Management of recurrent tonsillitis in children.

OBJECTIVE: To compare azithromycin (AZT) and benzathine penicillin (BP) in the treatment of recurrent tonsillitis in children. METHODS: The study comprised of 350 children with recurrent streptococcal tonsillitis, 284 of whom completed the study and 162 children received conventional surgical treatment. The rest of the children, 122, were divided randomly into two equal main groups. Group A children received a single intramuscular BP (600,000IU for children≤27kg and 1,200,000IU for ≥27kg) every two weeks for six months. Group B children received single oral AZT (250mg for children≤25kg and 500mg for ≥25kg) once weekly for six months. RESULTS: Both groups showed marked significant reduction in recurrent tonsillitis that is comparable to results of tonsillectomy. There were no statistical differences between group A and B regarding the recurrence of infections and drug safety after six-month follow-up. Group B showed better compliance. CONCLUSION: AZT proved to be good alternative to BP in the management of recurrent tonsillitis with results similar to those obtained after tonsillectomy.

Psychological stress and its relationship with persistent allergic rhinitis.

UNLABELLED: Allergic rhinitis is considered to be a major health problem that impairs quality of life. A possible relationship with psychological stress may exist. The aim of this study is to verify the relationship between persistent allergic rhinitis (PAR) and psychological stress aiming to improve treatment and thereby quality of life (QOL) of patients. Patients with PAR (166) were diagnosed then analyzed using the Kessler Psychological Distress Scale. Patients with allergic rhinitis and who were positive on the Kessler scale (122) were randomly divided equally into a control group which received levocetirizine and a study group which received levocetirizine and imipramine. Nasal symptom assessment and QOL assessment were performed in all patients after treatment. Of the 166 patients with PAR, 122 (73.5 %) were positive on the Kessler Psychological Distress Scale. There was a marked improvement in the study group compared with the control group as regards nasal symptoms with better QOL in the study group (6.93) compared with the control group (2.13). Psychological stress has a strong impact on persistent allergic rhinitis. When stress is controlled by a combined treatment of imipramine and levocetirizine, allergic rhinitis symptoms improved and a better QOL was obtained. LEVEL OF EVIDENCE: 3b.

Quality of life after tonsillectomy versus azithromycin.

BACKGROUND: Recurrent tonsillitis is a common disease with marked evidence of affecting children quality of life (QOL) such as their progression in school and increased burden to extended families. The aim of this study was to compare the QOL outcomes after conventional dissection tonsillectomy versus azithromycin treatment in controlling recurrent tonsillitis. METHODS: A double-blind, randomized clinical trial was carried out in 184 children with recurrent tonsillitis randomly divided into two groups: Group A was subjected to conventional dissection tonsillectomy, whereas Group B received single 250 mg (children ≤25 kg) and 500 mg (children ≥25 kg) of oral azithromycin once weekly. RESULTS: There were no significant differences between the groups with regard to ear, nose, and throat infections during the 5-year follow-up. Better QOL was observed in both groups when compared with the pretreatment, but similar QOL in both groups QOL after treatment. CONCLUSION: Azithromycin is an effective method as a prophylaxis against recurrent tonsillitis with a great benefit for better QOL outcomes.

Persistent cough: prevalence of gastroesophageal reflux and study of relevant laryngeal signs.

Cough is one of the atypical manifestations of gastroesophageal reflux disorder (GERD). The aim of this study was to evaluate the prevalence of GERD among patients presenting with persistent cough. The study included 80 patients over a period of 3 years. The inclusion criteria were nonsmoker adults with normal chest radiograph whose chief complaint was cough for at least 4 weeks duration. All patients included were subjected to nasal endoscopy, laryngoscopy, and 24-hour pH monitoring. Reflux was recorded in the different positions. Laryngeal signs of reflux were traced for and their significance was calculated. Patients who proved to have GERD received antireflux treatment with a follow-up of 3 months. The response to antireflux treatment was assessed according to subjective and objective improvement. Relapse in the follow-up period occurred in 9% of patients. It is concluded that laryngeal signs of GERD should be well known to diagnose and properly manage persistent cough.