

Necrotizing tonsillitis is an acute inflammatory disease of the tonsils, which is caused by the symbiosis of a spirochete oral cavity and fusiform rod. The disease leads to the appearance of ulcers on the tonsils (tonsils), covered with a dense coating of a dirty green color with an extremely unpleasant smell rotten meat. The pathology is rare and most often affects men aged 18 to 35 years. Necrotizing tonsillitis lasts from 1 to 4 weeks. Its second name is Simanovsky-Plaut-Vincent angina. The disease is considered conditionally not contagious, since transmission of the disease from person to person is extremely rare as a special exception.

Causes

The disease often accompanies purulent-necrotic stomatitis or turns out to be its complication. Sore throat can develop, like an independent disease, against the background of contributing factors, which are:

Necrotizing tonsillitis often occurs in people with oncological diseases, leukemia and radiation sickness.

Types and symptoms

There are 3 forms of the disease, which differ in the severity of symptoms and the degree of damage to the tonsils. Their clinics vary significantly.

1. Mild form - the patient experiences a slight increase in temperature (no more than 37.5°C) or its absence, mild pain in the throat at the time of swallowing, redness and swelling of the tonsils. The plaque does not extend beyond the tonsils. Lymph nodes are not changed.
2. Moderate form - temperature rise from 37 to 38°C. severe pain in the throat, significantly intensifying with the act of swallowing. The tonsils are red and very swollen. On the surface of the tonsils, oval grayish-white plaque islands are found, which have a diameter of up to 15 mm. The maxillary lymph nodes are not very enlarged and painless.
3. Severe form - temperature reaches 39°C; the inflammatory-necrotic process affects the palate (hard and soft), gums, larynx and back wall throats. Ulcers that form under the plaque layer have the shape of a crater. They destroy the mucous membrane and underlying tissues, and if left untreated, reach the periosteum. Painful sensations very strong. The lymphatic nodes of the maxillofacial nodes are enlarged and painful.

If left untreated, the disease may progress from mild to severe.

Depending on the characteristics of the process in the tonsils, the disease is divided into 2 types.

1. Pseudo-membranous tonsillitis, also known as ulcerative-membranous tonsillitis, involves the formation of a thin layer of plaque on the tonsils. The disease occurs against the background of a staphylococcal infection.
2. Ulcerative tonsillitis - an ulcer forms more often on 1 and less often on 2 tonsils. The coating is thick, dirty yellow.

Possible complications

Complications arise with a severe form of the disease or with a protracted course of a moderate one. Consequences necrotizing tonsillitis may be as follows:

• abscess of the root of the tongue;
• toxic shock;
• phlegmon of the oral cavity;
• gangrene of the tissues of one or both cheeks;
• gangrene of the larynx;
• sepsis.

With additional infection of ulcers by pathogenic microorganisms, the risk of work disturbances increases of cardio-vascular system, kidneys and liver.

Diagnostic methods

Different types of tonsillitis at the onset of the disease have similar symptoms, which is why test data is needed to make an accurate diagnosis.

During the initial visit to the doctor, the patient reports:

• time of occurrence of the first manifestations of the disease;
• diseases suffered in the last 45 days;
• presence of chronic diseases;
• regularly taken medications.

At the first appointment, the throat is also examined and the condition of the lymph nodes is assessed. In severe cases of necrotizing tonsillitis, the patient's heart and lungs are auscultated.

To definitively identify the disease, the results of a blood test and a throat smear (with culture on a nutrient medium and microscopic examination with contrasting coloring). With Simanovsky-Plaut-Vincent angina, the following is detected in the blood: increased level leukocytes and excessive erythrocyte sedimentation rate.

Treatment methods

Treatment of necrotizing tonsillitis should be carried out only by a doctor. Self-medication is dangerous due to the progression of the disease and the development of complications. Behind medical care It is necessary to contact as soon as the first symptoms of the disease appear. Therapy is carried out in the infectious diseases department under the constant supervision of an otolaryngologist. IN in rare cases at mild form The disease can be treated on an outpatient basis with constant visits to a doctor.

The following methods are used for therapy:

• medicinal;
• physiotherapy;
• surgical;
• folk remedies.

When to lower the temperature

Temperature at necrotic tonsillitis goes astray if it rises to 38°C. It is also indicated to reduce the temperature if the patient has difficulty withstanding even a slight increase in temperature.

Medication

Acute tonsillitis is immediately treated with antibiotics, while in the necrotic form they are used only for severe course diseases. If you apply antibiotic treatment immediately, there is a high risk that a pathogen resistant to this drug will form.

At the beginning of therapy, local treatment is used with antiseptic drugs, which are used to wipe the affected areas or irrigate them. For this purpose use:

intense pink manganese solution (for wiping);

• silver nitrate solution for wiping;
• hydrogen peroxide solution for rinsing and wiping;
• Lugol's solution for lubricating the tonsils and foci of necrosis in other areas;
• Chlorophyllipt infusion for irrigation, rubbing and rinsing.

If there is no improvement within 3-5 days, or progression of the pathology is observed, antibiotics are used:

• macrolides;
• penicillins;
• cephalosporins.

Antibacterial agents can be oral or injectable.

For children and pregnant women, treatment is carried out using local antibiotics in the form of a spray.

Physiotherapy

Physiotherapeutic effects are used to restore normal blood circulation in the tonsils and lymph nodes. Physiotherapy also speeds up the removal of swelling and reduces the amount of pathogenic bacteria at the site of the lesion. The standard course of therapy consists of 12 procedures that are completely safe for the general health of the patient. For treatment the following are used:

• magnetic therapy;
• dry heat - depending on equipment medical institution, it will be laser or ultraviolet;
• wave ultrasonic influence.

Medications are not administered during physiotherapeutic procedures for necrotizing tonsillitis.

Surgical

Surgical treatment is prescribed if the disease often relapses. In such a situation, tonsil removal is indicated. The operation is performed under anesthesia in the surgical department of a hospital or ENT department.

Folk remedies

Alternative therapy is used only as an auxiliary measure and in consultation with a doctor, if it does not reduce the effectiveness of the drug.

1. Sugar syrup with a concentration of 60%. It is used to wipe the tonsils twice a day. The product acts as a preservative and creates unsuitable conditions for most pathogens of necrotizing tonsillitis.
2. Rinsing with a decoction of eucalyptus, prepared at the rate of 1 tbsp. l. raw materials for 1 cup of boiling water. Gargle 3 times a day. Eucalyptus has a powerful antiseptic effect and stimulates tissue regeneration.
3. Rinse with aloe juice. The remedy is indicated from the moment the ulcer begins to heal to prevent it re-infection. In 1 glass boiled water add 1 tsp. fresh juice and process using the entire portion at a time. Rinse morning and evening.

It is prohibited to treat necrotizing tonsillitis only using folk remedies.

Nutrition rules and a gentle diet

It is difficult to treat a disease without a specific diet. In order not to irritate a sore throat, food should be soft, warm and not burning. Broths and puree soups are optimal. You should drink as much warm water as possible. You should not drink alcohol, carbonated drinks, strong tea or coffee. To enrich your diet with vitamins, you need to eat baked or blended fruits and vegetables.

Elena Malysheva and German Gandelman tell how to treat a sore throat.

Features of treatment during pregnancy and lactation

During pregnancy and breastfeeding therapy is subject to adjustment. If the child is more than 6 months old, it is recommended to stop lactation and undergo full treatment, since otherwise it will be necessary to give up antibiotics, which is dangerous in severe forms of the disease.

During pregnancy, therapy has the following features:

• complete refusal of physiotherapy;
• not using aspirin to lower the temperature;
• carrying out additional examination to determine the risk of intrauterine infection of the child;
• selection of antibiotics that have a low percentage of penetration through the placental barrier.

On early stages pregnancy, in order to carry out full therapy, the question of abortion is sometimes raised. This may be required in particularly severe forms of necrotizing tonsillitis.

Features of treatment in children

Cases of necrotizing tonsillitis in children are extremely rare, and when treating them, therapy is carried out almost identically to that prescribed for adults, but with selection medicines suitable for the patient's age.

1. Mandatory consultation with a doctor.
2. Bed rest to prevent disorders of the cardiovascular system.
3. Use only antibiotics prescribed by a doctor.
4. Compliance with recommendations for dosage and duration of antibiotic use.
5. Regular use of local therapy.
6. Take analgesics if the pain is severe.
7. Taking antipyretic medications if the temperature rises to more than 38°C.
8. Mandatory daily ventilation of the child’s room in his absence.

Using the advice given by pediatrician Komarovsky, you can properly treat your child without endangering his life.

What not to do

In case of illness, self-medication and changes at your own discretion in the amount of medication taken and the duration of the course of therapy are prohibited. Also unacceptable:

• physical exercise;
• exposure to dampness.

For maximum Get well soon and reducing the risk of complications, strict adherence to all medical recommendations is necessary.

Prognosis and prevention

If you seek medical help in a timely manner and undergo quality treatment the prognosis is favorable. Full recovery occurs in 10-30 days. In severe forms of the disease, therapy is complex and complications are possible, which is why the prognosis is unfavorable.

Prevention of the disease includes:

• maintaining oral health;
• promotion general immunity by hardening;
• high-quality nutrition with sufficient vitamins;
• treatment inflammatory diseases paranasal sinuses nose

Compliance with these simple rules reduces the risk of purulent-necrotic sore throat by several times.

Attending doctor

For an initial appointment, the patient can go to a therapist. After making the initial diagnosis, the patient will receive a referral to an otolaryngologist and to the ENT department. An otolaryngologist directly treats the disease.

Unfortunately, many people take colds very lightly. Fever and sore throat are not a cause for concern for them. Modern drugs, of course, easily eliminate the main symptoms of such insidious disease. However, they are not able to cure the disease itself.

This approach to the treatment of tonsillitis leads to the fact that the sore throat becomes advanced and becomes much more difficult to cope with. Necrotizing tonsillitis develops for a number of reasons. We will consider them in our article.

The causative agent of the disease is acute tonsillar pathology, which is caused by saprophytes localized in the oral cavity. These include the spirochete and spindle-shaped rod. Necrotizing ulcerative tonsillitis most often develops:

• In patients with weakened immunity and general exhaustion of the body;
• Leukemia and hypovitaminosis are also a provoking factor;
• Those prone to it and those suffering from radiation sickness.

As a rule, the pathology develops in one tonsil, but there are cases of damage to both tonsils by necrotizing tonsillitis. If there is no proper treatment, the disease begins to progress.

In this case, the velopharyngeal arches, oral mucosa, cheeks, and oropharynx are affected. In the necrotic stage, tonsillitis is not a contagious disease. However, there are cases when the disease reaches epidemic proportions.

Fortunately, if treatment was started in a timely manner and carried out adequately, the prognosis is favorable. In this case, it lasts no more than 8-14 days. However, in patients with weakened immune systems, sore throat often lasts up to several months.

According to the medical classification, necrotizing tonsillitis is primary and secondary. Saprophytes are not always involved in the development of pathology. Streptococcal and staphylococcal bacteria are often associated.

Primary necrotizing tonsillitis develops:

• With advanced caries;
• For suppuration or pyorrhea in the oral cavity.

Secondary pathological process develops against the background of the following diseases:

• Scarlet fever;
• Tularemia;
• Leukemia;
• Diphtheria.

In addition, other lesions of the oropharynx can provoke diseases. In addition to this, several more factors can be identified that are also positive in the development of pathology:

• Reduced reactivity;
• Often the disease is diagnosed in elderly patients;
• Availability chronic diseases;
• Carious teeth;
• Serious infectious diseases;
• Blood diseases, such as acute leukemia.

The insidiousness of necrotizing tonsillitis is that it develops almost asymptomatically. The patient does not have a fever, no painful sensations in the throat area. The only evidence that a pathological process is developing is discomfort when swallowing. Although it can also be attributed to many diseases of the oropharynx.

Symptoms of necrotizing tonsillitis

As mentioned above, necrotizing tonsillitis often develops practically asymptomatically. The patient experiences discomfort when swallowing. However, streptococci and staphylococci very quickly join the process. Therefore, the following symptoms are added to the difficulties when swallowing:

• Acute pain in the oropharynx;
• The patient feels as if he has a foreign body stuck in his throat;
• A bad taste comes out of the mouth putrid smell;
• During an examination using pharyngoscopy, the doctor discovers a grayish-yellowish coating on the tonsils;
• Over time, pus begins to separate, and in its place necrotic ulcers form. These formations have a pronounced grayish-yellowish bottom and uneven edges. In addition, ulcers often bleed.

How is the disease diagnosed?

The process in the patient’s oropharynx is very pronounced. However, the patient does not experience any discomfort. Body temperature most often remains within normal limits or does not rise above 37 degrees. At the same time, in some cases, purulent-necrotic tonsillitis can begin quite acutely with elevated temperature and feverish condition.

In addition, the symptoms of the disease also include:

• The affected tonsil has severe hyperemia;
• The patient develops drooling;
• There is an increase in lymph nodes;
• Leukocytosis develops to a moderate degree;
• The disease is characterized by the manifestation of symptoms of acute intoxication of the body.

If you undergo a timely examination by a doctor and begin treatment, you can avoid serious complications. On initial stage diseases pathological lesions tonsils are superficial and respond well to treatment.

However, if the patient does not consult a doctor, or tries to cope with the problem on their own, then the risk of developing serious complications cannot be excluded. In particular, bleeding may occur and even perforation of the hard palate may occur.

Gangrenous tonsillitis is treated exclusively in inpatient settings. The doctor examines the patient and then sends the patient for tests:

• A culture is taken from the affected tonsils for examination;
• A culture test for sensitivity to antibiotics is done to select the most appropriate treatment;
• Antigen test;
• In addition, it is necessary to exclude the presence of tuberculosis, syphilis, diphtheria, as well as lacunar tonsillitis and oncology.

Based on the results of the examination, the patient is sent to infectious diseases department hospitals for further treatment. Home treatment in the presence of necrotizing tonsillitis is completely excluded.

Treatment of necrotizing tonsillitis

After everyone has passed necessary tests, which will allow excluding others no less dangerous diseases, the doctor will prescribe treatment. Necrotizing tonsillitis requires treatment not only with antibiotics, but with local drugs:

• Hydrogen peroxide solution;
• Furacilin;
• Tincture of iodine;
• Silver nitrate;
• A solution of novarcelone in glycerin;
• Potassium chloride;
• Potassium permanganate.

For achievement positive result systematic treatment of the affected areas of the tonsils is required throughout the day. If this therapy does not bring the expected improvement, then antibiotics are added in the form of injections. Most often, drugs belonging to the penicillin series are prescribed to treat the symptoms of this type of tonsillitis.

In addition to local treatment, antibiotic therapy is necessary in many cases. Especially if the disease develops against the background of another respiratory disease. The following are prescribed as systemic antibiotics:

• Cephalosporins;
• Macrolides;
• Benzylpenicillin;
• Amoxiclav, as well as a number of other drugs in this group.

In the presence of drug allergies For antibiotics, azalides are prescribed, which do not have a toxic effect. These drugs are especially actively used in the treatment of children.

Macrolides include:

• Erythromycin;
• Midecamycillin;
• Azithromycin.

Data antibacterial drugs have an obvious advantage compared to cephalosporin and penicillin drugs.

• Effectively suppress harmful bacteria in the body;
• In large dosages, they can accumulate in the tissues of the tonsils;
• Support work immune system;
• Does not affect the activity of the gastrointestinal tract;
• They are characterized by low toxicity;
• Convenient release forms.

If antibiotic treatment is prescribed, you must complete the prescribed course of treatment to the end. Even with positive dynamics, interrupting therapy on your own can lead to unwanted complications.

What to eat during treatment

In order for the treatment to be successful and the duration of the disease to be short, you need to eat right. First of all, it is necessary to support the immune system. Therefore, if a patient has necrosis in the tissues of the tonsils, then he is shown a diet containing vitamins and microelements.

It is recommended to eat warm food. At the same time, it should be soft or semi-liquid. It is very useful to eat liver, curd products. However, it is necessary to exclude spicy foods and cold drinks from the diet. It is advisable to adhere to bed rest and drink more warm liquids. There will be healthy foods, rich in vitamin C.

It is useful to supplement the patient’s diet with fruit drinks, cranberry compotes, or drink tea with lemon. You can eat pureed fruits and vegetables. If you follow all the doctor’s recommendations, the disease can be dealt with in 7 to 20 days. However, if there are accompanying illnesses, then the duration of sore throat may increase.

In addition, even after recovery, you must adhere to the doctor’s recommendations. In particular, continue taking medications that strengthen the body and restore normal functioning of the immune system. In addition, you need to regularly gargle with antibacterial drugs.

Necrotizing tonsillitis is an acute tonsillar disease caused by saprophytes of the oral cavity (fusiform bacillus and spirochete).

This pathology develops in people with weakened and depleted immunity when radiation sickness, hypovitaminosis, leukemia and other diseases.

Often, pathological changes occur in only one tonsil, but sometimes bilateral ulcerative-necrotizing tonsillitis also occurs.

If the treatment of this pathology is not timely and competent, then it will begin to progress and the mucous membrane of the cheeks and gums, velopharyngeal arches will be involved in the pathological process (as it looks like in the photo below). Necrotizing tonsillitis is not contagious, but this disease can be epidemiological.

As a rule, the prognosis of the disease is favorable. With quick and correct therapy, the patient recovers completely within 8-14 days from the start of treatment.

Clinical manifestations

Necrotizing tonsillitis can be primary or secondary. In addition to saprophytes, the tonsils are affected by staphylococcal and streptococcal infections.

The factors causing the primary form of the disease may lie in oropharyngeal pyorrhea and the presence of dental caries, as shown in the photo.

Secondary necrotizing tonsillitis is diagnosed together with various infectious diseases:

1. diphtheria;
2. scarlet fever;
3. leukemia;
4. tularemia and so on.

At first, the progression of necrotizing tonsillitis is unnoticeable. The only minor symptom is discomfort that occurs during swallowing. But when staphylococcal and streptococcal infections occur, acute pain occurs.

Thus, the patient celebrates the presence of a foreign element in the pharynx. In addition, an unpleasant odor emanates from the patient’s mouth.

When performing pharyngoscopy on the tonsils, you can see gray-yellow coating. In the process of separating the exudate, necrotic bleeding ulcers are opened, having a gray-yellow bottom with torn edges, as shown in the photo.

Despite the characteristic local changes, the patient’s temperature is often normal and does not exceed the subfebrile level. But the ulcerative-necrotic type of sore throat almost always begins with chills and increased hyperthermia. Other manifestations of the disease include:

• acute intoxication;
• hyperemia of the diseased tonsil;
• leukocytosis (moderate);
• increased salivation;
• increase (this symptom is visible visually, which is confirmed by the photo).

Diagnosis and treatment

The diagnosis of ulcerative-necrotic type of sore throat is established by an ENT specialist, based on Clinical signs and results laboratory tests biomaterials taken from the surface of the diseased tonsil. Mucus or pus taken from the surface of the lacuna is subjected to laboratory tests:

1. PCR analysis, which allows you to determine the type of bacteria based on DNA fragments.
2. A rapid antigen test is used to detect beta-hemolytic streptococcus.
3. Sowing on a nutrient medium to determine the infection and its sensitivity to antibiotics.

When conducting differential diagnosis diseases such as malignant tumors, tuberculosis, lacunar tonsillitis, diphtheria of the pharynx and syphilitic ulcer.

Treatment of necrotizing tonsillitis is carried out in a hospital setting under the supervision of an ENT specialist. Local therapy Pathologies of a necrotic nature include the use of the following means:

• Potassium permanganate;
• Hydrogen peroxide;
• Sodium chloride;
• Furacilin;
• Novarselon solution in glycerin;
• Silver nitrate.

It is worth noting that affected tonsils must be treated regularly, that is, daily.

If the required therapeutic effect is not achieved, then antibiotics belonging to the penicillin group are prescribed, which are administered by injection.

Necrotizing form of tonsillitis and others infectious varieties This pathology is treated with antibiotics. In particular, penicillins, macrolides and cephalosporins are prescribed.

For example, drugs such as Cephalexin, Cephaloridine and Cefazolin - drugs belonging to the cephalosporin group - have proven their effectiveness. Effective penicillins include Phenoxymethylpenicillin, Amoxicillin and Benzylpenicillin. And patients who are allergic to B-lactams are prescribed adalides (macrolides).

In comparison with penicillins, drugs belonging to the macrolide group do not have a lot of adverse reactions. So, azalides do not have toxic effects on the functioning of the gastrointestinal tract and central nervous system. This is what makes it possible to use these antibacterial agents in the treatment of necrotic pathologies.

To the very effective antibiotics for necrotizing tonsillitis, macrolides include Clarithromycin, Erythromycin, Azithromycin, Leukomycin and Midecamycin. Compared to penicillins and cephalosporins, macrolides have a number of advantages:

1. Medicines are available in a convenient dosage form.
2. They have a strong bactericidal effect.
3. They have low toxicity.
4. They accumulate in large quantities in the lymphoid tissues of the tonsils.
5. Do not affect the functioning of the gastrointestinal tract.
6. They have an immunostimulating effect.

It is important to know that the course of antibacterial treatment must be completed to the end. After all, premature cessation of therapy may result in the development of complications, and bacteria will become resistant to the drug.

Since in order to cure the disease it is necessary to activate the body’s defenses, patients who have been diagnosed should adhere to a certain diet rich in microelements and vitamins. Moreover, dishes should be eaten warm, semi-liquid or soft.

So, the optimal protein-rich foods for tonsillitis are cheese, meat, cottage cheese, liver, etc. In addition, during illness it is advisable to avoid spicy, cold and hot foods.

The patient must also comply bed rest and drink plenty of fluids, which will eliminate the manifestations of acute intoxication. Moreover, it is useful to drink herbal infusions, decoctions and liquids that contain vitamin C (rosehip decoction, lemon juice, Holosas, cranberry juice) are also great for sore throat.

During the course of the disease, the patient should be isolated and his contact with others should be minimized. At the same time, he needs to allocate separate personal hygiene items and dishes.

In addition, the room where the patient stays must be well ventilated. At the same time, the room should be wet cleaned daily.

To prevent a sore throat from developing, you need to monitor oral hygiene, immunity, be systematically examined by a dentist and undergo timely treatment other diseases. In addition, in order for the body’s protective functions to work properly, it is necessary to healthy image and life and to eat well.

In the video in this article, a specialist reveals treatment methods severe cases tonsillitis.

(ulcerative-necrotizing tonsillitis) is atypical form inflammation palatine tonsils, accompanied by the formation of ulcers and fibrinous membranes on their surface. Clinically manifested by discomfort in the throat when swallowing, which later gives way to pain, putrid smell from the mouth, increased salivation. In the diagnostic process, patient complaints, anamnestic information, results of pharyngoscopy, general clinical tests, and bacteriological examination are used. Treatment consists of prescribing local antiseptics, restorative and symptomatic agents, and antibiotics.

ICD-10

A69.1 Other Vincent infections

General information

Ulcerative-membranous tonsillitis or Simanovsky-Plaut-Vincent tonsillitis is relatively rare, accounting for about 5-6% of all tonsillitis. This pathology was first described in 1899 by the domestic otolaryngologist N.P. Simanovsky. In 1898, the French bacteriologist J. Vincent and the German doctor S. Plaut identified the causative agents of this variant of tonsillitis. The incidence of this form of angina is predominantly sporadic, but epidemic outbreaks are also possible. Simanovsky-Vincent's angina is characterized by seasonality - the largest number of cases are recorded in the cold season: from mid-October to the end of April. People aged 18 to 40 years are most often affected.

Causes

The underlying etiology is fusospirochetous infection. The development of the disease is caused by penetration into the tissues of the tonsils and symbiosis of the opportunistic fusiform bacillus (B. Fuciformis) and a representative of the normal oral microflora– oral spirochetes (Spirochaeta buccalis). Also, pathogenic coccal flora can be determined at the site of infection: group B ß-hemolytic streptococcus, Staphylococcus aureus. The provoking factors of this form of tonsillitis are:

• Immunodeficiency. Activation of fusospirochetous symbiosis is facilitated by a decrease in the reactivity and resistance of the body against the background of HIV infection, diseases of the hematopoietic organs, malignant tumors, previous radiation therapy or chemotherapy treatment, nutritional dystrophy and cachexia, hypovitaminosis C and group B, acute or chronic infections, general hypothermia.
• Foci of chronic infection. The development of pathology is often caused by carious teeth, chronic stomatitis, periodontal disease, frontal sinusitis, sinusitis, ethmoiditis, sphenoiditis, pharyngitis, etc. Separately, adenoiditis is distinguished against the background of the growth of adenoid vegetations, since in addition to constant irritation of the tonsils with purulent masses, they are the cause of mouth breathing - one of the risk factors the occurrence of sore throat.

Pathogenesis

The parenchyma of the tonsils becomes a focus of infection, primary pathological changes arise as a result of the accumulation of microflora waste products. The emerging inflammatory reaction is accompanied by the release of histamine, pro-inflammatory cytokines, impaired vascular permeability of the microvasculature, and the release of leukocytes and proteins beyond their boundaries. Histological changes in the palatine tonsils are represented by hyperplasia of lymphatic follicles, small cell infiltration, thrombosis of regional venules of the covering epithelium, due to which the latter begins to peel off. Morphologically, the pathology is characterized by the formation of an area of ​​necrosis on the surface of the tonsil facing the pharynx. At the bottom of the lesion, a fibrinous membrane of loose consistency is formed, covering the necrotic lymphadenoid tissue.

Symptoms

The disease develops gradually. The first sign is a feeling of discomfort or a foreign body during swallowing, described by patients as a “lump in the throat.” Gradually these sensations transform into pain, which, when further development persists even at rest. In the vast majority of cases, there is a unilateral lesion. There is an unpleasant putrid odor from the mouth and increased salivation. A characteristic feature of this form of the disease is the absence of fever or intermittent low-grade fever. Only in some cases, Simanovsky-Vincent angina debuts with a sharp increase in body temperature to 38.5 ° C with chills. Patients experience an increase in the anterior and posterior cervical, occipital, submandibular postauricular lymph nodes on the side of the affected tonsil.

Complications

Complications in the ulcerative-necrotizing form of tonsillitis are associated with a long course of the disease, the spread of destructive processes to adjacent anatomical structures and underlying tissues. Develop by the end of 2-3 weeks of the disease. The lack of timely therapy leads to the formation of areas of necrosis on the surface of the velopharyngeal arches, the mucous membrane of the cheek, and other areas of the pharynx. During this period, the addition of pyogenic microflora is observed, accompanied by the formation of a systemic intoxication syndrome and the transformation of pathology into purulent tonsillitis. Next, the hard palate is destroyed, and anastomoses with the nasal cavity are formed. In some patients, destruction of dental sockets leads to tooth loss.

Diagnostics

The diagnosis is made on the basis of complaints, medical history, physical examination, laboratory tests and differentiation with other possible diseases. Differential diagnosis is carried out with lacunar and necrotizing tonsillitis, diphtheria of the tonsils, syphilitic and tuberculous ulcers, malignant tumors, acute leukemia. The examination program consists of:

• Collection of medical history and complaints. When interviewing the patient, the otolaryngologist details the complaints, finds out the presence of concomitant immunodeficiency conditions, pathologies of the ENT organs and other factors that could contribute to the activation of opportunistic flora.
• Examination of the pharynx. During pharyngoscopy, a grayish-yellow or green coating similar to a stearin suppository stain is visualized on the upper third or the entire surface of one of the palatine tonsils. Occasionally it is detected on the anterior palatine arch. After removing the membrane with a button probe, a bleeding surface is detected yellowish color with clear boundaries, covered with ulcers and areas of necrosis,
• General clinical laboratory tests. IN general analysis blood there is an increase in the level of leukocytes, a shift leukocyte formula towards band and young neutrophils, an increase in ESR. If differential diagnosis is necessary, a tonsil biopsy and Wasserman reaction can be performed.
• Bacteriological research. A smear from the affected area reveals a large number of spindle-shaped rods and spirochetes. To confirm the diagnosis and select antibacterial agents identified microorganisms can be cultivated on nutrient media followed by an antibiogram.

Treatment of ulcerative membranous tonsillitis

Treatment is conservative, if the patient’s condition is satisfactory and there is no risk of complications, it is carried out in outpatient setting. The main goals of drug therapy are sanitation of the source of infection, strengthening of nonspecific immunity, and prevention of complications. The following therapeutic agents are used:

• Local medications. Oral care by removing necrotic matter and rinsing with antiseptic solutions is of utmost importance. To treat the affected tonsil, hydrogen peroxide, solutions of manganese, iodine, and lapis are used. Rinsing is carried out with furatsilin, a solution of potassium permanganate.
• Systemic antibacterial drugs. Antibiotics are prescribed only for severe pathology. Medicines from the group of ß-lactams, namely amoxicillin with clavulanic acid or ampicillin, are considered effective. If the drugs are ineffective, they are replaced with drugs selected based on antibiotic sensitivity results.
• Symptomatic and general restoratives. Depending on the patient’s condition, antipyretics may additionally be used and intravenous infusions with plasma expanders, etc. To strengthen the body’s defenses, multivitamin complexes, adaptogens, and immunomodulators are introduced into the treatment program.

Prognosis and prevention

In the absence of complications, the prognosis for the patient’s life and health is favorable. The resulting ulcers on the tissues of the tonsils and adjacent structures heal without the formation of large connective tissue defects. The duration of the disease in most cases ranges from 7 to 21 days, rarely up to several months. Complications develop in no more than 3-7% of cases, but are characterized by a severe course. Specific prevention ulcerative membranous tonsillitis has not been developed. Nonspecific preventive measures include adherence to the principles of personal hygiene when caring for the oral cavity, prevention of immunodeficiency conditions and their timely elimination, early treatment pathologies of neighboring ENT organs.

(Simanovsky-Plaut-Vincent) - rare acute illness, expressed pathological change tonsils With this form of the disease soft fabric the gland becomes inflamed and necrosis. Gradual cell death occurs, which can lead to loss of functional and integrity of the tonsils.

Causes

The necrotic form of sore throat is provoked by actively reproducing saprophytes - spindle-shaped rods, spirochetes. These microbacteria belong to the conditionally pathogenic microflora and are present in varying quantities in the mucous membrane of any person.

Their growth can be triggered by a number of factors:

• weakened immune system;
• nutritional dystrophy;
• chronic infection of the nasopharyngeal area;
• state of exhaustion;
• hypovitaminosis;
• multiple caries.

In addition to these reasons, chronic problems with the gastrointestinal tract, addiction to alcohol, smoking, and a history of diabetes mellitus and immunodeficiency.

Symptoms

For necrotic form The disease is characterized by a satisfactory general feeling of well-being. The patient does not worry about anything except a sore throat, accompanied by increased salivation and an unpleasant putrid odor. In rare cases, the onset of the disease may be accompanied by a slightly elevated temperature and slight chills.

The main symptoms of the necrotic form:

1. Most often, this form of the disease affects one tonsil. It is increased in size and covered with a yellow-gray coating.
2. Inflammation can affect the palate, mucous membrane of the pharynx, and cheeks.
3. When removing plaque, you can find that the surface tissue of the tonsils is covered with ulcerations with a loose bottom and uneven edges.

Ifnecroticthe form is complicated streptococcal infection, the symptoms of the disease change:

• pronounced signs of general intoxication of the body appear;
• the sore throat becomes acute;
• the person feels bad.

The incubation stage of the disease lasts on average from 12 hours to 3 days. With timely and correct treatment, the disease goes away completely in 2-3 weeks.

Photo of necrotic sore throat: what it looks like

If you look into the patient's mouth, you can see a characteristic picture - one of the tonsils is swollen and very hyperemic. The tonsils are surrounded by a specific coating. In severe cases of the disease or complications, tissues located near the main source of infection are also inflamed.

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Diagnostics

Diagnosis of this rare disease based on the patient’s medical history: symptoms, the nature of their manifestations and other signs. The doctor may prescribe outpatient tests - a smear from the surface of the affected mucosa for subsequent PCR, culture and testing for beta-hemolytic streptococcus.

During the diagnostic process, the ENT specialist must exclude other possible diseases, similar in external symptoms: diphtheria of the pharynx, tuberculosis, syphilitic ulcer, tumor. An important factor in identifying necrotizing tonsillitis is its characteristic feature- not violated general state sick.

Treatment of necrotizing tonsillitis

Treatment of this type of sore throat should occur exclusively in a hospital under the supervision of medical staff. Antibiotics in the complex therapy of necrotic form are prescribed only if local treatment does not help and the patient becomes worse. The main methods used are: rinsing, lubricating the mucous membrane and diet. In case of complex course or advanced form, it may be indicated surgery- opening an abscess or removing tonsils.

Physiotherapy

Various kinds physiotherapeutic techniques are used to restore and normalize blood circulation in the tonsils and lymphatic system. Physiotherapy helps relieve swelling, reduce the number of pathogens and thereby improve general course illness, speed up recovery.

As a complex therapynecroticforms of sore throat are used:

• wave ultrasound;
• dry heat equipment: laser, ultraviolet;
• magnetotherapy.

Physiotherapy for necrotizing tonsillitis does not involve the administration of any medications!

Rinsing and irrigation

Patients are prescribed a course of rinsing using:

• hydrogen peroxide 3% - 1 tbsp. for one glass warm water;
• furatsilina - 1 pill per 100 ml of water;
• "Miramistin" - in pure form;
• salt and soda - 1 tsp each. for 250 ml of warm water.

To irrigate the oral cavity in a hospital, they usually use:

• silver nitrate;
• "Novarsenol" solution;
• potassium permanganate;
• potassium chloride;
• sprays - “Tantum Verde”, “Hexoral”, “Lugol”.

Lubricating the mucous membranes of the tonsils

Pills

For angina, antibacterial therapy is prescribed with a number of drugs: cephalosporins, macrolides, penicillins.

Antibiotics such as:

• "Cephalexin"
• "Amoxicillin"
• "Cefazolin"
• "Benzylpenicillin"
• "Cefaloridin"
• "Phenoxymethylpenicillin."

Macrolides, unlike the agents described above, have much lower side effects. They have virtually no effect on the central nervous system and gastrointestinal tract and are less toxic to the body as a whole.

The most popular macrolides:

• "Midecamycin"
• "Leukomycin"
• "Azithromycin"
• "Erythromycin"
• "Clarithromycin."

Abscess incision

A peritonsillar abscess forms in the oral cavity in case of complications of the disease.

Purulent formation appears on the affected area and provokes:

• the appearance of pain;
• difficulty swallowing;
• red throat.

A few days after the first symptoms, the patient’s lymph nodes become significantly enlarged, the tongue swells, the head begins to hurt, and all signs of intoxication of the body appear. As a rule, an abscess is always accompanied by fever.

The abscess is incised in a hospital setting. First, the doctor makes an incision on the affected area. Then a special tool is inserted into it, expanding the incision and tearing its bridges. If the state of suppuration allows, all liquid is pumped out of it. Sometimes, after opening the formation, its walls stick together, and the wound has to be drained. This procedure can take from 2 to 5 days.

Tonsil removal

Excision of the tonsils is the most radical way to solve the problem. As a rule, the attending physician and surgeon recommend that patients have two tonsils removed at once. Such an operation certainly reduces the risk of developing a sore throat in the future. However, it does not completely exclude it. In addition to the tonsils located near the throat, there are also small tonsils, which can also become inflamed and lead to a necrotic form of sore throat.

Surgery to remove tonsils is not performed without the use of anesthesia. Usually, local anesthesia does not give the desired effect, and the patient during the operation may experience quite unpleasant feelings. That's why surgical intervention It is recommended to carry out only under general anesthesia.

Diet

During necrotizing tonsillitis, you should not eat food that can irritate the already inflamed mucous membrane. It is necessary to exclude too hard, cold or very hot foods from the patient’s diet. During illness, you should not eat spicy, hot, or salty foods. But kefir, any fermented milk products, cheese and hard-boiled eggs can make up an excellent menu.

• exclude sweets and sugar from the diet;
• eat soft, liquid dishes, salads, soups, lean boiled meat;
• strictly prohibited - alcohol, soda;
• allowed - compotes, berry fruit drinks, teas, juices, warm milk;
• You can eat honey in small quantities and diluted form.

Treatment with folk remedies at home

IN national first aid kit there are many recipes that can be used as additional therapy during drug treatment.

Be sure to consult your doctor. Some products should not be used by people prone to allergic reactions. Remember, treating a sore throat exclusively with folk remedies is categorically unacceptable! Without adequate therapy, which only a doctor can prescribe, you risk serious complications.

Sage

A decoction of sage quickly and effectively relieves inflammation and reduces pain. This medicinal collection is sold in almost any pharmacy. It is better to buy a packaged collection. After brewing one sachet in a liter of boiling water, cover the resulting solution with a lid and let stand for several hours. The product should be used as a rinse - 3 times a day until symptoms disappear.

Aloe

This recipe can be used only after the ulcers in the mouth have begun to heal. Cut off a few large aloe leaves. Squeeze the juice out of them. Add one teaspoon of juice to 250 ml of boiled water. Gargle with the solution 2 times a day until recovery. In one rinse cycle, you must use the entire portion - 1 glass. The product should be prepared only immediately before the rinsing procedure. The squeezed juice for later use should be stored in the refrigerator for no more than two days.

Onions with garlic

Squeeze the juice from one head of garlic and one onion. Mix everything into a single substance. Soak a tampon in it and treat the affected area 2 times a day for a week.

Milk with garlic

Grind one head of garlic to the consistency of small cubes. Mix garlic chips with milk - 300 ml. Bring the substance to a boil, cool. Take the drink orally 2-3 times a day, 1-2 tbsp. Duration of treatment - 1 week.

Saline solution

Add 1 tbsp to one full-size glass. iodized sea ​​salt. Gargle with the solution every 3-4 hours until full recovery.

Eucalyptus

Take dry eucalyptus leaves. Grind the raw materials in the amount of one tablespoon. Pour the mixture with 1 cup of boiling water. Leave to brew overnight. Thoroughly rinse the inflamed area with the resulting product 3-4 times a day. This recipe can be used absolutely safely until complete recovery. Eucalyptus has a strong antiseptic effect, promotes tissue restoration and regeneration.

Calendula

The recipe with calendula can be used by both children and adults. Take a collection of dried calendula flowers in a volume of 1 tablespoon. Add the inflorescences to a vessel with hot water - 400 ml. Leave for 5-8 minutes. Bring the composition to readiness in a water bath - 15 minutes. Strain the resulting solution and cool until warm. Rinse the tonsil area with calendula decoction 3-4 times a day. Treatment can be continued until complete recovery.

All ingredients for preparing gargles or herbal infusions can be purchased at the pharmacy. When purchasing herbs at a pharmacy, you can be sure not only of their composition, but also that all dried flowers have undergone careful selection and processing before packaging.

A patient with necrotizing tonsillitis should follow the most gentle, pastel regimen. His diet should include food enriched with vitamins and microelements. All dishes should be warm and semi-liquid. Such measures will help avoid unnecessary trauma to the mucous membrane.

• drinking plenty of water;
• minimum physical activity;
• consumption of vitamin C;
• isolation of the patient in a separate room;
• daily wet cleaning of the room, ventilation;
• The sick person must have separate utensils and personal hygiene products.

Prevention

The best prevention necrotizing tonsillitis, like most other diseases, is a healthy lifestyle, good immunity and weekly exercise stress. In addition, in order to minimize the possibility of the occurrence of this form of the disease, you need to periodically visit the dentist, monitor oral and dental hygiene, and treat caries in a timely manner.

Principles of prevention:

• refrain from communicating with patients;
• don't visit public places during an epidemic;
• wash your hands after going outside;
• carefully monitor oral hygiene;
• eat healthy food rich in vitamins and microelements.

Complications and consequences

Incorrect or untimely treatment This type of sore throat can lead to a lot of consequences. Most mild complication- damage to nearby tissues. Severe consequences manifest themselves in the form of infection by pathogenic organisms of other organs through the bloodstream.

The most common complications:

• endocarditis,
• abscess,
• rheumatic fever,
• damage to the oral cavity by necrotic processes,
• pericarditis,
• perforation of the hard palate,
• sepsis,
• bleeding,
• myocarditis,
• phlegmon,
• rheumatism,
• glomerulonephritis.

Is it contagious and how is it transmitted?

Necrotizing tonsillitis is not contagious. However, there are known cases of the disease spreading among people with low social status and poor living conditions.

Features in children

Among children, this form of sore throat is much less common than among adults. Especially under the age of one year, when the child does not yet have chronic diseases and carious teeth. In a child with necrotizing tonsillitis, the disease proceeds in the same way as in an adult, only with more severe symptoms. Medicines and their dosage in pediatric therapy is used taking into account the age and characteristics of the patient.

During pregnancy

The appearance of necrotizing tonsillitis during the period when a woman is carrying a baby under her heart is quite dangerous for her. Pregnant women should immediately begin treatment using medications that are acceptable for their condition. It is very important to stop the disease and prevent complications from developing.

If you experience any signs of necrotizing tonsillitis during pregnancy, consult your doctor immediately! There is no need to hesitate and start self-medicating with folk remedies.

Video about sore throat

The famous TV presenter talks about how tonsillitis manifests itself, about the peculiarities of the course of the disease and what to do when the first signs of infection are detected.

Forecast

The prognosis for those suffering from this form of the disease is quite favorable, but only if treatment is started correctly and in a timely manner. With normal and slightly weakened immunity, a person will need from 7 to 14 days to fully recover. If the illness is complicated by the presence of other diseases and with a pathologically weakened immune system, the recovery process can take up to two months.