Tonsillitis at children - the infectious and allergic process proceeding with primary defeat of lymphoid fabric of almonds and their permanent inflammatory reaction. In the sharp period pain during the swallowing and yawning is noted, the febrilny temperature, intoxication; out of an exacerbation of tonsillitis at children the symptomatology poor, pays attention a hypertrophy of almonds, purulent traffic jams in lacunas, increase in submaxillary lymph nodes. Diagnosis of tonsillitis at children is carried out by the otolaryngologist by means of a faringoskopiya, capture of material from a pharynx on . Treatment of tonsillitis at children includes local therapy (washing of almonds, rinsing of a throat, inhalation), antibiotic treatment at aggravations; according to indications – surgical tactics.
Tonsillitis at children
Tonsillitis at children – the upper respiratory tract infection which is followed by an inflammation of lymphoid formations of a pharyngeal ring (is more often - palatal, is more rare – lingual or pharyngeal almonds). For designation of sharp tonsillitis the term "quinsy" is usually used; often repeating inflammations of almonds at children lead to development of chronic tonsillitis. Further, speaking about tonsillitis at children, we will mean a chronic form of an infection. Features of a course of quinsy at children are stated in the relevant article of "Children's diseases".
Incidence of tonsillitis among children aged up to 3 years makes 2–3%, and by 12 years increases to 12–15%. Not less than a half of often ill children has tonsillitis. At the same time, the tonsillitis problem at children is beyond far children's otolaryngology. The frequent infectious and allergic attacks to an organism of the child are fraught with development of a number of heavy complications: paratonzillyarny and zaglotochny abscesses, tonzilogenny sepsis, arthritises, rheumatism, the acquired heart diseases, vaskulit, a glomerulonefrit, etc. Therefore the tonsillitis problem in pediatrics is cross-disciplinary and demands involvement of experts from the field of children's rheumatology, cardiology, urology.
The tonsillitis reasons at children
Among the microbic flora participating in development of tonsillitis in children, streptococci (a beta and hemolytic streptococcus of group A, the green streptococcus), staphylococcus, a hemophilic stick, a pneumococcus, and also various microbic associations have paramount value. Frequency of allocation of a hemolytic streptococcus at tonsillitis makes of a pharynx from 30% to 60-80% of cases, and the raised caption of anti-streptococcal antibodies (antistreptolizina-0) is found by 4 times more often than at healthy at children. Causative agents of adenoviral and enteroviral infections occur among other representatives of pathogenic flora at children with tonsillitis; viruses of paraflu, flu and herpes, mushrooms, intracellular and membrane parasites (hlamidiya, mycoplasmas). Against the background of morphological reorganization of lymphoid fabric and a disbioz of the top airways process of self-cleaning of lacunas of almonds is broken that promotes reproduction of pathogens and development of a chronic inflammation.
In most cases precedes the beginning of a chronic course of tonsillitis at children once or repeatedly postponed quinsy. Activization of opportunistic flora and increase of its virulence in almonds happens under the influence of overcooling, viral and other diseases. Getting into a parenchyma of almonds, blood and lymphatic vessels, activators begin to develop ekzo-and zndotoksina, initiating development of toksiko-allergic reactions. Against the background of violation of local blood circulation, increase in permeability of a vascular wall, a local immunosuppression the next exacerbation of tonsillitis at children develops. Owing to a recidivous inflammation the parenchyma of almonds is exposed to a giperplaziya, sometimes – to an atrophy, a sklerozirovaniye, scarring.
In certain cases at children the bezanginny form of tonsillitis which gradually develops behind a mask of a SARS, adenoidit, sinusitis, stomatitises, caries, periodontosis is observed, i.e. involvement of palatal almonds in infectious and inflammatory process happens again.
Developing of tonsillitis at children is promoted by anatomo-topographical features of the lymphoid device of a throat: the narrow and deep lacunas of almonds, the multiple slit-like courses, solderings complicating depletion of lacunas. At tonsillitis at children palatal almonds do not perform the barrier function, and, on the contrary, become the constant chronic center of an infection and a factor of the general sensitization of an organism.
Tonsillitis children with the burdened accompanying background have more often: the perinatal pathology, food allergy, rickets, limfatiko-hypoplastic diathesis, violation of nasal breath, hypovitaminosis, intestinal infections and other factors reducing protective forces of an organism.
Classification of tonsillitis at children
On the clinical current children can have a compensated tonsillitis and dekompensirovanny. Existence of local signs of a chronic inflammation is characteristic of the compensated form (hyperaemia, puffiness, infiltration, a giperplaziya of handles; unions of handles with almonds; increases and morbidities of regionarny lymph nodes). At a dekompensirovanny form of tonsillitis at children, except local signs, tonzillokardialny, tonzillorenalny and other complications develop.
Depending on localization of an infection distinguish lacunary, parenchymatous (follicular) and lacunary and parenchymatous (mixed, total) tonsillitis at children. At lacunary tonsillitis inflammatory changes are localized in crypts: they are expanded, filled with pus and kazeozny masses; an epithelium of lacunas friable, thinned, places . At follicular tonsillitis at children in a parenchyma of almonds the located abscesses small podepitelialno reminding prosyany grains will be organized. At total defeat of lymphoid fabric of an almond take a form of the sponge filled with pus, kazeozy, detrity, the microbic masses allocating endo-and ekzotoksina.
Taking into account the patomorfologichesky changes happening in lymphoid fabric distinguish the hypertrophic tonsillitis at children which is characterized by increase in volume of almonds and atrophic tonsillitis at which limfadenoidny fabric is replaced connecting, fibrous that leads to wrinkling of almonds.
Tonsillitis symptoms at children
Out of an exacerbation of tonsillitis of the child moderate sore throat, an unpleasant smell from a mouth, persuasive dry cough disturb, subfebrilitt, perspiration, weakness and bystry fatigue. At some children of display of tonsillitis are limited to a pricking, burning in the field of almonds, dryness and feeling of a foreign matter in a throat. At strong fits of coughing from lacunas in an oral cavity the kazeozny masses having a putrefactive smell can be allocated. At a dekompensirovanny form of tonsillitis children, along with the listed signs, have artralgiya in luchezapyastny and knee joints, short wind, pains in heart.
Exacerbations of chronic tonsillitis at children usually happen 2-3 times a year and proceed in the form of pronounced quinsy. At the same time there is severe pain in a throat (especially during the swallowing, a zevaniye), the febrilny body temperature, oznoba, a headache, increase and morbidity of lymph nodes, refusal of food. Quite often at tonsillitis children have belly-aches, nausea, vomiting, spasms.
Such terrible complications as paratonzillyarny and zaglotochny abscess, tonzilogenny sepsis which can cause death of the child are accompanied by the recidivous course of tonsillitis at children. As heavy system complications with invalidiziruyushchy consequences autoimmune processes (rheumatism, polyarthritis, hemorrhagic vaskulit, glomerulonefrit), heart diseases (the acquired heart diseases, an infectious endocarditis, myocarditis, a miokardiodistrofiya), diseases of bronchopulmonary system (recurrent pneumonia, a bronkhoektatichesky disease), , etc. act. A number of skin diseases can be connected with tonsillitis at children: eczema, psoriasis, polymorphic ekssudativny eritema.
Diagnosis of tonsillitis at children
Diagnosis of chronic tonsillitis is preceded by collecting the anamnesis, survey of the child by the pediatrician and children's otolaryngologist, tool and laboratory inspection. When carrying out a faringoskopiya inflammatory changes of palatal handles are found; the friable increased almonds filled with purulent contents (in the form of traffic jams, liquid, kazeozny). By means of the pugovchaty probe depth of lacunas, existence of unions and solderings are defined. At a palpation of cervical lymph nodes regionarny lymphadenitis comes to light.
At a stage of laboratory inspection clinical blood test and urine, material from a pharynx on flora, definition of S-jet protein and ASL-O is made. At a dekompensirovanny form of chronic tonsillitis children have to be consulted by the children's rheumatologist, the cardiologist, the nephrologist.
Survey of the child by the children's stomatologist is necessary for an exception of other centers of an infection in an oral cavity. Tonsillitis demands differential diagnostics with chronic pharyngitis, tuberculosis of almonds from children. From additional researches carrying out the ECG, EhoKG, ultrasonography of kidneys, a X-ray analysis of additional bosoms of a nose, crops of blood on sterility, tuberkulinovy tests can be required.
Treatment of tonsillitis at children
At an exacerbation of chronic tonsillitis to the child the bed rest, the sparing diet, medicamentous therapy is appointed: antibiotics taking into account sensitivity of microflora (aminopenicillin, tsefalosporina, macroleads) desensibilizing medicines, vitamins, immunomodulators.
Local therapy includes washing of lacunas of palatal almonds antiseptics (solutions of a yodinol, hlorgeksidin, hlorofillipt), processing of almonds and a back wall of a throat solutions of Lugol, a fukortsin; regular rinsings by antiseptic solutions and broths of herbs; inhalations, dispersion of antiseptic aerosols and a rassasyvaniye of tablets with antimicrobic action. Among physical methods of treatment of tonsillitis at children the greatest distribution was gained microwave therapy, , Ural federal district, UVCh, laser therapy. Treatment of tonsillitis at children can be carried out with participation of the homeopath.
At frequent repeated quinsies, and also a dekompensirovanny form of tonsillitis at children the issue of carrying out a tonzilektomiya is resolved. As alternative (bloodless) methods of treatment of tonsillitis at children serve the laser lakunotomiya, cryotherapy. At the organization of paratonzillyarny abscess its opening is made.
The prevention of exacerbations of tonsillitis at children requires performing the antirecurrent treatment including vitamin therapy, reception of immunomodulators, the hyposensibilizing medicines, sanatorium treatment in the conditions of sea climate.
The forecast and prevention of tonsillitis at children
As criterion of an izlechennost of tonsillitis at children serves lack of aggravations within 5 years after 2 years of treatment. When carrying out a full complex of preventive and antirecurrent actions it is possible to lower as much as possible number of aggravations and to avoid emergence of complications. At frequent quinsies and development of metatonzillyarny diseases the forecast less favorable.
As measures of prevention of tonsillitis at children serve the hardening, immunity strengthening, carrying out sanitation of an oral cavity, an exception of overcoolings and contacts with infectious patients. Children with chronic tonsillitis have to be under observation of the otolaryngologist and receive antirecurrent treatment during the mezhanginozny period.