Оптимизация лечения гипертрофии органов лимфоглоточного кольца у детей, инфицированных герпесвирусами

Abstract

The aim of the work is to evaluate the prevalence of herpes virus infection of nasopharynx mucosa in children with hypertrophy of adenoid and palatine tonsils to improve the complex treatment methods. An open continuous prospective analytical study was carried out, which included examination and treatment of 186 patients with chronic adenoiditis. The patients were divided into three groups. The first group included 146 children with a diagnosis of adenoids grade 3 – 90 people; adenoids grade 3, hypertrophy of the tonsils grade 2-3 – 56 people. Endoscopic adeno- or adenotonsillotomy was performed in patients of the first group. Patients of the second group had adenoids grade 1–2 and received conservative treatment. Patients of the third group were children with compensatory hypertrophy of the palatine tonsils and recurrences of adenoids, who had a history of endoscopic anesthetic adenotomy. All patients were examined for the presence of Epstein-Barr and cytomegaloviruses DNA in swabs from the nasopharynx and oropharynx by PCR. The result was positive in 63.3% of patients with pharyngeal tonsil hypertrophy and in 76.8% of patients with pharyngeal and tonsil hypertrophy. The calculation of the odds ratio indicated that the probability of hypertrophy of these tonsils in children infected with herpes viruses is 3.3 times higher (OR 3.3; 95% CI 1.2-9.1) than in uninfected ones. Patients from the first group with a positive test result for herpes viruses, in addition to surgical and basic therapy, received a drug with antiviral and immunomodulatory activity. The results of endoscopic adenotomy and adenotonzillotomy in combination with the administration of etiotropic therapy indicated a high treatment efficiency.