Иммуномодулирующий эффект аденотомии у детей раннего и дошкольного возраста с высокими степенями гипертрофии глоточной миндалины и повторяющимися назофарингитами

Abstract

It is known that 50% of children with constantly recurrent acute nasopharyngitis have high degrees of hypertrophy of the pharyngeal tonsil (2nd and 3rd degree). Adenoidectomy can remove obstruction of the nose and Eustachian tube. At the same time, it is assumed that the removal of the pharyngeal tonsil will also limit inflammation on the mucous membrane of the nose and pharynx. This effect may be positive both in terms of reducing the frequency of respiratory diseases and in preventing the early manifestation of chronic respiratory diseases. Materials and methods. 101 children were examined, in the age range of 2–6 years, who were in the children’s department of Otolaryngology of the Regional Children’s Clinical Hospital in Kemerovo for adenoidectomy. An objective examination of the ENT organs in the main group was carried out; biological material from the pharyngeal tonsil for PCR tests and DNA markers of viruses, bacteria, and fungi in the pharyngeal bioburden was collected; nasopharyngeal lavages for cytokine testing were collected. Results: Adenoidectomy significantly reduces the incidence of nasopharyngitis in children with high degrees of pharyngeal tonsil hypertrophy. The effect of adenoidectomy is associated with an immunomodulatory effect on the mucosal immunity of the nose and pharynx. After adenoidectomy, the level of topical cytokines that increase inflammation (IL-1b, IL-1Ra) decreases. Adenoidectomy effectively reduces the incidence of nasopharyngitis in infants and preschool children with elevated levels of IL-4 in the nasopharyngeal lavage. Adenoidectomy has a significant biodebridement effect for the nasopharyngeal bioburden through a decrease in the expression of DNA markers of bacteria (pyogenic streptococcus), viruses (Epstein–Barr virus), and fungi (Candida genus). The effect of adenoidectomy in relation to limiting the frequency of nasopharyngitis in children of early and preschool age is reduced with concomitant bronchial asthma and seasonal allergic rhinosinusitis; high concentration in the nasopharyngeal washout of TNF-α, a significant representation of the coccal bioburden according to rhinocytogram data, and increased expression of DNA markers of the Epstein–Barr virus in the cells of the nasopharyngeal mucosa.