Subdivision

In general, acute, chronic, recurrent, unilateral and bilateral forms of angina tonsillaris can be distinguished. The simplest form of angina tonsillaris is redness and swelling of the palatal tonsils (catarrhal tonsillitis). Typical, however, is the deposit of fibrin as a whitish coating in the depressions of the tonsils, which are called “stippling” (follicular tonsillitis).

If the patient opens his mouth in this case, the swollen, reddened palatal tonsils (Tonsillae palatinae) with whitish deposits and small mucosal defects become visible. If the coating is particularly pronounced and converges to form a large area, this is known as confluent or lacunar tonsillitis. If the tissue is already dead, one speaks of necrotising tonsillitis.

Symptoms

Angina tonsillaris usually begins with a severe sore throat and can extend to difficulty swallowing, accompanied by high fever, headaches and fatigue. The pain often extends to the ear and spreads via swollen, sometimes painful, jaw lymph nodes. Due to the often enormous swelling in the throat, the patient’s speech sounds clumsy. The inflammatory secretion from the palatine tonsils causes a bitter aftertaste when it drains into the throat while eating and drinking. In the course of the sore throat, bad breath often occurs, which is perceived as unpleasant by the patient and fellow human beings.

Diagnosis

If the view into the pharynx shows strongly reddened adenoids with whitish coatings, angina tonsillaris can be assumed after exclusion of the differential diagnosis. This suspicion can be substantiated by the streptococcal rapid test. For this purpose, a throat swab is taken and smeared on a window of the test.

If the test is positive, an antibiotic is prescribed. If the test is negative, a bacterial culture of a throat swab can be taken in case of doubt. However, the results can only be expected after days, which means that this detection method has lost its value. A blood sample to show different inflammation values (BSG and CRP) or to exclude other diseases can be helpful in some cases. Antibodies in the blood can only be expected after weeks, which means that testing for antibodies only makes sense in special cases.

Therapy

At the beginning of the illness or accompanying drug treatment, chamomile tea, envelopes with essential oils or healing earth can provide relief. Fresh ginger with honey and lemon as a hot drink or sage tea and saltwater for gargling help to heal and reduce the pain. In acute bacterial angina tonsillaris, penicillin is usually prescribed for 7-14 days.

Alternatively, other antibiotics are available to choose from in case of existing allergies or other contraindications. If pain or fever persists, appropriate medication such as paracetamol or ibuprofen can be taken after consultation with a doctor. Iodine-containing pharyngeal irrigations for gargling and mucous membrane anaesthetics can be used concomitantly.

In the case of chronic tonsillar angina, an antibiotic therapy trial can be started first. The last therapeutic option is tonsillectomy. Typically, the triggers of acute angina tonsillaris are bacteria, mostly streptococci (Streptococcus pyogenes).

Only very rarely are viruses found as the causative agent of classic acute angina tonsillaris. Since the pathogens are bacteria, a purulent bacterial acute angina tonsillaris should always be treated with an antibiotic. Of course, this should not be taken or prescribed carelessly or lightly, which is why a doctor must examine the mouth and throat area and make his or her decision.

In most cases the proven Penicillin V is prescribed for 7 days. In case of penicillin intolerance there are of course other alternatives. For the treatment of acute angina tonsillaris, a number of well-proven home remedies are available in addition to conventional drug therapy: For example, a throat rinse or gargling with a disinfectant solution (e.g. sage, chamomile, ginger, each infused as tea and kept cool) often provides relief and makes swallowing easier.

Cold neck compresses also counteract the inflammation in the throat and can thus relieve the pain. In general, everything that works well against pain and fever is recommended; these can be cold cloths lying on the forehead, but also calf compresses, herbal teas and of course lots of rest. Many patients find chamomile tea especially pleasant for acute angina tonsillaris.

Drinking a lot is beneficial to recovery. However, if possible, fruit juices should not be chosen, as the acid contained in them irritates the throat area even more. Cold drinks or normal ice cream alleviate swallowing difficulties.

Food should be soft and only slightly spiced or not at all. It is also better to give up smoking for a while. The homeopathic approach is based on the assumption that acute angia tonsillaris is merely a symptom of a more profound disease and that it must therefore be treated as a direct cause.

For sore throats, preparations such as Aconitum napellus or also Belladonna or Mercurius corrosivus are recommended. However, there are many other alternatives in homeopathy. At the latest at the time pus appears in the throat, one should urgently consult a doctor!

Bacterial angina tonsillaris in particular should not be underestimated and must be treated with an antibiotic, which only a doctor can prescribe. A wrong diagnosis or a pure self-treatment can even impede the healing process! However, there is nothing wrong with using homeopathy to support the antibiotics at the patient’s request.