Tonsillitis is inflammation of the tonsils. Clinically, it can be divided into acute and chronic, and the main symptoms are sore throat, fever and throat discomfort. This disease can cause ear, nose, heart, kidney, joints and other local or systemic complications, which should be paid attention to.
Inflammation of palatine tonsil. It is divided into acute and chronic. Acute tonsillitis is mostly caused by hemolytic streptococcus. In addition, such as staphylococci, pneumococci, influenza bacilli and viruses can also cause. Acute onset, aversion to cold and high fever, especially when swallowed, and can cause radiation earache, limb pain and fatigue. Examination found that tonsils were congested and swollen, and most of them had yellow-white purulent secretions at the pit mouth. The symptoms of follicular suppuration are serious, and there is a small yellow-white abscess under the mucosa. The patient's mandibular angle lymph nodes are swollen and tender, and the white blood cells in the blood are elevated. Chronic tonsillitis has no obvious symptoms, such as dry throat and foreign body sensation, and there is often a history of recurrent acute tonsillitis. Excessive tonsillitis in children can affect breathing and swallowing. Examination showed chronic hyperemia of glossopharyngeal arch, chronic hyperemia or scar of tonsil, caseous pus embolism of pit mouth, and lymphadenopathy of mandibular angle. Pharyngeal diseases that need to be differentiated from acute tonsillitis include pharyngeal diphtheria, Vinson's angina, viscous leukopenia angina, ulcerative angina, pharyngeal keratosis and so on. Tonsillitis can cause many complications, such as abscess around tonsil, rheumatism, acute glomerulonephritis, arthritis, myocarditis and so on. Acute tonsillitis can be treated with antibiotics or sulfonamides. In addition, rest, defecation, drinking more water, taking antipyretic and analgesic drugs, etc. And it usually takes 5 ~ 7 days to recover. Any chronic tonsillitis with repeated acute attacks or complications can be surgically removed, and there are two surgical methods: peeling and squeezing. Because of the immune function of tonsils, there are fewer patients undergoing surgery than in the past.
Etiology and pathology tonsillitis is mainly caused by hemolytic streptococcus, and others such as staphylococcus, pneumococcus, influenza Bacillus and virus can also be caused. Pathogens spread through droplets? Direct contact, etc., is usually hidden in the tonsil fossa. When the body's resistance is weakened due to fatigue, cold or other reasons, pathogens multiply rapidly and cause disease. Inflammation begins in the crypt and then spreads to the whole tonsil. In acute inflammation, tonsil parenchyma is congested, polymorphonuclear leukocytes infiltrate, and yellow and white spots can be seen on the mucosal surface. The tonsils are obviously swollen, which can form most small abscesses. Purulent exudate composed of cellulose, exfoliated epithelium and pus cells in the fossa is discharged into the fossa, so pus spots can be seen in the tonsil fossa. Pathological changes of chronic inflammation are obvious, lymphocytes and reticular cells proliferate actively, tonsil hypertrophy. The mucosa epithelium of the pit is thickened, the surface is hyperkeratinized or a small ulcer is formed. Keratin, inflammatory exudate, exfoliated epithelial cells, white blood cells? Bacteria, etc. Mix together to form a cheese-like embolus and plug it in the pit. Long-term inflammation can lead to the occlusion of small blood vessels in tonsil, the degeneration of lymphoid tissue, and gradually replaced by connective tissue, and then the tonsil shrinks day by day, eventually leading to tonsil fibrosis. Because of scar stenosis, the contents of the fossa are difficult to be excluded, which often becomes the focus.
The clinical manifestations of acute tonsillitis are contagious, the incubation period is about 3 ~ 4 days, and the incidence rate is high in spring and autumn, which is more common in young people, followed by children, and rarely occurs after 50 years old. Symptoms vary in severity. Caused by virus, local and systemic symptoms are mild, tonsils are congested and there is no exudate on the surface. The symptoms caused by bacteria are severe, with acute onset, aversion to cold and high fever, and the body temperature can reach 39 ~ 40℃. The child will twitch with a high fever. Sore throat is obvious, especially when swallowed, and can even radiate to the ears. The course of disease is about 7 days. Examination showed that the tonsils were obviously swollen and congested, there were yellow-white punctate purulent exudates in the crypt, and yellow-white bulges formed by follicular suppuration could be seen under the mucosa. The punctate exudate can be connected into pieces, which is called pseudomembrane, but the pseudomembrane does not extend beyond the tonsils, so it is easy to wipe off, and the mucosa does not bleed after wiping off. This can be distinguished from pharyngeal diphtheria. At the same time, the mandibular angle lymph nodes are swollen and tender. There are high white blood cells in the blood, which can cause transient mild proteinuria.
Chronic tonsillitis has no obvious symptoms locally, and sometimes it has dry throat, foreign body sensation and itching. , and often have a history of acute attacks. Excessive tonsillar hypertrophy in children can affect breathing and swallowing. If the adenoids are also large, it will cause nasal congestion and snoring. Because of the absorption of bacteria and toxins in the pit, it can cause headache, fatigue and low fever. Examination showed chronic hyperemia and tonsil hypertrophy of glossopharyngeal arch; The course of the disease is older, the tonsils are not big or even atrophied, but there is caseous pus thrombus in the pit.
The diagnosis of acute tonsillitis has typical clinical manifestations, which is not difficult to diagnose, but it should be differentiated from pharyngeal diphtheria, Vinson's angina, leukemia and scarlet fever. At present, there is no satisfactory objective diagnosis method for chronic tonsillitis. Diagnosis can be made mainly according to the history of repeated acute attacks, combined with examination, such as chronic congestion of tonsil and glossopharyngeal arch, yellow-white embolus at the mouth of tonsil fossa, pus discharge at the mouth of glossopharyngeal arch, scar and adhesion on tonsil hypertrophy or reduced surface. Bacterial culture, cytological examination of exfoliated cells and determination of serum anti-streptolysin "O", anti-hyaluronidase and anti-streptokinase titer can all be used as diagnostic reference. Chronic tonsillitis should be differentiated from physiological hypertrophy of tonsil (more common in children and adolescents, without conscious symptoms and a history of repeated acute attacks), tonsil keratinization and tonsil tumor.
The treatment of acute tonsillitis is contagious and should be properly isolated. Because this disease is mostly streptococcus infection, antibiotics or sulfonamides can be used. In addition, we should pay attention to rest and defecation, drink plenty of water and cold liquid food, and give appropriate antipyretic painkillers and gargle. Most patients can recover in about 1 week.
There is no exact and effective conservative treatment for chronic tonsillitis. Traditional Chinese medicine, local tonsil medication, freezing and physical therapy have all been tried. You can also have tonsillectomy. In the past, tonsillectomy was very common to prevent serious complications caused by tonsillar lesions. In recent years, due to the understanding of the immune function of tonsil, it is controversial whether tonsillectomy is beneficial. So the number of operations is reduced. There are also different views on surgical indications, surgical effects and whether tonsillectomy will affect the immune function of the body. According to recent research, tonsils participate in humoral immunity and cellular immunity, and can produce B lymphocytes that synthesize various immunoglobulins. Therefore, some people think that tonsillectomy will affect local immune function, but it has no effect on systemic immune function. Tonsillectomy can be done in the following situations: ① those with repeated acute attacks or a history of abscess around tonsils; ② It may be that the primary focus causes lesions in other parts; ③ Affect normal breathing or swallowing function. In order to prevent adverse effects on immune function, tonsillectomy is generally not allowed before the age of 6. If swallowing and breathing are affected, one tonsil can be removed to relieve dysfunction. There is a tendency of bleeding, and surgery in the active stage of secondary diseases may lead to the aggravation of secondary diseases, and the patient's health condition does not allow it, so it is not suitable for surgery.
There are two main ways of tonsillectomy, stripping and squeezing. Stripping method has little damage to surrounding tissues and can be applied to various situations, so it is adopted by most doctors. The biggest advantage of extrusion method is its high speed, and the operation can be completed in 1 ~ 2 minutes, but it is not suitable for patients with excessive adhesion, abscess around tonsils and possible vascular abnormalities. Tonsillar surgery itself will also have complications, such as postoperative bleeding, infection, local injury and so on. In a few cases, compensatory hyperplasia of pharyngeal trunk and lymphoid tissue can occur after operation. The effect of operation is related to the choice of indications, the quality of operation and the physiological and psychological state of patients. As far as the disease itself is concerned, repeated acute attacks, tonsil hypertrophy's influence on normal physiological function, abscess around tonsil and benign tumor of tonsil have definite curative effect. For patients with systemic diseases such as nephritis, rheumatism and low fever, the curative effect is different. Tonsillectomy only removes one possible pathogenic factor, and has no effect on organic lesions in other parts, nor can it affect other pathogenic factors.
Complications Acute and chronic tonsillitis can cause various complications. Local complications include acute otitis media, rhinitis, sinusitis, pharyngitis, cervical lymphadenitis and abscess around tonsils. Common systemic complications include rheumatism, acute glomerulonephritis, septicemia, arthritis, skin diseases (such as psoriasis), myocarditis and bronchial asthma.
The mechanism of tonsillitis causing systemic diseases is not completely clear at present. According to the infection theory, hemolytic streptococcus and its toxin intermittently enter the blood stream or lymph, leading to diseases in distant parts. In recent years, adenovirus types Ⅱ, Ⅲ, Ⅳ and ⅶ have been isolated from throat, blood and heart valves of patients with rheumatism. It is believed that hyaluronidase from streptococcus can increase the permeability of pharyngeal tissue and make the virus easily invade the human body and cause disease. According to the theory of allergic reaction, bacteria and their toxins, metabolites or pit viruses can cause antibody formation after entering body fluids, and combine with antibodies through antigens to produce complexes, leading to pathological changes in other parts. The theory of infectious allergy holds that the above two processes exist at the same time and work together. Besides, what else? However, all kinds of theories lack sufficient evidence.
Tonsillitis generally refers to nonspecific inflammation of palatine tonsils, which can be divided into acute tonsillitis and chronic tonsillitis. Acute tonsillitis is mostly caused by infection with bacteria or viruses when the body's resistance drops. Acute onset, with sore throat as the main symptom, accompanied by chills, fever, headache and other symptoms. This is a common disease among children and adolescents. Chronic tonsillitis is caused by the recurrence of acute tonsillitis, which is characterized by dry throat, feeling of blockage, sticky secretion, difficulty in coughing and bad breath. Its recurrence can induce other diseases, such as chronic nephritis, arthritis and rheumatic heart disease, which must be actively treated. Patients should strengthen exercise at ordinary times, strengthen their physique, pay attention to oral hygiene, treat diseases in nearby tissues in time, have a light diet, quit spicy food, quit smoking and drinking, and consider surgical treatment once the disease becomes the focus of other diseases or has other surgical indications.
This disease is equivalent to the category of "suckling moth" in traditional Chinese medicine, acute tonsillitis is equivalent to "wind-heat suckling moth" and chronic tonsillitis is equivalent to "deficiency-fire suckling moth". Wind-heat moths generally spread to the lung and stomach due to sudden climate change, imbalance between cold and heat, unstable lung and health, excessive alcohol and tobacco, accumulation of heat in the spleen and stomach, or exogenous wind and heat, which burns the laryngeal nucleus and invades the laryngeal nucleus from the nose and mouth. Moths with deficiency fire are mostly moths with wind-heat or residual poison after epidemic febrile disease, with pathogenic heat damaging lung yin, or factor body yin deficiency, plus overwork, kidney yin loss, inflammation of deficiency fire and steaming throat. Common clinical syndromes are:
1, wind-heat type of lung meridian: fever, chills, sore throat, cough, white or yellow fur, and rapid pulse.
2. Lung-stomach heat accumulation type: high fever, chills, severe sore throat, dysphagia, thirst, bad breath, constipation, red tongue, thick yellow coating and rapid pulse.
3. Excessive toxic heat type: persistent high fever, increased pharyngeal epilepsy, pain in the same ear, dysphagia, Huang Chi coating, and rapid pulse.
4. Inflammation caused by deficiency fire: dry throat and mouth, blocked throat, dry cough, fever in hands and feet, shortness of breath, backache, less fur, red tongue and rapid pulse.
5. Kidney-yin deficiency type: dry mouth and throat, especially at dusk, burning sensation and slight pain, foreign body sensation, dizziness, unbearable, redness around the laryngeal nucleus, yellow-white pus and thrombosis on the laryngeal nucleus, red tongue with little coating and weak pulse.
6. Deficiency of lung and spleen: dry throat, itching, slight cough, little and sticky sputum, inability to spit out, profuse sweating on the head, dark red throat nucleus and surrounding areas, white punctate short marks on the throat nucleus, or cheese-like pus embolism, red tongue with little coating and rapid pulse.
First, optional western medicine.
1. Acute tonsillitis:
(1) Systemic treatment: Streptococcus infection is the most common cause of the disease. The first choice of antibiotics is mycobacteria. Erythromycin and lincomycin can be used for people who are allergic to penicillin. People with high fever, headache and body aches can choose antipyretic and analgesic drugs such as aspirin. If the condition is still not improved after 2-3 days of treatment, we should consider whether it is a virus or other bacterial infection, switch to antiviral drugs, sensitive antibiotics or sulfonamides, and use adrenocortical hormones such as prednisone and dexamethasone as appropriate.
(2) Local treatment: optional
pediatric tonsillitis
The human pharynx is like an arched door, consisting of two arched tissues. The lingual palatine arch and pharyngeal palatine arch straddle on both sides respectively, forming two nests, namely tonsils. Under normal circumstances, it secretes a small amount of mucus, which contains white blood cells and phagocytes. Once the bacteria and viruses pass through here, they are adsorbed on it and then swallowed and digested. With the development of immunology, people pay more and more attention to the function of tonsil as a recognized immune organ. For example, a "transfer factor" can be extracted from an excised tonsil. This factor can enhance immunity and inhibit viruses. In addition to tonsils, the adenoids behind the nasal cavity and the lymphatic tissue behind the pharynx form a ring-shaped lymphatic network, covering the top of the respiratory tract and filtering the air entering the respiratory tract. This is a powerful defense mechanism. Tonsils bear the brunt. Once people's resistance drops, bacteria and viruses will multiply here and tonsils will become inflamed. Inflammatory tonsils are congested, swollen and purulent. There are many small pus plugs on the fossa of tonsil, which will be covered with pus moss in severe cases. Frequent and repeated inflammation can form chronic tonsillitis. Because of repeated inflammation, tonsil hyperplasia and hypertrophy, both sides of tonsil almost meet together, like two doors blocking the pharynx.
The harm of tonsillitis is not limited to these. Once it becomes the focus, bacteria will multiply here, produce toxins, enter the human body with the blood, and make the human body have an immune response. This immune response is an abnormal allergic state, which can further lead to many important organ diseases, such as acute nephritis and rheumatism. These complications are far more harmful than tonsillitis itself.
When children suffer from tonsillitis, the symptoms of systemic infection are obvious. The child's symptoms are: high fever can reach 39 ~ 40℃, accompanied by chills, general weakness, headache and general pain, loss of appetite, nausea and vomiting. When examining the pharynx, pus can be found on the tonsils. This is the most powerful diagnostic basis, because it can't be distinguished from other colds only by systemic symptoms.
The treatment of acute tonsillitis is mainly to control infection. Tonsillitis is mostly bacterial infection, especially suppurative tonsillitis is caused by suppurative bacteria, so antibiotics must be used. Tonsil hypertrophy caused by chronic tonsillitis can cause dyspnea, especially when sleeping, because the tongue is slack and drooping, which leads to snoring like thunder. Long-term chronic hypoxia will affect growth and development, and chronic hypoxia will also affect children's intellectual development.
Key points of home care
1. Tonsillitis is usually the largest at the age of 3 ~ 10, and gradually decreases after 10, so childhood tonsillitis is the focus of prevention and treatment.
2. Strengthen exercise, especially in winter, and participate in outdoor activities to enhance the body's adaptability to cold and reduce the chance of tonsillitis.
Keep your mouth clean and rinse your mouth after meals.
4. Acute tonsillitis is mostly caused by bacterial infection, especially purulent bacteria, such as streptococcus and staphylococcus aureus. Therefore, antibiotics must be used, among which penicillins are the most effective, and oral or intravenous injection can be chosen according to the severity of inflammation.
5。 Tonsillectomy can be done for chronic tonsillitis or tonsil hypertrophy. Rapid tonsillectomy is commonly used at present. During the operation, the patient's mouth was sprayed with topical anesthetic. After waiting for a while, the patient will feel a dull pain in his throat, and then he will lie in bed. The doctor uses an instrument called an extrusion knife to remove all tonsils at the moment when the patient opens his mouth. The operation was very quick, and the operation was completed before the sick child felt pain. Sick children are always awake and can eat cold food immediately, with the aim of promoting vasoconstriction and preventing postoperative bleeding. You don't need to be hospitalized after operation, and you can go home after outpatient observation 1 ~ 2 hours.
6. Eat a semi-liquid diet, such as noodles and egg cakes, within 0/~ 2 weeks after operation.
7. It's not over after surgical resection, and you can get pharyngitis again. Therefore, the ideal method is to try not to remove it.
Tonsillitis
brief introduction
Tonsillitis is an acute or chronic inflammation of the pharyngeal tonsil. It is a common disease in childhood. Modern medicine believes that tonsils are the two largest lymphoid tissues in human pharynx. Generally, it gradually increases after 4-5 years old, and gradually decreases after 12 years old. Under normal circumstances, tonsils can resist bacteria from entering the nasal cavity and pharynx, and play a protective role for the human body. However, due to the child's low body resistance and a cold, the ability of tonsils to resist bacteria will be weakened, resulting in bacteria from the mouth, pharynx, nasal cavity and the outside world invading the tonsils, causing inflammation. In severe cases, the tonsils are swollen and suppurated, forming suppurative tonsillitis, which can turn into chronic tonsillitis after long-term treatment, which is easy to cause nephritis and heart disease. Rheumatism and systemic diseases such as chicken breast and funnel chest. In Chinese medicine, it is called "suckling moth" because it looks like a nipple or a silkworm moth. The main reason is that wind-heat pathogenic toxin invades the lung and stomach meridian from the nose and mouth, and the pathogenic toxin fumigates the throat and causes disease. Or the lung and stomach elements have accumulated heat, or the heat toxin is very serious, burning the yin of the lung and stomach, insufficient body fluid, and inflammation of deficiency fire, which often occurs repeatedly.
The clinical manifestations are fever, headache and chills in acute stage. Children may have convulsions due to high fever, obvious sore throat and increased saliva. It may be difficult to talk if it is serious. At the time of examination, the tonsils were red and swollen, with yellowish or white pus spots on the surface, and the mandibular lymph nodes were generally swollen. In the chronic stage, the symptoms are flushing of pharynx and tonsil, yellow secretion, inconspicuous sore throat, occasional low fever and poor appetite.
Massage method 1
1. Common methods
(1) Clearing lung meridian for 300 times and clearing water for 200 times.
(2) Push the thumb from the lateral edge of the wrist to the direction of the tiger's mouth, and repeat the operation 100 times.
(3) When the child lies on his back, the parents put the fingertips of the thumb and forefinger on the throat respectively and gently rub them from top to bottom for 200 times.
(4) When the child is prone, the parents directly push the muscles on both sides of the spine with the palm root, taking heat as the degree.
Step 2 add and subtract with syndrome
(1) wind-heat type: symptoms include fever, aversion to cold, sore throat, stuffy nose, head and body pain, cough with phlegm, red tongue and thin yellow fur. General operation enhanced edition
① Retreat six viscera for 300 times.
② Massage Dazhui point for 300 times.
③ Press Rouquchi and Hegu points 50 times each.
④ Hold Jianjing point 10 ~ 20 times.
(2) Lung and stomach heat excess type: symptoms include high fever, thirst leading to drinking, obvious sore throat, yellow and thick expectoration, abdominal distension, bad breath, salivation, constipation, Huang Chi in urine, red tongue with yellow coating. General operation enhanced edition
① Clear the large intestine 300 times, retreat the six fu organs 300 times and clear the small intestine 200 times.
② Push the spring 300 times.
③ Push down the seven bones for 300 times.
④ Massage Dazhui point 1 min.
(3) Yin deficiency and excessive fire type: the symptoms are usually low fever, which is obvious in the afternoon, dry throat and slight sore throat, which are aggravated by excessive pronunciation or spicy food, dry cough without phlegm, foreign body sensation when swallowing, poor spirit, red tongue and little tongue coating. General operation enhanced edition
① Tonifying the kidney meridian for 300 times and transporting it to the labor palace for 30 times.
② Push the spring 300 times.
③ Massage Shu Fei and Shenshu points for 65438 0 minutes each.
Massage method 2
1. Common methods
(1) Pinch bilateral Shaoshang points with thumb nails 1 ~ 2 minutes.
(2) Press and knead Hegu point with your fingers 1 ~ 3 minutes.
(3) Press Taixi point and Yongquan point 1 min.
(4) Rub the bilateral thenar of the child with the thumb pulp, and repeat the operation for 2-5 minutes.
(5) Wipe the lumbosacral region directly with the palm root, with heat penetration as the degree.
Life adjustment
(1) Children should pay attention to rest. The indoor temperature should not be too high. It is best not to feel cold. The air should be fresh. Don't smoke indoors to reduce throat irritation.
(2) Pay attention to oral hygiene, drink more boiled water or fruit juice, and replenish water in the body.
(3) Don't take children to cinemas, shopping malls and other crowded places, especially when respiratory and digestive diseases are prevalent.
(4) Pay attention to strengthening diet nutrition, enhancing physical fitness and improving the body's resistance.
(5) In the process of massage, if the child has sudden temperature rise, abdominal pain, or early symptoms of shock, he should go to the hospital as soon as possible.
Tonsillitis
(1) acute tonsillitis
Acute tonsillitis often occurs in children and young people. The main pathogen is hemolytic streptococcus B. In addition, staphylococcus, streptococcus pneumoniae and adenovirus can also cause it. According to its pathological characteristics, it can be divided into:
1. Acute catarrhal tonsillitis is mild, mostly confined to mucous membrane, with inflammatory cell infiltration and swollen tonsils, but the swelling is not obvious and there is no exudate on the surface.
2. Acute suppurative tonsillitis has obvious tonsil enlargement, systemic congestion, a large number of neutrophils infiltration, and the crypt is full of purulent exudate. In severe cases, most lymph follicles are swollen and suppurated, forming multiple follicular abscesses, which can penetrate into crypts or form ulcers on the surface, and small abscesses can also be fused to form suppurative tonsils.
(ii) Chronic tonsillitis
Chronic tonsillitis mostly evolved from repeated attacks of acute tonsillitis. According to its lesions can be divided into:
1. Chronic hypertrophic tonsillitis has enlarged tonsils in different degrees, obviously proliferated lymphoid tissue, increased lymphoid follicles, enlarged germinal center, a large number of plasma cells and some neutrophils can be seen in lymphoid tissue, especially submucosa, and inflammatory exudates can be seen in crypts. Sometimes, due to the proliferation of lymphoid tissue and connective tissue, polypoid masses can be formed.
2. Chronic fibrous tonsillitis due to a large number of fibrous connective tissue hyperplasia (scarring), tonsil volume shrinks and hardens, and lymphoid tissue often shrinks or even disappears. Due to outlet obstruction, the crypt often expands in a cystic shape, and inflammatory exudates can also be seen in the capsule. Sometimes cartilage or ossification can be seen in hyperplastic connective tissue.