Tonsil Hypertrophy Research Articles

Acute purulent otitis media: key features of pathogenetic therapy

Acute purulent otitis media is an inflammation of the mucous membrane of the middle ear, a disease often encountered both in pediatric practice and in adult patients. The prerequisite for the development of this pathology is a violation of the function of the auditory tube, often occurring in inflammatory diseases of the upper respiratory tract, as well as in conditions of hypertrophy of the pharyngeal tonsil. Bacterial microflora, represented in most clinical cases by S. pneumoniae and H. influenzae, traditionally acts as an etiological factor of acute purulent otitis media. The authors of the article discuss the features of the clinical course of the disease, the causes of frequent recurrent course and the risk of developing purulent complications. The article highlights current problems of diagnosis and treatment of acute otitis media at different stages, including rational and justified use of antibacterial drugs. The authors consider the possibility of using topical anti-inflammatory and analgesic drugs as an alternative to the systemic use of non-steroidal anti-inflammatory drugs (NSAIDs) for rapid relief of the main symptoms of the disease. The authors conclude that ear drops containing lidocaine and phenazone, due to their combined action, are effective as a symptomatic treatment for acute otitis media, including its recurrent course, help reduce the frequency of prescribing antibacterial drugs, effectively relieve pain, reduce the duration of the disease and significantly improve the patient’s quality of life. Due to the high safety profile and the possibility of using ear drops with phenazone and lidocaine from birth, this dosage form finds its successful application in pediatric practice.

Age-group-specific associations between adenoid/tonsillar hypertrophy and craniofacial features

BackgroundAge plays an important role in the association between adenotonsillar hypertrophy and craniofacial morphology. This study aimed to analyse the association of adenoid and tonsillar hypertrophy with craniofacial features in different age groups.MethodsLateral cephalograms were obtained from 942 patients aged 6–15 years (433 boys, 509 girls). They were divided into three age groups: 6–9 years (n = 189), 9–12 years (n = 383), and 12–15 years (n = 370). According to the different sites of pharyngeal obstruction, they were classified as control group (CG), adenoid hypertrophy group (AG), tonsillar hypertrophy group (TG) and adenotonsillar hypertrophy group (ATG). Cephalometric measurements were performed on each enrolled participant. Comparisons between groups and correlations between these cephalometric variables and obstruction sites were evaluated.ResultsAt 6–9 years of age, ATG and TG correlated with increased mandibular height (B = 2.2, p = 0.029; B = 2.6, p = 0.042, respectively). At the age of 9–12 years, AG showed a steep growth direction (B = 1.5, p = 0.002), TG showed a higher probability of Class III skeletal pattern (smaller SNB, ANB and SGn/FH, larger Go-Me) and ATG manifested a higher proportion of Class III skeletal pattern. At 12–15 years of age, there was no significant association between cephalometric measurements and pharyngeal lymphoid tissue enlargement.ConclusionsChildren with isolated adenoid hypertrophy have a vertical growth direction at 9–12 years of age. Isolated adenoid hypertrophy correlated with longer mandibular body, more anterior mandible and horizontal skeletal Class III pattern at 6–12 years. Combination of obstructive adenoids and tonsils manifested similarly to children with isolated tonsil hypertrophy.

Long-term effect observation after 10 years of tonsillotomy （Histological analysis of one case of secondary operation）

Objective:To investigate the long-term effect of partial tonsillectomy in children with tonsil hypertrophy. Methods:A total of 146 children with obstructive sleep apnea（OSA） who received surgical treatment for tonsil hyperplasia from January 2010 to January 2013 were selected and divided into the observation group（n=69） and the control group（n=77）. The observation group was received tonsillotomy（TT）, and the control group was received total tonsillectomy（TE）. Parental satisfaction and OSA quality of life questionnaire for children（OSA-18） were surveyed. Residual tonsil size was measured, and polysomnography（PSG） was monitored after 10 years. HE and immunohistochemical analysis were performed on tonsil tissues of one patient who performed a second operation after TT in 2017 year. Results:The results of questionnaire survey showed that the symptoms of respiratory obstruction were significantly improved in both groups, and the satisfaction of TT group was higher than that in the TE group. No increase in the number of respiratory tract infections was observed in all patients. In the TT group, nine cases（13.04%） had tonsil hyperplasia toⅡ°, and the remaining patients had tonsil hyperplasia to Ⅰ°. In addition, one case hadtonsil suppurative infection at the 14th month after surgery, and no recurrence or reoperation was found after treatment. There were seven cases in the TT group and eight cases in the TE group with occasional snoring and mouth breathing after surgery, but the PSG examination of the patients did not meet the diagnosis of OSA. The main causes were obesity and allergic rhinitis. Compared with the first operation, the cicatricial obstruction and infection of tonsil tissue in the second operation were not significantly changed, and the immunohistochemical results also demonstrated that the expression of CD20 was not changed, and the expression of CD3 was decreased. Conclusion:Both TT and TE can effectively improve the symptoms of OSA obstruction in children. TT has less trauma, less postoperative pain, faster recovery and lower rate of hyperplasia, which can be used as one of the main methods for the treatment of tonsil hypertrophy in children.

Возможности консервативной тактики ведения пациентов с гипертрофией и воспалением глоточной миндалины

Patients who suffer from pharyngeal tonsil hypertrophy or inflammation are very common visitors in outpatient physicians’ practice. Hypertrophy of the pharyngeal tonsil may be accompanied by persistent difficulty in nasal breathing and complications whilst adenoditis in the absence of a significant impact on the child’s quality of life and associated complications had not been regarded as a ‘pathology’ in pediatric physicians’ practice until the patient is reached the age of 7 to 9 years old. The purpose of this research was to compare the regimens of the use of the homeopathic medications in patients with pharyngeal tonsil hypertrophy or inflammation. Materials and methods used: a single-center controlled randomized observation of the use of homeopathic medications of a single active substance had been conducted in pediatric patients aged 1 to 18 y/o with pharyngeal tonsil hypertrophy or inflammation. The study included patients with pharyngeal tonsil hypertrophy or inflammation who had previously taken homeopathic single-substance medications, including in combination with standard treatment. Depending on the choice of patients (repetition of the homeopathic single-substance medications intake or prophylactic regimen) the patients were then divided into comparison groups. All of the patients had undergone both the routine examination and the ENT endoscopy, the parents’/caregivers’ satisfaction with the treatment results was then assessed using the 5-point Likert scale as well as the incidence of acute respiratory infections (ARI) in children while taking homeopathic medicines (compared to the period without taking them) and the willingness to use homeopathic medicines in the future. Results: after the ENT endoscopy (reduction in the size of the pharyngeal tonsil in 38% of cases, p≤0.001) and the parents’/caregivers’ survey (reduction in the ARI frequency in 62% of cases and high satisfaction with the treatment results), the majority of parents/caregivers have assessed the repetition of the repetition of the homeopathic single-substance medications intake as rather more effective in treatment of patients with inflammation of the pharyngeal tonsil of varying degrees of hypertrophy. Conclusion: the use of homeopathic medicines in patients with pharyngeal tonsil hypertrophy or inflammation has showed good effectiveness. According to the ENT endoscopy results before v. after the treatment and the parents’/caregivers’ survey it is preferable to repeat the homeopathic single-substance medications intake in the next adenoiditis episode. The parents’/caregivers’ readiness to go on with the homeopathic medicines’ intake ranges from 50% to 78%.

A comparison of the outcomes of tonsillectomy and expansion sphincter pharyngoplasty operations in patients with obstructive sleep apnea

ABSTRACT Objective To compare the efficacy of tonsillectomy and expansion sphincter pharyngoplasty (ESP) in the surgical treatment of obstructive sleep apnea (OSA). Methods OSA patients with Friedman grade III-IV tonsil hypertrophy diagnosed with polysomnography were separated into two groups according to the surgery performed, as the classic tonsillectomy group (Group 1) and the ESP group (Group 2). The primary endpoint of the study was to determine the Apnea-Hypopnea Index (AHI) value. Results Group 1 comprised 24 patients with median preoperative AHI of 19.7 and postoperative AHI of median 11.8 (p = .0001). Group 2 comprised 29 patients with median preoperative AHI of 25.1 and postoperative AHI of median 16.3 (p = .0001). Nine (37.5%) of the 24 patients in Group 1 accepted as cure (79.1%). Eight (27.5%) of the 29 patients in Group 2 accepted as cure (72.4%). Conclusion There was no superiority of ESP over tonsillectomy in patients with lateral pharyngeal obstruction.

Elaboration of selected respiratory system diseases in children in the pediatric hospital Bielsko-Biala In years 2015-2022.

Respiratory tract infections in children are an interdisciplinary problem that pediatricians, allergists, laryngologists and immunologists encounter on a daily basis. In the youngest children, these diseases are caused by the structure of the respiratory tract, which is shorter and narrower than in an adult, as well as the immaturity of the immune system. Among all children under 5 years of age hospitalized due to respiratory diseases, 20% of cases are acute respiratory infections. The aim of the study is to discuss selected respiratory diseases in children aged 0-18 years hospitalized at the Pediatric Hospital in Bielsko-Biała. In June 2023, statistical data from the Pediatric Hospital was received regarding the number of hospitalized children aged 0-18 in 2015-2022. This article covers the following respiratory diseases: acute laryngitis, acute pharyngitis, pneumonia, bronchitis and bronchiolitis, bronchial asthma, adenoid hypertrophy and palatine tonsil hypertrophy coexisting with adenoid hypertrophy. Then, a table was prepared illustrating the trends of individual disease entities in the discussed time period. A total of 5,573 hospitalizations were analyzed for the period from 2015-2022. The largest group of children (1,583) were hospitalized due to acute bronchitis and bronchiolitis (28.41%), due to hypertrophy of the adenoid (1,093) and palatine tonsils (1,039), which is 19.6% and 18.64% respectively. The smallest number of children and adolescents were hospitalized due to acute laryngotracheitis (474) and pharyngitis (361), which is 8.51% and 6.47%, respectively, and due to asthma (54), which is 0.97%. It has been observed that from 2017 to 2022 the number of hospitalized patients is constantly increasing due to acute pharyngitis and pneumonia, and from 2018 to 2022 due to acute laryngotracheitis. In the analyzed Pediatric Hospital in Bielsko-Biała, the number of hospitalized children (from 0 to 18 years of age) due to pharyngitis, laryngotracheitis and pneumonia increased during the COVID-19 pandemic (2020-2022). The number of hospitalized patients due to pneumonia increased by as many as 70 from 2021 (197) to 2022 (267). In the case of hospitalizations for pharyngitis during the COVID-19 period, the number ranged from 46 in 2019 to 69 in 2022. Also in the case of acute laryngotracheitis in the period 2019-2022, the number of hospitalized young patients increases and ranges from 61 to 76. Respiratory tract infections are an important and common health problem for children. The vast majority of respiratory infections are caused by viruses.

Association of clinical indicators in TMJ, craniofacial, occlusal, and upper airway changes with symptoms of pediatric obstructive sleep apnea and mouth-breathing

ABSTRACT Objective To assess the association between self-reported symptoms of pediatric OSA and clinical signs in MB children. Methods Seventy-three MB children aged 7–14 years answered an interview questionnaire on OSA symptoms in childhood, focusing on chewing, nasal, and sleep disturbances. MB children were checked for changes on the craniofacial, occlusion, TMJ, upper airway, and body posture by a multi-disciplinary team, consisting of medical residents, dental, and psychology postgraduate students. Multiple logistic regression analysis verified the association between clinical signs and self-reported symptoms. Results Reported symptoms of chewing disturbance as TMD noise, muscle pain, and morning headache were significantly associated with the presence of lip incompetence and Class II malocclusion. Sleep disturbances as snoring, waking up at night, daytime sleepiness, and sleeping with the mouth open were significantly associated with the presence of hypertrophic tonsils and obstructive Mallampati score. Conclusion Symptoms of pediatric OSA were found in mouth-breathing children, which should be carefully investigated in order to prevent OSA in the future.

The content of interleukin 1 (IL-1) in saliva in children before and after adenotomy

Pathology of the pharyngeal tonsil is widespread in childhood. Pathological chang es in the nasopharynx can manifest themselves in the form of hyperplasia of the pharyngeal tonsil (adenoids), chronic and acute adenoiditis, and persistence of the pharyngeal tonsil. To study the role of chronic inflammation in the pharyngeal tonsil hypertrophy, the content of the pro-inflammatory cytokine IL-1 in the saliva of children with adenoids and chronic adenoiditis before and after surgery was studied. All children were diagnosed with grade 2–3 adenoid hypertrophy. The content of IL-1 was increased compared to the control group in all subjects, regardless of the clinical diagnosis. This indicates the role of chronic persistent inflammation in the development of hypertrophy of the pharyngeal tonsil.

Omówienie wybranych chorób układu oddechowego u dzieci na terenie szpitala pediatrycznego w Bielska-Białej w latach 2015-2022

INTRODUCTION. Respiratory tract infections in children are an interdisciplinary problem that pediatricians, allergists, laryngologists and immunologists encounter on a daily basis. In the youngest children, these diseases are caused by the structure of the respiratory tract, which is shorter and narrower than in an adult, as well as the immaturity of the immune system. Among all children under 5 years of age hospitalized due to respiratory diseases, 20% of cases are acute respiratory infections. OBJECTIVE. The aim of the study is to discuss selected respiratory diseases in children aged 0-18 years hospitalized at the Pediatric Hospital in Bielsko-Biała. MATERIAL AND METHODS. In June 2023, statistical data from the Pediatric Hospital was received regarding the number of hospitalized children aged 0-18 in 2015-2022. This article covers the following respiratory diseases: acute laryngitis, acute pharyngitis, pneumonia, bronchitis and bronchiolitis, bronchial asthma, adenoid hypertrophy and palatine tonsil hypertrophy coexisting with adenoid hypertrophy. Then, a table was prepared illustrating the trends of individual disease entities in the discussed time period. RESULTS. A total of 5,573 hospitalizations were analyzed for the period from 2015-2022. The largest group of children (1,583) were hospitalized due to acute bronchitis and bronchiolitis (28.41%), due to hypertrophy of the adenoid (1,093) and palatine tonsils (1,039), which is 19.6% and 18.64% respectively. The smallest number of children and adolescents were hospitalized due to acute laryngotracheitis (474) and pharyngitis (361), which is 8.51% and 6.47%, respectively, and due to asthma (54), which is 0.97%. It has been observed that from 2017 to 2022 the number of hospitalized patients is constantly increasing due to acute pharyngitis and pneumonia, and from 2018 to 2022 due to acute laryngotracheitis. CONCLUSIONS. In the analyzed Pediatric Hospital in Bielsko-Biała, the number of hospitalized children (from 0 to 18 years of age) due to pharyngitis, laryngotracheitis and pneumonia increased during the COVID-19 pandemic (2020-2022). The number of hospitalized patients due to pneumonia increased by as many as 70 from 2021 (197) to 2022 (267). In the case of hospitalizations for pharyngitis during the COVID-19 period, the number ranged from 46 in 2019 to 69 in 2022. Also in the case of acute laryngotracheitis in the period 2019-2022, the number of hospitalized young patients increases and ranges from 61 to 76. Respiratory tract infections are an important and common health problem for children. The vast majority of respiratory infections are caused by viruses.

Case-control study of heart rate variability and sleep apnea in childhood sickle cell disease.

Obstructive sleep apnea (OSA) is common in sickle cell disease (SCD) despite the absence of overweight, suggesting a specific pathophysiology. We previously showed that otherwise healthy children with increased pharyngeal compliance, a main endotype of OSA, exhibited decreased sympathetic modulation. Our objective was to assess whether modifications of heart rate variability (HRV) and compliance are associated in SCD. Cases (children with SCD, African or Caribbean ethnicity) and controls (otherwise healthy children, same ethnicity), aged 4-18 years, were selected from our database of children referred for OSA and matched for sex, age, and obstructive apnea-hypopnoea index (OAHI) score. The children underwent polysomnography and acoustic pharyngometry (to compute compliance). HRV analyses were performed from 5 min ECG recordings in wakeful, NREM, and REM sleep states and from the whole night. Twenty-one pairs were analysed (median age 10.5 years, 24 girls). Children with SCD had lower BMI z-scores and more tonsil hypertrophy than control children. Children with SCD and OSA (OAHI ≥2/hour) were characterised by lower compliance than children with SCD without OSA. An inverse relationship between compliance and SD2 (HRV from whole night, inversely related to sympathetic modulation) was evidenced (negative relationship in SCD: R = -0.63, p = 0.002 vs. positive relationship in controls R = 0.59, p = 0.006). In conclusion, while the decrease in sympathetic modulation in control children may contribute to increasing pharyngeal compliance, its decrease seems protective in children with sickle cell disease, which underlines the specificity of OSAS pathophysiology in SCD that could be due to sickle cell disease related smooth muscle dystonia.

Association of Body Mass Index with Neck Circumference and Snoring in Adult Patients with Hypertrophic Tonsils

Objective: We aimed to determine association of Body mass index (BMI) with neck circumference and snoring in patients with hypertrophic tonsils. Study Design: Cross-sectional research. Settings: Ear Nose and Throat Department of a tertiary care hospital situated in Karachi Pakistan. Duration: January to July 2021. Methods: It was a cross-sectional research and non-probability consecutive sampling technique was utilized for data collection. A written informed consent was obtained by each enrolled participant following by recording of data by filling subject valuation proforma. Detailed history of participants and anthropometric data was noted followed by grading of tonsils during oral examination. The study was conducted at Otorhinolaryngology department of PNS Shifa hospital from January to July 2021.Data was entered and analyzed using SPSS 23.0 software. Results: The current study enrolled adult subjects (n=54) with hypertrophic tonsils between 18-60 years with mean age of 25.72 ± 7.9 SD. There were 29 (54%) males and 25(46%) females. There were 31(57%) subjects with normal BMI, 14(26%) overweight and 9 (17%) obese subjects. There were 24(44%) snorers and 30(55.5%) non-snorers. Regarding neck circumference 1(3%) male had neck circumference ≥42 cm whereas 28(97%) had neck circumference ≤ 37.5 cm. Statistically significant association was observed when compared BMI and snorers p-value 0.001, whereas regarding neck circumference significant association with BMI was observed in females (p-value 0.0001) as compared to males (p-value 0.310). Conclusion: Snoring was associated with raised BMI whereas increased neck circumference in females was seen to be associated with raised BMI as compared to male individuals. It is important to consider these anthropometric measurements when assessing patients with obstructive sleep apnea.

Microbiota of the upper respiratory tract in children with chronic adenoiditis

Background. Routine application of the GC-MS method to assess the URT microbiota can potentially improve the efficacy and safety of treatment for chronic respiratory diseases.
 Aim. To perform a comparative analysis of the microbiota from the surface of the pharyngeal tonsil, from the deep parts of the nose, and saliva in children with chronic adenoiditis.
 Materials and methods. The study included 90 patients with chronic adenoiditis (CA) and/or pharyngeal tonsil hypertrophy (PTH). All study participants had swabs taken from the surface of the pharyngeal tonsil, from the deep parts of the nasal cavity, and saliva as a biological fluid of the oral cavity. Microorganisms were identified by specific fatty acids using GC-MS to assess the composition of the microbial community on the surface of the pharyngeal tonsil.
 Results. The study showed that the microbiota of the nasopharynx is identical in its qualitative composition to microorganisms from the deep parts of the nose. However, according to the results of the analysis of microbial markers of saliva, the oral microbiota showed significant differences in the quantitative and qualitative composition of microorganisms compared with the nasopharyngeal microbiota.
 Conclusion. The introduction of the GC-MS method for assessing the URT microbiota enables its monitoring in clinical practice for the treatment of chronic respiratory system diseases without disturbing the ecology of the mucous membranes and the whole body.

Surgical Management of Pediatric Obstructive Sleep Apnea Beyond T&A – Tongue Base and Larynx

Pediatric patients with persistent obstructive sleep apnea (OSA) after adenotonsillectomy often have additional sites of upper airway obstruction such as the tongue base or larynx. Sleep endoscopy and cross-sectional, dynamic imaging can be used to direct the surgical management of persistent OSA. The tongue base is one of the most common sites of obstruction in children with persistent OSA, especially for patients with Trisomy 21. Lingual tonsillectomy, tongue suspension, and/or posterior midline glossectomy may be used to address lingual tonsil hypertrophy and tongue base obstruction. Epiglottopexy and/or supraglottoplasty may be used to address laryngomalacia and epiglottic prolapse resulting in OSA. Evidence shows that surgery can lead to significant improvement in postoperative polysomnographic outcomes. Important considerations following surgery of the tongue base and larynx include bleeding, edema, oropharyngeal stenosis, and dysphagia.

Relationship between vitamin D levels and inflammation in patients with recurrent tonsillitis and hypertrophic tonsil

Objectives: This study aimed to study the relationship between vitamin D levels and inflammation in patients with recurrent tonsillitis and hypertrophic tonsils. Patients and Methods: Sixty patients who were admitted between October 2016 and February 2018 and who either had indications for operation due to recurrent tonsillitis (n=30) or tonsillar hypertrophy (n=30) were included in the prospective study. Thirty healthy volunteers who applied to our clinic were included in the study as the control group. Vitamin D, interleukin (IL)-17, IL-18, immunoglobulin (Ig)A, and IgG were obtained, and the differences between the groups were investigated. Results: The IL-17 levels in the recurrent tonsillitis group were found to be significantly higher than in the control group (p=0.012). The tissue IgA levels were significantly higher in the recurrent tonsillitis group compared to the hypertrophic tonsil group (p=0.042). In 17 (56.7%) patients in the recurrent tonsillitis group and 12 (40%) patients in the tonsillar hypertrophy group, vitamin D levels were found to be under 20 ng/mL, which is the level of insufficiency. Conclusion: In this study, there was no significant difference between recurrent tonsillitis patients, hypertrophic tonsil patients, and healthy controls in terms of vitamin D, IL-18, IgG, and IgA levels. The IL-17 levels were higher in patients with recurrent tonsillitis and tonsillar hypertrophy patients compared to the control group.

The relationship between posttonsillectomy bleeding to hemogram and coagulation parameters.

Tonsillectomy is a common surgery performed for indications such as chronic tonsilitis, tonsil hypertrophy and obsructive sleep apnea. Although posttonsillectomy bleeding (PTB) is rare and can be controlled with simple interventions in many patients, it is one of the most feared complications of tonsillectomy surgery. In our study, we investigated the effects of changes in hemogram and coagulation values and seasonal effects on PTB. Pediatric and adult patients who underwent tonsillectomy with cold knife method between August 2020 and August 2023 in our clinic were retrospectively reviewed. Demographic data, hemogram and coagulation values of the patients in the control and study groups were recorded and the differences between the two groups in terms of these parameters were evaluated. Our study included 991 patients aged 1-51years. The rate of PTB was calculated as 2.82%. No patient with primary PTB was found. The duration of bleeding development was 7.03days. Age, WBC and neutrophil values were statistically significantly higher in the study group. There were no significant differences between two groups in terms of gender, season and other hemogram and coagulation parameters. Age, high WBC and neutrophil levels were determined as possible risk factors for PTB. Seasonal and gender distribution, aPTT and INR values were similar in the two groups. In order to prevent and predict bleeding, detailed infection investigation should be performed and the risk of bleeding should be considered to increase with increasing age.

Types of Epiglottic Collapse in Breathing Sleep Disorder and Their Impact in Clinical Practice.

Introduction Obstructive sleep apnea (OSA) is a severe form of sleep-disordered breathing (SDB) that is strongly correlated with comorbidities, in which epiglottic collapse (EC) and other contributing factors are involved. Objectives To evaluate the occurrence of EC in OSA patients through drug-induced sleep endoscopy (DISE) and to determine the factors contributing to EC. Methods A retrospective study of 37 adult patients using medical history. Patients were assessed for laryngopharyngeal reflux (LPR) and lingual tonsil hypertrophy (LTH) using reflux symptom index and reflux finding score (RFS); for OSA using polysomnography, and for airway collapse through DISE. An independent t -test was performed to evaluate risk factors, including the involvement of three other airway structures. Results Most EC patients exhibited trap door epiglottic collapse (TDEC) (56.8%) or pushed epiglottic collapse (PEC) (29.7%). Lingual tonsil hypertrophy, RFS, and respiratory effort-related arousal (RERA) were associated with epiglottic subtypes. Laryngopharyngeal reflux patients confirmed by RFS (t(25) = -1.32, p = 0.197) tended to suffer PEC; LTH was significantly associated (X2(1) = 2.5, p = 0.012) with PEC (odds ratio [OR] value = 44) in grades II and III LTH patients; 11 of 16 TDEC patients had grade I LTH. Pushed epiglottic collapse was more prevalent among multilevel airway obstruction patients. A single additional collapse site was found only in TDEC patients. Conclusion Laryngopharyngeal reflux causes repetitive acid stress toward lingual tonsils causing LTH, resulting in PEC with grade II or III LTH. Trap door epiglottic collapse requires one additional structural collapse, while at least two additional collapse sites were necessary to develop PEC. Respiratory effort-related arousal values may indicate EC.

ADENOID VEGETATIONS: EFFECTIVENESS OF THERAPY (REVIEW)

The problem of adenoids in childhood has not been solved to date. In pediatric otorhinolaryngology, 70-75% of operations in pediatric ENT hospitals are performed for hypertrophy of the pharyngeal tonsil. To this day, the question of the justification of this approach to adenoids has not been fully resolved. It is also not established in which cases surgical intervention is necessary and to what extent.

Эффективность применения Гроприносина в комплексной терапии гипертрофии глоточной миндалины и хронических аденоидитов у детей

Objective. Evaluation of the effectiveness of including the drug with immunostimulating and antiviral effects Groprinosin® in the combined treatment of children with hypertrophy of the pharyngeal tonsil (PHT) / chronic adenoiditis (DCA). Patients and methods. A comparative prospective study was conducted involving 355 children with PHT and DCA. 253 children received surgical treatment with the recommended basic therapy, 102 – the same, but with the addition of 2 courses of Groprinosin®. The children were observed for a year after surgery, and the frequency of episodes of acute respiratory infections (ARI) and relapses of HGM was assessed. Statistical analysis of the results was carried out using the Statistica 8 (USA) program. Results. In 81.4% of children with GGT/CA, DNA of lymphotropic herpes viruses with a significant predominance of the Epstein–Barr virus was found in the nasopharyngeal wash. In all groups after treatment, there was a statistically significant decrease in the frequency of ARI episodes: up to 2 (IQR 2–3) times a year with Groprinosin® treatment and up to 5 (IQR 2–4) without it, p = 0.023. In 29 children (8.2%) a relapse of HGM was observed: in one of the group treated with Groprinosin®, in 28 – without it. Conclusion. The high efficacy and safety of the drug Groprinosin® allows us to recommend its inclusion in the treatment protocol for children with clinically significant hypertrophy of the pharyngeal tonsil in combination with active Epstein–Barr viral infection after adenoidectomy. Key words: hypertrophy of the pharyngeal tonsil, chronic adenoiditis, treatment, relapses, inosine pranobex, children

A Case of Compensatory Hypertrophy of the Lingual Tonsils with Acute Inflammation and Hemorrhage

A Case of Compensatory Hypertrophy of the Lingual Tonsils with Acute Inflammation and Hemorrhage

Сочетанное использование свето- и фаготерапии у пациентов с гипертрофией глоточной миндалины

The adenoid hypertrophy is a fairly common pathology in children, which is steadily increasing. Objective. The assessment of clinical results of combined use of light and phage therapy in patients with pharyngeal tonsil hypertrophy. Patients and methods. The study is based on a clinical cases on 95 patients aged 3 to 7 years with pharyngeal tonsil hypertrophy of the 1st–2nd degree. The first group (49 people) received the treatment including irrigation of the nasal cavity and nasopharynx with isotonic NaCl solutions and local antibacterial therapy. The second group (46 people) received treatment according to the original method of combined use of light and phage therapy. Results. The combined use of light and phage therapy in patients with pharyngeal tonsil hypertrophy of the 1st-2nd degree statistically reliably helps to stop the typical symptoms of the disease, as well as other symptoms such as swelling of the mucous membrane and pathological discharge in the nasal cavity and nasopharynx. Conclusion. It has been clinically proven that light and phage therapy in patients with pharyngeal tonsil hypertrophy reduces the severity of symptoms and could be used in medical institutions with appropriate low-energy laser equipment, under the outpatient supervision of an otorhinolaryngologist and/or pediatrician at the local areas. Key words: hypertrophy of the pharyngeal tonsil, laser therapy, phage therapy