Impact of Low-Temperature Plasma Radiofrequency Tonsillectomy on Pain, Inflammatory Markers, and Sleep Quality in Adults with Chronic Tonsillitis.

AIM: Chronic tonsillitis (CT) is a very common ear, nose, and throat disease worldwide, and in severe cases it can cause sleep apnea hypoventilation syndrome, which can affect the patient's health and can even be life-threatening. Low-temperature plasma radiofrequency tonsillectomy is one of the commonly used methods for treating CT with remarkable results, but more detailed reports are lacking. In this study, we aimed to explore the impact of low-temperature plasma radiofrequency tonsillectomy on pain, inflammatory markers, and sleep quality in adult CT patients for clinical reference. METHODS: A retrospective study was performed on adult patients diagnosed with CT at our hospital between June 2019 and October 2023. Patients were categorized into a control group receiving traditional tonsillectomy and a treatment group undergoing low-temperature plasma radiofrequency tonsillectomy. The groups were compared in terms of baseline characteristics, surgical parameters, visual analogue scale (VAS) scores, 36-item short form (SF-36) health survey questionnaire scores, inflammatory markers, and Pittsburgh Sleep Quality Index (PSQI) scores. Group differences in postoperative complications were also analyzed. RESULTS: There were 160 patients, 80 in the treatment group (50 males and 30 females, mean age 28.90 ± 2.46 years) and 80 in the control group (46 males, 34 females, mean age 28.89 ± 2.01 years). Differences between the two groups in terms of age, sex, duration of disease, smoking history, body mass index, and other baseline characteristics were not statistically significant (p > 0.05). Operation time, intraoperative bleeding, return to normal diet, and pseudomembrane detachment time in the treatment group were all significantly lower than in the control group (p < 0.05). There were no significant differences in VAS or SF-36 scores before treatment (p > 0.05). Post-treatment, both groups had lower VAS scores and higher SF-36 scores in the treatment group compared to the control group (p < 0.05). There were no significant differences in levels of inflammatory markers before treatment (p > 0.05). Both groups showed increased levels of inflammatory markers post-treatment, but the treatment group had lower post-treatment levels of Interleukin-6 (IL-6) and hypersensitive-C reactive protein (hs-CRP) than the control group (p < 0.05). No significant difference was observed between the two groups in PSQI scores before treatment (p > 0.05). Following treatment, both groups had decreased PSQI scores, with lower scores in the treatment group than in the control group (p < 0.05). The complication rate was lower in the treatment group than in the control group, with rates of 8.75% and 23.75%, respectively (p < 0.05). CONCLUSIONS: Low-temperature plasma radiofrequency tonsillectomy for adult CT patients offers advantages such as shorter surgical time, reduced intraoperative bleeding, minimal trauma, and fewer postoperative complications. This procedure significantly alleviates pain, improves quality of life, reduces levels of inflammatory markers, and enhances sleep quality.

IL-8 and IFN-γ as Preoperative Predictors of the Outcome of Tonsillectomy.

OBJECTIVES: Tonsillectomy (TE) and tonsillotomy (TO) due to recurrent episodes of acute tonsillitis (RAT) belong to the most frequent surgical procedures. However, an adequate objective marker predicting the outcome of TE/TO preoperatively is missing. METHODS: Patients with RAT who underwent TE/TO (n = 31) were included in this pilot study. A panel of cytokines and chemokines in serum and saliva were determined preoperatively. Health-related quality of life was assessed pre- and postoperatively by the Tonsillectomy Outcome Inventory-14. RESULTS: Health-related quality of life improved significantly after surgery. Increased serum levels of interleukin-8 (IL-8) and interferon gamma (IFN-γ) are associated with a less successful outcome. No correlation between the number of acute tonsillitis episodes and the health-related quality of life after TE or TO could be observed. CONCLUSIONS: Tonsillectomy and TO improve health-related quality of life independently from the number of past acute tonsillitis episodes. Interleukin-8 and IFN-γ in serum may serve as promising markers, predicting the benefit of TE or TO for patients preoperatively.

Calprotectin, a new biomarker for diagnosis of acute respiratory infections.

Respiratory tract infections require early diagnosis and adequate treatment. With the antibiotic overuse and increment in antibiotic resistance there is an increased need to accurately distinguish between bacterial and viral infections. We investigated the diagnostic performance of calprotectin in respiratory tract infections and compared it with the performance of heparin binding protein (HBP) and procalcitonin (PCT). Biomarkers were analyzed in patients with viral respiratory infections and patients with bacterial pneumonia, mycoplasma pneumonia and streptococcal tonsillitis (n = 135). Results were compared with values obtained from 144 healthy controls. All biomarkers were elevated in bacterial and viral infections compared to healthy controls. Calprotectin was significantly increased in patients with bacterial infections; bacterial pneumonia, mycoplasma pneumonia and streptococcal tonsillitis compared with viral infections. PCT was significantly elevated in patients with bacterial pneumonia compared to viral infections but not in streptococcal tonsillitis or mycoplasma caused infections. HBP was not able to distinguish between bacterial and viral causes of infections. The overall clinical performance of calprotectin in the distinction between bacterial and viral respiratory infections, including mycoplasma was greater than performance of PCT and HBP. Rapid determination of calprotectin may improve the management of respiratory tract infections and allow more precise diagnosis and selective use of antibiotics.

Impact of adenotonsillectomy on the evolution of inflammatory markers.

BACKGROUND: Tonsils are first-line host defence organs against pathogenic agents and participate in local and systemic immunity. Persistent increases in systemic inflammatory responses may contribute to associated morbidity. The aim of this study was to verify the short- and long-term impact of adenotonsillectomy on the evolution of inflammatory markers in 3- to 9-year-old children. METHODS: A prospective and longitudinal study was conducted over 1 year in 29 children who underwent tonsillectomy due to either chronic tonsillitis or adenotonsillar hypertrophy. Measurements of high-sensitivity C-reactive protein (hs-CRP) levels were taken. Levels of Th1-type cytokines [interleukin-1, interferon-γ, and tumor necrosis factor-α (TNF-α)] and anti-inflammatory Th2-type cytokines [interleukin-4, -5, -6, -10 and -13] were measured. Levels of transforming growth factor-beta (TGF-ß) and intercellular adhesion molecule-1 (ICAM-1) were also determined. The results were compared to those of 29 control children. RESULTS: At baseline, children with surgery indications presented with higher levels of hs-CRP, interleukin-1 and -10, interferon-γ, TNF-α and ICAM-1, whereas values of interleukin-4 were significantly lower than in control children. Children with severe tonsillar obstruction had higher values of interleukin-1, -4, and -5 and lower values of interleukin-10 compared with children with recurrent tonsillitis. One year after surgery, the levels except IL-4 did not show a significant difference from those obtained in the control group. The levels of hs-CRP and TNF-α decreased significantly in the first month. CONCLUSION: Children with chronic tonsillitis and/or adenotonsillar hypertrophy have significantly elevated levels of proinflammatory cytokines. Adenotonsillectomy restores the normal values of these parameters 1 year after surgery.

Preoperative plasma fibrinogen as a predictive factor for post-tonsillectomy haemorrhage.

OBJECTIVES: To assess whether preoperative plasma fibrinogen is able to predict severe post-tonsillectomy haemorrhage. STUDY DESIGN: Retrospective chart review. METHODS: We included 456 patients who underwent tonsillectomy between 2008 and 2013. Preoperative plasma fibrinogen levels (PFL) were assessed in patients who developed severe bleeding requiring surgical revision under general anesthesia compared to those with uneventful postoperative courses. RESULTS: 414 (90.8%) had no severe post-tonsillectomy haemorrhage. In contrast, 42 (9.2%) patients needed surgical hemostasis. PFL were significantly higher (P = .023) in patients with a severe bleeding. Univariate Cox-regression analysis revealed that elevated preoperative fibrinogen represents a significant worse (P = .003; HR 2.66; 95% CI 1.38-5.10) prognostic factor for postoperative bleeding. Even at multivariable analysis, increased PFLs were a significantly worse prognostic factor for post-tonsillectomy haemorrhage (P = .016; HR 15.4; 95% CI 0.01-0.6). High preoperative PFL was associated with significantly higher risk for post-tonsillectomy haemorrhage within the first 31 days after surgery (65% vs 90%; P = .002). Moreover, accurate negative predictive value (NPV) of 95.1% pointed out that PFL could be used as a reliable preoperative screening marker. CONCLUSIONS: Elevated PFL represents an independent worse prognostic factor for severe bleeding after tonsillectomy and could be helpful to identify patients at higher risk for PTH.

Amigdalitis hemorrágica como presentación de Sarcoma de Kaposi / Hemorrhagic tonsillitis as a presentation of Kaposi's sarcoma

Introducción: Las lesiones en la cavidad oral son con frecuencia las primeras evidencias clínicas de la infección por VIH. Una amigdalitis hemorrágica debe hacer sospechar, entre otras causas, que exista un Sarcoma de Kaposi (SK). El SK, considerada una enfermedad marcadora de sida en la infección por VIH, afecta, fundamentalmente, la piel y con frecuencia la mucosa de la cavidad oral. Objetivo: identificar una amigdalitis hemorrágica como forma de presentación de un Sarcoma de Kaposi asociado al VIH Presentación del caso: Paciente masculino de 22 años, que consulta por odinofagia y disfagia. En la faringoscopìa se observan amígdalas hipertróficas y de aspecto hemorrágicas. Se sospecha causa sistémica, entre ellas la infección por VIH. Se confirma debut clínico de sida por SK con lesiones predominantes de cavidad oral incluyendo las amígdalas. Conclusiones: Las características hemorrágicas de una amigdalitis permitieron sospechar el diagnóstico infección por VIH con Sarcoma de Kaposi predominante en cavidad oral(AU)

Introduction: Lesions in the oral cavity can be the first clinical evidences of HIV infection. Hemorrhagic tonsillitis should be suspicious of a Kaposi's sarcoma, among other causes. Kaposi's sarcoma (KS) is considered a marker of AIDS in HIV infection, which mainly affects the skin, but often acts upon the mucosa of the oral cavity. Objective: To identify hemorrhagic tonsillitis as a form of presentation of Kaposi's sarcoma associated to HIV. Case presentation: A 22-year-old male patient comes to the doctor´s office complaining of odynophagia and dysphagia. Hypertrophic tonsils of hemorrhagic aspect are observed in the laryngoscopy. Systemic cause is suspected, mainly, an HIV infection. A clinical onset of AIDS as a result of KS with predominant lesions in the oral cavity including the tonsils is confirmed. Conclusions: The hemorrhagic characteristics of tonsillitis leads to a presumptive diagnostic of HIV infection with a Kaposi's sarcoma occurring predominantly in the oral cavity(AU)

Advanced oxidation protein product levels as a marker of oxidative stress in paediatric patients with chronic tonsillitis.

We aimed to determine whether advanced oxidation protein product (AOPP) levels can serve as a marker of oxidative stress in paediatric patients with chronic tonsillitis. Thirty children with chronic tonsillitis and 30 healthy children (control group) were recruited from the Otorhinolaryngology (ORL) and Paediatric Surgery departments, respectively, of Dumlupinar University Hospital. In the patient group, blood samples were collected before tonsillectomy, and tonsil tissue was sampled during the operation. Blood samples were also obtained from the control subjects. AOPP levels in the serum and tonsil tissue were measured by the spectrophotometric method. Serum AOPP levels were significantly higher in the patient group (13.1 ± 3.3 ng/ml) than in the control group (11.6 ± 2.3 ng/ml; P < 0.05). In addition, the mean AOPP level (41.9 ± 13.5 ng/mg protein) in the tonsil tissue in the patient group was significantly higher than the mean serum AOPP levels in the control and patient groups (P < 0.05). AOPP levels are elevated in the tonsil tissue and serum of patients with chronic tonsillitis compared to the serum AOPP levels in healthy controls. AOPPs may represent a novel class of pro-inflammatory molecules that are involved in oxidative stress in chronic tonsillitis. AOPPs may be used as a marker of oxidative stress in paediatric patients with chronic tonsillitis.

USE OF NEUTROPHILS TO LYMPHOCYTES RATIO AS AN INFLAMMATION MARKER IN PATIENTS WITH CHRONIC TONSILLITIS.

The aim of this study was to assess the neutrophil to lymphocyte ratio (NLR) as an inflammation marker in patients with chronic tonsillitis and to compare the NLR values to other inflammation markers, such as antistreptolysin-O (ASO), C-Reactive Protein (CRP) and erythrocyte sedimentation rate (ESR). Thirty patients aged between 4 and 15 y.o. who had undergone surgery for chronic tonsillitis were included in this retrospective study. Blood samples including haemogram, ASO, CRP and ESR were taken from the patients the day before and one month after the surgery and were analysed retrospectively. Preoperative ASO values were 170±75.5 U, CRP values were 7.6±5 mg/L, ESR values were 15.7±10 mm/H and NLR values were 0.9±0.2. Postoperative ASO values were 140.9±58.5 U, CRP values were 6.8±3.4 mg/L, ESR values were 12.5±5.4 mm/H and NLR values were 1.2±0.4. Statistically significant decreases were observed in the white blood cell count (WBC), lymphocytes, ASO and ESR results, with increase in NLR values after the surgery (p<0.05). The neutrophil and CRP values after the surgery have shown statistically insignificant decrease (p>0.05). The NLR values were compared with the ASO, CRP and ESR values, which were used as inflammation markers. Negative correlation was found between decrease in ASO and ESR and increase in the NLR values after the surgery.

Prevalence of rheumatic heart disease in patients with recurrent tonsillitis and elevated anti-streptolysin O titers.

INTRODUCTION: Patients with elevated anti-streptolysin O (ASO) titers (ASOT) and recurrent tonsillitis episodes are known to be at higher risk for rheumatic heart disease (RHD). However, there is no data regarding prevalence of RHD in this high risk population. In this study, we aimed to screen ambulatory patients with elevated ASOT and recurrent tonsillitis episodes using echocardiography for identification of RHD. We hypothesized that prevalence of RHD is higher in this patient group compared to general population. METHODS: 102 patients (10.33 ± 4.01 years, 50.98% female) who were diagnosed with recurrent tonsillitis and had elevated ASOT were included this study. Echocardiographic evaluation was performed by an experienced cardiologist. RESULTS: Echocardiographic examination revealed definite RHD in 2/102 (1.96%) patients and borderline RHD in 3/102 (2.94%) patients. CONCLUSION: Our study demonstrates a high prevalence of RHD in patients with recurrent tonsillitis episodes and high ASOT. Screening with echocardiography is beneficial to improve the detection rates of subclinical RHD in such high-risk populations.

Evaluation of iron and zinc levels in recurrent tonsillitis and tonsillar hypertrophy.

OBJECTIVES: The aim of this study is to look into the roles of iron and zinc metals in etiopathogenesis of recurrent tonsillitis and tonsillar hypertrophy by evaluating the levels of iron and zinc elements in the palatine tonsillar tissue. METHODS: In total, 40 patients who underwent a tonsillectomy to treat recurrent tonsillitis and tonsillar hypertrophy were included in the study. Patients were classified into two groups, recurrent tonsillitis and tonsillar hypertrophy, determined by the results of clinical and histopathological examination. The levels of iron and zinc elements were determined for each tonsillar tissue sample. RESULTS: There was a significant difference in the iron and zinc concentrations (p<0.001) between the tonsillar hypertrophy and recurrent tonsillitis groups. The levels of iron and zinc were significantly lower in the recurrent tonsillitis group. CONCLUSIONS: This study suggests that low tissue concentrations of iron and zinc may lead to recurrent tonsillitis.

Selenium, Zinc, Copper, and Total Antioxidant Status in the Serum of Patients with Chronic Tonsillitis.

Antioxidants can play a significant role in chronic inflammatory process. The aim of this study was to evaluate the content of selenium (Se), zinc (Zn), copper (Cu), and total antioxidant status (TAS) of patients with chronic tonsillitis (CT). The study group consisted of 84 patients with CT from 18 to 62 years old and the control group of 67 healthy people aged 19-65 years. Se, Zn, and Cu concentration in serum samples were determined by atomic absorption spectrometry. Serum TAS was measured spectrophotometrically, using the test by Randox Laboratories-Us Ltd. The mean content of Se and Zn in the serum of patients with CT (61.122 ± 12.73 µg/L, 0.887 ± 0.26 mg/L, respectively) was lower compared to the control group (77.969 ± 12.73 µg/L, 0.993 ± 0.32 mg/L, respectively). The mean serum concentration of Cu in patients with CT (1.219 ± 0.35 mg/L) was higher compared to its serum concentration in healthy people (1.033 ± 0.37 mg/L). Serum TAS of patients with CT (1.171 ± 0.33 mmol/L) was lower in comparison with healthy volunteers (1.333 ± 0.42 mmol/L). The serum concentration of Se, Zn, and TAS in patients with CT was lower, whereas the concentration of Cu was higher compared to healthy volunteers. Smoking has an influence on reducing the concentration of Se and TAS of patients with CT.

Tonsillitis in children: unnecessary laboratory studies and antibiotic use.

BACKGROUND: The Finnish Current Care Guidelines on diagnostics and treatment of sore throat recommend the treatment of only group A streptococcus (GAS) positive cases with penicillin. The aim of the study was to evaluate how these guidelines are followed in the pediatric emergency unit. METHODS: We analyzed retrospectively the data on microbiological studies and blood tests done, and data on prescribing of antibiotics, of 200 children admitted for febrile exudative tonsillitis. RESULTS: After the clinical diagnosis of exudative tonsillitis, antigen test and/or culture for GAS identification was done in >95% of cases. All the 32 (16%) children with GAS infection, but also 52 (38%) of the 137 children without any evidence of bacterial infection received antibiotics. Additional laboratory studies were done in 96% of children. Serum C-reactive concentrations or white blood cell counts were not able to separate streptococcal from non-streptococcal tonsillitis. No serious bacterial infection was diagnosed. CONCLUSIONS: The Finnish Current Care Guidelines lead to over-treatment with antibiotics. None of the 200 children returned after discharge, suggesting that undertreatment did not happen.

Blood parameters as indicators of upper airway obstruction in children with adenoid or adenotonsillar hypertrophy.

UNLABELLED: Adenotonsillar hypertrophy (ATH) is the most common cause of obstructive sleep apnea in children. This study aimed to evaluate the blood parameters of children with ATH who underwent surgery. METHODS: The study included a review of the medical records of 130 children who underwent adenoidectomy or adenotonsillectomy with a diagnosis of adenoid hypertrophy and/or chronic tonsillitis. Patients were classified into 3 groups: group 1 (n=69) underwent adenoidectomy, group 2 (n=61) underwent adenotonsillectomy, and group 3 consisted of 82 healthy children. White blood cell count, platelet count, hemoglobin levels, mean platelet volume, and platelet distribution width values were the primary outcome measures. RESULTS: Mean platelet volume, platelet distribution width and hemoglobin values decreased in the groups that underwent surgery. Whereas the decrease in group 1 was insignificant, it was significant in group 2. White blood cell count values increased in both group 1 (adenoidectomy) and group 2 (adenotonsillectomy), but the increase in group 2 was significant. No significant difference in platelet count was detected before versus after the operation. CONCLUSIONS: Upper airway obstruction caused by ATH remarkably changes the blood parameters related to chronic hypoxia. Significant improvement can be achieved after adenotonsillectomy rather than adenoidectomy alone.

The efficacy of tonsillectomy in chronic tonsillitis patients as demonstrated by the neutrophil-to-lymphocyte ratio.

OBJECTIVES: Adenoidectomy and tonsillectomy are the oldest surgical procedures. The neutrophil-to-lymphocyte ratio is an inflammatory marker. This study aimed to investigate neutrophil-to-lymphocyte ratios in chronic tonsillitis patients and to determine whether this ratio reflects the pre- and post-operative inflammatory status in these patients. METHODS: Patients and healthy individuals were assigned to four groups: the adenoid hypertrophy, adenotonsillar hypertrophy, chronic tonsillitis and control groups. The neutrophil-to-lymphocyte ratio was calculated for each patient before surgery and one month post-surgery. Pre- and post-operative white blood cell, neutrophil and lymphocyte counts and neutrophil-to-lymphocyte ratios were compared both within and between groups. RESULTS: Pre- and post-operative neutrophil-to-lymphocyte ratios were significantly higher in the chronic tonsillitis group than in the adenoid hypertrophy and adenotonsillar hypertrophy groups (p < 0.01 and p < 0.05, respectively). In the chronic tonsillitis group, post-operative neutrophil-to-lymphocyte ratios were significantly lower than pre-operative ratios (p = 0.045). The pre-operative neutrophil-to-lymphocyte ratio was significantly higher in the chronic tonsillitis group than in the adenoid hypertrophy, adenotonsillar hypertrophy and control groups (p = 0.000). In contrast, there was no significant difference in post-operative neutrophil-to-lymphocyte ratios among all groups (p = 0.584). CONCLUSION: The neutrophil-to-lymphocyte ratio measurement can be used in chronic tonsillitis patients as an effective auxiliary method for determining the necessity and timing of tonsillectomy and post-operative follow up, thereby helping prevent complications due to delayed or inadequate treatment.

Preoperative serum pattern analysis to predict the outcome of tonsillectomy in adults with chronic tonsillitis.

The method of classification and tree analysis (CART) was used to predict the outcome of tonsillectomy for chronic tonsillitis (CHT) analyzing patterns of serological markers. In a prospective case study of 24 adult patients with CHT in comparison to 24 patients with acute peritonsillar abscess (PTA) blood samples were assessed 1 day before (T-1) and 3 days after tonsillectomy. Outcome 6 months later (T180) was documented using the Glasgow Benefit Inventory (GBI) and the Specific Benefits from Tonsillectomy Inventory (SBTI). In comparison to PTA, patients with CHT were at best classified by C-reactive protein with a cut-off value of <16.735 mg/dl. For CHT, immunoglobulin E ≤ 144.65 kU/l and the combination of monocytes ≤ 0.565 Gpt/l plus leucocytes >5.855 Gpt/l at T-1 were the best classificators for higher SBTI overall score and symptom score symptom score, respectively, at T180. A higher benefit subscore at T180 was associated to γ-globulin >15.85 % plus α2-globulin >8.950% at T-1. The best classificator for better GBI overall score at T180 was an ASL titer >169.0 IU/ml or the combination of an ASL titer ≤ 169.0 IU/ml with lymphocytes ≤ 2.195 Gpt/l. Lymphocytes ≤ 2.195 Gpt/l were associated with higher GBI general subscore. Leukocytes ≤ 6.780 Gpt/l were related to higher GBI social support subscore. The combination of immunoglobulin A >1.360 g/l with procalcitonin level >0.058 ng/ml was the best combination to classify for higher physical health score. Instead of looking on isolated serologic markers, CART of multiple parameters seems to be more effective to predict the outcome of tonsillectomy for CHT.

Clinical significance and diagnostic usefulness of serologic markers for improvement of outcome of tonsillectomy in adults with chronic tonsillitis.

BACKGROUND: The aim of the present study was to explore serological biomarkers which predict the outcome of tonsillectomy for chronic tonsillitis. METHODS: A case study in a University ENT department of 24 adult patients with chronic tonsillitis (CHT) in comparison to 24 patients with acute peritonsillar abscess (PTA) was performed. Blood samples for clinical routine hematological and serological parameters were assessed prior to surgery (T-1) and five days (T5) after tonsillectomy. Outcome 6 months later (T180) was documented using the Glasgow Benefit Inventory (GBI) and the Specific Benefits from Tonsillectomy Inventory (SBTI). Correlation analyses between CHT and PTA group as well as between the different time points within each group concerning the serological parameters and the outcome parameters were performed. RESULTS: At T-1, patients in the CHT group presented with significantly higher lymphocytes counts (relative and absolute), basophils (relative and absolute) and eosinophils but less white-cells, monocytes, neutrophils (absolute and relative), alpha-1, alpha-2, beta globulins, immunoglobulin and lower C-reactive protein and procalcitonin values than patients in the PTA group (all p < 0.05, respectively). Within each group, different significant changes of the serum parameters (often in opposite direction) were observed between T-1 and T5. SBTI scores at T-1 were significantly lower in the CHT group. In contrast, most GBI scores at T180 were significantly higher in the CHT group. Between T-1 and T180 the SBTI scores improved in three quarters of the CHT patients but only in three fifths of the PTA patients. Higher eosinophil counts and immunoglobulin E levels at T-1 predicted higher GBI scores at T180 in the CHT group. CONCLUSIONS: This pilot study showed a specific serological pattern for patients with chronic tonsillitis with a specific pattern of changes after tonsillectomy. But there is no established role for biomarkers currently used in clinical practice to predict the outcome of tonsillectomy for chronic tonsillitis.

Circulating cytokines in patients undergoing tonsillectomy with fibrin glue.

OBJECTIVE: Fibrin glue is used as a haemostatic agent or as a sealant. The aim of this study is to objectively evaluate the efficacy of the use of fibrin glue Quixil - a human surgical sealer - in tonsillectomy, for the reduction of post-operative inflammatory response. STUDY DESIGN: A prospective randomized single-blind study. METHODS: The study was performed on 40 consecutive patients undergoing adenotonsillectomy (T&A). Patients were randomly assigned to one of two sub-groups: a study group and a control group. The tonsillar beds of patients in the study group were coated with fibrin glue (Quixil, OMRIX biopharmaceuticals) at the end of the operation; the patients in the control group were treated for hemostasis without the use of fibrin glue. Complete blood counts and circulating pro-inflammatory cytokines (assayed by specific immunoassay - ELISA) were assessed in samples drawn pre- and 16 h post-tonsillectomy. RESULTS: Forty patients (aged 5.8 ± 2.4 years) were consecutively enrolled; 45% (18) of the patients were treated with fibrin glue, 55% (22) were not. Compared to controls, Quixil-treated patients demonstrated a reduction in post-tonsillectomy circulating leukocytes (29.2% vs. 45.4%, p<0.05), neutrophiles (28.3% vs. 42.1%, p<0.05), IL-6 (+1% vs. +42%, p<0.05), and TNF-alpha (+8% vs. +26%, p<0.05. CONCLUSIONS: Intra-operative fibrin glue therapy is associated with decreased immediate inflammatory response following T&A. Further studies are warranted to assess long-term outcome. LEVEL OF EVIDENCE: 1B.

The correlation between EBV viral load in the palatine tonsils of patients with recurrent tonsillitis and concurrent serum titers of VCA­IgG.

Epstein­Barr virus (EBV) infection usually occurs in early childhood and can persist in palatine tonsil lymphocytes to induce tonsillitis at a later date. We have examined the presence of EBV in palatine tonsils and relationship between EBV-DNA quantity in tonsil tissues and VCA-IgG quantity in autologous sera. Tonsils were obtained from 36 patients, male 20 (55.6%), female 16 (44.4%) (mean age 7.96 ± 6.97 years), who underwent tonsils removal because of recurrent tonsillitis. Tissues were processed for real-time PCR and patient's sera were assayed to determine VCA-IgG by VCA-IgG ELISA. In 27 out of 36 cases (75%), positive EBV-DNA reaction was found. However, statistical analysis showed no correlation between EBV-DNA quantity and VCA-IgG quantity. We conclude that tonsils of children can be colonized by EBV and that virus may have a direct and indirect role in recurrent tonsillitis and nasopharyngeal carcinoma.

[Peripheral T cell subsets in chronic tonsillitis patients].

OBJECTIVE: To investigate the characteristics of T lymphocytic subsets in chronic tonsillitis patients for evaluation of their clinical implication. METHOD: Fresh peripheral blood samples were obtained from 54 chronic tonsillitis patients and 52 healthy counterparts. CD4+ and CD8+ T lymphocyte subsets including the naive (CD45RA+), memory (CD45RO+), functional (CD28+), activated (HLA-DR+, CD25+) and apoptosis (CD95+) T lymphocytes, were analyzed by flow cytometry, respectively. The clinical data such as serum Cystatin C con centration, ASO and ESR were simultaneously recorded from each chronic tonsillitis patient. RESULT: The CD4+ T cells, the rate of CD4+/CD8+ and CD4+ CD45RA+ /CD4+ CD45RO+, the CD4+ CD45RA+ T cells and the CD4+ CD25+ T cells in chronic tonsillitis were significantly lower than those of the control group (P < 0.05) while an obviously increasing percentage of memory (CD45RO+) and apoptosis (CD95+) T lymphocytes in chronic tonsillitis patients, and there were significant differences between the patients with chronic tonsillitis and the healthy volunteers (P < 0.05). Furthermore, in the chronic tonsillitis patients, Serum Cystatin C level was negatively correlated with CD4+ CD45RA+ T(P < 0.05), and not significantly correlated with other T lymphocyte subtypes (P > 0.05). CONCLUSION: Immune disorder is present in the peripheral blood of chronic tonsillitis patients. Our data may provide valuable information for evaluation of disease progression of chronic tonsillitis patients.

The effect of adenotonsillectomy on oxygen saturation in children with sleep breathing disorders.

OBJECTIVE: To evaluate the effect of adenotonsillectomy on the oxygen saturation measures by nocturnal pulse oximetry in children with sleep breathing disorders (SBD). METHODS: A non-controlled clinical trial was performed. Thirty-one children with suspected SBD and a clinical indication for adenotonsillectomy were recruited. All of them underwent overnight oxygen saturation monitoring before and after surgery. RESULTS: Twenty-seven patients completed the study. The mean age was 5.2+/-1.8 years. Eighteen (66.7%) were male. The most prevalent symptoms were: snoring (100%), respiratory pauses (96.8%), nocturnal mouth breathing (96.8%), restless sleep (80%) and drooling (74.1%). Twenty-three children (85.2%) presented grade 3 or 4 tonsillar hyperplasia. There was a significant improvement in the postoperative oxygen desaturation index (ODI) (0.65; 0.5-1.3) compared with the preoperative index (1.63; 1.1-2.4) (p<0.001). CONCLUSION: Adenotonsillectomy improved the oxygen saturation measures by nocturnal pulse oximetry in children with sleep breathing disorders.