Treatment of chronic tonsillitis: a personalized approach to prevent metatonsillar complications

V.A. Belov, E.P. Karpova, A.I. Asmanov, O.I. Belova, D.A. Tulupov, O.G. Naumov

1) Veltischev Research Clinical Institute of Pediatrics and Pediatric Surgery, Pirogov Russian National Research Medical University, Moscow, Russia; 2) Russian Medical Academy of Continuous Professional Education, Moscow, Russia; 3) Filatov Children’s City Clinical Hospital No. 13, Moscow, Russia

Modern science has the latest theoretical data on the function and structure of the tonsillar apparatus, which are able to detail the issues of the occurrence and development of chronic tonsillitis (CT) taking into account the rich and diverse material accumulated by modern clinics. CT caused by BHSA-infection has the most unfavorable course, accompanied by frequent relapses of acute tonsillitis and the development of severe complications (peritonsillar abscess, purulent lymphadenitis, etc.) from the first days, as well as diseases associated with CT (glomerulonephritis, rheumatic fever, etc.). An important role in the occurrence of CT belongs to the interaction of microorganisms located in the crypts of the palatine tonsils with the macroorganism. Given the increased activity of the tonsils in childhood and their impact on the normal development of the immune system, approaches to surgical treatment should be very thoughtful and balanced. One of the urgent problems of otolaryngology remains the search for pathogenetically substantiated, effective and safe methods of treating CT. The emergence of new strains of antibiotic-resistant microorganisms is a serious clinical problem that is associated with a more severe course of diseases. Exacerbation of CT and sore throat remains a common reason for the unjustified prescription of systemic antibacterial therapy. In most cases, with the exception of streptococcal tonsillitis, antibiotics can be considered excessive treatment, since they are a completely inappropriate solution for the treatment of viral infections. In conservative therapy, agents that can, on the one hand, restrain the inflammatory reaction, and on the other, are able to modulate the immune response are of great interest. The article highlights the possibilities of modern herbal medicine in the conservative treatment of CT, promoting a balanced and scientifically substantiated personalized approach in the interests of the patient. The presented herbal remedies are included in clinical guidelines, their use is pathogenetically substantiated. 

For citations: Belov V.A., Karpova E.P., Asmanov A.I., Belova O.I., Tulupov D.A., Naumov O.G. Treatment of chronic tonsillitis: a personalized approach to prevent metatonsillar complications. Farmateka. 2025;32(1 suppl. 1):88-95. (In Russ.). DOI: https://dx.doi.org/10.18565/pharmateca.2025.1-s1.88-95

Authors’ contribution: All authors made an equivalent contribution to the preparation of the publication.
Conflicts of interest: The authors confirm that they have no conflicts of interest to declare.
Funding: The study was conducted without any sponsorship.

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About the Authors

Vladimir A. Belov, Cand. Sci. (Med.), Teaching Assistant, Department of Pediatric Otolaryngology named after prof. B.V. Shevrygin, Russian Medical Academy of Continuous Professional Education; Head of the Otolaryngology Department, Veltischev Research Institute of Pediatrics and Pediatric Surgery, Pirogov Russian National Research Medical University, Moscow, Russia; ORCID: https://orcid.org/0000-0002-2955-2015
Elena P. Karpova, Dr. Sci. (Med.), Professor, Head of the Department of Pediatric Otolaryngology named after prof. B.V. Shevrygin, Russian Medical Academy of Continuous Professional Education, Moscow, Russia; ORCID: https://orcid.org/0000-0002-8292-9635
Alan I. Asmanov, Cand. Sci. (Med.), Head of the Department of Acute and Chronic Pathology of the Ear, Throat and Nose, Veltischev Research Institute of Pediatrics and Pediatric Surgery; Assistant Professor, Department of Otolaryngology, Faculty of Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia; ORCID: https://orcid.org/0000-0002-3116-6447
Olga I. Belova, Cand. Sci. (Med.), Pulmonologist, Consultative and Diagnostic Department, Veltischev Research Institute of Pediatrics and Pediatric Surgery, Pirogov Russian National Research Medical University, Moscow, Russia Pirogov, Moscow, ORCID: https://orcid.org/0009-0003-2893-1413
Denis A. Tulupov, Cand. Sci. (Med.), Associate Professor, Department of Pediatric Otolaryngology named after prof. B.V. Shevrygin, Russian Medical Academy of Continuous Professional Education; Otolaryngologist, Department of Otolaryngology, Filatov Children’s City Clinical Hospital No. 13, Moscow, Russia; ORCID: https://orcid.org/0000-0001-6096-2082
Oleg G. Naumov, Cand. Sci. (Med.), Associate Professor, Department of Pediatric Otolaryngology named after prof. B.V. Shevrygin, Russian Medical Academy of Continuous Professional Education; Otolaryngologist, Otolaryngology Department, Filatov Children’s City Clinical Hospital No. 13, Moscow, Russia; ORCID: https://orcid.org/0000-0002-8243-8385

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