Probably everyone is familiar with the severe sore throat that accompanies tonsillitis. With chronic tonsillitis, there is often little discomfort. But such a chronic inflammation can sometimes cause serious secondary diseases and must therefore be reliably treated.
What is chronic tonsillitis?
The tonsils are located in the throat area. Their job is to help form the immune system. This happens mainly during the first three years of life. After that, the tonsils become increasingly less important. Due to their location in the oral cavity, where they come into contact with food, but also with the air we breathe and, in connection with this, possibly also with exhaust fumes or cigarette smoke, the tonsils become inflamed quite easily. These are usually acute inflammations with painful symptoms. If these acute tonsillitis occur very frequently in succession, about five times or more per year, or last for a very long time, for several months, chronic tonsillitis is present.
Causes
Thus, if an acute illness occurs very often or lasts for a long time, it may take a chronic form. In chronic tonsillitis, this means that the palatine tonsils are permanently inflamed by bacteria – rarely by viruses. It can happen that a previous acute tonsillitis was not treated with antibiotics for a sufficiently long time, then within a very short time there is a relapse and inflammation occurs again. Another cause may be that previous inflammations have led to scarring on the tonsils. This causes furrows to form where bacteria and dead cells collect. These foci of inflammation are often noticed late, allowing the infection to progress and spread deeper into the tissue.
Symptoms, complaints, and signs
While acute tonsillitis often causes severe discomfort, no clear symptoms initially appear in a chronic course. Typically, difficulty swallowing presents, often accompanied by bad breath and an unpleasant taste in the mouth. In addition, there is dry mouth and occasionally dry lips, which can subsequently tear and become inflamed. This is often accompanied by a general feeling of illness, which is accompanied by reduced mental and physical performance for those affected. A characteristic sign of chronic tonsillitis is the increasing sore throat, which in the course of the disease can spread to the oral cavity or even deep into the pharynx. Externally, the inflammation can be recognized by the swollen lymph nodes in the angle of the jaw. If the disease is not treated, serious secondary diseases can develop. A first sign of a severe course is an abscess on the tonsils. This is painful and fills with pus, which eventually oozes out and causes a foul-smelling taste in the mouth. The pus may also accumulate in the surrounding tissues. If the pathogens enter the bloodstream, sepsis may develop, which is manifested by a high fever.
Diagnosis and course
While acute tonsillitis is often accompanied by severe symptoms, the typical symptoms are rarely present in a chronic course. There may be difficulty swallowing, and an unpleasant taste and bad breath are also frequently noticeable. In addition, there is often a general feeling of illness and reduced performance. For a definitive diagnosis, it must first be ruled out that the disease is similar to scarlet fever or mononucleosis. A throat swab is helpful in this regard. In addition, chronically inflamed tonsils may release pus under pressure or a light-colored, crumbly mass caused by dead cells. A blood test can support the diagnosis, but does not always give a clear indication of chronic tonsillitis. Only the entire combination of the patient’s history, physical examination, and laboratory results allow a definitive diagnosis. The main problem with chronic tonsillitis is the fact that it is a constant source of inflammation in the body. This can lead to numerous diseases. In the case of lateral gangrene, for example, there is additional inflammation in the back of the throat and further pain associated with it.Another possible complication of chronic tonsillitis is an abscess. In this case, pus forms in the tissue surrounding the tonsils. Severe difficulty swallowing and lockjaw occur, and the tonsils are severely swollen, displacing the pharyngeal uvula. Such an abscess may require immediate surgery to prevent breathing problems or blood poisoning. More serious possible sequelae of chronic tonsillitis may include rheumatic fever, kidney inflammation, or heart muscle inflammation. In very rare cases, a heart valve defect may also develop.
Complications
Chronically inflamed tonsils represent a permanent focus of infection in the body and consequently can be the starting point for serious secondary diseases. Streptococci can spread throughout the body and cause rheumatic fever, inflammation of the kidneys, inflammation of the heart, or inflammation of the joints. Permanent damage can also be left to the organs, such as a heart valve defect. In addition, there may be a rapid decline in kidney function. In chronic tonsillitis, a peritonsillar abscess may form. Pus accumulates in the surrounding tissue. There may be difficulty swallowing, usually on one side, fever may increase, and the mouth may become difficult or impossible to open. The pathogens can enter the nearby bloodstream, spread throughout the body, and cause serious illness in other organs. Chronic tonsillitis often brings mild swallowing difficulties. Those affected experience a subjectively bad taste in the mouth, which is not improved by brushing the teeth. Other people often notice an unpleasant bad breath. Chronic tonsillitis can cause enlargement of the lymph nodes in the neck. Slight lumps are visible below the lower jaw. Acute recurrences with the typical symptoms of acute tonsillitis can always develop from chronic inflammation. In association with chronic tonsillitis, there may be a general decrease in performance, difficulty concentrating, and drowsiness.
When should you see a doctor?
Chronic tonsillitis is usually preceded by acute tonsillitis. The doctor should be consulted at the latest when swallowing causes pain, body temperature is elevated, the lymph nodes in the neck are swollen, and the tonsils themselves are covered with bright spots. If acute streptococcal tonsillitis is not properly cured, the germs can become permanently lodged in the deeply fissured tissue of the tonsils. Even though the symptoms are often not perceived as troublesome, the body is exposed to constant inflammatory processes in the throat. In addition, there is a risk that the pathogens will spread through the body via the bloodstream and damage other organs. Therefore, a doctor should always be consulted if chronic tonsillitis is suspected. This is especially true if inflammation of the throat occurs repeatedly, even if it is not accompanied by severe symptoms. A doctor should be consulted even if the throat is permanently red. Other indications of chronic tonsillitis are constant bad breath, enlarged lymph nodes in the throat that no longer go down, and a very fissured surface of the tonsils. If purulent secretion escapes when a cotton swab is pressed against the tonsils, a doctor should be consulted immediately and this fact pointed out.
Treatment and therapy
In the course of therapy, the symptoms can first be alleviated. Basically, tonsillitis is treated with antibiotics, usually penicillin is prescribed for this purpose. Gargling with anti-inflammatory additives such as sage or chamomile can reduce the discomfort. Warm drinks and moist throat compresses also contribute to a feeling of improvement. Smoking and physical exertion should be avoided. However, to actually eliminate chronic tonsillitis, the generally recommended treatment is surgical removal of the tonsils. This operation is usually performed under general anesthesia, followed by a hospital stay of about one week. Because of the risk of postoperative bleeding, the patient must be observed. For a period of about two weeks after the operation, spicy foods should be avoided, as well as sports. Cold drinks and mild juices are recommended.Soft food can usually be eaten without problems during this time.
Outlook and prognosis
Chronic tonsillitis always recurs. The only reasonable treatment is surgical removal of the tonsils. If chronic tonsillitis is always treated only symptomatically, it may lead to or aggravate chronic disease. Chronic tonsillitis often leads to bronchial asthma, eye inflammation or skin diseases such as hives and psoriasis. A permanently untreated tonsillitis can even lead to serious complications, such as myocarditis or endocarditis, i.e. a life-threatening inflammation of the inner lining of the heart. Even if these complications do not occur, the prognosis for untreated or incorrectly treated chronic tonsillitis is rather poor, because the everyday life of the affected person is severely affected by the symptoms. Permanently enlarged lymph nodes should be mentioned in this context, as well as difficulty swallowing and unpleasant sore throat. In addition, there may be constant, pronounced bad breath, which is also a burden for relatives. However, if chronic tonsillitis is detected and treated in time, sufferers can usually return to a symptom-free life. Thus, in order to improve the prognosis and avoid complications altogether, it is advisable to consult an ear, nose and throat specialist immediately if the symptoms mentioned above occur.
Prevention
Chronic tonsillitis is difficult to prevent. Because of their exposed location, tonsils generally become inflamed easily. It is important to take prescribed antibiotics for a sufficiently long time if the inflammation is acute to prevent recurrences. If the inflammation has become chronic, surgery is considered the most appropriate treatment because of the potential for milder to more severe sequelae.
Follow-up care
Chronic diseases usually remain for a lifetime. Follow-up care then has the task of preventing complications and making the patient’s daily life bearable. In chronic tonsillitis, however, this procedure may not be an option. If the symptoms are not treated conclusively, it is not uncommon for further consequences to develop. For example, life-threatening myocarditis is possible. Chronic tonsillitis is treated surgically. The prospects are considered good, which is why a symptom-free life is often possible after a single operation. Doctors take great care to make an accurate diagnosis. This is due to the fact that other diseases can also cause the typical symptoms. If the focus of the infection is removed, these symptoms remain with triggers unrelated to the cause. In the initial period after the operation, slight restrictions apply to diet and sporting activities. The attending physician arranges for a blood test and, if necessary, orders a throat swab. This can clearly document the success of the treatment. In principle, patients should reconsider their lifestyle after an operation. Nicotine consumption in particular is considered to be a trigger for tonsillitis. It should be completely stopped. General measures such as a balanced diet and cold protection around the neck are considered the best measures against infections.
What you can do yourself
If tonsillitis takes a chronic course, the affected person should review his lifestyle. Smoking should be completely stopped, and environments where toxins are increased should be entered only with respiratory protection. Enclosed spaces where people smoke or work with toxins are to be avoided as a matter of principle. Regular breathing of clean and fresh air can already reduce the symptoms. The use of products containing menthol should be avoided. Attention should be paid to the ingredients of mouthwash, toothpaste and chewing gum, as they can trigger inflammation in sensitive people. In addition, attention should be paid to a healthy and balanced diet with sufficient vitamins and trace elements. Food should always be transported to the esophagus well chewed and swallowing foreign bodies should be avoided. These measures will not cause damage to the vessel walls, which are used by disease triggers to spread. In cold environments, wearing adequate neck protection and warm clothing is necessary.As a preventive measure, foods with a soothing effect on the throat can be consumed. Sore throat sweets help to soothe the mucous membranes. Kissing or using the same eating utensils with sick people should be avoided in order not to transport their germs into your own organism. One’s immune system should be continuously strengthened and stabilized.
