Histopathological criteria for recurrent, (chronic) tonsillitis. Clinical and pathological correlation

Abstract

Introduction: Recurrent tonsillitis is diagnosed when an individual has 7 episodes of tonsillitis in 1 year, 5 episodes in 2 consecutive years, or 3 episodes each year for 3 years consecutively. Chronic tonsillitis is a poorly understood definition and the difference between chronic and recurrent tonsillitis is not well known. Materials and Methods: This is a prospective study aimed at finding the correlation between the diagnostic histopathological criteria in cases with recurrent tonsillitis with laboratory findings. This was carried out in the Otorhinolaryngology Departments of Suez Canal University and Ismailia General Hospitals and the Pathology laboratory, Suez Canal University Hospital, Egypt. The study included 175 patients sampled from those patients attending the E.N.T outpatient clinic. There were 69 females and 106 males. The patient’s age ranged between 4-12 years old. Results: Histopathological examination of removed tonsils revealed that all samples studied had small to moderate lymphocytic infiltration. Diffuse lymphocytic infiltration was observed in 78.3%. Ugras abscess was found in 52.6%. Half of the patients (50.9%) had 2 histopathological findings and 40% had 3 findings while only 9.1% had one finding.Ugras abscess was more common among patients with elevated ESR. Most of patients with normal ESR were found to have only 2 histopathological findings (67.6%) while 44.7% of patients with elevated ESR were found to have three of the histopathological findings of chronic tonsillitis. Ugras abscess were more common among patients with elevated ASOT (62.2% versus 35.9% in patients with normal ASOT). Total number of histopathodlogical findings of chronic tonsillitis was not significantly different between patients with normal ASOT and elevated ASOT. Conclusion: Recurrent tonsillitis is a clinical criterion and different from chronic tonsillitis which is a pathological diagnosis. Chronic tonsillitis is found in tonsils with fewer recurrence rate. Combined clinical and laboratory criteria increase the likelihood for the diagnosis of chronic tonsillitis.