Sore throat: treatment, symptoms, photos, signs in an article by infectious disease specialist P. A. Aleksandrov.

Etiology and pathogenesis
Classification of tonsillitis Clinical forms of vulgar tonsillitis

Complications of sore throat

Treatment of sore throats

Treatment of vulgar tonsillitis.

Antibacterial therapy for acute streptococcal tonsillitis

Prevention of sore throat

As a disease of the pharynx, sore throat has been known since ancient times.
Sore throat is described in the works of Hippocrates (IV–V century BC), Celsus (I century AD), and also in the manuscripts of the Tajik physician Abu Ali Ibn Sina (Avicenna, 11th century) mention of intubation and tracheotomy for asphyxia due to tonsillitis, etc. Sore throat is a common acute infectious disease in which local inflammation affects the lymphadenoid tissue of various tonsils of the pharynx. In the vast majority of cases, tonsillitis occurs in the palatine tonsils, while other tonsils are involved in the process much less frequently. Angina is not a homogeneous disease; it differs in etiology, pathogenesis and form of clinical course.

Description of the disease

Lacunar tonsillitis is the third most severe form of tonsillitis.
Pathology can occur in children aged 1 to 18 years. One episode of the disease lasts on average 10-14 days, if the initial treatment is chosen correctly. The disease develops acutely. The chronic form of lacunar tonsillitis is extremely rare (up to 2%). Due to the massive penetration of bacteria into the palatine tonsils, in the absence of adequate treatment, the risk of complications increases:

formation of peritonsillar abscesses;
layering of secondary infection with transition to a septic state (sepsis);
exacerbation of existing chronic diseases.

One common complication of frequent episodes of sore throat in childhood is acute rheumatic fever (formerly “rheumatism”). It develops due to the ability of bacteria (streptococci) to remain in the tissues of the tonsils for a long time. Pathogens trigger autoimmune processes in the body, which leads to the appearance of characteristic symptoms. The most unfavorable are lesions of the cardiovascular system with the formation of acquired heart defects. Therefore, it is so important to carry out adequate and timely treatment of lacunar tonsillitis when symptoms are identified.

Complications of sore throat

Patients with angina may experience the following local complications: peritonsillitis and peritonsillar abscess, otitis media, etc. They usually occur in people whose treatment was started relatively late - after the 3rd day from the moment of illness. Peritonsillitis and paratonsillar abscess have similar symptoms, which include: high fever, predominance of unilateral pain in the oropharynx, sharply intensifying when swallowing, increased salivation, trismus and pain when opening the mouth, unilateral edema, hyperemia of the soft palate, swelling of the palatine arch on the affected side, and also a shift to the center of the affected tonsil and asymmetry of the uvula.

Symptoms of lacunar tonsillitis in children

Lacunar tonsillitis develops acutely. Sometimes the patient begins to complain of the first signs of the disease 4-6 hours after exposure to the provoking factor. The pathology is characterized by moderate and severe course, which in 40-60% of cases may require hospitalization of the child. Clinical symptoms of lacunar tonsillitis in children:

Fever with an increase in body temperature to 40°C and chills.
Severe sore throat that makes it difficult to swallow. Breasts often refuse breast milk due to discomfort during feeding.
Bright redness (hyperemia) of the palatine tonsils and their increase in size (hypertrophy).
The formation of islands of gray-white mucopurulent films that line the tonsils.
Dry tongue, redness or white coating.
Enlargement of nearby lymph nodes (sublingual, submandibular).
Severe general weakness, moodiness, sleep disturbance.

When the temperature rises, the child becomes lethargic and wants to sleep. In severe situations, hallucinations or seizures may occur at the peak of the fever. This development of events requires hospitalization of the patient.

Causes of lacunar tonsillitis in children

Lacunar tonsillitis, like other forms of tonsillitis, is a consequence of the penetration of bacteria and viruses into the lymphatic tissue of the tonsils.
The most common pathogens (up to 70-75%) are group A streptococci. Viruses, staphylococci, and E. coli cause the disease much less frequently. This is due to the specific tropism of streptococci - they more easily penetrate the cells of the palatine tonsils and linger there. After pathogens enter the lymphatic tissue, their active reproduction begins. Against the background of bacterial activity, a focus of local inflammation is formed. The vessels dilate, the tonsils enlarge, the patient first feels a bloating in the throat, which quickly develops into pain.

Normally, the palatine tonsils serve as the primary barrier between the external environment and the respiratory tract, protecting against pathogenic microorganisms. However, with pronounced aggressiveness of bacteria or with reduced immunity, they become a pathological focus where the pathogen settles.

Factors that increase the risk of developing lacunar tonsillitis:

Frequent hypothermia.
Clinical conditions characterized by a decrease in immune defense of a congenital or acquired nature.
Chronic diseases in the acute stage.
Diabetes mellitus, obesity, hypothyroidism.
The presence of a focus of chronic infection near the palatine tonsils (carious teeth, inflamed paranasal sinuses).

Causes

Lacunar tonsillitis is caused by bacteria (staphylococcus, streptococcus) or viruses, fungi and is an infectious disease. This type of sore throat is transmitted through the air from a sick person to a healthy one. The development of the disease may also continue due to:

Hypothermia of the body.
Allergic reactions.
Chronic diseases of organs and systems.
Experiences, stress.
Lack of normal, full sleep.
Deterioration of immunity.
Poor, poor quality food.
Diseases of the ENT organs.
Advanced dental diseases.

Expert opinion

As an ENT specialist, I must note that lacunar tonsillitis is a rather dangerous disease in pediatric practice. Against the background of severe intoxication syndrome, the child’s condition is often difficult to stabilize. Convulsions at the peak of fever are especially dangerous. Children under 3 years of age must be examined by a doctor if characteristic symptoms of the disease are detected. This group of patients is prone to a sharp deterioration in health with the development of complications. Immediate medical attention is required.

Diagnosis of lacunar tonsillitis in children

Diagnosis of lacunar tonsillitis in children is carried out by an ENT doctor.
In 99% of cases, the otolaryngologist identifies the disease at the initial appointment. The specialist collects an anamnesis of the disease, assesses the general condition of the patient, and analyzes the complaints of the child and parents. A slight drop in body temperature after taking antipyretics for 3-4 hours is typical. After this, the fever returns to its previous levels. However, the key element in diagnosing lacunar tonsillitis is pharyngoscopy. An ENT doctor, using a special mirror and a light source, visually assesses the condition of the palatine tonsils and the entire oropharyngeal cavity. If characteristic white deposits are detected, the diagnosis of lacunar tonsillitis is beyond doubt.

For a comprehensive assessment of the condition of a sick child, the following diagnostic procedures are prescribed:

General and biochemical blood test. These tests are used to assess the severity of infectious inflammation.
Sowing a swab or smear from the tonsils onto a nutrient medium. The procedure allows you to accurately determine the type of causative agent of the disease and select adequate treatment.
Polymerase chain reaction (PCR) is an optional method that allows you to accurately identify the DNA or RNA of a particular pathogen, even with its minimal amount in the body.

If the child’s condition is serious and there is a suspicion of concomitant pathology, the patient is examined by related specialists (pediatrician, cardiologist, ophthalmologist).

Diagnostics

Children with suspected acute tonsillitis need to consult a therapist or pediatric otolaryngologist. At the stage of primary diagnosis, the doctor studies and analyzes complaints, conducts a visual examination of the mucous membrane of the throat, and palpates regional lymph nodes.

Characteristic signs of tonsillitis are detected when examining the pharynx - swollen, red tonsils and arches, infiltration, white plaque, and sometimes pus with an unpleasant odor. Plaque on the tonsils is easily removed with a spatula and does not leave bleeding marks.

To identify the pathogen and determine its sensitivity to antibacterial drugs, sputum culture is performed for flora. All children are prescribed a clinical blood test to determine the activity of the inflammatory process.

Reference!
An alternative to the bacteriological method is a rapid test.
The analysis is characterized by a reliable level of sensitivity and high speed of execution, which makes it possible to make a diagnosis in 15–20 minutes and begin treatment immediately. If necessary, additional instrumental studies are prescribed: ultrasound of the kidneys, radiography of the paranasal sinuses, electrocardiography of the heart. Differential diagnosis is carried out with acute respiratory infections, acute pharyngitis, and pharyngeal diphtheria.

Treatment of lacunar tonsillitis in children

Lacunar tonsillitis in children, like other tonsillitis, responds well to conservative treatment. The main thing is to contact a specialist in time. In this case, a lot depends on the time of initiation of therapy. Surgical intervention is used when complications develop with the formation of local abscesses.

Conservative treatment

Lacunar tonsillitis is a disease that develops against the background of active activity of pathogenic microorganisms. Therefore, the most rapid and complete destruction of the pathogen remains an obligatory aspect in the conservative treatment of pathology. For this purpose, ENT doctors prescribe the following groups of medications:

Antibiotics. These drugs are always prescribed for lacunar angina. The doctor starts with broad-spectrum agents. In 90% of cases, it is possible to suppress pathogenic microorganisms in this way at an early stage of treatment.
Local antiseptics containing painkillers. These medications are needed to enhance the effectiveness of antibiotics and combat pain. After irrigating the throat, it becomes easier for the child to eat and drink liquids.
Antipyretic. In combination with antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs) help quickly eliminate the source of inflammation in the oropharynx. Drug therapy is carried out against a background of bed rest, plenty of warm (not hot) drinks and the use of vitamins. They should be used to strengthen immune defense and speed up recovery.

Surgery

Surgical treatment for lacunar angina may be required when, in the absence of timely seeking help, a peritonsillar abscess forms. The ENT doctor excises the abscess, evacuates its contents and drains the tissue. At the same time, medications are prescribed to accelerate healing.

Treatment

After identifying the causative agent of a sore throat, the doctor will prescribe the patient special medications that will help kill the bacteria. The patient will also need rest and bed rest. To reduce discomfort and get rid of discomfort, doctors advise taking:

Drugs that lower body temperature and relieve fever.
Antihistamines.
Vitamin complexes to improve immunity.
Medicines to fight viruses.
Immunomodulators.

The patient should also drink warm drinks and liquids, gargle with antiseptics, and inhale when possible. Often patients are sent for a further course of treatment - physiotherapy. It quickly gives effect and includes ten treatment procedures.

Questions

Which doctor treats lacunar tonsillitis in children?
An otolaryngologist is involved in identifying and treating lacunar tonsillitis in children.
How to independently treat lacunar tonsillitis in children?
Self-medication and the use of traditional medicine in cases of lacunar tonsillitis lead to a deterioration in the child’s well-being. The disease is characterized by rapid progression. Without taking antibacterial agents and examining a doctor, it is very difficult to change anything. This is especially true for children under 3 years of age, when the general condition can change for the worse before our eyes. Therefore, it is always worth consulting with an ENT specialist first.
Does piercing help with sore throat?
Stabbing is a set of measures aimed at strengthening a person’s physical health. It should be used with caution in children. It is known that stabbing enhances the effectiveness of the body's immune defense. Therefore, it is considered a factor that reduces the risk of developing angina. However, if the disease develops, hardening is contraindicated.
Is it possible to smear the throat with iodine for lacunar tonsillitis?
Traditional alcohol solution of iodine is not suitable for the treatment of tonsillitis. It irritates the mucous membrane of the oropharynx and can even cause a local chemical burn. It is better to use Lugol's solution or other analogues of aqueous iodine solutions. Such drugs are a good addition to antibiotic therapy for lacunar angina, but cannot ensure recovery (in combination, antimicrobial drugs are required).

Is it contagious and how is it transmitted?

Because Lacunar tonsillitis is of an infectious nature in 99% of all cases (not counting unique autoimmune reactions); naturally, it is contagious. A person becomes contagious during the incubation period (1-2 days before the first symptoms appear) and remains so until complete recovery.

Methods of infection:

airborne - if you just stay near the patient for enough time;
through shared utensils;
through food (therefore you cannot finish eating or drinking anything while sick).

In particular, contact of the patient with children and people already suffering from something (for example, acute respiratory infections) is unacceptable.

Sources

Chronic tonsillitis: different views on an old problem. / G.R. Kaspranskaya, A. S. Lopatin. // Medical advice. - 2013. - No. 5-6. — P. 69-71.
Immunological aspects of chronic tonsillitis associated with Ebstein-Barr virus infection / A.S. Krasnitskaya, N.A. Borovskaya. // Fundamental research. – 2012. – No. 4-2. – pp. 299-305.
Belov, V.A. Modern methods of microbiological diagnostics for exacerbation of chronic and acute forms of tonsillitis in children. / V.A. Belov. // Issues of modern pediatrics. - 2012. - T. 11, No. 2. - P. 128-131.