RESUMO
BACKGROUND: Medical guidelines are an important basis for qualitative and cost-effective patient care. However, there is a lack of clinical recommendations in anthroposophic medicine (AM), an integrative medicine approach frequently practised in Europe. Acute tonsillitis, which includes tonsillopharyngitis, is a common childhood disease. that is mostly caused by a viral infection. Symptomatic treatment is therefore of high importance, and AM can offer several therapy options. METHODS: 53 physicians from Germany, Spain, Netherlands, Switzerland, Austria, and Hungary with at least one year of experience in anthroposophic paediatric medicine were invited to participate in an online Delphi process. The process comprises five survey rounds starting with open-ended questions and ending with final statements, which need 75% agreement of experts to reach consensus. Expert answers were evaluated by two independent reviewers using MAXQDA and Excel. RESULTS: Response rate was between 28% and 45%. The developed recommendation included 15 subtopics. These covered clinical, diagnostic, therapeutic and psychosocial aspects of acute tonsillitis. Six subtopics achieved a high consensus (>90%) and nine subtopics achieved consensus (75-90%). CONCLUSION: The clinical recommendation for acute tonsillitis in children aims to simplify everyday patient care and provide decision-making support when considering and prescribing anthroposophic therapies. Moreover, the recommendation makes AM more transparent for physicians, parents, and maybe political stakeholders as well.
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Medicina Integrativa , Médicos , Tonsilite , Criança , Humanos , Consenso , Medicina Antroposófica/psicologia , Tonsilite/terapia , Técnica DelphiRESUMO
OBJECTIVE: In clinical practice, identifying abscesses in tonsillar infections is crucial for early therapeutic management. Diagnosis of a peritonsillar abscess is usually based on clinical symptoms. Complementary examination procedures, such as laboratory parameters and imaging, are available for confirmation. PATIENTS AND METHODS: A retrospective analysis was carried out of data for 752 patients who presented with acute tonsillar infection and were hospitalized between January 2012 and February 2021. The data analyses involved evaluating the patient's clinical symptoms, inflammatory parameters, and previous medical history in relation to the predictive power of these factors for the presence of an abscess. RESULTS: Predictor analysis for the presence of an abscess showed significant values for trismus (OR 2.392; 95% CI, 1.305 to 4.383; p=0.005) and palatal arch protrusion (OR 29.679; 95% CI, 17.460 to 50.447; p=0.000). The inflammatory parameter C-reactive protein and the leukocyte count were not statistically significant as predictors. CONCLUSIONS: The presence of a tonsillar abscess can be diagnosed from the clinical presentation alone if the findings are clear. Further diagnostic procedures are indicated in case of inconclusive findings, and ultrasound should be the primary noninvasive method. Computed tomography is only required in selected cases. Inflammatory parameters can be assessed in order to monitor therapy, but do not predict the presence of an abscess. However, if defined action sequences are being considered, tonsillar abscesses can be differentiated at an early point.
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Abscesso Peritonsilar , Tonsilite , Humanos , Estudos Retrospectivos , Tonsilite/diagnóstico , Tonsilite/terapia , Abscesso Peritonsilar/diagnóstico , Abscesso Peritonsilar/terapia , Contagem de Leucócitos , Proteína C-ReativaRESUMO
Background: The frequency of adenotonsillar hypertrophy in mouth-breathing children when compared to the average found in the general population is considered to be higher. Mouth breathing is considered as one of the causative factors for tonsillitis in children. Through continuous irritation on tonsillar wall, tonsils swell up and inflammation develops. Purpose: The purpose of the study is to evaluate Streptococcus pyogenes count using colony-forming units (CFUs) and N-acetylgalactosamine-6-sulfatase side chain marker on ELISA (enzyme linked immunosorbent assay) in mouth breathers and to establish its correlation with pharyngeal airway space pre- and post-oral screen appliance therapy. Materials and Methods: A total number of 24 (n) mouth breathers aged between 5 and 12 years were included in the study and given oral screen appliance therapy. The subjects were evaluated for the various parameters before the delivery of a habit-breaking appliance and then reevaluated for the same parameters (presence of S. pyogenes and its counts, size of tonsils, and pharyngeal airway space dimensions) after 6 months of appliance usage. Results: A statistically significant difference was seen in levels of S. pyogenes using ELISA and CFUs. Furthermore, statistically significant difference was observed in Friedman tonsil scoring and pharyngeal airway space and pre- and post-oral screen appliance therapy. Conclusion: Oral screen appliance therapy reduced the frequency of occurrence of tonsillitis in mouth breathers by decreasing the counts of S. pyogenes bacteria. Upper and lower pharyngeal airway space dimensions were increased after 6 months of appliance therapy in mouth breathers.
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Streptococcus pyogenes , Tonsilite , Criança , Humanos , Pré-Escolar , Acetilgalactosamina , Respiração Bucal , Tonsilite/terapia , Tonsilite/complicações , Tonsilite/epidemiologia , SulfatasesRESUMO
PURPOSE: The aim of this study was to compare the costs of two different telemedicine-assisted tonsillitis care pathways with traditional face-to-face visits at the Department of Otorhinolaryngology - Head and Neck Surgery (ORL-HNS) at Helsinki University Hospital. METHODS: We characterized and analyzed the patient flows and their individual episodes of all tonsillitis patients at the Department of ORL-HNS between September 2020 and August 2022. Records were collected by doctors at the clinic. We investigated costs and allocated resources in four categories: invoice from the Department of ORL-HNS to the public payer, expenses to the Department, patient fees, and doctor's resource. RESULTS: At least a third of the tonsillitis patients were eligible for telemedicine. The digital care pathway was 12.6 % less expensive for the public payer compared to the previous virtual visit model. For the Department, the expense of the digital care pathway was 58.8 % less per patient than the virtual visit model. Patient fees decreased 79.5 %. The digital care pathway reduced the doctor's resource from 30.28 min to 19.78 min, which accounts for a 34.7 % reduction. Patients finished the digital care pathway in a median of 62 min (SD = 60) compared to the 2-4 h which they would spend on an outpatient clinic visit. CONCLUSION: Our study demonstrates that tonsillitis patients are eligible for preoperative telemedicine. With at least a third of the tonsillitis patients being eligible for telemedicine, major cost savings can be achieved with efficient e-health-assisted solutions.
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Procedimentos Clínicos , Tonsilite , Humanos , Tonsilite/terapia , Assistência Ambulatorial , Instituições de Assistência Ambulatorial , Redução de CustosRESUMO
BACKGROUND: Healthcare systems face unprecedented numbers of patients waiting for elective treatments in the wake of the COVID-19 pandemic. Hospitals must urgently optimise patient pathways and build capacity to meet the populations health needs. Criteria-led discharge (CLD) is frequently used to optimise elective care pathways but may hold potential in discharging patients at the end of an acute hospital admission. METHODS: We conducted a quality improvement project to design and introduce a novel inpatient pathway using CLD for patients with severe acute tonsillitis. Our analysis compared the standardisation of treatment, length of stay, discharge time and readmission rate between those treated on the novel pathway compared with standard treatment. RESULTS: The study population included 137 patients admitted to a tertiary centre with acute tonsillitis. Introduction of the tonsillitis pathway using CLD resulted in a significant reduction in median length of stay from 24 hours to 18 hours. Of those treated on the tonsillitis pathway, 52.2% were discharged prior to midday compared with 29.1% who received standard treatment. No patient discharged using CLD required readmission. CONCLUSION: CLD is safe and effective at reducing length of stay in patients requiring acute hospital admission for acute tonsillitis. CLD should be used and evaluated in further novel patient pathways across different areas of medicine to optimise care and build capacity for provision of elective healthcare services. Further research is required to investigate safe and optimal criteria which indicate patients are fit for discharge.
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COVID-19 , Tonsilite , Humanos , Alta do Paciente , Pandemias , Tempo de Internação , Tonsilite/terapiaRESUMO
OBJECTIVE: This study investigated how the coronavirus disease 2019 pandemic has impacted on presentations to ENT first-on-call services. METHODS: All appointments to a rapid access triage clinic from 1 June to 31 August in 2019 and 2020 were reviewed retrospectively and their reasons for consultation classified. A binomial proportion test was used to determine whether the proportions of consultations per presentation differed significantly between years. This analysis was repeated with the number of unique patients per presenting complaint. RESULTS: The proportions of nine reasons for consultation differed significantly between 2019 and 2020, including an increase in otitis media and nasal trauma presentations, and a decrease in otitis externa and tonsillitis presentations. Reattendances caused some variation in the frequency of certain diagnoses. CONCLUSION: Our data suggest a shift in the presentations to first-on-call services, which may be a result of changes in patient behaviour and access to healthcare services.
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Assistência Ambulatorial/estatística & dados numéricos , COVID-19/epidemiologia , Otorrinolaringopatias/epidemiologia , Orelha/lesões , Corpos Estranhos/epidemiologia , Corpos Estranhos/terapia , Humanos , Otite Externa/epidemiologia , Otite Externa/terapia , Otite Média/epidemiologia , Otite Média/terapia , Otorrinolaringopatias/diagnóstico , Otorrinolaringopatias/terapia , Estudos Retrospectivos , Tonsilite/epidemiologia , Tonsilite/terapia , Reino Unido/epidemiologiaRESUMO
INTRODUCTION: With tonsillectomy surgery subject to increasingly strict commissioning criteria over the past 20 years in the UK, the total number of admissions for acute tonsillitis has been rising steadily. Multiple single-centre studies have demonstrated how introduction of a standardised management protocol can be effective in improving the delivery of treatment for acute tonsillitis in the emergency department. METHODS: Using a novel approach, we aimed to implement an acute tonsillitis management protocol within a formal clinical decisions unit (CDU) pathway. Following a retrospective baseline audit, we carried out two post-intervention cycles of data collection to assess safety and efficacy. RESULTS: The median number of initial treatments increased significantly from two of five at baseline, to three of five in both the first (U = 86, p = 0.004) and second (z = 2.959, p = 0.003) audit cycles. Admission rate was reduced from 0.79 to 0.44 in the first cycle, representing a 44.6% relative risk reduction [95% confidence interval (CI) 0.304-1.012; p = 0.0547]. Admission rate remained reduced at 0.48 in the second cycle, with a relative risk reduction of 39.2% compared with baseline (95% CI 0.380-0.972; p = 0.038). CONCLUSIONS: Utilisation of the CDU led to an improvement in the delivery of initial treatment, an extended period of observation and subsequently a greater percentage of patients being discharged. An acute tonsillitis management protocol within a CDU appears to be a safe and effective model and is now standard practice in our hospital.
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Tonsilite/terapia , Doença Aguda , Adulto , Tomada de Decisão Clínica , Protocolos Clínicos , Procedimentos Clínicos , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Estudos RetrospectivosRESUMO
INTRODUCTION: allergy may be an important risk factor for adenotonsillar disease in children, although conflicting results have been reported in the literature. In previous articles, authors often failed in distinguishing between adeno-tonsillar hypertrophy and recurrent tonsillitis and in not discriminating between isolated or combined adenoid and tonsillar hypertrophy. AIM: to evaluate clinical evidence and biomarkers linking allergy to different phenotypes of adeno-tonsillar disease. Furthermore, we questioned whether anti-allergy treatment might prevent occurrence of adeno-tonsillar disease or improve its specific management. METHODS: our systematic review, in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) process, yielded 1010 articles finally screened. This resulted in 21 full texts that were included in a qualitative analysis. RESULTS: literature data support the association between allergy and combined adeno-tonsillar hypertrophy and isolated adenoid hypertrophy, whereas describe a mainly negative correlation between allergy and isolated tonsillar hypertrophy. The results of this review suggest that local allergic inflammation may play a role in adeno-tonsillar hypertrophy. Data correlating bacterial recurrent tonsillitis and allergy are few, although evidence from the lab revealed that allergy might suppress innate immunity in tonsillar tissue by reducing levels of anti-microbial proteins. CONCLUSION: basing on our qualitative analyses allergy should not be misdiagnosed in children with combined adenotonsillar hypertrophy or isolated adenoid hypertrophy, whereas evidence do not support a link between allergy and isolated tonsil hypertrophy. Finally, some data support a link between allergy and recurrent adeno-tonsillar infection although future studies are required to confirm this data. We summarized our conclusions in a practical algorithm.
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Hipersensibilidade , Tonsilectomia , Tonsilite , Biomarcadores , Criança , Humanos , Hipersensibilidade/complicações , Hipersensibilidade/diagnóstico , Hipertrofia , Tonsila Palatina , Tonsilite/complicações , Tonsilite/diagnóstico , Tonsilite/terapiaRESUMO
BACKGROUND: The impact of coronavirus disease 2019 on healthcare has led to rapid changes in otolaryngology service provisions. As such, new standard operating procedures for the management of suspected tonsillitis or quinsy were implemented in our centre. METHODS: A retrospective audit was performed of acute referrals to ENT of patients with suspected tonsillitis, peritonsillar cellulitis or quinsy, during the 10 weeks before (group 1) and 10 weeks after (group 2) implementation of the new standard operating procedures. RESULTS: Group 2 received fewer referrals. Fewer nasendoscopies were performed and corticosteroid use was reduced. The frequency of quinsy drainage performed under local anaesthetic increased, although the difference was not statistically significant. Hospital admission rates decreased from 56.1 to 20.4 per cent, and mean length of stay increased from 1.13 to 1.5 days. Face-to-face follow up decreased from 15.0 to 8.2 per cent, whilst virtual follow up increased from 4.7 to 16.3 per cent. There were no significant differences in re-presentation or re-admission rates. CONCLUSION: Management of suspected tonsillitis or quinsy using the new standard operating procedures appears to be safe and effective. This management should now be applied to an out-patient setting in otherwise systemically well patients.
Assuntos
COVID-19/epidemiologia , Abscesso Peritonsilar/terapia , Melhoria de Qualidade , Tonsilite/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Drenagem , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Londres , Masculino , Pessoa de Meia-Idade , Otolaringologia/métodos , Otolaringologia/normas , Otolaringologia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Encaminhamento e Consulta , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVES: This study examined the uptake of ENT UK coronavirus disease 2019 adult tonsillitis and quinsy guidelines at our tertiary centre, and assessed perceived barriers to uptake. METHODS: A retrospective case series of tonsillitis and quinsy patients was analysed in two arms: before and after the introduction of new ENT UK management guidelines. A survey assessed perceptions and practice differences between ENT and emergency department doctors. RESULTS: Each study arm examined 82 patients. Following the introduction of new ENT UK guidelines, ENT clinicians demonstrated significant changes in practice, unlike their emergency department counterparts. Survey results from emergency department doctors highlighted a lack of appreciation of guideline change and identified barriers to guideline uptake. CONCLUSION: The introduction of new management guidelines for tonsillitis and quinsy patients during the pandemic resulted in disparate uptake within ENT and emergency department departments at the tertiary centre. Clearer dissemination to all affected clinicians is paramount for future rapidly introduced changes to practice, to ensure clinician safety.
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COVID-19/epidemiologia , Fidelidade a Diretrizes/estatística & dados numéricos , Abscesso Peritonsilar/terapia , Tonsilite/terapia , Adulto , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/estatística & dados numéricos , Estudos Retrospectivos , Inquéritos e Questionários , Reino Unido/epidemiologia , Adulto JovemRESUMO
OBJECTIVES: The global pandemic of coronavirus disease 2019 has necessitated changes to 'usual' ways of practice in otolaryngology, with a view towards out-patient or ambulatory management of appropriate conditions. This paper reviews the available evidence for out-patient management of three of the most common causes for emergency referral to the otolaryngology team: tonsillitis, peri-tonsillar abscess and epistaxis. METHODS: A literature review was performed, searching all available online databases and resources. The Medical Subject Headings 'tonsillitis', 'pharyngotonsillitis', 'quinsy', 'peritonsillar abscess' and 'epistaxis' were used. Papers discussing out-patient management were reviewed by the authors. RESULTS: Out-patient and ambulatory pathways for tonsillitis and peritonsillar abscess are well described for patients meeting appropriate criteria. Safe discharge of select patients is safe and should be encouraged in the current clinical climate. Safe discharge of patients with epistaxis who have bleeding controlled is also well described. CONCLUSION: In select cases, tonsillitis, quinsy and epistaxis patients can be safely managed out of hospital, with low re-admission rates.
Assuntos
Assistência Ambulatorial/organização & administração , COVID-19/epidemiologia , Epistaxe/terapia , Otolaringologia/organização & administração , Abscesso Peritonsilar/terapia , Tonsilite/terapia , COVID-19/prevenção & controle , COVID-19/transmissão , Emergências , Serviço Hospitalar de Emergência/organização & administração , Humanos , Encaminhamento e Consulta/organização & administraçãoRESUMO
BACKGROUND: Coronavirus disease 2019 imposed dramatic changes on ENT service delivery. Pre-pandemic, such changes would have been considered potentially unsafe. This study outlines the impact of lockdown on the incidence and management of ENT emergencies at a large UK centre. METHODS: After modification of pre-pandemic guidelines, ENT emergency referrals data during the UK lockdown were prospectively captured. A comparative analysis was performed with retrospective data from a corresponding period in 2019. RESULTS: An overall reduction (p < 0.001) in emergency referrals (n = 119) and admissions (n = 18) occurred during the lockdown period compared to the 2019 period (432 referrals and 290 admissions). Specifically, there were reduced admission rates for epistaxis (p < 0.0001) and tonsillar infection (p < 0.005) in the lockdown period. During lockdown, 90 per cent of patients requiring non-dissolvable nasal packing were managed as out-patients. CONCLUSIONS: Coronavirus disease 2019 compelled modifications to pre-pandemic ENT guidelines. The enforced changes to emergency care appear to be safe and successfully adopted. Arguably, the measures have both economic and patient-related implications post-coronavirus disease 2019 and during future similar pandemics and lockdowns.
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Assistência Ambulatorial/estatística & dados numéricos , COVID-19 , Epistaxe/terapia , Hospitalização/estatística & dados numéricos , Abscesso Peritonsilar/terapia , Tonsilite/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Orelha , Otopatias/epidemiologia , Otopatias/terapia , Emergências , Serviço Hospitalar de Emergência , Epistaxe/epidemiologia , Feminino , Corpos Estranhos/epidemiologia , Corpos Estranhos/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Otorrinolaringopatias/epidemiologia , Otorrinolaringopatias/terapia , Abscesso Peritonsilar/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/tendências , SARS-CoV-2 , Tonsilite/epidemiologia , Reino Unido/epidemiologia , Adulto JovemRESUMO
OBJECTIVES: To report changes in practice brought about by COVID-19 and the implementation of new guidelines for the management of tonsillitis and peritonsillar abscess (PTA), and to explore factors relating to unscheduled re-presentations for patients discharged from the emergency department (ED). DESIGN: Prospective multicentre national audit over 12 weeks from 6 April 2020. SETTING: UK secondary care ENT departments. PARTICIPANTS: Adult patients with acute tonsillitis or PTA. MAIN OUTCOME MEASURES: Re-presentation within 10 days for patients discharged from the ED. RESULTS: 83 centres submitted 765 tonsillitis and 416 PTA cases. 54.4% (n = 410) of tonsillitis and 45.3% (187/413) of PTAs were discharged from ED. 9.6% (39/408) of tonsillitis and 10.3% (19/184) of PTA discharges re-presented within 10 days, compared to 9.7% (33/341) and 10.6% (24/224) for those admitted from ED. The subsequent admission rate of those initially discharged from ED was 4.7% for tonsillitis and 3.3% for PTAs. IV steroids and antibiotics increased the percentage of patients able to swallow from 35.8% to 72.5% for tonsillitis (n = 270/754 and 441/608) and from 22.3% to 71.0% for PTA (n = 92/413 and 265/373). 77.2% of PTAs underwent drainage (n = 319/413), with no significant difference in re-presentations in those drained vs not-drained (10.6% vs 9.5%, n = 15/142 vs 4/42, P = .846). Univariable logistic regression showed no significant predictors of re-presentation within 10 days. CONCLUSIONS: Management of tonsillitis and PTA changed during the initial peak of the pandemic, shifting towards outpatient care. Some patients who may previously have been admitted to hospital may be safely discharged from the ED.
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Assistência Ambulatorial/métodos , COVID-19/epidemiologia , Auditoria Clínica/métodos , Gerenciamento Clínico , Pandemias , Admissão do Paciente/tendências , Tonsilite/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Estudos Prospectivos , Estudos Retrospectivos , SARS-CoV-2 , Fatores de Tempo , Tonsilite/terapia , Reino Unido/epidemiologia , Adulto JovemRESUMO
INTRODUCTION: Pediatric tonsillitis is encountered frequently across specialties, and while high quality guidelines exist, there is persistent evidence of care which is not evidence based, including antibiotic overprescribing and surgical practice variability. Quality indicators (QIs) can be utilized for initiatives to improve the quality of care and subsequent patient outcomes. We sought to develop pediatric tonsillitis QIs that are applicable across specialties and that cover aspects of both diagnosis and the spectrum of management options. METHODS: A guideline-based approach to QI development was employed. Candidate indicators (CIs) were extracted from international guidelines deemed high quality by two reviewers and evaluated by an eleven-member expert panel consisting of otolaryngology - head & neck surgeons, a pediatrician and a family physician. The final QIs were selected utilizing a modified RAND/UCLA appropriateness methodology. RESULTS: Twenty-six CIs were identified after initial literature review. After the first round of evaluations, the panel agreed on thirteen candidate indicators as appropriate QIs. A subsequent expert panel meeting provided a platform to discuss areas of disagreement, discuss any recently published research, and to brainstorm additional CIs not identified from the guideline extraction. Following the second round of evaluations, the expert panel agreed upon sixteen QIs as appropriate measures of high-quality care. CONCLUSIONS: This study proposes sixteen QIs developed through a multidisciplinary lens to guide practitioners in the diagnosis and management of pediatric tonsillitis. These QIs can be used to improve transparency, accountability, and provide objective data to assist future quality improvement initiatives.
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Indicadores de Qualidade em Assistência à Saúde , Tonsilite , Criança , Humanos , Melhoria de Qualidade , Tonsilite/diagnóstico , Tonsilite/terapiaRESUMO
An update of the Spanish consensus document on the diagnosis and treatment of acute tonsillopharyngitis is presented. Clinical scores should not be used to prescribe antibiotics, unless microbiological tests are not available or there is a child at risk of rheumatic fever. There is no score better than those set out in the previous consensus. Microbiological tests are recommended in proposed cases, regardless of the result of the scores. Penicillin is the treatment of choice, prescribed twice a day for 10 days. Amoxicillin is the first alternative, prescribed once or twice a day for the same time. First-generation cephalosporins are the treatment of choice in children with non-immediate reaction to penicillin or amoxicillin. Josamycin and midecamycin are the best options for children with immediate penicillin allergic reactions, when non-beta-lactam antibiotics should be used. In microbiological treatment failure, and in streptococcal carriers, the treatments proposed in the previous consensus are still applicable.
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Antibacterianos/administração & dosagem , Faringite/terapia , Tonsilite/terapia , Doença Aguda , Criança , Humanos , Faringite/diagnóstico , Espanha , Tonsilite/diagnósticoRESUMO
Oral supplements (OS) support the immune system in fighting upper airways infection. This study aimed to analyze the effect of Difensil Immuno (DI) on the recurrence of tonsillitis and fever in children. A multicentric randomized clinical trial was conducted. One-hundred and twenty children with chronic tonsillitis were randomly assigned to group A, B or control. Patients in group A were treated with 10 mL of DI for 90 consecutive days, patients in group B underwent treatment with 15 mL of DI for 45 consecutive days. The following data were collected at baseline (T0), T1 and T2: tonsillitis and fever episodes, tonsillar volume, blood test results. One-way ANOVA was used to analyze within and between variances. Patients in group A and B statistically improved their clinical parameters (episode of tonsillitis and fever, tonsillar volume) when compared to control group both at T1 and T2. However, T1 variances were more consistent in group A than in group B. All patients in the study groups improved their clinical outcomes. No statistically significant variances were observed in blood parameters both at T1 and T2. Our results suggest that children treated with DI had fewer episodes of tonsillitis and fever and a reduction in their tonsillar volume.
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Adjuvantes Imunológicos/administração & dosagem , Adjuvantes Imunológicos/farmacologia , Suplementos Nutricionais , Sistema Imunitário/imunologia , Prevenção Secundária , Tonsilite/imunologia , Tonsilite/terapia , Criança , Pré-Escolar , Feminino , Febre/prevenção & controle , Galactanos , Humanos , Lactobacillus acidophilus , Masculino , Sambucus nigra , Selênio , Índice de Gravidade de Doença , Tonsilite/prevenção & controle , Resultado do Tratamento , Vitaminas , ZincoRESUMO
Probiotics, defined as "living microorganisms that, whether ingested in useful amount, may have beneficial effects on human body", are widely used in various products for human use, such as dietary supplements, medical devices and pharmaceutical products. The European Directive on medical devices (MDs) (DDM 93/42), also includes those MDs containing live microorganisms, particularly probiotics, that may have various destinations of use, including that of assisting the therapy of several human pathologies. In this brief note we analyzed the use of probiotics in MDs and how probiotics administration could represent one of the new frontiers of scientific research on the prevention and treatment of various diseases. We'll analyze the literature on probiotics based MDs, to review their major targets in the therapy of some of the most common human pathologies: bacterial vaginosis and vaginitis, atopic dermatitis, infantile colic, obesity, type 2 diabetes, and pharyngotonsillitis.
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Probióticos/administração & dosagem , Vaginose Bacteriana/terapia , Administração Oral , Adolescente , Adulto , Criança , Pré-Escolar , Cólica/terapia , Dermatite Atópica , Diabetes Mellitus Tipo 2/terapia , Método Duplo-Cego , Equipamentos e Provisões/microbiologia , Feminino , Humanos , Lactente , Recém-Nascido , Lactobacillus , Masculino , Obesidade/prevenção & controle , Obesidade/terapia , Faringite/terapia , Prebióticos/administração & dosagem , Prebióticos/efeitos adversos , Probióticos/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Supositórios , Simbióticos/administração & dosagem , Simbióticos/efeitos adversos , Tonsilite/terapia , Vaginite/microbiologia , Vaginite/terapia , Vaginose Bacteriana/microbiologiaRESUMO
OBJECTIVE: To assess the effectiveness of tonsillectomy/adenotonsillectomy in reducing medical care visits for pharyngitis or tonsillitis in children and adults with chronic/recurrent tonsillitis. DESIGN: Retrospective cohort study. SETTING: Data were retrieved from the VEGA register, a comprehensive regional cohort in Sweden. PARTICIPANTS: 1044 children (<15 years) and 2244 adults. INTERVENTION: Tonsillectomy/adenotonsillectomy compared with no surgical treatment. MAIN OUTCOME MEASURES: Changes in yearly mean rates of medical care visits due to pharyngitis/tonsillitis. RESULTS: In children, there was a significant decrease in the yearly mean medical care visits rate from 1.93 (1.82 to 2.04) before surgery to 0.129 (0.099 to 0.165) after surgery, with a mean change of -1.80 (-1.90 to -1.69), p<0.0001. In patients who did not undergo surgery, the corresponding mean change was -1.51 (-1.61 to -1.41), resulting in a mean difference in the change in visit rates between the intervention and control groups of -0.283 (-0.436 to -0.135), p=0.0002. In adults, a significant decrease in the yearly mean medical care visit rate was observed from 1.45 (1.39 to 1.51) before surgery to 0.152 (0.132 to 0.173) after surgery, with a mean change of -1.30 (-1.36 to -1.24), p<0.0001, compared with -1.18 (-1.24 to -1.13) in the control group. The difference in the change in yearly mean visit rate between the surgical and non-surgical groups was -0.111 (-0.195 to -0.028), p=0.0097. The subgroup analysis showed a greater effect of surgery in children, in patients with a higher number of medical care visits before surgery and in the first year of follow-up. CONCLUSION: In this cohort of patients moderately or less affected with chronic/recurrent tonsillitis, the effectiveness of tonsillectomy/adenotonsillectomy in reducing medical care visits for pharyngitis and tonsillitis compared with no surgical treatment was low and of questionable clinical value.
Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Faringite/epidemiologia , Tonsilectomia , Tonsilite/epidemiologia , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Faringite/prevenção & controle , Faringite/terapia , Estudos Retrospectivos , Suécia/epidemiologia , Tonsilectomia/estatística & dados numéricos , Tonsilite/prevenção & controle , Tonsilite/terapia , Adulto JovemRESUMO
For the purpose of decrease in intraoperative blood loss during a tonsillectomy the technique of a laser diaphanoscopy (DS) of the palatal tonsil (PT) and paratonsil space is developed. In the conditions of a transillumination of tissues of throat vessels paratonsil space which are preventively coagulated by the holmium laser are visualized. In carrying out DS of structures of a throat the 'pilot' red laser of the surgical laser LUMENIS Versa Pulse Power Suite 20W system was used. In a research there were 60 patients with chronic tonsillitis. Laser DS was carried out before tonsillectomy, at the same time 120 PT were subjected to raying. As result of the conducted research established that 60% of PT (n=72) anatomic were deeply shipped in a sidewall of a throat, 44,2% of PT (n=53) - had the expressed top pole, 0,8% of PT (n=1) - an additional segment. Also it was established that laser transillumination of paratonsil space is possible in the conditions of infiltration of fabrics isotonic physiological NaCl solution of 0,9%. Carrying out preventive coagulation of vessels of paratonsil space of Ho:YAG laser in the conditions of DS allows to reduce the volume of intraoperative blood loss to 4,17±0,37 ml that is 10,1 time less in comparison with the tonsillectomy which is carried out on traditional techniques.
Assuntos
Terapia a Laser , Tonsila Palatina , Tonsilectomia , Tonsilite , Humanos , Lasers Semicondutores , Tonsilectomia/métodos , Tonsilite/terapia , TransiluminaçãoRESUMO
BACKGROUND AND OBJECTIVE: Acute tonsillitis is one of the most common reasons for application to otorhinolaryngology clinics. In the treatment of acute tonsillitis, supportive therapies are mostly used. As antibiotic therapy, penicillin or erythromycin can be used. The aim of this study is to decrease the clinical recovery time of acute tonsillitis by providing parenteral treatment and daily cleaning of tonsillar lesions. MATERIAL AND METHODS: Patients with an age range of 15-60 years were included in the study. The patients were divided into two groups. The first group used an i.v. combination of ampicillin + sulbactam and the tonsillar membranes of patients were cleaned daily. The second group used only the i.v. combination of ampicillin + sulbactam. RESULTS: Patients who received antibiotherapy and debridement had a clinical improvement of 90% on the 2nd treatment day and 95% on the 5th treatment day. The patients receiving only antibiotics had a clinical improvement of 65% on the 5th treatment day and 75% on the 7th treatment day. The recovery time of both groups was significantly different (p < 0.05). CONCLUSION: The solution and technique used in this clinical study showed that patients with acute tonsillitis could recover in a very short time without any complications.