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Taha A, Yeheskeli E, Gavriel H, Berkovitch M, Mizrakli Y, Shlamkovitch N, Kohn E. The Safety, Tolerability, and Efficacy of DL-Lactic Acid Syrup (Tonsitin) in Children With Recurrent Tonsillitis: A Pilot Study. Clin Pediatr (Phila) 2024:99228231222317. [PMID: 38205711 DOI: 10.1177/00099228231222317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
To evaluate Tonsitin (10% DL-lactic acid) safety, tolerability, and efficacy, as a treatment for recurrent tonsillitis (RT) in children. This is a clinical prospective, randomized, double blind pilot study, to evaluate the safety, tolerability and efficacy of Tonsitin in healthy children with RT. Safety evaluated in terms of adverse events (AEs), tolerability in terms of compliance, and efficacy in terms of tonsils' size and frequency of tonsillitis, and quality of life. The study included 51 children. The treatment regimen was tolerable among the participants. Six children experienced AEs, but mostly mild. Tonsil size declined in both groups, but these results did not reach statistical significance. Tonsillitis episodes' frequencies were random and not significant. Tonsitin treatment was found to be feasible in the clinical setup and was well tolerated, and appears to be safe. Study efficacy results did not reach statistical significance.
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Affiliation(s)
- Ahmed Taha
- Department of Otolaryngology-Head and Neck Surgery, Shamir Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Eyal Yeheskeli
- Department of Otolaryngology-Head and Neck Surgery, Shamir Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Haim Gavriel
- Department of Otolaryngology-Head and Neck Surgery, Shamir Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Matitiahu Berkovitch
- Clinical Pharmacology and Toxicology Unit, Shamir Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Yuval Mizrakli
- Department of Otolaryngology-Head and Neck Surgery, Shamir Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Natan Shlamkovitch
- Department of Otolaryngology-Head and Neck Surgery, Shamir Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Elkana Kohn
- Clinical Pharmacology and Toxicology Unit, Shamir Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Schafer A, Worobetz N, Lukens J, Bourgeois T, Onwuka A, Elmaraghy C, Chiang T. Assessing the Relationship Between Infection Frequency and Risk of Post-Tonsillectomy Hemorrhage. Ann Otol Rhinol Laryngol 2023; 132:1424-1429. [PMID: 37005553 DOI: 10.1177/00034894231159328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
OBJECTIVE To determine the relationship between frequency of tonsillitis and the risk of post-tonsillectomy hemorrhage (PTH) in pediatric patients undergoing tonsillectomy for recurrent tonsillitis. METHODS After obtaining IRB approval from Nationwide Children's Hospital, charts for all patients who underwent a total tonsillectomy in 2017 for recurrent or chronic tonsillitis were retrospectively reviewed (n = 424). Patients were divided into 2 cohorts based on the frequency of tonsillitis prior to surgery: those meeting the 1-year criteria with 7 or more infections in the past year (n = 100), and those who did not meet criteria defined as those with fewer than 7 infections in the past year (n = 324). The primary outcome of interest was PTH. Comparison of cohorts and frequency of PTH were assessed using bivariate analyses. Kaplan-Meier curves were used to compare time to onset of hemorrhage between primary vs. secondary PTH. Generalized mixed and logistic regression models were used to evaluate risk of hemorrhage following tonsillectomy. RESULTS Among a total cohort of 424 patients undergoing tonsillectomy, 23.58% (n = 100) met criteria while 76.42% (n = 324) did not. A total of 8.73% (n = 37) patients experienced PTH. Compared to those who did not meet criteria, those who met criteria had a higher odds of developing PTH; however, this was not significant (OR: 1.42 [95% CI: 0.67, 2.98], P = .3582). Estimated probability of developing PTH for those who met criteria was 11% [95% CI: 6.19, 18.81] compared to 8.03% [95% CI: 5.52, 11.54] for those who did not meet criteria. Among all PTH cases, 5.41% (n = 2) were primary hemorrhage while 94.59% (n = 35) were secondary hemorrhage with 50% of those with secondary PTH having experienced hemorrhage within 6 days [95% CI: 5, 7] of tonsillectomy. Patients with neuromuscular conditions had significantly higher odds of PTH (OR: 4.75 [95% CI: 1.19, 18.97], P = .0276). CONCLUSION Patients who met the 1-year criteria for tonsillectomy did not have a significantly higher odds of PTH. Further research is needed to better evaluate the relationship between infection frequency and risk of PTH.
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Affiliation(s)
- Austin Schafer
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Noah Worobetz
- Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jordan Lukens
- Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Tran Bourgeois
- The Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Amanda Onwuka
- The Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Charles Elmaraghy
- The Ohio State University College of Medicine, Columbus, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Tendy Chiang
- The Ohio State University College of Medicine, Columbus, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA
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Johnston J, Wagner Mackenzie B, Biswas K, Waldvogel-Thurlow S, Clark ST, Radcliff F, Mahadevan M, Douglas RG. The Effect of Amoxicillin with Clavulanate on the Microbiota of Tonsillar Tissue in Disease: a Randomized Control Trial. Microbiol Spectr 2022; 10:e0123922. [PMID: 36318025 PMCID: PMC9769914 DOI: 10.1128/spectrum.01239-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/13/2022] [Indexed: 12/23/2022] Open
Abstract
Despite antibiotics being the primary medical treatment for recurrent tonsillitis, the impact of antibiotics on the tonsillar microbiome is not well understood. This study aimed to determine the effect of amoxicillin with clavulanate on the composition and quantity of bacteria in the tonsils of children with recurrent tonsillitis. A multicenter randomized clinical trial in Auckland, New Zealand was undertaken between August 1, 2017, and June 30, 2018. Sixty children undergoing tonsillectomy for the indication of recurrent tonsillitis were recruited for this study. Following random allocation, 30 participants were prescribed amoxicillin with clavulanate for the week before surgery. The remaining 30 received no antibiotics. Immediately following surgery, the crypts of the right and left tonsils were swabbed. Bacterial 16S rRNA gene-targeted amplicon sequencing and histological techniques were utilized. In the control group, there were significantly higher relative abundances of Haemophilus, Streptococcus, Neisseria, and Porphyromonas. Members from the genera Fusobacterium and Treponema were found to be significantly more abundant in the antibiotic group. There were no significant differences in the absolute quantities of bacteria between the groups. Microscopic examination found fewer bacterial microcolonies present in the tonsillar crypts of participants in the antibiotic group. Streptococcus pyogenes was not present in these bacterial microcolonies. These results suggest that a single course of antibiotics has a significant impact on the tonsil microbiota composition. The duration of this effect and the effect that the altered microbiome has on the course of the condition need to be determined. IMPORTANCE Several studies have identified the presence of multiple pathogenic bacteria in hyperplastic adenoids and palatine tonsils. However, there are currently no studies that utilize this technology to investigate the effect of oral antibiotics in children with recurrent tonsillitis on the tonsillar microbiome. This is the first study to investigate the effect of antibiotics on the microbiome of tonsillar tissue in children with recurrent tonsillitis using molecular techniques. This study has shown that participants who received amoxicillin with clavulanate immediately before tonsillectomy had a significantly reduced number of bacterial taxa commonly associated with recurrent tonsillitis, as well as the number of bacterial microcolonies observed in the tonsillar crypts. This novel finding suggests that either the effect of antibiotics is not sustained or that they are not an effective treatment for recurrent tonsillitis.
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Affiliation(s)
- James Johnston
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | | | - Kristi Biswas
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | | | - Sita Tarini Clark
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Fiona Radcliff
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Murali Mahadevan
- Department of Surgery, University of Auckland, Auckland, New Zealand
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Muacevic A, Adler JR, Al Mansour MH, Safhi AA. Evaluation of Serum 25(OH) Vitamin D as a Risk Factor in Adult Recurrent Tonsillitis. Cureus 2022; 14:e32083. [PMID: 36600833 PMCID: PMC9803801 DOI: 10.7759/cureus.32083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
Background Studies have reported that the rate of upper respiratory tract infections in children and adults is inversely related to serum vitamin D levels and supplementation with vitamin D reduces the incidence of this infection. This study aimed to examine if vitamin D serum levels were a risk factor for recurrent tonsillitis among adult patients. Methods Retrospective comparative analysis was carried out on 100 patients diagnosed with recurrent tonsillitis with 100 age- and sex-matched individuals as controls between June 2016 and May 2022. Tonsillar size was assessed based on Brodsky grading system. Serum levels of 25-hydroxy (25(OH)) vitamin D, total calcium, iron, hemoglobin, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were analyzed. Results There was a statistically significant low vitamin D levels in tonsil size grades III+IV compared to grade I+II (p <0.001) among cases. There was a significantly lower serum value for 25(OH) vitamin D in the cases as compared to the control group (p <0.001). A high percentage (68%) of cases had vitamin D deficiency (<20 ng/mL) and this was statistically significant (p <0.001). There were statistically significant higher values of CRP and ESR among cases compared to the control group (p <0.001). At a cut off (≤21.2), serum vitamin D levels achieved 78% sensitivity, 65% specificity (p <0.001) to differentiate cases from controls. Following logistic regression analysis, the level of vitamin D was the only significant risk factor. Conclusion Findings from our study also suggest an association between recurrent tonsillitis among our adult cohorts and low serum 25(OH) vitamin D levels. Therefore, we opine that serum vitamin D levels should be considered in the management of adult patients with tonsillitis.
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Klagisa R, Racenis K, Broks R, Balode AO, Kise L, Kroica J. Analysis of Microorganism Colonization, Biofilm Production, and Antibacterial Susceptibility in Recurrent Tonsillitis and Peritonsillar Abscess Patients. Int J Mol Sci 2022; 23:ijms231810273. [PMID: 36142185 PMCID: PMC9499404 DOI: 10.3390/ijms231810273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/30/2022] [Accepted: 09/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Despite the widespread use of antibiotics to treat infected tonsils, episodes of tonsillitis tend to recur and turn into recurrent tonsillitis (RT) or are complicated by peritonsillar abscesses (PTAs). The treatment of RT and PTAs remains surgical, and tonsillectomies are still relevant. Materials and methods: In a prospective, controlled study, we analyzed the bacteria of the tonsillar crypts of 99 patients with RT and 29 patients with a PTA. We performed the biofilm formation and antibacterial susceptibility testing of strains isolated from study patients. We compared the results obtained between patient groups with the aim to identify any differences that may contribute to ongoing symptoms of RT or that may play a role in developing PTAs. Results: The greatest diversity of microorganisms was found in patients with RT. Gram-positive bacteria were predominant in both groups. Candida species were predominant in patients with a PTA (48.3% of cases). Irrespective of patient group, the most commonly isolated pathogenic bacterium was S. aureus (in 33.3% of RT cases and in 24.14% of PTA cases). The most prevalent Gram-negative bacterium was K. pneumoniae (in 10.1% of RT cases and in 13.4% of PTA cases). At least one biofilm-producing strain was found in 37.4% of RT cases and in 27.6% of PTA cases. Moderate or strong biofilm producers were detected in 16 out of 37 cases of RT and in 2 out of 8 PTA cases. There was a statistically significant association found between the presence of Gram-positive bacteria and a biofilm-formation phenotype in the RT group and PTA group (Pearson χ2 test, p < 0.001). S. aureus and K. pneumoniae strains were sensitive to commonly used antibiotics. One S. aureus isolate was identified as MRSA. Conclusions: S. aureus is the most common pathogen isolated from patients with RT, and Candida spp. are the most common pathogens isolated from patients with a PTA. S. aureus isolates are susceptible to most antibiotics. Patients with RT more commonly have biofilm-producing strains, but patients with a PTA more commonly have biofilm non-producer strains. K. pneumoniae does not play a major role in biofilm production.
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Affiliation(s)
- Renata Klagisa
- Department of Otorhinolaryngology, Daugavpils Regional Hospital, LV-5401 Daugavpils, Latvia
- Department of Doctoral Studies, Riga Stradins University, LV-1007 Riga, Latvia
- Correspondence: ; Tel.: +371-28471191
| | - Karlis Racenis
- Department of Biology and Microbiology, Riga Stradins University, LV-1007 Riga, Latvia
- Center of Nephrology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia
| | - Renars Broks
- Department of Biology and Microbiology, Riga Stradins University, LV-1007 Riga, Latvia
| | - Arta Olga Balode
- Department of Microbiology, NMS Laboratory, LV-1039 Riga, Latvia
| | - Ligija Kise
- Department of Doctoral Studies, Riga Stradins University, LV-1007 Riga, Latvia
| | - Juta Kroica
- Department of Biology and Microbiology, Riga Stradins University, LV-1007 Riga, Latvia
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Al-Rawashdeh BM, Altawil M, Khdair Ahmad F, Alharazneh A, Hamdan L, Muamar ASH, Alkhaldi S, Tamimi Z, Husami R, Husami R, Ababneh NA. Vitamin D Levels in Children with Recurrent Acute Tonsillitis in Jordan: A Case-Control Study. Int J Environ Res Public Health 2022; 19. [PMID: 35886596 DOI: 10.3390/ijerph19148744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 02/01/2023]
Abstract
Background: Vitamin D is essential for many functions of the body. In addition to its primary function of regulating the absorption of calcium in the small intestine, its role in the immune system has recently been studied. The current study aimed to test the impact of vitamin D deficiency on the rate of recurrent acute tonsillitis in children. Methods: According to Paradise criteria, two hundred forty-two children with recurrent acute tonsillitis were recruited. A group of healthy children (n = 262) was also recruited as controls. Poisson regression was run to predict the number of tonsillitis episodes per year based on vitamin D levels. The mean vitamin D level in the study group was lower than in the control group (p < 0.0001). Poisson regression of the rate of recurrent tonsillitis and vitamin D level (OR = 0.969 (95% CI, 0.962−0.975)) showed that for every single unit increase in vitamin D level, there was a 3.1% decrease in the number of tonsillitis episodes per year (p < 0.0001). Conclusions: Vitamin D deficiency is associated with higher rates of recurrent acute tonsillitis. Future controlled trials should investigate the role of vitamin D supplementation in reducing the rate of recurrent tonsillitis.
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Alston K, Sklar R, Stead TS, Lopez Ortiz CO, Ganti L. Bilateral Tonsillitis With Peritonsillar Abscess. Cureus 2021; 13:e17546. [PMID: 34646603 PMCID: PMC8478693 DOI: 10.7759/cureus.17546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 11/05/2022] Open
Abstract
The authors present a case of an adolescent female who presented to the emergency department with a second case of tonsillitis in the span of two weeks. The patient recovered after treatment with a broader-spectrum antibiotic and was discharged home. The authors highlight the importance of weighing the costs and benefits of tonsillectomy with the potential that additional antibiotics may be enough in cases of recurrent tonsillitis.
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Affiliation(s)
- Kyra Alston
- Emergency Medicine, Trinity Preparatory School, Winter Park, USA
| | - Rachel Sklar
- Emergency Medicine, Brown University, Providence, USA
| | - Thor S Stead
- Medicine, Warren Alpert Medical School, Brown University, Providence, USA
| | - Carlos O Lopez Ortiz
- Emergency Medicine, Ocala Regional Medical Center, Ocala, USA.,Emergency Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI
| | - Latha Ganti
- Emergency Medicine, Envision Physician Services, Plantation, USA.,Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA.,Emergency Medicine, Ocala Regional Medical Center, Ocala, USA.,Emergency Medicine, HCA Healthcare Graduate Medical Education Consortium Emergency Medicine Residency Program of Greater Orlando, Orlando, USA
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Slouka D, Čejková Š, Hanáková J, Hrabačka P, Kormunda S, Kalfeřt D, Skálová A, Šimánek V, Kucera R. Risk of Postoperative Bleeding in Tonsillectomy for Peritonsillar Abscess, as Opposed to in Recurrent and Chronic Tonsillitis-A Retrospective Study. Int J Environ Res Public Health 2021; 18:1946. [PMID: 33671349 DOI: 10.3390/ijerph18041946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 11/24/2022]
Abstract
Tonsillectomy is a routine surgery in otorhinolaryngology and the occurrence of postoperative bleeding is not a rare complication. The aim of this retrospective, observational, analytic, cohort study is to compare the incidence of this complication for the most common indications. A group of patients indicated for tonsillectomies for peritonsillar abscess (group I) was compared to a group of patients indicated for chronic and recurrent tonsillitis (group II). There are a lot of pathophysiological differences in patients indicated for acute tonsillectomy for peritonsillar abscess and in patients indicated for elective tonsillectomy for chronic or recurrent tonsillitis. No technique to minimize the risk of bleeding after tonsillectomy has been found and a large part of postoperative bleeding occurs in postoperative home-care, which makes this issue topical. In total, 2842 unilateral tonsillectomies from the years 2014–2019 were included in the study. Bleeding occurred in 10.03% and, surprisingly, despite completely different conditions in the field of surgery (oedema, acute inflammation in peritonsillar abscess), there was no statistically significant difference between incidence of postoperative bleeding in the studied groups (p = 0.9920). The highest incidence of bleeding was found in the patients of group I on the eighth postoperative day, with those aged 20–24 years (p = 0.0235) being the most at risk, and in group II, on the sixth postoperative day, with those aged 25–29 years (p = 0.0128) and 45–49 years (p = 0.0249) being the most at risk.
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Li S, Xie H, Chiang HJ, Liu Z, Han Z, Liang J, Wang L, Wang Q, Li J, Li Y. Effectiveness of TCM cauterization in recurrent tonsillitis: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22597. [PMID: 33031313 PMCID: PMC10545315 DOI: 10.1097/md.0000000000022597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Recurrent tonsillitis (RT) is often treated with antibiotic therapy and surgery. Although these treatments have advantages, they are also controversial. The purpose of this study is to analyze the safety and effectiveness of traditional Chinese medicine (TCM) cauterization in the treatment of RT, so as to provide an alternative for the clinicians and to cover the shortage of therapeutic methods. METHODS AND ANALYSIS This protocol is guided by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and by the Cochrane Collaboration Handbook. We will formulate strict inclusion and exclusion criteria in English databases (PubMed, EMBASE, and Web of Science), Chinese databases (CNKI, Wanfang databases, CBM, and VIP), and search literatures in different clinical registration platforms (Cochrane Library, Chinese Cochrane Centre's Clinical Trial Registry Platform). The included articles will be evaluated using Cochrane RCT evaluation criteria. Stata 15.0 will be used for data analysis. Subgroup analysis, sensitivity analysis, and meta-regression will detect sources of heterogeneity. Egger's Test or Begg's Test will detect publication bias quantitatively. CONCLUSION Cauterization can effectively control the recurrence of tonsillitis through clinical trials, but evidence-based medicine needs to be adopted to provide strong evidence for its effectiveness. The purpose of our research is to provide the evidence. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/PZ69Q.
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Affiliation(s)
- Sha Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Hui Xie
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Han-Jen Chiang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Zhiqing Liu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Zhenzhen Han
- Yibin Hospital of T.C.M, West of South Bank District, Yibin City, Sichuan Province, P.R. China
| | - Jiao Liang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Lu Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Qiu Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Jiongke Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Yusi Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
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Li J, Luo L, Chen W, Zhang J, Deng X, Liao L, Zeng X, Wang B. Application of Coblation Tonsillectomy with Inferior Pole Capsule Preservation in Pediatric Patients. Laryngoscope 2020; 131:1157-1162. [PMID: 32975857 DOI: 10.1002/lary.29089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/18/2020] [Accepted: 08/19/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the application and advantages of coblation tonsillectomy with inferior pole capsule preservation in pediatric patients with tonsillar hypertrophy and recurrent tonsillitis. STUDY DESIGN Retrospective chart review. METHODS A total of 726 children who were diagnosed with either tonsillar hypertrophy or recurrent tonsillitis were included. Children were divided into two groups according to the surgical technique: conventional coblation tonsillectomy and coblation tonsillectomy with inferior pole capsule preservation. The duration of surgery, intraoperative hemorrhage volume, and postoperative pain, as well as postoperative hemorrhage data in the format of time, location, and degree were compared between the two groups. RESULTS Of the 726 children included, conventional coblation tonsillectomy was performed in 320 children, coblation tonsillectomy with inferior pole capsule preservation was performed in 406 children. There were no significant differences in duration of surgery or intraoperative hemorrhage volume between the two groups. Children who underwent coblation tonsillectomy with inferior pole capsule preservation showed a remarkable improvement in postoperative pain on days 3 and 5 postoperatively. Additionally, the coblation tonsillectomy with inferior pole capsule preservation group exhibited a significantly lower total postoperative hemorrhage rate, secondary hemorrhage rate, and hemorrhage rate in the inferior pole compared with that in the conventional coblation tonsillectomy group. During the 1-year follow-up period, no cases of tonsillar re-hypertrophy or recurrent tonsillitis were observed in either group. CONCLUSION For pediatric tonsillar hypertrophy and recurrent tonsillitis, coblation tonsillectomy with inferior pole capsule preservation is a safe and effective technique, capable of reducing postoperative pain and hemorrhage, especially secondary hemorrhage at the inferior pole. LEVEL OF EVIDENCE 3b Laryngoscope, 131:1157-1162, 2021.
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Affiliation(s)
- Jingjia Li
- Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Foshan, Foshan, China
| | - Lixia Luo
- Department of Nosocomial Infection Control, The First People's Hospital of Foshan, Foshan, China
| | - Weixiong Chen
- Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Foshan, Foshan, China
| | - Jianli Zhang
- Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Foshan, Foshan, China
| | - Xuequan Deng
- Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Foshan, Foshan, China
| | - Lieqiang Liao
- Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Foshan, Foshan, China
| | - Xianping Zeng
- Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Foshan, Foshan, China
| | - Bin Wang
- Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Foshan, Foshan, China
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Katkowska M, Garbacz K, Kopala W, Schubert J, Bania J. Genetic diversity and antimicrobial resistance of Staphylococcus aureus from recurrent tonsillitis in children. APMIS 2019; 128:211-219. [PMID: 31692060 DOI: 10.1111/apm.13007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/30/2019] [Indexed: 12/14/2022]
Abstract
The aim of this study was to analyze the prevalence of Staphylococcus aureus in the tonsils of children subjected tonsillectomy due to recurrent tonsilitis and to determine the spa types of the pathogens, carriage of virulence genes and antimicrobial resistance profiles. The study included 73 tonsillectomized children. Bacteria, including S. aureus were isolated from tonsillar surface prior to tonsillectomy, recovered from tonsillar core at the time of the surgery, and from posterior pharynx 2-4 weeks after the procedure. Staphylococcus aureus isolates were compared by spa typing, tested for antimicrobial susceptibility and for the presence of superantigenic toxin genes (sea-seu, eta, etb, tst, lukS/lukF-PV) by multiplex polymerase chain reaction. Seventy-three patients (mean 7.1 ± 4.1 years, 61.6% male) were assessed. The most commonly isolated bacteria were S. aureus. The largest proportion of staphylococcal isolates originated from tonsillar core (63%), followed by tonsillar surface (45.1%) and posterior pharynx in tonsillectomized children (18.2%, p = 0.007). Five (6.3%) isolates were identified as MRSA (mecA-positive). Up to 67.5% of the isolates synthesized penicillinases (blaZ-positive isolates), and 8.8% displayed MLSB resistance. The superantigenic toxin genes were detected in more than half of examined isolates (56.3%). spa types t091, t084, and t002, and clonal complexes (CCs) CC7, CC45, and CC30 turned out to be most common. Staphylococcus aureus associated with RT in children showed pathogenicity potential and considerable genetic diversity, and no clones were found to be specific for this condition although further studies are needed.
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Affiliation(s)
- Marta Katkowska
- Department of Oral Microbiology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Katarzyna Garbacz
- Department of Oral Microbiology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Wacław Kopala
- Voivodeship Specialist Children's Hospital, Olsztyn, Poland
| | - Justyna Schubert
- Department of Food Hygiene and Consumer Health Protection, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Jacek Bania
- Department of Food Hygiene and Consumer Health Protection, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
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12
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Abstract
Objective This study was performed to compare the intraoperative and postoperative courses of coblation tonsillectomy and coblation tonsillectomy with ties in adults. Methods All patients who underwent tonsillectomy from July 2012 to September 2016 were retrospectively reviewed. Intraoperative and postoperative bleeding, pain, and return to normal food intake were compared between patients who underwent coblation tonsillectomy and those who underwent coblation tonsillectomy with ties. Results Of 515 patients, 300 (58.3%) underwent coblation tonsillectomy and 215 (41.7%) underwent coblation tonsillectomy with ties. Twenty-five (4.9%) patients developed postoperative hemorrhage, 22 (88.0%) of whom had undergone coblation tonsillectomy and 3 (12.0%) of whom had undergone coblation tonsillectomy with ties. Patients who underwent coblation tonsillectomy reported less pain than those who underwent coblation tonsillectomy with ties. Patients who underwent coblation tonsillectomy with ties resumed a normal diet significantly later than those who underwent coblation tonsillectomy (10.0 ± 3.2 vs. 8.2 ± 1.9 days, respectively). Conclusion Coblation tonsillectomy is associated with less intraoperative bleeding, a shorter surgery time, less postoperative pain, and fewer days to recovery of a normal diet than is coblation tonsillectomy with ties. However, coblation tonsillectomy with ties is associated with remarkably reduced postoperative hemorrhage.
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Affiliation(s)
- Xuanchen Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Anting Xu
- Department of Otorhinolaryngology and Head and Neck Surgery, The Second Hospital of Shandong University, Jinan, China
| | - Xiaoyue Zhen
- Minimally Invasive Urology Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Kun Gao
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Zhaoyang Cui
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Zhiyong Yue
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Jie Han
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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Radcliff FJ, Waldvogel-Thurlow S, Clow F, Mahadevan M, Johnston J, Li G, Proft T, Douglas RG, Fraser JD. Impact of Superantigen-Producing Bacteria on T Cells from Tonsillar Hyperplasia. Pathogens 2019; 8:pathogens8030090. [PMID: 31252586 PMCID: PMC6789895 DOI: 10.3390/pathogens8030090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/23/2019] [Accepted: 06/24/2019] [Indexed: 02/07/2023] Open
Abstract
Staphylococcus aureus and Group A Streptococcus (GAS) are common occupants of the tonsils and many strains produce potent exotoxins (mitogens) that directly target T cells, which could be a driver for tonsillar hyperplasia. Tonsil tissues from 41 patients were tested for these bacteria in conjunction with profiling of B and T cells by flow cytometry. S. aureus and GAS were detected in tonsil tissue from 44% and 7%, respectively, of patients by bacteriological culture; immuno-histology showed bacteria in close proximity to both B and T lymphocytes. The presence of tonsillar S. aureus did not alter B or T cell populations, whereas peripheral blood mucosal-associated invariant T (MAIT) cells were significantly increased in S. aureus culture positive individuals (p < 0.006). Alterations of tonsil CD4+ TCR Vβ family members relative to peripheral blood were evident in 29 patients. Three patients had strong TCR Vβ skewing indicative of recent exposure to superantigens, their tonsils contained mitogenic bacteria, and supernatants from these bacteria were used to partially recapitulate the skewing profile in vitro, supporting the notion that superantigens can target tonsillar T cells in situ. Tonsils are a reservoir for superantigen-producing bacteria with the capacity to alter the composition and function of key immune cells.
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Affiliation(s)
- Fiona J Radcliff
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland 1023, New Zealand.
| | | | - Fiona Clow
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland 1023, New Zealand
| | - Murali Mahadevan
- Department of Surgery, University of Auckland, Auckland 1023, New Zealand
| | - James Johnston
- Department of Surgery, University of Auckland, Auckland 1023, New Zealand
| | - Gen Li
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland 1023, New Zealand
| | - Thomas Proft
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland 1023, New Zealand
| | - Richard G Douglas
- Department of Surgery, University of Auckland, Auckland 1023, New Zealand
| | - John D Fraser
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland 1023, New Zealand
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14
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Tzelnick S, Hilly O, Vinker S, Bachar G, Mizrachi A. Long-term outcomes of tonsillectomy for recurrent tonsillitis in adults. Laryngoscope 2019; 130:328-331. [PMID: 30908668 DOI: 10.1002/lary.27928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/16/2019] [Accepted: 02/22/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND There is uncertainty regarding the effectiveness of tonsillectomy for recurrent tonsillitis in the adult population. Several studies have described a reduced number and severity of tonsillitis episodes; however, the impact of tonsillectomy on healthcare burden has yet to be studied. The aim of the present study was to evaluate the long-term outcomes of tonsillectomy in the adult population. METHODS A retrospective review of the central database of Clalit Health Services, Tel Aviv, Israel, between 2003 and 2009 was performed. The study included all adult patients (>18 years) who underwent tonsillectomy due to recurrent tonsillitis. Clinical and epidemiological data from 3 years before and after surgery were collected and analyzed. RESULTS A total of 3,701 patients were included in the study. Mean age was 37.4 years, and 42.9% were males. Following surgery, there was a significant decrease in the total number of tonsillitis episodes, otolaryngologist clinic visits, consumption of pertinent antibiotics, and respiratory complaints. Moreover, a reduced number of hospitalizations to the otolaryngology department and shorter hospitalization duration were also noted. Although the total number of hospitalizations was unaffected, there was an increase in the number of primary care office visits. Finally, a break-even time analysis revealed an average of 2.7 years following tonsillectomy. CONCLUSION Tonsillectomy for recurrent tonsillitis is effective in decreasing the number and severity of tonsillitis episodes and might also have an economic benefit. The impact of tonsillectomy on general health needs to be further evaluated; however, it appears that there is no increase in overall morbidity. LEVEL OF EVIDENCE NA Laryngoscope, 130:328-331, 2020.
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Affiliation(s)
- Sharon Tzelnick
- Department of Otorhinolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Hilly
- Department of Otorhinolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Vinker
- Department of Family Medicine, Clalit Health Services, Central District, Tel Aviv, Israel
| | - Gideon Bachar
- Department of Otorhinolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Mizrachi
- Department of Otorhinolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Aydin S, Gokhan Demir M, Oguztuzun S, Kilic M, Yilmaz C, Dirican O. Glutathione S-transferase enzyme activity and protein expression in patients with recurrent tonsillitis and idiopathic tonsillar hypertrophy. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 163:349-354. [PMID: 30765895 DOI: 10.5507/bp.2019.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 01/29/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The palatine tonsil is a significant part of the secondary immune system. Tonsillitis and idiopathic tonsillar hypertrophy (ITH) are the most common pathologies of this component. Although there are studies on their pathogenesis, there is insufficient study of the role of antioxidant agents. Glutathione S-transferase (GST) isozymes contribute to the antioxidation reactions in the tissue via the glutathione pathway. The purpose in this study was to reveal the levels of the GST enzyme activity and protein expression of GSTP1 and GSTA1 isozymes in patients with tonsillitis and tonsil hypertrophy, and to investigate their role in the pathogenesis of these diseases. MATERIALS AND METHODS Sixteen patients with recurrent tonsillitis and 5 patients with ITH and were included in the study. Cytosolic extracts were prepared from post-tonsillectomy tissues of both patient groups and GST enzyme activities were measured. RESULTS The expression of GSTP1 was found to be significantly higher than GSTA1 in tissue samples of patients with ITH and recurrent tonsillitis (P<0.001). Increased GST activity and GSTP1 isozyme expression were shown in patients with recurrent tonsillitis compared to the idiopathic tonsillar hypertrophy study group. There was a positive correlation between the expressions of GSTP1 (P=0.040; r=0.47). CONCLUSION Increased GST activity and GSTP1 isozymes were demonstrated histologically in the pathogenesis of ITH and recurrent tonsillitis. We believe that the data of changes in antioxidant capacity, obtained from studies with more extensive and larger samples, would support our findings.
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Affiliation(s)
- Sedat Aydin
- Department of Otorhinolaryngology, Kartal Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
| | | | - Serpil Oguztuzun
- Department of Biology, Kirikkale University, Faculty of Arts and Sciences, Kirikkale, Turkey
| | - Murat Kilic
- Department of Pharmacy Services, Ankara University Vocational School of Health Services, Ankara, Turkey
| | - Can Yilmaz
- Department of Molecular Biology and Genetic, Yuzuncu Yil University, Van, Turkey
| | - Onur Dirican
- Department of Biology, Kirikkale University, Faculty of Arts and Sciences, Kirikkale, Turkey
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Abstract
Recurrent tonsillitis is described as when an individual suffers from several attacks of tonsillitis per year. Chronic and recurrent tonsillitis both cause repeated occurrences of inflamed tonsils which have a significant impact on a patient's quality of life. Numerous children suffer from recurrent tonsillitis and sore throats, and these illnesses become part of their life. Antimicrobials can provide temporary relief, but in many cases, tonsillitis recurs. The cause of such recurrent infections have been identified as microorganisms which often create biofilms and a repository of infection in the wet and warm folds of the tonsils. This review discusses different treatment modalities, their advantages and disadvantages, and new treatment options focusing on biofilms. All treatment options should be selected based on evidence and individual need.
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Affiliation(s)
- Muhamad Abu Bakar
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia,
| | - Judy McKimm
- Swansea University School of Medicine, Swansea University, Swansea, wales, UK
| | | | | | - Mainul Haque
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia,
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17
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Watanabe H, Goto S, Mori H, Higashi K, Hosomichi K, Aizawa N, Takahashi N, Tsuchida M, Suzuki Y, Yamada T, Horii A, Inoue I, Kurokawa K, Narita I. Comprehensive microbiome analysis of tonsillar crypts in IgA nephropathy. Nephrol Dial Transplant 2018; 32:2072-2079. [PMID: 27683270 DOI: 10.1093/ndt/gfw343] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 08/10/2016] [Indexed: 12/29/2022] Open
Abstract
Background Immunoglobulin A nephropathy (IgAN) is the most prevalent primary chronic glomerular disease, in which the mucosal immune response elicited particularly in the tonsils or intestine has been estimated to be involved in the development of the disease. To explore the relationship between IgAN and bacterial flora in the tonsils, we conducted a comprehensive microbiome analysis. Methods We enrolled 48 IgAN patients, 21 recurrent tonsillitis (RT) patients without urine abnormalities and 30 children with tonsillar hyperplasia (TH) who had undergone tonsillectomy previously. Genomic DNA from tonsillar crypts of each patient was extracted, and V4 regions of the 16S ribosomal RNA gene were amplified and analysed using a high-throughput multiplexed sequencing approach. Differences in genus composition among the three study groups were statistically analysed by permutational multivariate analysis of variance and visualized by principal component analysis (PCA). Results Substantial diversity in bacterial composition was detected in each sample. Prevotella spp., Fusobacterium spp., Sphingomonas spp. and Treponema spp. were predominant in IgAN patients. The percentage of abundance of Prevotella spp., Haemophilus spp., Porphyromonas spp. and Treponema spp. in IgAN patients was significantly different from that in TH patients. However, there was no significant difference in the percentage of abundance of any bacterial genus between IgAN and RT patients. PCA did not distinguish IgAN from RT, although it discriminated TH. No significant differences in microbiome composition among the groups of IgAN patients according to clinicopathological parameters were observed. Conclusions Similar patterns of bacteria are present in tonsillar crypts of both IgAN and RT patients, suggesting that the host response to these bacteria might be important in the development of IgAN.
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Affiliation(s)
- Hirofumi Watanabe
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shin Goto
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiroshi Mori
- Department of Biological Information, Graduate School of Bioscience and Biotechnology, Tokyo Institute of Technology, Tokyo, Japan
| | - Koichi Higashi
- Department of Biological Information, Graduate School of Bioscience and Biotechnology, Tokyo Institute of Technology, Tokyo, Japan
| | - Kazuyoshi Hosomichi
- Division of Human Genetics, Department of Integrated Genetics, National Institute of Genetics, Shizuoka, Japan
| | - Naotaka Aizawa
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Nao Takahashi
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masafumi Tsuchida
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yusuke Suzuki
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takuji Yamada
- Department of Biological Information, Graduate School of Bioscience and Biotechnology, Tokyo Institute of Technology, Tokyo, Japan
| | - Arata Horii
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ituro Inoue
- Division of Human Genetics, Department of Integrated Genetics, National Institute of Genetics, Shizuoka, Japan
| | - Ken Kurokawa
- Department of Biological Information, Graduate School of Bioscience and Biotechnology, Tokyo Institute of Technology, Tokyo, Japan.,Earth-Life Science Institute, Tokyo Institute of Technology, Tokyo, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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18
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Abstract
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.
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Affiliation(s)
| | - Mohamed Rifaat Ahmed
- Otolaryngology Unit, Faculty of Medicine, Suez Canal University , Ismailia, Egypt
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19
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Lourijsen ES, Wong Chung JERE, Koopman JP, Blom HM. Post-operative morbidity and 1-year outcomes in CO2-laser tonsillotomy versus dissection tonsillectomy. Acta Otolaryngol 2016; 136:983-90. [PMID: 27224472 DOI: 10.1080/00016489.2016.1183040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE In this study a type of partial tonsil surgery, CO2-laser tonsillotomy, was compared to regular tonsillectomy. The effectiveness and post-operative recovery rate of both interventions in adult patients was assessed by using a questionnaire. STUDY DESIGN Prospective follow-up non-randomized cohort study. METHOD One hundred and seven adults were included; 46 tonsillectomies and 61 tonsillotomies were performed. Patients in the tonsillectomy group underwent general anaesthesia, while tonsillotomy was performed in an ambulatory setting with local anaesthesia. Post-operative questionnaires were administered by mail after 2 weeks, 6 months, and 1 year to assess recovery rate and symptom recurrence. RESULTS In total, 72.5% of patients were cured from their initial symptoms after tonsillotomy. Three patients (7.5%) required re-surgery for their initial complaints. After tonsillectomy, 97.2% of patients were cured. Both groups showed equally high satisfaction scores after treatment. Post-operative evaluation after 2 weeks showed a mean pain-intensity score of 5.4 (Visual Analogue Scale 0-10) after tonsillotomy and a mean pain-intensity score of 7.7 after tonsillectomy. The post-operative use of analgesics was twice as long in the tonsillectomy group compared to the tonsillotomy group and the tonsillectomy group required twice as many days for full recovery. After tonsillectomy a higher rate of major post-operative haemorrhage was seen. CONCLUSION CO2-laser tonsillotomy is associated with a shorter and less painful recovery period. Both surgical methods are equal in terms of long-term satisfaction, although tonsillotomy comes with a higher recurrence rate of mild symptoms. A strict pre-operative patient selection for CO2-laser tonsillotomy is necessary.
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Affiliation(s)
| | | | - Jan Pieter Koopman
- Department of Otorhinolaryngology, HagaZiekenhuis, the Hague, the Netherlands
| | - Henk M. Blom
- Department of Otorhinolaryngology, HagaZiekenhuis, the Hague, the Netherlands
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20
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Vaikjärv R, Kasenõmm P, Jaanimäe L, Kivisild A, Rööp T, Sepp E, Mändar R. Microbiology of peritonsillar abscess in the South Estonian population. Microb Ecol Health Dis 2016; 27:27787. [PMID: 27113570 PMCID: PMC4845694 DOI: 10.3402/mehd.v27.27787] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 03/07/2016] [Accepted: 03/09/2016] [Indexed: 12/02/2022]
Abstract
Objective The first aim of this study was to compare the microbiota of different locations (pus, tonsillar fossa, blood) in peritonsillar abscess (PTA) patients in order to optimize the sampling scheme. The second aim was to estimate the occurrence of tonsillitis episodes and macroscopic oropharyngeal signs characteristic of recurrent tonsillitis in PTA patients. Methods The study group consisted of 22 consecutive patients with PTA undergoing bilateral tonsillectomy. The PTA was punctured; pus and tonsillar fossa biopsy samples and the peripheral blood cultures were collected. The index of tonsillitis was calculated by multiplying the number of tonsillitis episodes per year by the morbidity period in years. Macroscopic oropharyngeal signs were evaluated and they were as follows: tonsillar sclerosis, obstruction of the tonsillar crypts, scar tissue on tonsils, cryptic debris, and lymphatic tissue aggregates. Results The cultures of the pus were positive in 16 out of 22 patients and the cultures of the tonsillar fossa samples were positive in all cases. In total, 62 different organisms were found from tonsillar fossa, pus, and blood samples, which belonged to 5 different phyla and 18 different families. In the tonsillar fossa, the most frequent bacteria found were Streptococcus spp. In pus samples, the most frequently found bacteria were Streptococcus spp. and bacteria from the Streptococcus milleri group. Conclusion PTA patients had mixed anaerobic and aerobic microbiota both in the tissue of the tonsillar fossa and the pus of the peritonsillar space. We demonstrated that the tonsillar fossa specimen is a better material for microbiological analyses, because it reveals more bacteria per culture. PTA patients usually have a low number of tonsillitis episodes in their previous history, but a relatively high number of macroscopic oropharyngeal signs, indicating the sclerotic process in palatal tonsils.
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Affiliation(s)
- Risto Vaikjärv
- Department of Oto-Rhino-Laryngology, University of Tartu, Tartu, Estonia
| | - Priit Kasenõmm
- Department of Oto-Rhino-Laryngology, University of Tartu, Tartu, Estonia;
| | - Liis Jaanimäe
- Department of Microbiology, University of Tartu, Tartu, Estonia
| | - Ave Kivisild
- Department of Microbiology, University of Tartu, Tartu, Estonia
| | - Tiiu Rööp
- Department of Microbiology, University of Tartu, Tartu, Estonia
| | - Epp Sepp
- Department of Microbiology, University of Tartu, Tartu, Estonia
| | - Reet Mändar
- Department of Microbiology, University of Tartu, Tartu, Estonia
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Garcia-Romo GS, Gonzalez-Ibarra M, Donis-Hernandez FR, Zendejas-Buitron VM, Pedroza-Gonzalez A. Immunization with heat-inactivated Staphylococcus aureus induced an antibody response mediated by IgG1 and IgG2 in patients with recurrent tonsillitis. Microbiol Immunol 2016; 59:193-201. [PMID: 25648612 DOI: 10.1111/1348-0421.12241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/29/2015] [Accepted: 01/30/2015] [Indexed: 12/22/2022]
Abstract
Currently Staphylococcus aureus is the predominant pathogen isolated from the respiratory tract of patients with recurrent tonsillitis. Because of an increase in multi-drug resistant strains of S. aureus, there is a pressing need for effective treatments and preventive approaches to reduce the risk of invasive and life-threatening infections. A preventive vaccine against S. aureus would have a tremendous clinical impact. However, multiple clinical trials have failed to identify an agent that can induce protective responses. Most trials have been based on subunit vaccines using one or a few purified antigens, which may not be enough to confer protection. Here, the impact of a whole-cell vaccine comprised of heat-inactivated S. aureus was investigated in patients with RT. The vaccine was well tolerated and had no significant local or systemic reactions. Immunization with heat-inactivated S. aureus elicited a significant antibody response characterized by production of IgG1 and IgG2 antibodies and, to a lesser extent, of IgA antibodies. Notably, this response was associated with an important decrease in the incidence of tonsillitis and bacterial colonization of the oropharyngeal mucosa. Our results show that whole-cell inactivated S. aureus is safe and capable of evoking specific antibody responses in patients with recurrent tonsillitis.
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Affiliation(s)
- Gina Stella Garcia-Romo
- Department of Immunology and Medical Mycology, Research Division, Hospital Juarez of Mexico, Mexico City, 07760, Mexico; Faculty of Higher Studies Cuautitlan, National Autonomous University of Mexico, Mexico City, 54740, Mexico; Department of Nephrology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA Leiden, the Netherlands
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Onouchi T, Mizutani Y, Shiogama K, Inada KI, Okada T, Naito K, Tsutsumi Y. Application of an enzyme-labeled antigen method for visualizing plasma cells producing antibodies against Strep A, a carbohydrate antigen of Streptococcus pyogenes, in recurrent tonsillitis. Microbiol Immunol 2015; 59:13-27. [PMID: 25403787 PMCID: PMC6681172 DOI: 10.1111/1348-0421.12213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 11/12/2014] [Accepted: 11/13/2014] [Indexed: 12/26/2022]
Abstract
Streptococcus pyogenes is the main causative pathogen of recurrent tonsillitis. Histologically, lesions of recurrent tonsillitis contain numerous plasma cells. Strep A is an antigenic carbohydrate molecule on the cell wall of S. pyogenes. As expected, plasma cells in subjects with recurrent tonsillitis secrete antibodies against Strep A. The enzyme‐labeled antigen method is a novel histochemical technique that visualizes specific antibody‐producing cells in tissue sections by employing a biotin‐labeled antigen as a probe. The purpose of the present study was to visualize plasma cells producing antibodies reactive with Strep A in recurrent tonsillitis. Firstly, the lymph nodes of rats immunized with boiled S. pyogenes were paraformaldehyde‐fixed and specific plasma cells localized in frozen sections with biotinylated Strep A. Secondly, an enzyme‐labeled antigen method was used on human tonsil surgically removed from 12 patients with recurrent tonsillitis. S. pyogenes genomes were PCR‐detected in all 12 specimens. The emm genotypes belonged to emm12 in nine specimens and emm1 in three. Plasma cells producing anti‐Strep A antibodies were demonstrated in prefixed frozen sections of rat lymph nodes, 8/12 human specimens from patients with recurrent tonsillitis but not in two control tonsils. In human tonsils, Strep A‐reactive plasma cells were observed within the reticular squamous mucosa and just below the mucosa, and the specific antibodies belonged to either IgA or IgG classes. Our technique is effective in visualizing immunocytes producing specific antibodies against the bacterial carbohydrate antigen, and is thus a novel histochemical tool for analyzing immune reactions in infectious disorders.
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Affiliation(s)
- Takanori Onouchi
- Department of Pathology, Fujita Health University School of Medicine, Toyoake, Japan
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