Recurrent Tonsillitis Group Research Articles

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.

TSLP activates the production of IFN-γ via CD8-positive T cells in recurrent tonsillitis

The role of thymic stromal lymphopoietin (TSLP) in chronic infection is not well understood. We report an increased number of cluster of differentiation 8 (CD8+ T) cells and higher expression of TSLP in the tonsil tissues of patients with recurrent tonsillitis as compared to that in the tonsil tissues of patients with tonsillar hypertrophy. Stimulation of tonsil CD8+ T cells with TSLP in the recurrent tonsillitis group resulted in higher production of interferon gamma (IFN-γ) and increased cell proliferation when compared to that in the tonsillar hypertrophy group. These results suggest the possibility that recurrent infection of tonsils may enhance local CD8+ T cell proliferation and IFN-γ and TSLP production. Anti-TSLP antibodies, which are potential therapeutic agents in allergic diseases, could have beneficial effects in patients with recurrent tonsillitis.

Weber's gland immune/histopathology in pediatric recurrent tonsillitis and obstructive tonsillar hypertrophy cases.

Recurrent tonsillitis and obstructive tonsillar hypertrophy are very common in childhood and constitute the two major causes of tonsillectomy in this age group. There is no study in the literature on the immune/histopathological changes in the recurrent and obstructive tonsillar hypertrophy of Weber's glands. In this study, we aimed to histopathologically and immunohistochemically examine the Weber's glands of pediatric patients with recurrent. A total of 63 patients, with 31 patients aged 6-9 who had surgery for recurrent tonsillitis, and 32 patients aged 6-11 years who had surgery for obstructive tonsillar hypertrophy, were included in the study. The removed Weber's glands were included in the obstructive tonsillar hypertrophy or recurrent tonsillitis group according to the patient's clinical diagnosis. All specimens were coded with a numbering method, where only the surgeon knew which patient was in which group. All specimens were evaluated in the same histology center and by the same histologist, unaware of the clinical diagnosis of the patients (blind). The comparison of Weber's gland immunohistochemical parameter scores of the groups revealed that the scores of the RT group were significantly higher for all three parameters (VEGF: t=6.777; p<0.001), (EGFR: t=4.386; p<0.001), (IL-6: t=5.072; p<0.001). The comparison of the groups in terms of inflammation, basement membrane thickening, myoepithelial cell and glycoprotein accumulation revealed significantly higher Weber's gland evaluation scores in the RT group for all four parameters. (inflammation: t=7.794; p<0.001), (basement membrane thickening: t=6.582; p<0.001), [myoepithelial cell: t=3.693; p<0.001), (glycoprotein accumulation: t=5.287; p<0.001)]. Histopathological and immunohistochemical examination of Weber's gland in pediatric recurrent tonsillitis and obstructive tonsillar hypertrophy cases revealed inflammatory changes in both disease groups. As expected, inflammatory manifestations were more common in the recurrent tonsillitis group. Besides, inflammatory changes detected in Weber's glands of obstructive tonsillar hypertrophy cases without a history of tonsillitis may contribute to the Weber's gland hypothesis, which attempts to explain the etiology of peritonsillar abscess.

Analysis of Microorganism Colonization, Biofilm Production, and Antibacterial Susceptibility in Recurrent Tonsillitis and Peritonsillar Abscess Patients.

Background: Despite the widespread use of antibiotics to treat infected tonsils, episodes of tonsillitis tend to recur and turn into recurrent tonsillitis (RT) or are complicated by peritonsillar abscesses (PTAs). The treatment of RT and PTAs remains surgical, and tonsillectomies are still relevant. Materials and methods: In a prospective, controlled study, we analyzed the bacteria of the tonsillar crypts of 99 patients with RT and 29 patients with a PTA. We performed the biofilm formation and antibacterial susceptibility testing of strains isolated from study patients. We compared the results obtained between patient groups with the aim to identify any differences that may contribute to ongoing symptoms of RT or that may play a role in developing PTAs. Results: The greatest diversity of microorganisms was found in patients with RT. Gram-positive bacteria were predominant in both groups. Candida species were predominant in patients with a PTA (48.3% of cases). Irrespective of patient group, the most commonly isolated pathogenic bacterium was S. aureus (in 33.3% of RT cases and in 24.14% of PTA cases). The most prevalent Gram-negative bacterium was K. pneumoniae (in 10.1% of RT cases and in 13.4% of PTA cases). At least one biofilm-producing strain was found in 37.4% of RT cases and in 27.6% of PTA cases. Moderate or strong biofilm producers were detected in 16 out of 37 cases of RT and in 2 out of 8 PTA cases. There was a statistically significant association found between the presence of Gram-positive bacteria and a biofilm-formation phenotype in the RT group and PTA group (Pearson χ2 test, p < 0.001). S. aureus and K. pneumoniae strains were sensitive to commonly used antibiotics. One S. aureus isolate was identified as MRSA. Conclusions: S. aureus is the most common pathogen isolated from patients with RT, and Candida spp. are the most common pathogens isolated from patients with a PTA. S. aureus isolates are susceptible to most antibiotics. Patients with RT more commonly have biofilm-producing strains, but patients with a PTA more commonly have biofilm non-producer strains. K. pneumoniae does not play a major role in biofilm production.

Is There a Difference between the Preoperative and Postoperative Serum Levels of Interleukin-6 and Tumor Necrosis Factor-α in Children Submitted to Adenotonsillectomy?

Introduction Palatine and pharyngeal tonsils are the first line of defense against pathogens. Clinically, two alterations may require surgical removal of the tonsils: hypertrophy and recurrent tonsillitis. The two conditions probably result from a dysfunction of the immune system. Objective To evaluate possible differences in the plasma levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) in patients submitted to adenotonsillectomy. Methods Prospective, longitudinal study with 25 children undergoing adenotonsillectomy separated into 3 different groups: recurrent tonsillitis (RT), composed of 7 patients; recurrent hypertrophy tonsillitis (RTTH), with 8 patients; and the tonsillar hypertrophy (TH) group, with 10 patients. Ten healthy control children (SD) were also included in the study. Peripheral blood was collected, and plasma was separated to measure the levels of TNF-α, IL-6, and IL-10. The Mann-Whitney test was used for statistical analysis. Results The plasma level of IL-6 was higher in the RT ( p = 0.0394) and TH ( p = 0.0009) groups, compared with the control group. The TH group also had higher levels of IL-6 than the RT group ( p = 0.039). The IL-6/IL-10 ratio was higher in the RT ( p = 0.029) and TH ( p = 0.0005) groups compared with the control group. Between the RT and RTTH groups, the IL-6/IL-10 ratio was higher in the RT group, with a statistically significant difference ( p = 0.0091). Conclusion Patients with a history of chronic tonsillitis had higher levels of IL-6, compared with the control group.

Cellular senescence in recurrent tonsillitis and tonsillar hypertrophy in children

ObjectiveTo observe the difference in cellular senescence patterns between recurrent tonsillitis and tonsillar hypertrophy. Methods and materialsForty-three patients diagnosed with recurrent tonsillitis or tonsillar hypertrophy, based on medical history and symptoms, underwent tonsillectomy. The specimens were collected and examined using senescence β-galactosidase staining for cellular senescence. Macrophages were detected by immunochemistry. ResultsCellular senescence was found in both recurrent tonsillitis and tonsillar hypertrophy groups. The comparison of cellular senescence in microcompartments of tonsil tissue (germinal centre, mantle zone, subepithelial and intraepithelial) revealed a significant increase of senescent cells in germinal centres in tonsillar hypertrophy compared with that in tonsillar hypertrophy. The majority of senescent cells in both groups were CD68-positive. ConclusionsDifferent cellular senescence patterns were found between the two studied paediatric tonsillar diseases. Macrophage senescence may play a role in the pathogenesis of these diseases.

Secondary tonsillar hemorrhage requiring surgical intervention: Analysis of 1429 tonsillectomy cases on single surgeon experience

Objective:&nbsp;Determination of risk factors affecting secondary tonsillar hemorrhage of the requiring surgical intervention. Material and Method:&nbsp;1429 tonsillectomy cases performed with three different dissection techniques (dissection and snare, bipolar and monopolar dissection) by a single surgeon were examined retrospectively.&nbsp; Age, sex, surgical knowledge, indications and postoperative tonsillar hemorrhage day of the patients were recorded. Patients who were operated on for hemorrhage were evaluated statistically in terms of technique used, age, sex and indications. Findings:&nbsp;A total of 25 cases of a secondary hemorrhage cases requiring surgical intervention were detected. The relationship between age and bleeding was statistically significant (p=0.003). Hemorrhage frequency requiring surgical intervention was significantly higher in patients with recurrent tonsillitis than in patients with tonsillar hypertrophy (p = 0.001). 19 of the 25 patients who were operated on for hemorrhage were in the group of tonsillectomy patients due to recurrent tonsillitis. There was no meaningful relationship in terms of sex. The hemorrhage rate in the dissection and snare technique was 1.74% (12 patients), the hemorrhage rate in bipolar dissection was 2.78% (9 patients), and the monopolar dissection- hemorrhage rate was 0.96% (4 patients). There was no statistically significant difference between the results (p = 0.170). It was determined that the hemorrhage required surgery at most was between 6th and 10th days. Conclusion:&nbsp;While there was no significant relationship between the incidence of secondary tonsillar hemorrhage requiring surgery and gender and dissection techniques, it has been observed that the risk was increased in patients operated due to recurrent tonsillitis and older age group.

Evaluation of iron and zinc levels in recurrent tonsillitis and tonsillar hypertrophy

ObjectivesThe aim of this study is to look into the roles of iron and zinc metals in etiopathogenesis of recurrent tonsillitis and tonsillar hypertrophy by evaluating the levels of iron and zinc elements in the palatine tonsillar tissue. MethodsIn total, 40 patients who underwent a tonsillectomy to treat recurrent tonsillitis and tonsillar hypertrophy were included in the study. Patients were classified into two groups, recurrent tonsillitis and tonsillar hypertrophy, determined by the results of clinical and histopathological examination. The levels of iron and zinc elements were determined for each tonsillar tissue sample. ResultsThere was a significant difference in the iron and zinc concentrations (p<0.001) between the tonsillar hypertrophy and recurrent tonsillitis groups. The levels of iron and zinc were significantly lower in the recurrent tonsillitis group. ConclusionsThis study suggests that low tissue concentrations of iron and zinc may lead to recurrent tonsillitis.

Detection of the Epstein–Barr virus, Human Bocavirus and novel KI and KU polyomaviruses in adenotonsillar tissues

ObjectivesWe aimed to investigate the seasonal disturbations and the rates of detection of Epstein–Barr virus (EBV), Human Bocavirus (HBoV), and polyomaviruses KI and WU (KIPyV and WUPyV) in adenoid and tonsil tissues during the absence of acute infection symptoms. Study designCross-sectional prospective study. SettingTertiary hospital. MethodsDNA expressions of EBV, HBoV, polyomaviruses KIPyV and WUPyV were investigated in children with chronic tonsillar and adenoidal diseases using real-time polymerase chain reaction. The patients were grouped as follows: adenoid, recurrent tonsillitis and hypertrophic tonsillitis group. The relationships of the expressions of these viruses with age, gender, recurrent infection and airway obstruction were also analyzed. Seasonal variations in rates of detection of these viruses in adenoid and tonsil tissues were also investigated. ResultsConsidering adenoid specimens, HBoV was found to be the most frequent virus with the rate of 43.1%. In specimens of recurrent tonsillitis and hypertrophic tonsils, EBV was the most frequently encountered virus (53.8%, and 32.0%, respectively). In children with hypertrophic adenoids, while HBoV was detected to be positive throughout the year, EBV was present throughout the year in children with recurrent tonsillitis. ConclusionsThe detection of HBoV and EBV throughout the year in samples of children with asymptomatic chronic adenotonsillar diseases may indicate that these viruses may remain persistently in lymphoepithelial tissues of upper respiratory tract. Virus persistence may have a pathogenetic potential for development of lymphoid hypertrophy and a chronic stimulatory effect for inflammation.

Prevalence of smoke exposure amongst children who undergo tonsillectomy for recurrent tonsillitis

PurposeThe hypothesis tested was that smoke exposure has a detrimental effect on the developing upper respiratory tract. The purpose of this study was to determine if more children undergoing tonsillectomy for recurrent tonsillitis had smoke exposure in comparison to a control group of children undergoing hernia repair. MethodsThis was a retrospective case-control study. Medical records of children less than 15 years of age that underwent tonsillectomy for recurrent tonsillitis at Penn State Hershey Medical Center from July 2009 to October 2012 were retrospectively reviewed to determine exposure to smoking contacts. Records of children less than 15 years of age that underwent hernia repair surgery at this facility during the same time, were also retrospectively reviewed for smoke exposure. ResultsA total of 256 children who underwent tonsillectomy for recurrent tonsillitis and 241 children who underwent hernia repair surgery met the inclusion criteria. Of the children in the tonsillectomy for recurrent tonsillitis group, 121 (47.27%) had previous smoke exposure, compared to 67 (27.80%) in the hernia repair group. Further analysis of the data using logistic regression yielded an odds ratio of 2.49 (P=0.004), indicating that children with smoke exposure had more than twice the odds of having tonsillectomy for recurrent tonsillitis compared to those with no exposure. ConclusionsExposure to smoking contacts was more common in children who underwent tonsillectomy for recurrent tonsillitis than children who underwent hernia repair surgery. Future studies could address the relation of smoke exposure quantity to health outcomes in children.

The Role of Vitamin D in Children with Recurrent Tonsillopharyngitis

The exact etiology of recurrent tonsillopharyngitis in children is not clear. Recurrent tonsillitis in children has multifactorial etiology like most of the diseases in childhood. In this study, our aim was to determine the potential role of vitamin D in recurrent tonsillitis by measuring serum 25-OH vitamin D levels and determining the vitamin D receptor polymorphism among children with recurrent tonsillitis. Eighty-four children with recurrent tonsillitis and seventy-one healthy children aging between 2 and 10 years were enrolled in this study. Serum 25-OH vitamin D level was measured with ELISA and vitamin D receptor gene polymorphism (Apa1, Taq 1, Fok1) was determined by PCR. Serum 25-OH vitamin D level below 50 nmol/L was accepted as deficiency. The vitamin D receptor gene polymorphism in each group was compared. The mean age was 5.6 ± 2.4 and 6.1 ± 2.7 years in study and control group, respectively. The average serum 25-OH vitamin D level was 142.7 ± 68.1 nmol/L in study group and 192.3 ± 56.1 nmol/L in control group. There was significant difference between the groups (p < 0.01). In study group, 4.7% (n = 4) of children had serum 25 OH vitamin D levels below 50 nmol/L. None of the children in control group had serum 25-OH vitamin D level below 50 nmol/L. There was no significant differences in vitamin D receptor gene polymorphisms between groups. Serum 25-OH vitamin D levels in recurrent tonsillitis group were lower than those in healthy children. But, there was no difference in the incidence of vitamin D receptor gene polymorphism between the two groups.

Weight Gain after Adenotonsillectomy Is More Common in Young Children

Adenotonsillectomy (TA), performed for obstructive sleep apnea (OSA) or recurrent tonsillitis (RT), has been associated with weight gain after surgery. The objective of this study was to look at a large population of children undergoing TA and the demographic factors that contribute to postoperative weight gain. Case series with retrospective chart review. Tertiary, urban academic care center. Children undergoing TA at an academic center between 2008 and 2011 were included in this study. Demographic data (age, gender, race), OSA disease severity, preoperative and 3- to 6-month postoperative normalized body mass index (BMI; z-scores), and changes in z-scores were compared. Complete weight data after TA were available for 115 children, 85 of whom underwent surgery for OSA. Mean age (7.2 ± 4.3 vs 7.3 ± 4.4 years, P = .955) and gender distribution (38% female vs 50% male; P = .323) were similar for the OSA and RT groups. However, children with OSA were more likely to be black (60% vs 33%) than RT patients (P = .026). Overall, the preoperative BMI z-score increased from 0.98 ± 1.50 to 1.21 ± 1.25 (P = .0009) with no difference by surgical indication (P = .58). Multiple linear regression analysis demonstrated that only age was significantly, and negatively, associated with changes in BMI z-scores (P = .015). Similar to previous studies, children had weight gain after TA. In this analysis, younger age (≤ 6 years) was a significant predictor of postoperative weight gain. Future research should prospectively evaluate the association between weight gain and demographic factors in children undergoing TA, with special attention to the relationship with age.

The Immunomodulatory Effects of Garenoxacin on Interleukin-8 Produced by Human Tonsillar Lymphocytes with Lipopolysaccharide Stimulation

It has been reported that macrolides and some quinolones have an immunomodulatory effect and show synergy in their antimicrobial activity. Garenoxacin (GRNX), a recently developed fluoroquinolone, has been reported to show strong antimicrobial activity against respiratory pathogens such as Streptococcus pneumoniae and Haemophilus influenzae and high treatment efficacy for acute infectious diseases of the upper and lower respiratory tracts. To study the immunomodulatory effects of GRNX, we investigated its influence on interleukin-8 (IL-8), one of the products of proinflammatory cytokines, in human tonsillar lymphocytes stimulated with lipopolysaccharides (LPS). Palatine tonsils were obtained from patients with recurrent tonsillitis (n=12) and with hypertrophic tonsils (n=8). The tonsillar lymphocytes were stimulated with LPS (25 μg/ml) and were incubated with GRNX (5, 10, 15, 30 μg/ml) for 48 hours. IL-8 production of the treated lymphocytes was then measured with an ELISA. The IL-8 production of tonsillar lymphocytes was significantly suppressed by GRNX in the recurrent tonsillitis group, but not in the hypertrophic tonsil group. In conclusion, it is strongly suggested that GRNX has immunomodulatory effects on tonsillar lymphocytes with repeated episodes of infection through the suppression of IL-8 production. Thus GRNX has synergistic anti-inflammatory effects with its anti-bacterial properties, which is a favorable characteristic in the treatment of upper respiratory tract infections.

The immune status in situ of recurrent tonsillitis and idiopathic tonsillar hypertrophy

To analyze the immune status in situ of tonsils of patients with recurrent tonsillitis (RT) and idiopathic tonsillar hypertrophy (ITH) with the aim to discuss the indications of tonsillectomy (TE) and tonsillotomy (TT) in young children. The histological and immunohistological study of tonsillar tissue of RT and ITH in correlation with immunological parameters in peripheral blood in 13 patients with RT and 16 patients with ITH. In the RT group, we found a higher degree of fibrosis with a higher density of memory lymphocytes (CD45R0+), B-lymphocytes (CD20+) and cytotoxic T-lymphocytes (CD8+) in surface epithelium of tonsils compared to the ITH group (NS). The density of immunoglobulin IgG in the crypt epithelium in RT was significantly higher than in the ITH group (p = 0.041). We also measured a higher sera concentration of immunoglobulines (IgG, IgM, IgA) and TNF-α in RT compared to the ITH group (NS) and TH-1 immune response in tonsillar tissue based on differences between local cytokine concentration TNF-α and IL-4. RT has a higher inflammatory reaction in tonsillar tissue as a result of persistent bacterial antigenic stimulation. In patients with RT, the tonsillectomy might be the only option for surgical treatment. In patients with ITH with mild symptoms, the tonsillotomy should be preferred (Tab. 3, Ref. 24).

Comparison of tonsillar biofilms between patients with recurrent tonsillitis and a control group

Conclusion: The results of the study suggest that biofilms play a causative role in recurrent tonsillitis. Objective: To analyze the association between tonsillar biofilms and recurrent tonsillitis. Methods: The recurrent tonsillitis group comprised patients with a history of at least five episodes of tonsillitis per year over the previous 2 years. The control group comprised volunteers scheduled for laryngeal microsurgery with no history of tonsillitis over the previous 2 years. Between October 2009 and August 2010, specimens were obtained from 20 patients with recurrent tonsillitis and 20 volunteers (controls). Scanning electron microscopy (SEM) was used to confirm the presence of biofilms. Biofilms were graded at a magnification of ×500 by SEM and classified into five grades. The percentages of subjects affected and biofilm grades were compared between the recurrent tonsillitis and control groups. Results: The two groups were matched for age and sex. SEM revealed that biofilms were significantly more prevalent in the recurrent tonsillitis group than in the control group. Furthermore, the biofilms in the recurrent tonsillitis group were of significantly higher grade than those in the control group.

The role of vitamin D in children with recurrent Tonsillopharyngitis

BackgroundThe exact etiology of recurrent tonsillopharyngitis in children is not clear. Recurrent tonsillitis in children has multifactorial etiology like most of the diseases in childhood. In this study, our aim was to determine the potential role of vitamin D in recurrent tonsillitis by measuring serum 25-OH vitamin D levels and determining the vitamin D receptor polymorphism among children with recurrent tonsillitis.MethodsEighty-four children with recurrent tonsillitis and seventy-one healthy children aging between 2 and 10 years were enrolled in this study. Serum 25-OH vitamin D level was measured with ELISA and vitamin D receptor gene polymorphism (Apa1, Taq 1, Fok1) was determined by PCR. Serum 25-OH vitamin D level below 50 nmol/L was accepted as deficiency. The vitamin D receptor gene polymorphism in each group was compared.ResultsThe mean age was 5.6 ± 2.4 and 6.1 ± 2.7 years in study and control group, respectively. The average serum 25-OH vitamin D level was 142.7 ± 68.1 nmol/L in study group and 192.3 ± 56.1 nmol/L in control group. There was significant difference between the groups (p < 0.01). In study group, 4.7% (n = 4) of children had serum 25 OH vitamin D levels below 50 nmol/L. None of the children in control group had serum 25-OH vitamin D level below 50 nmol/L. There was no significant differences in vitamin D receptor gene polymorphisms between groups.ConclusionSerum 25-OH vitamin D levels in recurrent tonsillitis group were lower than those in healthy children. But, there was no difference in the incidence of vitamin D receptor gene polymorphism between the two groups.

Molecular study of Beta-Haemolytic Streptococci in Patients with Tonsillitis In Ramadi City

Objectives: To evaluate the sensitivity and specificity of polymerase chain reaction PCR technique in early detection of infection with group A beta-haemplytic streptococci in comparing with conventional diagnostic methods among the patients with tonsillitis. Methods: One hundred ninety one swabs and blood specimens were obtained from patients with tonsillitis in addition to samples of healthy control group during a period between 2008-2009 in general Ramadi hospital, Iraq and the tests (PCR) and other bacteriological and serological test at the same time on these samples. Results: Our data show that in recurrent tonsillitis group out of 72 GBHS isolates 43 (59.7%) were detected by PCR, however 15(20.8%) were positive by serogrouping. Out of 75 bacterial isolates, 22 (29.4%) isolates were GABHS and 15 (83.5%) of these were GABHS detected by PCR and only 4 (5.3%) of GABHS detected by serogrouping methods in acute recurrent group, and our results revealed that the inoculation of penicillin and L-therionine to the brain heart infusion broth improved the DNA extraction from gram positive bacteria (GBHS). Conclusion: Our study confirmed that the PCR technique more sensitive and highly specific in early detection of GBHS among the patients with tonsillitis in comparing with conventional; diagnostic methods.

The role of the actinomyces in obstructive tonsillar hypertrophy and recurrent tonsillitis in pediatric population

Objective To determine the prevalence of tonsillar Actinomyces in subjects with recurrent tonsillitis and those with obstructive tonsillar hypertrophy, and to determine the association between the presence of Actinomyces and tonsillar volume, and crypt abscess. Subjects and methods A prospective designed cross-sectional study consisted of 90 children subjects who underwent tonsillectomy or adenotonsillectomy for recurrent tonsillitis and obstructive tonsillar hypertrophy. The subjects of recurrent tonsillitis (Group A) and obstructive tonsillar hypertrophy (Group B) were compared to the presence of Actinomyces. The relationship between the presence of Actinomyces and the presence of crypt abscess, and tonsillar volume were also compared. Results Actinomyces was found to be significantly more prominent in obstructive tonsillar hypertrophy group (61.5%) compared to recurrent tonsillitis group (26.6%) ( p < 0.001). Additionally, the mean tonsillar volume was significantly higher in tonsils with Actinomyces than those without ( p < 0.001). The histopathological study revealed that there was no significant inflammatory response to the existence of Actinomyces. Conclusion According to the presented study, Actinomyces was seen more prominent in subjects with obstructive tonsillar hypertrophy compared those with recurrent tonsillitis. Furthermore Actinomyces had a pathological influence on tonsil size. This study showed there was a significant relation between Actinomyces and enlargement of tonsillar tissue. However, how causes tonsillar hypertrophy is not understood yet in tonsillar disease.

Vitamin D levels in children with recurrent tonsillitis

Aim Although recurrent tonsillitis can be the consequence of defects in immune system, the exact etiology of recurrent tonsillitis is not clear. In this study, our aim was to determine the serum vitamin D levels and vitamin D receptor polymorphism among children undergone tonsillectomy due to the recurrent tonsillitis. Methods A 106 children undergone tonsillectomy due to recurrent tonsillitis and a 127 healthy children aging between 2 and 12 years were enrolled in this study, to determine serum 25-hydroxyvitamin D level and vitamin D receptor gene polymorphisms (Apa1, Taq 1, fok1). Serum vitamin D level was measured with ELISA (nmol/L) and receptor gene polymorphism was determined by PCR. Vitamin D serum level below 80 nmol/L was accepted as insufficient. Results The average serum vitamin D level was 176 ± 79 nmol/L in recurrent tonsillitis group and 193 ± 56 nmol/L in control group. There was no significant difference between the groups ( p = 0.13). In recurrent tonsillitis group, 18% ( n = 15) of children had their serum vitamin D levels below 80 nmol/L. The vitamin D receptor gene polymorphism ( APA1, TAQ 1, FOK 1) in each group was compared ( AA, Aa, aa, TT, Tt, tt, FF, Ff, ff). There was no significant difference between the two groups. The vitamin D serum levels and receptor sub-genotypes are also compared, and there was no significant difference between the groups. Conclusion There is no difference between the serum vitamin D level and receptor gene polymorphism among children with recurrent tonsillitis and healthy children. But vitamin D insufficiency is more prevalent in children with recurrent tonsillitis group (18%).

Enzymatic study of tonsil tissue alkaline and acid phosphatase in children with recurrent tonsillitis and tonsil hypertrophy

Objective Indications for tonsillectomy in recurrent tonsillitis are defined according to the number of episodes of acute bacterial infections in a year. However, little is known about the tonsil immune competence status in patients presenting with recurrent tonsillitis with either hypertrophied or atrophied tonsils, or in patients presenting with obstructive sleep apnoea. In this study we examined the tonsil immune status in children with 3–5 acute recurrent infections a year and in children with obstructive sleep apnoea by comparing the activity of tonsil and adenoid tissue nonspecific alkaline and acid phosphatase. Methods Specific activity of tonsil and adenoid tissue nonspecific alkaline and acid phosphatase was investigated in children who underwent tonsillectomy and adenoidectomy for recurrent infection (72 children) and for obstructive sleep apnoea (10 children). Tissue enzyme activities were measured using p-nitrophenylphosphate as a substrate. Tissue samples were examined by the haematoxylin–eosin histological technique. Statistical analyses were performed using SPSS v. 16 software. Results The tissue nonspecific alkaline phosphatase activity was similar in hypertrophied tonsils in the recurrent infection group and in the obstructive sleep apnoea group (3.437 ± 1.226 and 3.978 ± 0.762 U/mg of protein, respectively). The enzyme activity in both hypertrophied tonsil groups was significantly higher as compared to atrophied tonsils in the recurrent tonsillitis group, p = 0.021 and p = 0.006, respectively. The enzyme activity was significantly higher in the adenoids compared to the tonsils from all three groups. Contrary to this, no significant differences were noticed for tonsil and adenoid acid phosphatase activities among the groups. Conclusion Similar acid phosphatase activity in all three groups implies that all three groups have preserved antigen presenting cell activity. In patients with hypertrophied tonsils similar tissue nonspecific alkaline phosphatase activity suggests preserved B cell tonsil immune activity, regardless of the pathology. Patients with atrophied tonsils had significantly lower alkaline phosphatase activity, indicating relative tonsil B cell immune deficiency. Thus, different immunological status in patients presenting with hypertrophied vs. atrophied tonsils could point to a different underlying pathophysiologic mechanism of the disease.