Recurrent Tonsillitis Patients 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.

Comparison of innate lymphoid cells from tissue and blood in chronic tonsillitis and tonsillar hypertrophy.

Recurrent tonsillitis and tonsillar hypertrophy are two common diseases in children for which tonsillectomy is the definitive solution. The underlying causes of both diseases are not fully known. The aim of this study was to identify the predominant innate lymphoid cells in both diseases of the palatine tonsils, which are known to play an important role in the immune system. Children who underwent tonsillectomy were divided into two groups as recurrent tonsillitis and tonsillar hypertrophy according to the indication for surgery. The proportions of innate lymphoid cell (ILC) groups and IFN-gamma, IL-10 and IL-17 secreting T lymphocyte cells were determined in tonsil and blood samples obtained during surgery. Local and peripheral immune responses were evaluated. Innate immune responses and acquired immune responses were compared. The results of our study showed that the proportions of the innate lymphoid cell 1 group (ILC1) were similar in tonsil tissue in patients with recurrent tonsillitis and tonsil hypertrophy, with no statistically significant difference. It was observed that the innate lymphoid cell 2 group (ILC2) was the predominant group in tonsil hypertrophy, the innate lymphoid cell 3 group (ILC3) was the predominant innate lymphoid cell group in recurrent tonsillitis, and the proportion of IL-17 secreting T lymphocytes in blood and tonsillar mononuclear cells was higher in recurrent tonsillitis patients than in tonsil hypertrophy patients. With the results obtained, the predominant innate lymphoid cells in the pathogenesis of both diseases were identified and local and peripheral responses were compared. These findings may be a guide for possible medical treatments for both diseases in the future.

Does a tonsillectomy indicated according to the German S2k guideline affect short-term quality of life in adults?

Tonsillectomy (TE) for recurrent tonsillitis (RT) is one of the most common surgical interventions. Since 2015, the indication criteria for TE have become much stricter (German S2k guideline). Patient-reported outcome measures (PROMs) of short-term quality of life (QoL) after TE have not yet been investigated. To clarify if stringent indication for TE will better identify patients worthy of surgery and patients' QoL. We prospectively studied the Tonsillectomy Outcome Inventory 14 (TOI-14) responses of 38 RT-patients recruited according to the S2k guideline in 2020 and compared their TOI-14 scores with those of a historical RT cohort from 2006 to 2008 and with a healthy middle-European cohort. New RT patients were assessed before, 2, 4, and 14days and 6months after TE. TOI-14 was measured as total and as disease-specific score. From pre- to 6-month postoperative, patients' QoL was significantly different, measured by TOI-14 (49.92 vs. 6.35; p < 0.001) and disease-specific score (60.35 vs. 9.9; p < 0.001). Preoperative disease-specific score was not different from that of the 2nd and 4th postoperative days but from the 14th postoperative day (60.35 vs. 29.26; p < 0.001). The historical cohort had significantly less RT complaints than the new cohort beforehand, but more dissatisfaction in QoL after TE. New TE patients had worse QoL pre- (49.92 vs. 11.78; p < 0.001) but more QoL postoperatively (6.34 vs. 11.78; p = 0.004) than healthy individuals. Our results show that the tightening of the indication criteria for TE was justified and that TE patients significantly benefit from this surgery from day 14.

Altered tonsillar toll-like receptor (TLR)-1 and TLR-2 expression levels between periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA), and group A beta-hemolytic streptococcal (GAβHS) recurrent tonsillitis patients

IntroductionTonsillar microenvironment is thought to contribute to innate immune dysregulation responsible for the periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) because of beneficial effects of tonsillectomy on treatment of the syndrome. Accordingly previous studies reported altered lymphocyte frequency, cytokine level and microbial composition in PFAPA tonsils. The aim of our study is to monitor expression levels of pro-inflammatory cell surface Toll-like receptors (TLRs) which have important role in induction of inflammation and maintaining tissue haemostasis. Materials and methodsSeven patients with PFAPA syndrome, and eight patients with group A beta-hemolytic streptococcal (GAβHS) recurrent tonsillitis were included in our study. Tonsillar expression levels of TLR-1, -2, -4, -5, and -6 were monitored by immunohistochemistry (IHC). Expression levels were scored using semi-quantitative analysis method and were statistically analyzed by Two-Way Repeated Measures Analysis of Variance test. ResultsIHC analysis demonstrated expression of all TLRs in tonsillar surface epithelium (SE) and lymphoid interior (LI) except for TLR-6 which was not present in the former. There has not been any statistically significant difference in TLR expression levels between PFAPA and GAβHS tonsils, except for TLR-1 and TLR-2 which were higher on LI and lower on SE of PFAPA tonsils, respectively, than that of the GAβHS samples. ConclusionsAltered TLR expression levels may be involved in PFAPA pathogenesis. Future studies with higher patient number, uninflamed tonsils and cellular markers are required to further enlighten the role of TLRs in the development of syndrome.

Differential cytokine profiles in pediatric patients with PFAPA syndrome and recurrent tonsillitis.

Objective : An attempt was made to identify characteristic cytokine profiles to distinguish periodic fever with aphthous stomatitis, pharyngitis and cervical adenitis syndrome (PFAPAS) from recurrent tonsillitis, of which clinical manifestations are similar to those of PFAPAS in children. Methods : Serum concentrations of IL-6, IL-4 and IFN-γ were measured during febrile episodes in pediatric patients. Results : The levels of IL-6 during febrile episodes were markedly increased above the upper limit of normal ranges in patients with both PFAPAS and recurrent tonsillitis, but there were no significant differences between groups. The levels of IL-4 during febrile episodes in PFAPAS patients were significantly lower than those in recurrent tonsillitis patients. The levels of IFN-γ during febrile episodes in PFAPAS patients were significantly higher than those in recurrent tonsillitis patients. Conclusion : In pediatric patients with PFAPAS, despite an increase of IL-6, IL-4 was suppressed with a marked increase of IFN-γ during febrile episodes. On the contrary, in febrile pediatric patients with recurrent tonsillitis, both IL-6 and IL-4, but not IFN-γ were increased. The characteristic cytokine profiles of IL-6, IL-4 and IFN-γ can be used for differential diagnosis of PFAPAS from recurrent tonsillitis in children in clinical ear, nose and throat (ENT) settings. J. Med. Invest. 68 : 38-41, February, 2021.

Aberrant mucosal immunoreaction to tonsillar microbiota in immunoglobulin A nephropathy.

BackgroundImmunoglobulin A nephropathy (IgAN) is the most common glomerulonephritis worldwide, characterized by mesangial polymeric IgA1 deposition. IgAN is believed to develop owing to aberrant mucosal immunoreaction against commensals in the tonsils. However, the exact interrelation between pathogenic IgA and mucosal microbiota in IgAN patients is unclear.MethodsBiopsy-proven IgAN or recurrent tonsillitis (RT) patients who had undergone tonsillectomy were enrolled. We used 16S ribosomal RNA gene amplicon sequencing with a flow cytometry-based bacterial cell sorting technique) and immunoglobulin repertoire sequencing of the IgA heavy chain to characterize IgA-coated bacteria of the tonsillar microbiota (IgA-SEQ) and their corresponding IgA repertoire. Furthermore, we fractionated patient serum using gel-filtration chromatography and performed flow cytometry-based analysis of IgA binding to bacteria cultured from incised tonsils.ResultsTonsillar proliferation-inducing ligand and B-cell activating factor levels were significantly higher in IgAN than in RT patients. IgA-SEQ for tonsillar microbiota revealed the preferential binding ability of IgA to Bacteroidetes in IgAN tonsils compared with those from RT patients. Expression of immunoglobulin heavy (IGH) constant alpha 1 with IGH variable 3–30 was significantly higher in IgAN than that in RT, and positively correlated with the IgA-coated enrichment score of Bacteroidetes. Serum polymeric IgA, comprising high levels of GdIgA1, exhibited considerable binding to Bacteroidetes strains cultured from the tonsils of IgAN patients.ConclusionsThese findings provide evidence that aberrant mucosal immune responses to tonsillar anaerobic microbiota, primarily consisting of members of the phylum Bacteroidetes, are involved in IgAN pathophysiology.

Comparative Study between Recurrent Tonsillitis and Tonsillar Hypertrophy Based: Histopathological Grading and Hematological Parameters in Children

The current study investigates the differences between recurrent tonsillitis patients (T patients) and tonsillarhypertrophy patients (H patients) according to histopathological grading and some hematological testes inthe study groups. The samples were taken (removed tonsil, and blood) from 20 children with tonsillitis and20 children with tonsillar hypertrophy, by which tonsils kept in formalin(10%) for histopathological study.Blood samples were obtained during the period from November 2019 to January 2020. The histopathologicaldifference in tonsils tissue was observed between the two groups. The result showed significant differencesin the lymph follicles, germinal center, fibrosis, necrosis, and infiltration of inflammatory cell. No significantdifference (p &gt; 0.05) of the Erythrocyte Sedimentation Rate (ESR) level in T patient group(13.2±8.3mm/hr), compared to H patient group (13.06±7.5mm/hr). The WBC count (White blood cell) showed a nonsignificant difference (p &gt; 0.05) between the groups.

Current Trends of Surface Versus Core Bacterial Flora among Recurrent Tonsillitis Patients in a North Indian Tertiary Care Hospital

Current Trends of Surface Versus Core Bacterial Flora among Recurrent Tonsillitis Patients in a North Indian Tertiary Care Hospital

The bacterial community and local lymphocyte response are markedly different in patients with recurrent tonsillitis compared to obstructive sleep apnoea

IntroductionObstructive sleep apnea (OSA) is now a more common indication for tonsillectomy than recurrent tonsillitis (RT) [1,2]. Few studies have addressed possible differences in pathogenesis between these two conditions. Children with RT and OSA are often being treated in the community with multiple courses of antibiotics before surgery. Current understanding of the role of bacteria in disorders of the tonsils is mainly based on the culture of tonsil swabs. Swab cultures reflect only a very small fraction of the bacteria present on the mucosal surface and may not represent the bacterial communities within the tonsil crypts [3,4]. This study aimed to evaluate the local lymphocyte response and associations with bacterial community composition using molecular techniques of the tonsils removed from children for RT or OSA. MethodThe palatine tonsils were removed by extracapsular dissection from 24 patients with age range one to ten years, 14 of whom had RT and 10 had OSA. The fixed tonsil tissues were evaluated for bacteria by Gram-staining and presence of connective tissue by safranin staining. B lymphocytes and T lymphocytes were also measured immunohistochemically. Finally, previously published bacterial community data for this cohort were reassessed for associations with RT and OSA, and with the observed lymphocyte patterns. ResultsIn tonsils from patients with RT, large micro-colonies of bacteria were observed in the tonsil crypts, and a large number of B and T lymphocytes were noted immediately adjacent to the tonsil crypt itself. In marked contrast, the tonsils from patients with OSA had no bacteria identified, and no significant skewing of lymphocytes based on site (such as follicles or crypts). We observed that the majority of lymphocytes surrounding the bacterial micro-colonies were B lymphocytes with a mean ratio of 109:55 (B lymphocytes: T lymphocytes). Bacterial community diversity was not different between the two cohorts; however, there were significant differences in bacterial community composition. Children with RT had a higher relative abundance of members from the genera Parvimonas, Prevotella, and Treponema. While children with OSA had a higher relative abundance of Haemophilus, and Capnocytophaga. ConclusionThese results demonstrate significant differences in the local lymphocyte response and bacterial community composition in tonsil tissue between RT and OSA patients. It suggests that the response to antibiotics used in the treatment of these two conditions may be different. Furthermore, the presence of lymphocytes in RT within the tonsil crypt outside the tonsil epithelium is a unique observation of the location of these cells.

Histological changes in the tonsils of patients infected by Epstein –barr virus

This study was conducted on 50 subjects whom had visited the AL-Sadder Medical City and Al-Hakeem hospital in AL- Najaf governorate. The subjects of this study were chronic or recurrent tonsillitis patients, their age ranged from 4 to 33 years.. The biopsy of tonsils were fixed in 10% neutral buffered formalin and then processed in routine histopathological techniques.The histopathological changes revealed infiltration of the inflammatory cells, multinucleated giant cell, germinal hyperplasia and large abnormal lymphocytes can be seen. Slight-moderate lymphocyte infiltration and/or diffuse lymphocyte infiltration leading to the defect in the surface epithelium of tonsils.

Clinical grading of tonsils: does it truly represent total tonsil volume in patients with recurrent tonsillitis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tonsils undergo hypertrophy due to recurrent infection or as a part of generalized lymphoid hypertrophy. There is a good correlation between clinical tonsil grade and objective tonsil volume in adult snorers and obstructive sleep apnea (OSA) patients.Relationship between clinical grading, oropharyngeal tonsil volume and total tonsil volume has been investigated in OSA patients but a very few in recurrent tonsillitis patients&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 50 tonsillectomy specimens from 25 patients who underwent tonsillectomy for recurrent tonsillitis were evaluated for tonsil volume oropharyngeal volume. These volumes were evaluated by a mathematical formula. Total volume, oropharyngeal and tonsillar volume were correlated with clinical grading of the tonsil. Also neck circumference, body mass index was assessed and correlation with clinical grading was found out with spearman correlation coefficient&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A spearman’s correlation was used to determine the relationship between 50 tonsillectomy specimens for total volume and clinical grading. There was a moderate positive monotonic correlation between total tonsil volume and clinical grading (rs =0.407, n =50, p &amp;lt;0.01, Correlation is significant at the 0.01 level 2-tailed) and there was a mild positive monotonic correlation between intraoral tonsil volume and clinical grading (rs =0.351, n =50, p &amp;lt;0.05 Correlation was significant at the 0.05 level 2-tailed)&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Total tonsil volume and oropharyngeal volume correlates well with clinical grading of the tonsil. BMI and neck circumference does not correlate with the clinical grading of the tonsil&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Comprehensive microbiome analysis of tonsillar crypts in IgA nephropathy.

Immunoglobulin A nephropathy (IgAN) is the most prevalent primary chronic glomerular disease, in which the mucosal immune response elicited particularly in the tonsils or intestine has been estimated to be involved in the development of the disease. To explore the relationship between IgAN and bacterial flora in the tonsils, we conducted a comprehensive microbiome analysis. We enrolled 48 IgAN patients, 21 recurrent tonsillitis (RT) patients without urine abnormalities and 30 children with tonsillar hyperplasia (TH) who had undergone tonsillectomy previously. Genomic DNA from tonsillar crypts of each patient was extracted, and V4 regions of the 16S ribosomal RNA gene were amplified and analysed using a high-throughput multiplexed sequencing approach. Differences in genus composition among the three study groups were statistically analysed by permutational multivariate analysis of variance and visualized by principal component analysis (PCA). Substantial diversity in bacterial composition was detected in each sample. Prevotella spp., Fusobacterium spp., Sphingomonas spp. and Treponema spp. were predominant in IgAN patients. The percentage of abundance of Prevotella spp., Haemophilus spp., Porphyromonas spp. and Treponema spp. in IgAN patients was significantly different from that in TH patients. However, there was no significant difference in the percentage of abundance of any bacterial genus between IgAN and RT patients. PCA did not distinguish IgAN from RT, although it discriminated TH. No significant differences in microbiome composition among the groups of IgAN patients according to clinicopathological parameters were observed. Similar patterns of bacteria are present in tonsillar crypts of both IgAN and RT patients, suggesting that the host response to these bacteria might be important in the development of IgAN.

( Vinegar ) as Anti-bacterial Biofilm formed by Streptococcus pyogenes Isolated from Recurrent Tonsillitis Patients , in vitro

Failure of antibiotic treatment in eradication of bacterial tonsillitis induced us to postulate presence of ''bacterial biofilms'' attached to living tissues that can be considered as an etiologic factor, among others. The knowledge about biofilm existence supports a new concept to explain chronic infections. Tonsillectomy is often the required choice as a consequence of frequent tonsillitis during the previous years, subsequently a novel studies propose using of non-antibiotic and non-surgical modalities for eradication of biofilm-related tonsillitis. In our designed study we used ''vinegar'' as antibiofilm agent due to its antimicrobial effect. Vinegar is a sour liquid composed mainly of acetic acid, which has an important role in disruption of biofilm aggregations. This study has been undertaken to determine biofilm production ability by Streptococcus pyogenes isolated from tonsillitis patients and to evaluate effectiveness of different types of vinegar for eradication of Streptococcal-tonsillar biofilm, in vitro. Twenty nine isolates of S. pyogenes belonged to 19 patients, were tested for biofilm production by using Microtiter-plate method. Also, Modified Microtiter-plate method was conducted to study the effect of different vinegar types (Date, Apple, and Grape) as anti-biofilm, in vitro. Out of 75.9% produced biofilm according to depending biofilm criteria, while 24.1% were non-biofilm producers. Biofilm producer isolates distributed into 12(54.5%) and 10(45.5%) which was detected on tonsil surface and crypts respectively. Concerning the anti-biofilm activity, our results demonstrated that types of vinegar eradicated biofilm by (100%), (95.5%), and (90.9%) for Date, Apple, and Grape vinegar respectively in compare with distilled water as negative control. It was concluded that there was no significant differences in biofilm production between S. pyogenes isolated from tonsil surface and crypts. Furthermore, our study concluded that the three types of vinegar eradicated streptococcal biofilm remarkably, but Date vinegar was the best for eradication of streptococcal biofilm in vitro.

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.

Weight Gain Post‐tonsillectomy More Common in Young Children

Objective: Adenotonsillectomy (TA), performed for either obstructive sleep apnea (OSA) or recurrent tonsillitis (RT), has been associated with significant weight gain after surgery. The objective of this study was to look at a large population of children undergoing TA and the demographic factors which may contribute to weight gain. Method: Retrospective chart review of children undergoing TA at an urban tertiary-academic center between 2008 and 2011. Demographic data (including age, gender, and race), OSA disease severity, pre- and 6-month postoperative normalized body mass index (z scores), and changes in were compared. Results: One hundred fifteen children had complete data after TA; 85 of whom underwent surgery for OSA. There were no significant differences between OSA and RT patients in mean age (7.2 ± 4.3 vs 7.3 ± 4.4 years, P = .955) or gender (38% female vs 50%; P = .323). However, the OSA patients were more likely to be black (60% vs 33%) than RT patients ( P = .026). Overall, the preoperative BMI z scores increased from 0.98 ± 1.50 to 1.21 ± 1.25 ( P = .0009) with no significant difference by surgical indication ( P = .58). Multiple linear regression analysis found that only age was significantly, and negatively, associated with changes in BMI z scores ( P = .015). Conclusion: Similar to previous studies, children had significant weight gain after TA. This analysis suggests that younger age is a significant predictor of weight gain after surgery. Further investigation of the relationship between weight gain and demographic factors would benefit from prospective evaluation with special attention to the relationship with age.

Manganese-superoxide dismutase and glutathione peroxidase 1 polymorphisms in recurrent tonsillitis and tonsillar hypertrophy

ObjectivesTo investigate the association of manganese-superoxide dismutase and glutathione peroxidase 1 polymorphisms with susceptibility to recurrent tonsillitis and tonsillar hypertrophy. MethodsThe study consisted of 103 patients with recurrent tonsillitis, 105 patients with tonsillar hypertrophy and 106 control subjects with similar age and sex. Genomic DNA was extracted from peripheral leukocytes of whole blood which were obtained from all patients and control subjects. Genotyping was performed to identify MnSOD Ala-9Val and GPx1 Pro198Leu polymorphisms by a method based on PCR amplification and detection of polymorphisms with hybridization probes labeled with fluorescent dyes. Genotype and allele frequencies were compared between patients with recurrent tonsillitis and tonsillar hypertrophy and 106 healthy control subjects. ResultsThe genotype distribution of the MnSOD Ala-9Val single nucleotide polymorphism was significantly different for the controls and the recurrent tonsillitis patients (P=0.009). Whereas, no significant difference was found between the patients with tonsillar hypertrophy and the control group (P=0.369). The frequency of the MnSOD CC genotype was lower, and that of the T allele was significantly higher, in recurrent tonsillitis patients than in control subjects. In addition, the frequency of tonsillitis was significantly higher in recurrent tonsillitis patients with the MnSOD Ala-9Val polymorphism than the patients with wild-type (P=0.008). Also, no significant difference was found between patient groups and control subjects in the distribution of the genotype and allele frequency of the GPx1 Pro198Leu single nucleotide polymorphism. ConclusionsThe MnSOD Ala-9Val polymorphism causes susceptibility to recurrent tonsillitis in Turkish children. And we suggest that there may be a possible relation between local and recurrent infections or inflammation of the tonsillar tissue and the MnSOD Ala-9Val single nucleotide polymorphism in pediatric patients with RT.

POU2AF1(+) follicular helper T (Tfh) cells in obstructive sleep apnea syndrome (OSAS) (69.3)

Abstract OSAS is attributable to periodic collapse of the upper airway due to adenotonsillar hypertrophy, featuring prominent germinal centers and wide interfollicular zones. However, the mechanism is still unclear. Here we present the possible involvement of Tfh cells in the pathogenesis of OSAS as indicated by comprehensive analysis of tonsillar lymphocytes of OSAS patients. The results revealed that tonsillar Tfh cells were plentiful in OSAS compared to recurrent tonsillitis (RT) without any discrepancy of T-cell components between the tonsils of OSAS and RT patients, indicating a ‘Tfh shift’ in OSAS tonsils. In addition, in vitro experiments delineated a unique function of the Tfh cells of OSAS, which could help expand the number of naive B cells and, more extensively, memory B cells, which allowed the Tfh cells to produce larger amounts of IL-4 and IFN-γ. Microarray studies newly identified transcripts characterizing the Tfh cells, including TIGIT and POU2AF1 regulating CXCR5 of B cells. Indeed, B-cell expansion was under the control of TIGIT, and large numbers of POU2AF1(+) Tfh cells were observed in and outside of germinal centers of OSAS tonsils. Overall these findings indicate that POU2AF1(+) Tfh cells cooperate with regional B-cell subsets to induce lymphoid hyperplasia.Focusing on the TIGIT-selective regulation of POU2AF1(+) Tfh cells, further investigations may provide a new modality for a noninvasive approach to treatment of this condition.

Tonsillectomy under threat: auditing the indications for performing tonsillectomy

The 2009 McKinsey National Health Service report considered that tonsillectomy was relatively ineffective and often unjustified, and that its frequently could be greatly reduced. ENTUK argued against this, for severe recurrent tonsillitis. This study audited clinical indications for tonsillectomy. CRITERIA AND STANDARDS: Current guidelines state that patients with recurrent tonsillitis must have disabling sore throat episodes five or more times per year, and symptoms for at least a year, to justify tonsillectomy. Seventeen recurrent tonsillitis patients receiving tonsillectomy were audited prospectively. Indications were poorly documented in the referral letter, so surgeons agreed to list specified tonsillectomy criteria when scheduling patients for tonsillectomy. A pro forma reminder was distributed to all clinics, and the next 100 scheduled tonsillectomy patients were audited. In the first audit, all 17 tonsillectomies were justified but only two (11.8 per cent) had documented indications. In the second audit, 85 per cent of patients had all essential criteria, which were documented in the listing letter. Tonsillectomy risks being removed from the UK essential otolaryngological surgical register, risking increased patient morbidity and work absence, despite valid supporting evidence of efficacy for recurrent tonsillitis. All UK otolaryngology units should strictly adhere to the ENTUK and Scottish Intercollegiate Guidelines Network recommendations for tonsillectomy, and should document essential criteria in the listing letter, to strengthen the advocacy argument for tonsillectomy as essential, valid treatment for recurrent tonsillitis.

Intracellular Persisting Staphylococcus aureus Is the Major Pathogen in Recurrent Tonsillitis

BackgroundThe two major indications for tonsillectomy are recurrent tonsillitis (RT) and peritonsillar abscess (PTA). Unlike PTAs, which are primarily treated surgically, RT is often cured by tonsillectomy only after a series of failed drug therapy attempts. Although the bacteriological background of RT has been studied, the reason for the lack of success of conservative therapeutic approaches is not well understood.MethodsIn a prospective study, tonsil specimens from 130 RT patients and 124 PTA patients were examined for the presence of extra- and intracellular bacteria using antibiotic protection assays. Staphylococcus aureus isolates from RT patients were characterized by pulsed-field gel electrophoresis (PFGE), spa-typing and MSCRAMM-gene-PCR. Their ability for biofilm formation was tested and their cell invasiveness was confirmed by a flow cytometric invasion assay (FACS), fluorescent in situ hybridization (FISH) and immunohistochemistry.Findings S. aureus was the predominant species (57.7%) in RT patients, whereas Streptococcus pyogenes was most prevalent (20.2%) in PTA patients. Three different assays (FACS, FISH, antibiotic protection assay) showed that nearly all RT-associated S. aureus strains were located inside tonsillar cells. Correspondingly, the results of the MSCRAMM-gene-PCRs confirmed that 87% of these S. aureus isolates were invasive strains and not mere colonizers. Based upon PFGE analyses of genomic DNA and on spa-gene typing the vast majority of the S. aureus isolates belonged to different clonal lineages.ConclusionsOur results demonstrate that intracellular residing S. aureus is the most common cause of RT and indicate that S. aureus uses this location to survive the effects of antibiotics and the host immune response. A German translation of the is provided as supplementary material ( S1).

Oropharyngeal flora changes after tonsillectomy

Objective We aimed to investigate the effect of tonsillectomy on oropharyngeal flora in children who underwent tonsillectomy for chronic recurrent tonsillitis. Study Design and Setting A prospective study was performed comprising patients with chronic recurrent tonsillitis who underwent tonsillectomy at the Department of Otolaryngology, Cerrahpasa Medical School. Incisional core biopsies of excised tonsils were also performed. Swabs and core biopsy specimens were transferred and maintained in Stuart's medium and sent to the Department of Microbiology and Clinical Microbiology at Cerrahpasa Medical School for microbiologic evaluation. Subjects and Methods Oropharyngeal swabs and tonsillar core biopsy specimens from 31 patients operated on for recurrent tonsillitis were cultured. Follow-up oropharyngeal swabs were cultured one month after tonsillectomy. Results There was no significant difference between the preoperative and postoperative isolation rate of the potentially pathogenic bacteria. Normal aerobic flora did not change significantly. However, the isolation rate of the Neisseria species dropped ( P = 0.097) but did not reach statistical significance. Among anaerobes, Bacteroides fragilis, one of the major anaerobic bacteria, dropped significantly ( P = 0.007). The Propionibacterium acnes isolation rate increased significantly ( P = 0.009). Conclusion Oropharyngeal anaerobic bacterial flora decreases after tonsillectomy in recurrent tonsillitis patients. The isolation rate for bacteria of the normal flora and potentially pathogenic bacteria does not change. Tonsils with recurrent infections may become a nidus for anaerobic bacteria. In patients with chronic recurrent tonsillitis, tonsillectomy may help change anaerobic bacterial oropharyngeal flora to the normal flora found in healthy individuals.