The changes of morphological structure of the tonsils in chronic tonsillitis

Anatomical and histological features of the tonsils create favorable conditions for the persistence of microflora in their lacunae (crypts) in violation of protective and adaptive mechanisms. This is due, in particular, to the fact that in the palatine tonsils there are deep lacunas, the lumens of which always contain detritus from rejected epithelial cells and lymphocytes, as well as microflora, for which this detritus is a favorable nutrient medium. In addition, one part of the crypt openings under physiological conditions is covered with a triangular fold of His, and the other part is narrowed or closed by scar tissue, which develops as a result of chronic inflammation. Under these conditions, the inflammation constantly occurring in the tonsils leads to a change in their micro-architectonics, including the microvasculature bed. Thus, the development and maintenance of chronic inflammation is facilitated by the anatomical and histological features of the tonsils. The aim of this work was a comparative study of the features of the histological structure and microcirculatory blood flow of tonsil biopsies in patients with chronic tonsillitis caused by Streptococcus pyogenes. It has been established that the same form of the disease can be accompanied by various types of structural restructuring of the tonsils, which may have an impact on the clinical manifestations of the disease and is associated with its prognosis. At the same time, it was revealed that the operated patients with low clinical efficacy of antibiotic therapy and preserved sensitivity of the isolated microflora in vitro to antibiotics in the removed tonsils showed a similar pathological picture. In the epithelial layer of the tonsils surface, in addition to areas of epithelial infiltration, areas of its thinning or complete desquamation were very often recorded, less often areas with replacement of the integumentary epithelium with scar tissue. The data obtained make it possible to recommend the study of the morphological structure of removed tonsils to clarify the issues of pathogenesis, features of the clinical course and prognosis of the disease.