Everyone knows the severe sore throat that comes with tonsillitis. With chronic tonsillitis, there are often hardly any symptoms. However, such chronic inflammation can sometimes lead to serious secondary diseases and must therefore be treated reliably.
What is chronic tonsillitis?
According to DigoPaul, the tonsils sit in the throat area. Their job is to help train the immune system. This mainly happens in the first three years of life. After that, the almonds lose their importance. Due to their position in the oral cavity, where they come into contact with food, but also with breathing air and in connection with this, possibly also with exhaust fumes or cigarette smoke, the tonsils ignite quite easily.
This is usually acute inflammation with painful symptoms. If these acute tonsillitis occur very often one after the other, about five times or more per year, or last for a very long time, over several months, it is chronic tonsillitis.
So if an acute illness occurs very often or lasts for a long time, it can take on a chronic form. In the case of chronic tonsillitis, this means that the tonsils are permanently inflamed by bacteria – more rarely by viruses.
It can happen that a previous acute tonsillitis has not been treated with antibiotics for long enough, then within a very short time there is a relapse and renewed inflammation.
Another cause may be that previous inflammation caused scarring on the tonsils. This creates furrows in which bacteria and dead cells can collect. These foci of inflammation are often noticed late, so the infection can progress and spread deep into the tissue.
Symptoms, ailments & signs
While acute tonsillitis often cause severe symptoms, with a chronic course there are initially no clear symptoms. Typically, difficulty swallowing occurs, often accompanied by bad breath and an unpleasant taste in the mouth. In addition, there is a dry mouth and occasionally dry lips, which can tear and become infected as a result.
This often goes hand in hand with a general feeling of illness, which for those affected is associated with reduced mental and physical performance. 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 throat. Externally, the inflammation can be recognized by the swollen lymph nodes in the corner of the jaw.
If the disease is not treated, serious complications can develop. The first sign of a severe course is an abscess on the tonsils. This is sensitive to pain and fills with pus, which eventually escapes and causes a bad-smelling taste in the mouth. The pus can also build up in the surrounding tissue. If the pathogens get into the bloodstream, sepsis can set in, which is expressed as a high fever.
Diagnosis & course
While acute tonsillitis are often associated with severe symptoms, the typical symptoms are rarely seen in a chronic course. Difficulty swallowing can occur, and an unpleasant taste and bad breath are often noticeable.
In addition, there is often a general feeling of illness and poor performance. For a clear diagnosis it must first be ruled out that the disease is similar to scarlet fever or glandular fever. A throat swab is helpful. In addition, pressure on chronically inflamed tonsils can cause pus to loosen or a pale, crumbly mass from dead cells. A blood test can support the diagnosis, but it does not always give a clear indication of chronic tonsillitis.
Only the entire connection of the medical history, the physical examination and the laboratory values allow a clear diagnosis. The main problem with chronic tonsillitis is the fact that it creates a constant focus of inflammation in the body. This can lead to numerous diseases. In the case of a lateral cord angina, for example, there is also inflammation in the back of the throat and, associated with this, further pain.
Another possible complication of chronic tonsillitis is an abscess. As a result, pus forms in the tissue that surrounds the tonsils. There is severe swallowing difficulty and a blocked jaw, the tonsils are badly swollen, so that the pharynx is displaced. Such an abscess may require immediate surgery to prevent breathing problems or blood poisoning. More serious possible sequelae of chronic tonsillitis can be rheumatic fever, kidney infections or myocarditis. In very rare cases, a heart valve defect can also occur to develop.
Chronically inflamed tonsils represent a permanent source of infection in the body and can therefore be the starting point for serious secondary diseases. The streptococci can spread around the body and cause rheumatic fever, inflammation of the kidneys, inflammation of the heart, or inflammation of the joints. Permanent damage to the organs can also remain, for example a heart valve defect. In addition, there can be a rapid decline in kidney function.
With chronic tonsillitis, a peritonsillar abscess can form. Pus accumulates in the surrounding tissue. It can lead to swallowing difficulties, usually one-sided, fever can rise and the mouth can be difficult or impossible to open. The pathogens can penetrate the nearby bloodstream, spread throughout the body and cause serious illness in other organs.
Chronic tonsillitis often causes slight swallowing difficulties. Those affected perceive a subjectively bad taste in the mouth, which is not improved by brushing their teeth. Other people often perceive an unpleasant bad breath. Chronic tonsillitis can cause the lymph nodes in the neck to enlarge. Slight knobs are visible below the lower jaw.
Chronic inflammation can repeatedly develop into acute relapses with the typical symptoms of acute tonsillitis. Chronic tonsillitis can lead to a general decline in performance, difficulty concentrating and drowsiness.
When should you go to the doctor?
Chronic tonsillitis is usually preceded by acute tonsillitis. The doctor should be consulted at the latest when swallowing causes pain, the body temperature is increased, the lymph nodes on the neck are swollen and the tonsils themselves are covered with pale dots.
If an acute tonsillitis caused by streptococci is not properly cured, the germs can lodge permanently in the deeply fissured tissue of the tonsils. Even if the symptoms are often not perceived as troublesome, the body is exposed to constant inflammatory processes in the throat. There is also the risk that the pathogens will spread through the bloodstream in the body and damage other organs. A doctor should therefore always be consulted if chronic tonsillitis is suspected.
This is especially true if there are repeated inflammations in the throat area, even if these are not accompanied by serious side effects. A doctor should be consulted if the throat is permanently reddened. Further indications of chronic tonsillitis are constant bad breath, enlarged lymph nodes on the neck that no longer swell, and a strongly fissured surface of the tonsils. If purulent secretion emerges when a cotton swab is pressed against the tonsils, a doctor must be consulted immediately and this fact must be pointed out.
Treatment & Therapy
In the course of therapy, the symptoms can first be alleviated. Generally, tonsillitis is treated with antibiotics, and penicillin is usually prescribed for this.
Gargling with anti-inflammatory additives such as sage or chamomile can reduce discomfort. Warm drinks and moist neck wraps also contribute to a feeling of improvement. Smoking and physical exertion should be avoided. In order to actually get rid of chronic tonsillitis, the generally recommended therapy is surgical removal of the tonsils.
This operation is usually performed under general anesthesia, followed by a stay of around a week in the clinic. The patient must be observed because of the risk of rebleeding. Spicy foods should be avoided for about two weeks after the operation, as well as exercise. Cold drinks and mild juices are recommended. Soft food can usually be consumed without problems during this time.
Outlook & forecast
Chronic tonsillitis occurs again and again. The only sensible treatment is surgical removal of the tonsils. If chronic tonsillitis is always treated symptomatically, it can lead to chronic illnesses or exacerbate them. Chronic tonsillitis often results in bronchial asthma, eye inflammation or skin diseases such as hives and psoriasis (psoriasis).
Permanently untreated tonsillitis can even lead to serious complications, such as heart muscle inflammation or endocarditis, i.e. 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 those affected is severely affected by the symptoms.
Permanently enlarged lymph nodes should also be mentioned in this context, as well as difficulty swallowing and unpleasant sore throats. In addition, there can be constant, strongly pronounced bad breath, which is also a burden for relatives.
However, if chronic tonsillitis is recognized and treated in good time, those affected can usually return to a symptom-free life. In order to improve the prognosis and avoid complications altogether, it is advisable to consult an ear, nose and throat doctor immediately if you experience the symptoms mentioned.
Chronic tonsillitis is difficult to prevent. Due to their exposed position, the tonsils are generally easy to ignite. In the case of acute inflammation, it is important to take the prescribed antibiotics for long enough to prevent relapses. If the inflammation has become chronic, surgery is considered the most suitable therapy because of the possible mild to severe secondary diseases.
Chronic diseases usually last a lifetime. The aftercare then has the task of preventing complications and making the patient’s everyday life tolerable. In the case of chronic tonsillitis, however, this procedure cannot be an option. If the symptoms are not finally treated, further consequences often arise.
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 one-time procedure. Doctors take great care in making an accurate diagnosis.
This is due to the fact that other diseases can also cause the typical symptoms. If the focus of infection is removed, these symptoms remain with non-causal triggers. In the first time after the operation, there are slight restrictions on diet and sporting activities. The attending physician will arrange for a blood test and, if necessary, a throat swab.
This enables the success of the treatment to be clearly documented. Basically, patients should rethink their lifestyle after surgery. Nicotine consumption in particular is considered to be the trigger for tonsillitis. It should be completely discontinued. General measures such as a balanced diet and protection against the cold around the neck are considered the best measures against infections.
You can do that yourself
If tonsillitis takes a chronic course, the person affected should review their lifestyle. The smoke is completely set and environments that are intensified toxins can only be entered with a respirator. Closed rooms in which people smoke or work with toxic substances are to be avoided as a matter of principle. Regular inhalation of clean, fresh air can already reduce the symptoms.
The use of products containing menthol should be avoided. The ingredients of mouthwash, toothpaste and chewing gum should be considered as they can cause inflammation in sensitive people. In addition, it is important to ensure a healthy and balanced diet with sufficient vitamins and trace elements. Food should always be chewed well and transported into the esophagus and swallowing foreign objects should be avoided. These measures do not cause any damage to the vessel walls, which are used by disease triggers to spread.
In cold environments it is necessary to wear adequate neck protection and warm clothing. As a preventive measure, foods that have a calming effect on the throat can be consumed. Throat lozenges also help calm the mucous membranes. Kissing or using the same eating utensils with sick people should be avoided so as not to transport their germs into your own organism. Your own immune system should be continuously strengthened and stabilized.