Yellow coating on the tongue: reasons, what to do?

ENT Clinic No. 1 provides professional treatment for sore throats in children and adults

Author:

• Khirnetkina Ayuna Fedorovna

  otorhinolaryngologist, otoneurologist, audiologist

5.00 (Votes: 1)

Sore throat is a general infectious disease with local manifestations of acute inflammation of the palatine tonsils (“tonsils”) and pharyngeal tonsil (“adenoids”).

The palatine tonsils are located on the sides of the entrance to the pharynx, on the sides of the root of the tongue. In the vast majority of cases, tonsillitis of the palatine tonsils and pharyngeal tonsils (in children) occurs, while other tonsils are involved in the inflammatory process much less frequently. Therefore, in medical practice, it is customary to use the term “angina” to mean tonsillitis of the palatine tonsils. Angina is not a homogeneous disease; it differs in etiology (causal factor), nature and form of the disease.

Causes

In 70-80% of cases, the causative agent is group A β-hemolytic streptococcus (GABHS). In addition, the pathogens can be other types of streptococci, staphylococci, influenza bacillus, Klebsiella, mycoplasma, chlamydia, etc. Sources of infection are patients and carriers of pathogenic microbes. Most often, infection occurs through airborne droplets (through the air) or nutritional routes (through hygiene items, dishes, etc.). There is a seasonality of sore throats - outbreaks of morbidity occur in the winter-spring period. Sore throat most often occurs within 1-2 days from the moment of infection.

In the development of tonsillitis, a certain role may be played by the body’s reduced adaptive ability to cold, sharp seasonal fluctuations in environmental conditions (temperature, humidity, nutrition, intake of vitamins, etc.), trauma to the tonsils, constitutional predisposition to tonsillitis, the state of the central and autonomic nervous system . Factors predisposing to angina are chronic inflammatory processes in the mouth, nose and paranasal sinuses.

Angina

Angina

Sore throat is an infectious disease that develops acutely and begins with inflammation of the palatine tonsils (most often), as well as the lingual, laryngeal and nasopharyngeal tonsils. Then, due to intoxication, general symptoms of the disease develop and a high body temperature (38-41 C) occurs. Prevalence of the disease
Sore throat most often affects children of preschool and school age and adults under 35-40 years of age, especially in the autumn and spring periods.

Etiopathogenesis (why and how tonsillitis occurs)

Initially, against the background of hypothermia, infection (contamination) of the tonsils occurs with various microorganisms (staphylococcus, streptococcus, pneumococcus). Infection can be from one’s own microbes (caries, chronic tonsillitis) or from outside (airborne and foodborne routes). Multiplying microbes release toxins that enter the blood and cause intoxication (weakness, loss of appetite, high fever).

Symptoms of a sore throat

Main symptoms: headache, sore throat, joint pain, chills, weakness. The temperature during a sore throat reaches 38.5-40 degrees during the day. After 1-2 days, small white lesions (necrotic follicles) appear on the surface of the tonsils. This is follicular tonsillitis. The appearance of grayish-white purulent contents in the lacunae (folds of the tonsils) is a symptom of lacunar tonsillitis. Changes in the tonsils can be necrotic in nature - this is a purulent-necrotic form of tonsillitis.

Diagnosis of the disease

Diagnosis of angina is not difficult; the main diagnostic technique for recognizing it is examination of the pharynx - pharyngoscopy, as well as assessment of complaints and medical history. It is necessary to make a differential diagnosis of lacunar tonsillitis and diphtheria of the pharynx, as well as catarrhal tonsillitis and acute pharyngitis. To clarify the diagnosis, swabs from the throat and nose for diphtheria and laboratory tests for hemolytic staphylococcus are used. During the course of the disease, it is necessary to monitor peripheral blood counts.

Treatment of sore throat

At the onset of the disease, it is necessary to observe bed rest (to reduce the possibility of developing complications - from the heart, kidneys, joints). Spicy, rough foods are excluded from the diet. It is recommended to drink plenty of warm drinks (milk with honey, tea with lemon), broth, liquid porridge, jelly (all from a separate container). Drug therapy involves the use of antibacterial drugs (selected on the basis of culture, or broad-spectrum antibiotics) and anti-inflammatory drugs, desensitizing drugs. A treatment regimen can only be prescribed by an experienced doctor after an examination. Self-medication can lead to undesirable outcomes. In the case of the development of phlegmonous tonsillitis, the first step is opening the abscess.

Concomitant therapy:

rinsing: various antibacterial solutions are used for rinsing. As antiseptics, use a 1% solution of iodinol for rinsing the throat, a 3% solution of hydrogen peroxide, a 0.1% solution of potassium permanganate, a 2-4% solution of boric acid, a solution of bicarmine, 0.05-0 ,1% solution of rivanol, calendula tincture, aqueous solution of chlorhexidine and dioxidine; inhalations: for inhalation use decoctions of the following herbs - chamomile, eucalyptus, marigold flowers, Siberian elderberry, caragona mane (camel's tail), blueberry, etc.; compresses: it is recommended to use compresses locally, especially with enlarged regional lymph nodes. Apply a mixture of alcohol (100 ml), menthol (2.5 g), novocaine (1.5 g), anesthesin - menovazin (1.5 g) to the front of the neck, wrapping the neck with a scarf or scarf.

Prevention of sore throat

General and local hardening of the body is important: systematic physical education and sports, morning hygienic exercises, air baths, rubdowns and showers with gradually decreasing water temperature. In order to increase the resistance of the pharyngeal mucosa to cooling, local hardening is carried out - gargling with water of a gradually decreasing temperature (from warm to cold). It is necessary to remember the basic rules of hardening: gradualism, systematicity and taking into account individual characteristics. General UV irradiation contributes to increasing the protective properties of the body, especially in the autumn-winter period. Treatment of concomitant diseases of the oral cavity and nose. Carious teeth, sore gums, purulent lesions of the paranasal sinuses predispose to the development of sore throat. Various pathological conditions of the nasal cavity and nasopharynx that interfere with nasal breathing (deviated nasal septum, polyps, adenoids, hypertrophic rhinitis, etc.) force the patient to breathe through the mouth, and at the same time the mucous membrane of the oropharynx cools and dries out. Treatment of sore throats must begin as early as possible after diagnosis. In this case, it is possible to shorten the recovery time and reduce the likelihood of complications.

Doctors of OJSC CDC Euromedservice are ready to help you in the diagnosis and treatment of sore throats. It should also be noted that during the febrile period of sore throat it is necessary to observe bed rest. In this case, it is preferable to invite a doctor to your home rather than attend an outpatient appointment.

Classification of sore throats in children and adults

1. primary: catarrhal, lacunar, follicular, ulcerative-necrotic.
2. secondary:

• for acute infectious diseases - diphtheria, scarlet fever, tularemia, typhoid fever, infectious mononucleosis.
• for diseases of the blood system - agranulocytosis, nutritional-toxic aleukia, leukemia.

Catarrhal sore throat

Catarrhal tonsillitis manifests itself predominantly as a superficial lesion of the palatine tonsils. The duration of the incubation period can vary greatly: from several hours to 4 days.

Symptoms of catarrhal tonsillitis:

• Catarrhal tonsillitis is characterized by an acute, abrupt onset.
• There is a sore and dry throat.
• General malaise, headache, pain in joints and muscles.
• Temperature increase.

Body temperature is usually up to 38.0; There are small, inflammatory changes in the peripheral blood. Upon examination, diffuse hyperemia of the tonsils and the edges of the palatine arches is determined; the tonsils are somewhat swollen, in places they may be covered with a thin film of mucopurulent secretion. The tongue is dry, coated. There is often a slight enlargement of regional lymph nodes. In childhood, clinical phenomena are most often more pronounced than in adults. Usually the illness lasts 3–5 days.

Follicular tonsillitis - deeper inflammation of the tonsil tissue

Symptoms:

• begins with sudden chills with an increase in body temperature to 40°C,
• severe sore throat
• symptoms of intoxication are pronounced - severe general weakness, headache, pain in the heart, joints and muscles.

On examination, the palatine tonsils are clearly red and swollen, with pinpoint whitish-yellowish formations visible on the surface. The surface of the tonsil takes on the appearance of a “starry sky”. Peripheral lymph nodes are clearly visible.

Lacunar tonsillitis

Lacunar tonsillitis is characterized by even deeper damage to the tissue of the tonsils, the formation of plaque on their surface.

Symptoms:

• A sharp rise in body temperature to 39-40 degrees.
• A sore throat.
• Pain in the heart and joints.
• Headache.
• Increased salivation.
• Children often vomit.

The onset of the disease and its general symptoms are the same as with follicular tonsillitis. More often, lacunar tonsillitis is more severe than follicular tonsillitis. The clinical picture of lacunar angina is characterized by more pronounced redness of the tonsils, an increase in their size and the formation of islands of yellowish-white plaque covering the tonsils. Sometimes individual areas of plaque merge and cover a larger or smaller part of the tonsil, without going beyond its limits.

Body temperature usually remains subfebrile until the inflammatory reaction in the regional lymph nodes subsides. The duration of the disease is 5–8 days; in case of complications, it can drag on for a longer period.

Ulcerative membranous tonsillitis

The causative agents of this disease are fusiform bacillus and oral spirochete (they are conditionally pathogenic flora of the oral cavity).

Factors determining the development of the disease are immunodeficiency states, caries, hypovitaminosis, cachexia, chronic intoxication.

Symptoms:

• moderate unilateral sore throat.
• the temperature reaction is weakly expressed.
• There are no signs of intoxication.
• enlargement of the submandibular lymph nodes on the affected side.
• bad breath.

Upon examination: on one of the tonsils there is an ulcer covered with a gray-yellow coating, after removing which the clear edges of the ulcer are determined, its bottom is gray. Ulcerations can spread beyond the tonsils to the soft palate, oral mucosa, posterior wall of the pharynx, vestibular part of the larynx, and rarely can spread to the periosteum.

The duration of the disease is 7-12 days. The prognosis is favorable.

Particularly dangerous: which sore throat will alert the therapist

Acute tonsillitis, which patients usually call simply sore throat, is an ENT pathology - that is, the area of ​​application of the professional efforts of an otolaryngologist. However, some types of tonsillitis are also of great interest to therapists.

Unpleasant variety

Tonsillitis is an infectious inflammation of the tonsils, special formations consisting primarily of lymphoid tissue and playing an important role in the functioning of the immune system. There are several tonsils (pharyngeal, palatine, lingual, tubal), but they are all located in the nasopharynx. Most often the palate becomes inflamed; this condition is usually called sore throat.

Depending on the stage of inflammation, sore throats can be catarrhal, purulent and phlegmonous. Based on the type of reaction of the lymphoid tissue, follicular and lacunar tonsillitis are distinguished. There are also specific sore throats, that is, those caused by a specific pathogenic microorganism: diphtheritic, syphilitic, tuberculous. But all this, at least at the stage of initial treatment, is the lot of the ENT doctor. Why does the therapist so often ask: “Have you had a sore throat recently?”

Fatal resemblance

One of the common causative agents of acute tonsillitis is β-hemolytic streptococcus of group A. Sore throat caused by this streptococcus, in general, usually goes away - for some it is easier, for others it is more severe, but in general everyone recovers as “established” deadlines. And after a while, some people who have recovered from the disease experience problems that, at first glance, have no connection with the throat. For example, joints begin to ache and swell. And not like with an injury - whichever joint is damaged is the one that hurts - but today one, tomorrow another, the day after tomorrow two at the same time, but again new ones (and the first two have passed).

...Or, for example, 1-3 weeks after a sore throat, a recovered person suddenly develops blood in the urine, weakness and lower back pain. This happens more often to children, especially boys, but can also happen to adults. And again the local doctor will ask the frightened patient: didn’t you have a sore throat a couple of weeks ago?

Read also: Sore throat: main complications

The point is the reaction of our immune system to the same causative agent of sore throat. This streptococcus produces a number of proteins that are very similar in structure to some proteins in the human body - those found in the glomeruli of the kidney, in the heart muscle and in joint tissues. Therefore, antibodies produced by the body against a pathogenic bacterium, after some time, affect the patient’s body. Damage to the kidneys is called post-streptococcal glomerulonephritis, damage to the heart and joints (they often “come together”) is called rheumatism. Rheumatism in its outcome can lead to the formation of severe heart defects affecting several valves at once.

Alert

Another angina that will be of interest to the therapist is the so-called Vincent-Simanovsky angina, or ulcerative-necrotic. True, the doctor will no longer ask about it in the past tense - most likely, the patient himself will come with a complaint about a constantly sore throat and non-healing ulcers on the tonsils. And the therapist, having examined the patient, will send him not only to an ENT specialist, but also to the laboratory to do a general blood test and tests for HIV infection.

Vincent-Simanovsky angina is caused by saprophytic microflora - fusiform bacillus and buccal spirochete, which usually live in the oral cavity of healthy people without causing any harm. The fact that these usually non-aggressive microbes suddenly become pathogenic indicates a severe imbalance in the immune system. The cause may be immunodeficiency - one of the primary ones or infection with the human immunodeficiency virus.

Another option for a sudden weakening of the immune system is hemoblastosis, i.e., cancer of the blood. The avalanche-like proliferation of pathological blood cells displaces its other useful elements - in particular, lymphocytes responsible for the formation of immunity.

***

Sore throat can be an insidious disease, so it is advisable to consult a doctor with any discomfort in the tonsil area. If the doctor has prescribed a course of antibiotics, it must be completed in full, and additional examinations should not be ignored, no matter how illogical they may seem to you. Do not allow complications to develop - and be healthy.

Lidiya Kulikova

Photo depositphotos.com

Complications of tonsillitis

Patients with tonsillitis may experience local complications: paratonsillitis and paratonsillar abscess, sinusitis, otitis media, etc.

Peritonsillitis and peritonsillar abscess have similar symptoms, which include high fever, a predominance of unilateral sore throat, sharply worsening when swallowing; increased salivation, difficulty and pain in opening the mouth, unilateral swelling, hyperemia of the soft palate, swelling of the palatine arch on the affected side, as well as displacement to the center of the affected tonsil and asymmetry of the uvula.

This complication requires surgical treatment - opening the abscess, often in a hospital setting.

After a sore throat, diseases of other organs and systems may occur: rheumatism, infectious-allergic myocarditis and polyarthritis, cholecystocholangitis.

With timely and rational treatment of sore throat, complications can be avoided.

Diagnosis of tonsillitis:

1. collection of complaints, medical history and life history
2. clinical examination of the patient
3. endoscopy of ENT organs
4. general blood and urine test
5. bacteriological examination

   isolating pathogen culture from smears

   from the surface of the tonsils and/or the posterior wall of the pharynx)

6. rapid determination of streptococcal

   antigen using test strips from the surface of the tonsils

After a sore throat, taking into account the risk of complications, the following studies are indicated:

1. control blood and urine test
2. rheumatoid tests (C-reactive protein, ASLO, rheumatoid factor)
3. ECG
4. consultations with specialists (according to indications): infectious disease specialist, therapist, cardio-rheumatologist, etc.