Recurrent Episodes Of Tonsillitis Research Articles

Recurrence of follicular dendritic cell sarcoma in tonsils after 7 years: a rare case report

Dystrophic calcifications are pathological mineral precipitates which occur in degenerative or dead tissue, despite normal serum calcium and phosphate levels, mostly seen in subcutaneous tissues secondary to infection or trauma. Chronic inflammation of the tonsils may lead to the formation of calcifications called tonsilloliths. The prevalence amongst the population is 2% to 16%, in age groups ranging from 10 years to 77 years of age, with a male/female ratio of 1:1. These calcifications display radiopaque images that are single or multiple, round or irregular, unilateral or bilateral and are superimposed upon the mandibular ramus. Computed tomography (CT) can be the investigation of choice for definitive diagnosis. The treatment of tonsilloliths is dependent on the size and presence of symptoms. It’s preferable to remove a single, large tonsillolith, as they can cause recurrent episodes of tonsillitis. Usually manual compression, curettage or a simple incision to release the calcified body should suffice for the relief. In case of numerous tonsilloliths, an attempt to remove them individually is not a feasible approach. Hence, bilateral tonsillectomy is opted.

Association Between Vitamin D Deficiency and Recurrent Tonsillitis.

Tonsillitis is defined as an inflammation of the tonsils characterized by signs of tonsillar erythema and exudates and recurrent tonsillitis is at least 7 episodes of acute tonsillitis in a year, or a minimum of 5 episodes in a year for 2 consecutive years, or at least 3 episodes in a year for 3 consecutive years. There are many research that have hypothesized the association of low level of Vitamin D and recurrent attacks of acute tonsillitis. A single centre prospective, cross sectional analytical study was conducted from 2021 June to 2022 March in Department of ENT and Head and Neck surgery in Kathmandu Medical College Teaching Hospital. The study participants were recruited from ENT Head and Neck OPD and the data on number of episodes of recurrent attacks of tonsillitis and serum level of Vitamin D were collected. 78.8% of patients with tonsillitis had low level of serum Vitamin D (less than 30ng/ml) and 21.2% had optimal level of serum Vitamin D (more than 30ng/ml). The incidence of recurrent tonsillitis was 40.9% in patients with low level of Vitamin D where as the incidence of recurrent tonsillitis was 18.1% in patients with optimal level of Vitamin D. The low serum level of Vitamin D was found to be associated with recurrent episodes of tonsillitis.

Role of serum vitamin D levels in patients with chronic tonsillitis in paediatric age group

Background: Vitamin D has got an important role in the defence system of our body. Objective were to assess the vitamin D levels in chronic tonsillitis and to find the association between the vitamin D deficiency and chronic tonsillitis in paediatric age group. Methods: A total of 325 patients aged between 5 and 15 years were enrolled in this study who were diagnosed with recurrent tonsillitis between January 2021 and December 2022. The patients were followed-up for one year and the total episodes of acute tonsillitis were recorded. Patients were divided into three groups: Those who had <5 episodes per year (Group 1), those with >5 episodes per year (Group 2) in the last two years, those who come to OPD with otological complaint, with no tonsillar involvement as a control group (Group 3). The total number of recurrent tonsillitis episodes within one year, demographic characteristics and the mean serum 25 (OH) D levels of the groups were compared. Results: The tonsil size according to the Brodsky Scale and the mean 25 (OH) D levels were compared and we found, lower vitamin D levels were significantly associated with larger tonsil sizes (p=0.023). Conclusions: There is a statistically significant association between vitamin D levels and recurrent episodes of tonsillitis. As the grade of tonsillar enlargement increased, the level of vitamin D were reduced significantly, thus correlating vitamin D levels not only with recurrence, but also grade of tonsillar enlargement.

Evidence-based Indications for Tonsillectomy

One of the most significant clinical trials, demonstrating the efficacy of tonsillectomy (TE) for recurrent throat infection in severely affected children, was published in 1984. This systematic review was undertaken to compile various indications for TE as suggested in the literature after 1984 and to stratify the papers according to the current concept of Evidence-based Medicine. A systematic Medline research was performed using the key word "tonsillectomy" in combination with different filters such as "systematic reviews", "meta-analysis", "English", "German" and "from 1984/01/01 to 2015/05/31". Further research was performed in the Cochrane Database of Systematic Reviews, National Guideline Clearinghouse, Guidelines International Network and BMJ Clinical Evidence using the same key word. Finally, data from the "Trip Database" were researched for "tonsillectomy" and "indication" and "from: 1984 to: 2015" in combination with either "systematic review" or "meta-analysis" or "metaanalysis. A total of 237 papers were retrieved but only 57 matched our inclusion criteria covering the following topics: peritonsillar abscess (3), guidelines (5), otitis media with effusion (5), psoriasis (3), PFAPA-Syndrome (6), evidence-based indications (5), renal diseases (7), sleep-related breathing disorders (11), and tonsillitis/pharyngitis (12), respectively. 1) The literature suggests, that TE is not indicated to treat otitis media with effusion. 2) It has been shown, that the PFAPA-syndrome is self-limiting and responds well to steroid administration, at least in a considerable amount of children. The indication for TE therefore appears to be imbalanced but further research is required to clarify the value of surgery. 3) Abscesstonsillectomy as a routine is not justified and indicated only for cases not responding to other measures of treatment, evident complications, or with a significant history of tonsillitis. In particular, interval-tonsillectomy is not justified as a routine. 4) TE, with or without adenoidectomy, is efficacious to resolve sleep-related breathing disorders resulting from (adeno)tonsillar hypertrophy in children. However, the benefit is reduced by co-morbidities, such as obesity, and further research required to identify prognostic factors for this subgroup of patients. Further research is indicated to clarify selection criteria not only for this subpopulation that may benefit from less invasive procedures such as tonsillotomy in the long-term. 5) Further trials are also indicated to evaluate the efficacy of TE on the clinical course in children with psoriasis guttata as well as on psoriasis vulgaris in adults, not responding to first-line therapy. 6) Conflicting results were reported concerning the role of TE in the concert to treat Ig-A nephropathy, mandating further clinical research. 7) Most importantly, randomized-controlled clinical trials with an adequate long-term follow-up are desirable to clarify the benefit of TE in patients with recurrent episodes of tonsillitis, with or without pharyngitis. Factors like age, spontaneous healing rate and postoperative quality of life have to be included when comparing TE with antibiotic therapy.

Tonsillotomy: facts and fiction

In contrast to total or extracapsular tonsillectomy (TE), subtotal/intracapsular/partial tonsillectomy (SIPT) or tonsillotomy (TT) is associated with significant less postoperative morbidity. It has been stated that patients older than 8years of age or with a history of tonsillitis should be excluded from SIPT/TT. Some health insurance companies mandate utilization of particular surgical instruments. Finally, it has been stated that the remaining tonsillar tissue may become a subject of recurrent tonsillitis or tonsillar regrowth, in both cases requiring revision surgery in terms of TE. This literature review was undertaken to clarify what has been validated in the literature concerning indications, surgical techniques, complications and outcome of SIPT/TT as reported since 1960. A Medline review was undertaken and all papers included that were published in English or German language until September 30, 2013. Exclusion criteria were: publication date 1960 and earlier, other languages, no relation to tonsil surgery, papers not available to the authors, uncommon surgical techniques, national surveys or studies without patients. The quality of the papers was classified according to "The Oxford 2011 Levels of Evidence". The surgical techniques were classified according to Windfuhr and Werner and extended to interstitial tonsil therapy. Other issues were: study period, hemorrhage, dehydration, intake of analgesics, return to normal diet, surgical instruments, operation time, number of surgeons involved, number of patients, age, indications, follow-up, rate of tonsillar regrowth, tonsillitis and secondary TE. A total of 379 different publications were retrieved, but only 86 studies found eligible for further analysis. There were 10,499 patients in the study groups and 10,448 patients in the control groups. Utilization of the microdebrider largely prevailed, followed by Coblation, CO2-LASER, surgical scissor, Radiofrequency, Interstitial ThermoTherapy with various instruments, Diode-LASER, and other instruments. Instruments were not specified for 1,815 patients. Data for operation time, intraoperative bleeding, return to normal diet, analgesic intake were in favor for SIPT/TT and ablation procedures. Regrowth and tonsillitis occurred in rates of <6% on average. Secondary surgery became necessary in only every third patient of this subgroup. Studies of variable quality impede comparison of all aspects in the papers. At least every second study did not address issues like operation time, intraoperative bleeding, return to normal diet, analgesic intake, rates of tonsillar regrowth, postsurgical tonsillitis and secondary TE. There are insufficient data to show that a single surgical instrument is superior. A history of tonsillitis and an age >8years are definitely not commonly accepted as contraindication for SIPT, TT or ablation procedures. There is a strong evidence that pain is less after SIPT, TT and tonsil ablation resulting in an earlier return to normal diet and activity. Large, well-designed randomized controlled trials with an adequate follow-up are necessary to determine whether the procedure is capable to replace TE to resolve upper airway obstruction resulting from tonsillar hypertrophy as well as recurrent episodes of tonsillitis in children and adults.

Acute Tonsillitis

Sore throat is a common condition in primary care. As many as 1 in 10 people suffer recurrent episodes of tonsillitis. The cost per year to the NHS for primary care consultations, before investigation and treatment, for sore throats is estimated at 60 million pounds. It is also estimated that 35 million work and school days are lost in the UK per year because of sore throats.

The role of anaerobic bacteria in recurrent episodes of sinusitis and tonsillitis.

Chronic and recurrent upper respiratory tract infections represent a significant clinical challenge. The causative organisms tend to be heterogeneous, involving both aerobes and gram-positive and gram-negative anaerobes. There is evidence that these mixed groups of bacteria interact synergistically, enhancing and prolonging the overall virulence of infection. The role of anaerobic bacteria, in particular their proposed ability to protect susceptible organisms by the production of beta-lactamases, has been the subject of intense speculation. The evidence of a significant role for anaerobic bacteria in recurrent episodes of tonsillitis and sinusitis is reviewed and the most appropriate antimicrobial strategies and possible future developments in diagnosis and therapy are discussed.

Peritonsillar Abscess: Recurrence Rate and Treatment

• In 161 patients treated for a peritonsillar abscess by stab incision as the only surgical procedure, a follow-up study was conducted after 3½ to eight years. Of all the patients examined, 51% had experienced no throat symptoms, 22% had had recurrent peritonsillar abscesses, 20% had had recurrent episodes of tonsillitis with fever, and 7% had had symptoms resembling episodic pharyngitis in varying degrees. The age of the patient and the patient's history of previous throat infections were found to have prognostic value. Older patients (older than 40 years) had a lower incidence of new throat infections (peritonsillar abscess, tonsillitis, or both) than younger patients. Patients without previous throat symptoms had a lower incidence of new throat infections than patients with a history of throat infection before the peritonsillar abscess, which in itself might indicate the need for tonsillectomy. ( Arch Otolaryngol 1981;107:540-542)