Geographical differences in tonsillar carriage rates of Fusobacterium necrophorum - A cross-sectional study in Sweden and Zambia.

While Fusobacterium necrophorum historically has been considered normal tonsillar flora, recent studies from Europe and the US have suggested that carriage occur transiently in adolescence and young adulthood. However, no studies originating from Africa exist. In this cross-sectional study of tonsillar carriage of F. necrophorum, we aimed to investigate geographical differences in tonsillar carriage rates of F. necrophorum in healthy participants aged 15-25 years in Sweden and Zambia and further investigate the age distribution of tonsillar carriage in Zambia. Specimens were obtained by tonsillar swabs and analyzed with real-time PCR for F. necrophorum. In participants aged 15-25 years, tonsillar carriage was more common in Sweden 21/100 (21%) than in Zambia 6/192 (3%), p < 0.001. In Zambian participants aged above 25 years tonsillar carriage was rare 1/76 (1%). In conclusion, the high rate of tonsillar carriage in participants aged 15-25 years in Sweden has implications on the interpretation of tonsillar findings in patients with pharyngotonsillitis. Interestingly, a geographical difference was found with tonsillar carriage rarely identified in Zambia.

Assessment of Tonsil Volume With Transcervical Ultrasonography in Both Children and Adults.

OBJECTIVES: To investigate the success of ultrasonography (USG) in the objective measurement of palatin tonsil volume in both children and adults and to compare those results with clinical findings. METHODS: Eighty-five patients, who were scheduled to undergo tonsillectomy with the indications of recurrent tonsillitis and obstructive sleep apnea syndrome, were included in the study. The tonsil grades of the patients were recorded according to the Friedman tonsil grading. The tonsil size and volume were measured with transcervical USG. After tonsillectomy, the volumes of the tonsils were calculated by the displacement method. The correlation between the obtained data was evaluated. In all analyses, P < .05 was accepted as a statistical level of significance. RESULTS: Fifty children and 35 adults were included in the study. In children, the mean actual volume ± SD of 100 tonsils was measured as 3.5 ± 1.45 mL, and the USG volume was 3.67 ± 1.59 mL; a high correlation was found between both methods (r = 0.842; P < .05). In adults, the mean actual volume of 70 tonsils was measured as 5.15 ± 2.25 mL, and the USG volume was 5.71 ± 2.98 mL; a moderate correlation was found between the methods (r = 0.589; P < .05). In children, a moderate correlation was found between the Friedman grading and the USG (r = 0.532; P < .05), and actual (r = 0.549; P < .05) tonsil volumes. In adults, a low correlation was found between the Friedman grading and the USG (r = 0.363; P < .05) and actual (r = 0.384; P < .05) tonsil volumes. CONCLUSIONS: Ultrasonography is a useful, accessible, and noninvasive imaging method for objective measurement of tonsil volume in adults and children.

Weight change before and after adenotonsillectomy in children: An analysis based upon pre-surgery body mass category.

OBJECTIVES: To determine the standardised body mass index (BMIz) trajectory before and after adenotonsillectomy/tonsillectomy between children in different weight classifications in a larger sample than has been studied previously, and to identify which patient factors would explain the difference in these outcomes. DESIGN: We used a retrospective chart review and leveraged data of weight status pre- and post-adenotonsillectomy/tonsillectomy from a cohort of paediatric patients seen between May 2004 and April 2017. SETTING: Data were collected from an electronic medical record at a single Midwest paediatric health system. PARTICIPANTS: The study population included a convenience sample of 1,751 paediatric patients who underwent adenotonsillectomy or tonsillectomy and had at least two height and weight measurements recorded on the same date both before and after surgery. MAIN OUTCOME MEASURES: Change in BMIz trajectories before and after surgery. RESULTS: Of 1751 paediatric patients (ages 3-11) underwent adenotonsillectomy/tonsillectomy procedures. Age at time of surgery and gender were not significant predictors. Children in different weight classifications demonstrated differences in BMIz trajectory after surgery. Children with overweight/obesity experience a decrease in BMIz, whereas children with underweight or normal weight experience an increase in BMIz. CONCLUSIONS: Improvement in weight status is seen after surgery: increased BMI for those underweight and decreased BMI for those with overweight/obesity. We advocate for behavioural strategies as a first-line treatment in children with underweight or overweight/obesity, and results suggest that coordinating these efforts alongside adenotonsillectomy/tonsillectomy when indicated for medical reasons may be warranted. However, further research is needed to confirm these findings due to the observational nature of this study.

[The comparative evaluation of the effectiveness of the treatment of the patients presenting with the sub-compensated form of chronic tonsillitis making use of the antiseptic herbal medicinal product in the combination with the standard conservative therapy: the results of the open randomized study]. / Sravnitel'naia otsenka éffektivnosti lecheniia patsientov s subkompensirovannoi formoi khronicheskogo tonzillita antisepticheskim sredstvom rastitel'nogo proiskhozhdeniia v komplekse so standartnoi konservativnoi terapiei: rezul'taty otkrytogo randomizirovannogo issledovaniia.

The objective of the present study was the comparison of the effectiveness of the application of tonsilgon-N in the combination with the physical methods for sanitization of the palatine tonsil lagunes with that of the standard conservative treatment. A total of 60 patients having the confirmed diagnosis of sub-compensated form of chronic tonsillitis were recruited to participate in the study. All the patients were divided into two groups. Group 1 was comprised of 30 patients to whom tonsilgon-N was prescribed for the oral administration (25 droplets thrice daily for 30 days) in the combination with lagune cleansing with the use of the Tonsillor apparatus during 30 days (a total of 10 procedures). Group 2 consisted of 30 patients to whom only 10 sessions of rinsing the palatine tonsil lagunes were prescribed. The inoculums taken from the tonsils of the patients of group 1 contained no Klebsiella oxytoca, Escherichia coli, Enterobacter cloacae, and Moraxella catarhalis on the 15th day after the initiation of the treatment whereas the presence of the persisting pathogenic bacterial species was documented in 23.3% of the patients of this group. 10% of the patients in group 2 were found to retain Klebsiella oxytoca, Enterobacter cloacae, and Moraxella catarhalis in their tonsils whereas the rate of isolation of the pathogenic biotope amounted to 36,6%.

[The specific pathogenetic features of the development of chronic tonsillar pathology]. / Patogeneticheskie osobennosti formirovaniia khronicheskoi tonzilliarnoi patologii.

The authors discuss the mechanisms underlying the development of chronic tonsillar pathology confirmed by the methods of histological, autoradiographic, and bacteriological diagnostics. The new aspects of vital activity of microorganisms in the parenchymal tissue of the palatine tonsils are highlighted that account for the low effectiveness of the conservative therapy of chronic tonsillitis and give evidence of the necessity of the surgical treatment of this condition.

Hyperplasia and the degree and activity of inflammation in chronic recurrent tonsillitis: a histopathological study.

Postoperative haemorrhage following tonsillectomy occurs in 5.98% of all cases with up to 10 deaths reported annually in Germany. When comparing tonsillectomy (TE) and tonsillotomy (TT), the same long-term frequency of ENT infections is displayed in children and young adults. However, taking postoperative haemorrhaging into account, TT is more favourable. Chronic tonsillitis is one of the most common indications for TE in the adult population; however, a histopathological characterization may reveal objective criteria and provide a foundation for routinely performing TT in adults too. Three essential parameters hyperplasia (HP), grade of inflammation (GOI) and activity of inflammation (AOI), which are responsible for, and associated with a clinically relevant disease were histopathologically examined in the tonsils of 100 adult patients with chronic recurrent tonsillitis. The parameters were analysed and compared separately in the pharyngeal and basal parts of the tonsils as well as in three sections (upper and lower pole of the tonsil, middle part) as this may influence the indication for TT. The comparison of the basal and pharyngeal portions displayed a significant difference in the GOI and the HP in all three sections: grade 2 HP as well as GOI were more commonly found in the basal than pharyngeal portions (p > 0.001). AOI (grade 2) displayed the same properties in the middle section (p < 0.002), but did not reach statistical significance in the cranial and caudal sections (p = 0.107 and p = 0.186). An overabundance of grade 1 GOI, AOI, and HP was seen in the pharyngeal sections. The results show that two out of three relevant parameters that demonstrate histopathological changes in recurrent inflamed tonsils have a significantly stronger presence in the basal section of the tonsil as opposed to the pharyngeal section. The processes initiated by inflammation next to the surface responsible for a clinically relevant recurrent tonsillitis seem to cause stronger reactions in the deep follicular portion of the tonsils.

Clinical practice guideline: tonsillitis I. Diagnostics and nonsurgical management.

More than 120,000 patients are treated annually in Germany to resolve repeated episodes of acute tonsillitis. Therapy is aiming at symptom regression, avoidance of complications, reduction in the number of disease-related absences in school or at work, increased cost-effectiveness and improved quality of life. The purpose of this part of the guideline is to provide clinicians in any setting with a clinically focused multi-disciplinary guidance through different conservative treatment options in order to reduce inappropriate variation in clinical care, improve clinical outcome and reduce harm. Surgical management in terms of intracapsular as well as extracapsular tonsillectomy (i.e. tonsillotomy) is the subject of part II of this guideline. To estimate the probability of tonsillitis caused by ß-hemolytic streptococci, a diagnostic scoring system according to Centor or McIsaac is suggested. If therapy is considered, a positive score of ≥3 should lead to pharyngeal swab or rapid test or culture in order to identify ß-hemolytic streptococci. Routinely performed blood tests for acute tonsillitis are not indicated. After acute streptococcal tonsillitis, there is no need to repeat a pharyngeal swab or any other routine blood tests, urine examinations or cardiological diagnostics such as ECG. The determination of the antistreptolysin O-titer (ASLO titer) and other antistreptococcal antibody titers do not have any value in relation to acute tonsillitis with or without pharyngitis and should not be performed. First-line therapy of ß-hemolytic streptococci consists of oral penicillin. Instead of phenoxymethylpenicillin-potassium (penicillin V potassium), also phenoxymethlpenicillin-benzathine with a clearly longer half-life can be used. Oral intake for 7 days of one of both the drugs is recommended. Alternative treatment with oral cephalosporins (e.g. cefadroxil, cefalexin) is indicated only in cases of penicillin failure, frequent recurrences, and whenever a more reliable eradication of ß-hemolytic streptococci is desirable. In cases of allergy or incompatibility of penicillin, cephalosporins or macrolides (e.g. Erythromycin-estolate) are valuable alternatives.

Does the quality of life impact of tonsillitis correlate with SIGN guideline compliance? An assessment of range and normality.

OBJECTIVES: To assess the scores of those who are eligible to be listed for tonsillectomy through compliance with the SIGN guidelines for any trends or range. DESIGN: A prospective study of all patients (aged 16 or above) listed for elective tonsillectomy from a nurse led tonsil clinic. Patients were given a TOI-14 questionnaire to complete after they had been added to the waiting list for surgery, but before undergoing tonsillectomy. Scores were assessed using SPSS. SETTING: Outpatient clinic. PARTICIPANTS: Patients aged over 16 listed for Tonsillectomy via SIGN Guideline 117. MAIN OUTCOME MEASURE: Scores from TOI-14, completed pre-operatively. RESULTS: 155 patients were listed from the nurse led clinic from October 2012 to August 2014; 5 questionnaires were excluded for being incomplete. The score range was 55 (15-70), with a calculated mean score of 45.62 and standard deviation of 9.701. Over 95% of results were within 2 standard deviations of the mean. A calculated negative skew also confirms that most patients who have clinical indications for tonsillectomy compliant with the SIGN guidelines show a higher score on the TOI-14. CONCLUSION: This analysis indicates a trend of pre-intervention scores on the TOI-14 questionnaire for those patients who have a SIGN guideline compliant clinical indication for a tonsillectomy. We therefore propose that this suggests correlation between 'clinically strong' indication for tonsillitis and patient perceived Quality of Life impact.

[The rationale for the conservative treatment of chronic tonsillitis in the patients of the older age groups by the «soft¼ therapy methods]. / Obosnovanie konservativnogo lecheniya khronicheskogo tonzillita u lits starshikh vozrastnykh grupp metodami «myagkoi¼ terapii.

The objective of the present study was to develop an efficient system for the treatment of chronic tonsillitis in the patients of advanced and middle age based on the application of polyvalent bacteriophages in the combination with the physical factors and herbal medicines. The study involved 65 patients (39 women and 276 men) at the age from 65 to 73 years presenting with chronic tonsillitis. The treatment included washing the tonsillar lacunae with herbal infusion consisting of a tetterwort (Choledoniummajus) extract. This procedure was followed by phonophoresiswith the use of the combined polyvalent bacteriophage preparation in the non-liquid formulation during 7-10 days. The effectiveness of such treatment was evaluated based on the results of clinical examination and the analysis of the subjective feelings reported by the patients. In addition, the rosette-forming function of lymphocytes was estimated and palatine tonsil microbiotas in different patients were compared. The effectiveness of therapy was estimated at 89.2%. The positive outcome of the proposed treatment was documented in 78.6% of the cases within 6 months after the onset of therapy. It is concluded that the treatment of chronic tonsillitis with bacteriophagal preparations and herbal infusions in combination with thetraditionallow-frequency ultrasound treatment is highly efficacious (favourable outcome in 78.6% of the patients of middle and advanced age) without the use of antibiotic medications.

[The use of the enzymes for the enhancement of the effectiveness of antimicrobial photodynamic treatment of the patients presenting with chronic tonsillitis].

The objective of the present study was to enhance the effectiveness of the treatment of the patients presenting with various forms of chronic tonsillitis (CT) by means of antimicrobial photodynamic therapy (APDT). The study included 48 patients at the age from 18 to 55 years divided into three groups; all of them suffered from various forms of CT. Group 1 was comprised of 12 patients given a course of traditional conservative therapy. Group 2 consisted of 17 patients treated by APDT while group 3 included 19 patients in whom a course of antimicrobial photodynamic therapy was preceded by the treatment of the mucous membrane of the palatine amygdalae with a lidase solution. The microbiological testing was performed on days 5, 12, and 24 after APDT and also within the next 6-9 months. The results of the microbiological and clinical studies give evidence of the possibility to improve the effectiveness of the treatment of chronic tonsillitis by means of antimicrobial photodynamic therapy with the use of the preventive treatment of palatine tonsillar mucosa with a lidase solution. Such treatment was found to facilitate degradation of theintercellular matrix of the biofilm and reduced its resistance to the photodynamic impact.

Effect of antibiotic use on bacterial flora of tonsil core in patients with recurrent tonsillitis.

The aim of this study was to investigate the effects of commonly used antibiotics on bacterial flora of the tonsil core. Patients who underwent tonsillectomy for recurrent chronic tonsillitis were included in the study. Three groups were formed: group 1 was treated for 10 days preoperatively with amoxicillin/clavulanic acid; group 2 was treated for 10 days preoperatively with clarithromycin; and group 3 included patients who underwent tonsillectomy without preoperative antibiotic use. The removed palatine tonsils were sent to our microbiology department in sterile tubes for bacteriological analysis. Seventy-three patients (group 1 = 19, group 2 = 20, group 3 = 34 patients) aged 3-18 years (mean 7 years) were included in the study. At least one bacterium was isolated from all tonsils, except for two cases in group 1; the difference in single bacterial growth among groups was not significant (p = 0.06). On the other hand, the numbers of patients with pathogenic bacterial growth was significantly lower in group 2 (n = 2) compared with group 1 (n = 10) and group 3 (n = 27) (p < 0.001). The bacterium isolated most frequently from the tonsils was Streptococcus viridans. Pseudomonas aeruginosa was the only pathogenic bacterium that grew in all three groups. Clarithromycin was more effective than amoxicillin/clavulanic acid in eradicating pathogenic bacteria in the tonsil core. Pseudomonas aeruginosa might be responsible for resistant or recurrent tonsil infections. To prevent endocarditis, antibiotic prophylaxis toward S. viridians, which is the most prevalent bacterium in the tonsil core, should be kept in mind for patients with heart valve damage.

[Chronic tonsillitis, etiological and pathogenetic aspects of the development of metatonsillar complications].

The objective of the present study was to summarize the data of the current literature publications concerning the tonsillar biotope under the normal conditions and in the course of the development of the pathological process. Specific microbiological characteristics of the potential causative agents of tonsillar pathology are considered. The structural, immunological, and genetic prerequisites for the for progress of infection are discussed with special reference to the morphological and functional changes in the tissue of palatine tonsils associated with different forms of the disease and the mechanisms underlying immunopathological conditions and metatonsillar complications.

[Topical preparations for therapy of tonsillar pathology].

This paper highlights clinical and diagnostic aspects of tonsillar pathology with special reference to modern methods for the treatment of pharyngeal diseases of different etiology. A detailed characteristic of local symptomatic therapy is presented including the use of NSAIDs (non-steroidal anti-inflammatory drugs). These agents have advantages over other medications for local therapy due to high anti-inflammatory and analgesic activities. Also, they significantly improve the patients' quality of life. The use of a local anti-inflammatory drug is a major component of the treatment of inflammatory pharyngeal pathology. Regardless of the nature of the disease, either bacterial or viral.

[The morphofunctional prerequisites for the development of exudative otitis media in the children presenting with chronic adenoiditis].

The objective of the present study was to elucidate the structural and functional mechanisms underlying disturbances of the protective nasolaryngeal barrier with special reference to the following histological and immunohistochemical characteristics of the pharyngeal tonsils (CD4, CD20, CD68, IgA, P53, BCL2, Ki67, TGF-beta) in the children aged 3-6 years and presenting with complicated (n=20) or uncomplicated (n=20) chronic adenoiditis (CA). It was shown that adenoids of the patients with complicated chronic adenoiditis less frequently exhibit markers of active inflammation, such as hyperemia, intraepithelial infiltration, and hemosiderophages. Also, they have the smaller mean area of lymphoid follicles and the number of functional intrafollicular macrophages suggesting impaired immunological reactivity. Lymphoid follicles of the pharyngeal tonsils in the children with uncomplicated chronic adenoiditis show up enhanced density of B-lymphocytes (CD20) and CD69-positive cells which may suggest functional tension. However, density of IgA-producing lymphocytes responsible for the protection of nasolaryngeal mucosa is identical in the patients with complicated and uncomplicated chronic adenoiditis. Taken together with the decreased number of T-helpers (CG4), this finding indicates the compromised immunological response in the children with this pathology. It is concluded that the structural characteristics of pharyngeal tonsils revealed in the present study may provide a basis for the disturbances of congenital and adaptive immunity; moreover, they can serve as the predictors of complications of chronic adenoiditis.

[A rare case of thalassemia concomitant with chronic decompensated tonsillitis].

The present paper reports a rare combination of Cooley's disease (thalassemia B) and the decompensated variant of chronic tonsillitis in a 14-year old girl. The patient presented with the severe form of hypochromic anemia and degenerative changes of erythrocytes. She was treated by means of bilateral tonsillectomy associated with the high risk of postoperative hemorrhage. In the preoperative period, the child received drop intravenous infusion of tranexam at a dose of 15 mg/kg body weight together with hemostatic agents. Hemorrhage during the surgical intervention was stopped by pressing tampons impregnated with tranexamic acid known to exert local and systemic hemostatic and antifibrinolytic action. The patient was discharged from the hospital for the further treatment of the primary disease.

[The microbiocenosis of intestine and immune status of children of primary school age].

The article deals with the study of species and quantitative structure of microbiocenosis of intestine and characteristics of immune status in children aged 8-10 years. In children with chronic tonsillitis pharyngitis and bronchitis and with diseases of gastro-intestinal tract (biliary dysfunction, chronic gastroduodenitis and gastritis) the microbe imbalance of various degree of manifestation was established which was prevailing in cases of children with pathology of gastrointestinal tract. The increase of quantity of opportunistic microflora induces the production of both immunoglobulins and cytotoxic lymphocytes and cells-natural killers.

[The state of palatine tonsils in the patients presenting with the deviation of the nasal septum].

The objective of the present study was to further improve diagnostics and treatment of chronic tonsillitis (ChT). It included 100 patients presenting with disturbances of the nasal breathing that resulted in the deviation of the nasal septum and hypertrophy of the inferior turbinate bones. The signs of the simple form of chronic tonsillitis were detected in the 87 patients enrolled in the study. The patients who enjoyed the normalization of the nasal breathing after the surgical intervention had a more favourable clinical course of chronic tonsillitis compared with the patients given no such treatment. The results of the study provide an additional information concerning the relationship between the disturbances of the basal bleeding and the development of changes in palatine tonsils; moreover, they allow determining early indications for the surgical treatment for the correction of the deviation of the nasal septum.

[The use of immunocorrection therapy for the combined treatment of the inflammatory diseases of the pharynx].

The objective of the study. To estimate the efficacy of the combined treatment of the patients presenting with chronic tonsillitis, acute and chronic pharyngitis with the use of traditional methods supplemented by the immunocorrective preparation imudon. A total of 320 patients with inflammatory pharyngeal diseases were examined and treated. It was shown that the introduction of imudon therapy in the combined treatment of chronic tonsillitis, acute and chronic pharyngitis produces a more pronounce and stable beneficial effects than conventional therapy.

[Influence of сycloferon on the сytokine blood profile and production of proinflammatory сytokines in the cultures of mononucleares of peripheral blood of the patients with chronic tonsillitis].

The 88 patients with chronic tonsillitis (CT) was investigated. The 46 patients (basic group) got the modern immunoactive preparation cycloferon and 42 patients (comparison group) - only the generally accepted therapy. During immunological researches on a background clinical manifestation of СT the increase proinflammatory cytokines (CK) (TNFα, IL-1Β) in the serum, and also increase the level of spontaneous products of these CK in the cultures mononucleares of periferal blood was detected. At general accepted treatment took place increase level proinflammatory CK at serum on background decline stimulated product of CK at mononucleares cultures. Aрplication of cycloferon at the treatment of CT provided to normalization cytokines profile of the blood and production of CK in the cultures mononucleares.

[The application of a CO(2)-laser for tonsillectomy in the patients presenting with chronic decompensated tonsillitis as an alternative to the traditional methods of surgical treatment].

AIM OF THE STUDY: to estimate the clinical efficiency and advantages of the surgical treatment of palatal tonsils with the use of a CO(2)-laser in comparison with the traditional methods of tonsillectomy. METHODS: A total of 175 patients presenting with decompensated tonsillitis were available for the observation of which 79 were operated with the use of a CO(2)-laser. The control group was comprised of the patients undergoing conventional tonsillectomy. RESULTS: The study confirmed the high clinical efficiency of the ablation of palatal tonsils using the CO(2)-laser and its advantages in terms of reduced duration of the postoperative period, requirements for analgesic and antibacterial medications, recovery of the swallowing function and speech.