Tonsils become smaller and tougher

Introduction Small tonsils and toughness are one of the symptoms of chronic tonsillitis. Chronic tonsillitis is a chronic inflammation of the tonsils. It is caused by repeated episodes of acute tonsillitis or poor drainage of the crypts, resulting in chronic inflammatory lesions in the tonsils and their parenchyma. . It can also occur after some acute infectious diseases. Patients often have sore throat, a cold and a history of acute tonsillitis. Usually, the symptoms are less, and there may be pharyngeal discomfort, foreign body sensation, irritating cough, bad breath or slight pain. Children with tonsil hypertrophy, often have poor breathing, snoring, language vague and slow eating and other symptoms.

Cause

In chronic tonsillitis, epithelial necrosis in the crypt, bacterial and inflammatory exudate accumulate, the crypt can produce small ulcers and scar formation and poor drainage, suitable for bacterial growth and reproduction, so the infection is not easy to eliminate. Repeated acute tonsillitis, the body's resistance is reduced or the treatment is not complete, it is easier to turn chronic. The pathogenesis of this disease is still unclear, but in recent years, based on the immunological point of view, it is considered that its own allergic reaction is an important mechanism for causing chronic tonsils.

an examination

Related inspection

Body temperature measurement blood routine otolaryngology CT examination

According to the medical history, combined with the above symptoms and signs for diagnosis, rather than the size of simple tonsils, because with the increase of age, tonsils are shrinking, chronic tonsillitis is divided into three types, namely proliferative, fibrous And crypt type, so the size of the tonsils does not indicate the degree of inflammation, so it cannot be diagnosed.

According to its pathological changes, it can be divided into three types.

Proliferative type

More common in children. Metaplasia of tonsil lymphoid tissue, increased lymphoid follicles, increased connective tissue, chronic hyperemia of the tonsils, hypertrophy.

2. Fiber type

More common in adults. The tonsil lymphoid tissue shrinks, the fibrous scar tissue grows in the interstitial, the crypt is blocked, and the tonsils become smaller and tough.

3. The crypt type

The main lesions are deep in the tonsil crypt, the lymphoid follicles are chronic inflammation, and the lymphoid tissue is scarred. Because the crypt is blocked by scar tissue, the crypt is obviously enlarged, or there are a large number of shed epithelium, bacteria, lymphocytes and white blood cells to form a pus. Chronic septic tonsillitis is also known as a complication due to the severity of the disease.

[clinical manifestations]

Patients often have sore throat, a cold and a history of acute tonsillitis. Usually, the symptoms are less, and there may be pharyngeal discomfort, foreign body sensation, irritating cough, bad breath or slight pain. Children with tonsil hypertrophy, often have poor breathing, snoring, language vague and slow eating and other symptoms. Due to frequent infiltration of inflammatory secretions, stimulating bacteria in the gastrointestinal tract or crypt, toxins are absorbed to cause systemic reactions, leading to indigestion, loss of appetite, fatigue, fatigue, fatigue, weight loss, headache, low fever and other symptoms.

Check the tongue and bowel and tonsil chronic congestion, the mucous membrane is dark red. The tonsils are often inflammatory with the anterior and posterior arch; the surface is flat or flat, or lobulated. Sometimes visible linear scars, enlarged crypt openings and cheese-like plugs or submucosal yellow-white spots. Use the tongue depressor to squeeze the tonsils on the outside of the lingual arch, and the secretions may overflow from the crypt. The enlarged lymph nodes are often touched under the mandibular angle.

What tests should be done for chronic tonsillitis:

Examination showed that the tonsil was chronically congested, the surface of the tonsil was uneven, scars, and it was implicated in the surrounding tissues. Sometimes the crypts were closed, showing yellow-white dots, which were covered with a thin mucous membrane or adhesion. There may be purulent secretions or cheese-like secretions at the opening of the crypt, and secretions may overflow when squeezed. The tongue and the pharyngeal arch are congested. Mandibular lymph nodes are enlarged.

When chronic tonsillitis has caused systemic complications, the serum A, gamma globulin and mucin are abnormally increased, while the reactive protein test is mostly positive. The anti-streptolysin "O" has higher titer and more erythrocyte sedimentation rate. accelerate. By immunohistochemical examination, amino acid quantification, high serum 2 protein, is important for focal tonsillitis. Using electron microscopy and serum fluorescent antibody examination, the mass change of tonsil formation (IgG predominance) was determined in the tonsil tissue sections, and it was confirmed that this change was mainly located in the crypt-lymphatic stroma (the latter under normal conditions) Without this function, there is sufficient evidence to suggest that there are potential or active lesions in the tonsil.

Differential diagnosis

The disease should be differentiated from the following diseases.

1. Keratoosis of tonsil: hyperkeratosis of the epithelial cells of the tonsil crypt, shaped like yellow-white horns or pointed sand-like keratin, hard to touch, firm foundation, can not be wiped off, no Obvious symptoms, or anti-pharyngeal discomfort or foreign body sensation, can occur at the posterior pharyngeal wall, pharyngeal side and tongue base. The course of the disease is longer, mostly occurring in young people before the age of 30. The cause is not clear and generally does not require special treatment.

2. Tonsil tumors: One side of the tonsil is rapidly enlarged or the tonsils are swollen and ulcerated, and the possibility of tumor should be considered. Such as tonsil sarcoma, early can be confined to the tonsil mucosa, the surface is smooth, the main symptoms are one side of the tonsil rapidly increased, often cervical lymph node metastasis, more common in young people, biopsy can be diagnosed.

3. Tonsillary hypertrophy: a local manifestation of certain systemic diseases, such as when suffering from leukemia, the tonsils may be symmetrically enlarged. Sometimes pharyngeal symptoms can be their first symptoms. Diagnosis is based on peripheral blood and bone marrow.

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