Throat Specialist Research Articles

A Silent Spring

A Silent Spring

Incidence and 5-year survival rate for head and neck cancers in Grenada compared to the African American population over the period 1991-2010.

Very little data exist on the incidence and burden of cancer in the individual Caribbean countries. Some data are available for larger areas, reported under a bigger geographical region; Latin America and the Caribbean, but many of the individual countries are not included. One of the main reasons is a lack of official cancer registries. Data are usually collected from hospital records or private physician records, and since it is not in an official registry, these data are not always accessible for inclusion in databases such as SEER and GLOBOCAN. Grenada is one of the countries that currently does not have a registry. Our aim is to report on the incidence for head and neck cancer with subcategories; hypopharynx, oropharynx, oral cavity, salivary glands, and larynx from data collected by the sole ear nose and throat specialist over a 20-year period. The age adjusted incidence per 100,000 for these cancers, whether combined or individually, is lower than that of similar populations. The incidence in males is only slightly higher than those reported in some parts of Africa. In females, only Eastern Africa is reported to have a lower incidence than that found in our study. While the incidence of oral cancers is lower than that of African Americans, the survival rate is comparable. Socioeconomic status, lack of infrastructure, and advanced stage at diagnosis appear to be closely related to the survival rate. Incidence reports suggest that incidence of head and neck cancers in individuals of African descent is lower than other populations. It is therefore not surprising that the incidence in Grenada is relatively low, although the incidence may be underestimated.

Sternoclavicular joint osteophytosis: a difficult diagnosis to swallow

Unexplained dysphagia requires prompt investigation to rule out a possible underlying malignancy. We describe the case of a 60-year-old man who presented to his family practitioner with a 1-year history...

Relation Between the Type of Hospitals and the Decision of Adenotonsillectomy Indication.

This study aims to apply tonsillectomy criteria, symptoms and outcomes proposed in earlier studies to investigate patients who were given tonsillectomy indications at different clinical centers but were treated in our clinical center. The prospective sample of patients at the ear, nose, and throat clinic within our hospital consisted of 855 male patients and 684 female patients (1539 in total) with ages between 3 and 16 years old who had been given a tonsillectomy or adenotonsillectomy indication. The patients were allocated to 1 of 3 groups, depending on whether they had been treated in a public hospital, a private hospital, or a university/training research hospital. Of the total of 1539 patients, tonsillectomy indication criteria were exhibited by 966 of them (62.8%) but were absent in the rest of 573 patients (37.2%). Most of the 966 patients with tonsillectomy indication criteria had been treated in private hospitals (n = 546; 56.5%), while the others were treated in public hospitals (n = 309; 31.9%) or in university/training research hospitals (n = 111; 15.9%). Furthermore, the majority of the 966 patients (84.1%) received the tonsillectomy indication in just 1 examination, while some of them (n = 154; 15.9%) received it after follow-up appointments. Tonsillectomy decisions can pose difficulties for ear, nose, and throat specialists. Therefore, such decisions should be made based on assessment of clinical evaluation and follow-up, information from patients' parents, and the results of examination against the criteria outlined in the literature.

The Reported Incidence and Nature of Voice Disorders in the Private Healthcare Context of Gauteng

The study aimed to determine the incidence and nature of voice disorders, as reported by ear, nose, and throat specialists (ENTs), in the Gauteng private healthcare context. This is a cross-sectional survey design. The respondents had to be certified ENTs working in the private healthcare context in Gauteng. The survey was sent out electronically to all 94 ENTs, registered with the ENT Society, working in the private healthcare context; thus, no additional requirements had to be met. The survey inquired about the total number of referrals from January 2015 to January 2016, the total number of referrals who were diagnosed with a voice disorder, as well as information regarding the patients such as the nature of the voice disorders. Of the 94 surveys sent out, 24 of them were completed (25.5%). The incidence of voice disorders reported was 5.2%. The most commonly diagnosed voice disorder is acute laryngitis (32%). The majority of ENTs (75%) received referrals from general practitioners and referred to speech-language pathologists if the patient presented with a voice disorder. The results from this study may enable healthcare professionals to adequately plan service delivery resource allocations to provide appropriate services. Additional studies are required to examine the incidence of voice disorders in the public healthcare context as well as the prevalence of voice disorders in Gauteng.

Sympathetic neural hyperalgesia edema syndrome as a cause of autoimmune hearing loss

To describe another previous unreported manifestation of the sympathetic neural hyperalgesia edema syndrome - autoimmune hearing loss. Dextroamphetamine sulfate 30 mg extended release capsules was given to a woman to try to help her conceive since, with her pelvic pain, chronic fatigue syndrome, and diarrhea, it was thought that an inflammatory condition related to permeation of unwanted chemicals into endometrial tissue related to the sympathetic neural hyperalgesia edema syndrome could be inhibiting her failure from conceiving despite three cycles of embryo transfer. Not only did the symptoms mentioned above disappear, but she also noted marked improvement of hearing loss that had been present for several years. The improvement in hearing was documented by audiology tests and had not responded to many months of 15 mg/day prednisone. Autoimmune hearing loss (diagnosis established by her ear nose and throat specialist) should be added to the long list of manifestation of the sympathetic neural hyperalgesia edema syndrome.

Anatomy of the human orbital muscle (OM): Features of its detailed topography, syntopy and morphology

The human orbital muscle (OM) is not readily accessible during ordinary anatomical teaching because of insufficient time and difficulties encountered in the preparation. Accordingly, its few anatomical descriptions are supported only by drawings, but not by photographs. The aim of this study was to present OM in dissected anatomic specimens in more detail. Following microscope-assisted dissection, its location, syntopy and morphology were analyzed in 88 orbits of 51 cadavers. Together with the periorbital connective tissue OM filled the infraorbital fissure (IOF) and extended back to the cavernous sinus. As a new finding, we here report that in 34% of the orbits we observed OM-fibers, which proceeded from IOF caudally to the facies infratemporalis of the maxilla. OM had a mean width of 4±1mm, a mean length of 22±5mm and its mean mass was 0.22±0.19g. The subsequent histological analysis of all specimens showed features of smooth muscle tissue: long, spindle-like cells with a centrally located cell nucleus (hematoxylin-eosin staining) which were innervated by tyrosine-hydroxylase immunopositive adrenergic fibers. We conclude that precise knowledge on OM might be very helpful not only to students in medicine and dentistry during anatomical dissection courses, but also to head and neck surgeons, ear–nose–throat specialists and neurosurgeons working in this field.

The frequency of sleep-disordered breathing in children with asthma and its effects on asthma control

ABSTRACTBackground: The presence of sleep-disordered breathing (SDB) in children with asthma may cause difficult to control asthma. Objectives: The aim of this study was to determine the frequency of SDB in children with asthma, to evaluate its effects on asthma control and to assess the risk factors associated with the presence of SDB. Methods: Parents of children who Sleep Questionnaire (PSQ) and the Childhood Asthma Control Test (C-ACT). Asthma control level was assessed according to Global Initiative for Asthma (GINA). Same ear–nose–throat (ENT) specialist evaluated all patients. A 4-point tonsil grading method and adenoid-nasopharynx ratio were used to categorize tonsil and adenoid size, respectively. Results: A total of 408 children (275 male, 67.4%) with a mean age of 8.1 ± 3.2 years were included. Nearly 40% of asthmatic children were not-well-controlled according to GINA and 34.6% of all patients had SDB according to PSQ. Multivariate logistic regression analysis revealed that coexistence of SDB [OR: 6.62, 95% CI (4.21–10.41); p < 0.001)] and tonsillar hypertrophy [OR: 3.47; 95% CI (1.05–11.5); p < 0.041] were independent risk factors for not-well-controlled asthma in asthmatic children after other established contributors to asthma control were adjusted. Conclusions: Our study showed that SDB is a strong risk factor for not-well-controlled asthma in asthmatic children independent of other confounders. In addition, tonsillar hypertrophy may have a role in the association between SDB and not-well-controlled asthma in childhood.

Primary laryngeal localization of multiple myeloma: A case report.

Multiple myeloma is a lymphoproliferative disease that may involve the bone marrow as well as extramedullary soft tissues. However, laryngeal localization of multiple myeloma is extremely rare. We herein present the case of a 68-year-old male patient with a history of dyspnea, dysphonia and dysphagia. Laryngoscopic examination revealed a lesion involving the right glottis and right vestibular (false) vocal fold, with absence of ipsilateral laryngeal motility and constriction of the airway. Computed tomography and magnetic resonance imaging revealed a gross swelling infiltrating the right glottis and right false vocal fold, sized 33×19×33 mm, with sub-centimeter laterocervical lymph nodes bilaterally. Careful integration of the clinical manifestations with the radiological and pathological data led to the diagnosis of multiple myeloma. Given the rarity of this localization, the purpose of this study was to increase knowledge of this disease among ear, nose and throat specialists, in order to enable a more timely diagnosis.

Evaluate the incidence of thyroid cancer metastases to cervical lymph nodes in patients referred to an ear, nose and throat specialist Imam Khomeini in Iran in 2013 to 2016

Background: Thyroid cancer is the most common endocrine malignancy. Lymph node metastasis is common in patients with papillary thyroid carcinoma, especially in children and young adults and can be sued during admission. Aim of this study is Evaluate the incidence of thyroid cancer metastases to cervical lymph nodes in patients referred to an ear, nose and throat specialist Imam Khomeini in Iran in 2013 to 2014.Material and Method: all patients who were hospitalized and undergoing thyroid surgery at a medical center of Imam Khomeini Hospital (RA) in Ahvaz from early in April 2013 to end of March 2016 and the thyroid cancer diagnosis was confirmed according to the pathology samples for them. Pathology samples were collected through existing records in the archives of Imam Khomeini Hospital (RA) of Ahvaz Jundishapur University. The information contained in the records includes age, gender, types of thyroid cancer, history of thyroidectomy keeping with the nodules, presence of metastasis and its sites on the basis of information contained in the records. analysis was performed by using SPSS 16 software.Results: frequency related to papillary cancer with 23 patients (59%) and medullary cancer with 6 patients (15.4%) and follicular and anaplastic cancers each ones with 3 patients (7.7%). 20 patients (51.3%) were diagnosed with metastatic thyroid cancer. Most metastasis was related to lymph metastasis in 11 patients (28.2%) and the lowest metastasis was lung metastasis in 2 patients (5.1%) and 19 patients (48.7%) had no metastasis and 7 patients had metastasis to several organs. 24 patients (61.4 %) had thyroid nodules. 9 patients (23.1%) cold nodules with calcification and 10 patients (25.6%) cold nodules without calcification and 1 patient (2.6%) with hot nodules have been reported.Conclusion: papillary cancer had the highest frequency and it is suggested to conduct specific study in this field and also carry out a study on pathologic assessment of lymph nodes isolated for checking the hidden metastases

PP.32.09] EPISTAXIS

Objective Background: Epistaxis and hypertension are frequent diseases in the adult population. A relationship between the increase of the blood pressure (BP) and the prevalence and incidence of epistaxis has been suggested (Kikidis et al, 2013). Design and method: Aim of our study was to analyze blood pressure changes in patients with active or recent onset epistaxis (<12 hours) from admission to the emergency department (ED) to discharge. Patients and methods: 126 consecutive subjects (84 males, age range 15–93 years, mean age 67 ± 17 years) admitted to the ED (April 2014-February 2015) with primary epistaxis, were prospectively evaluated. BP was measured with an automatic device (OMRON MT10-E) in accordance to ESH-ESC guidelines 2013; measurements were performed at admission to the ED and 30 minutes after the ear, nose and throat (ENT) specialist visit (and possible hemostasis). Results Results: a diagnosis of hypertension was present in 68% of subjects; 75% of them were on antihypertensive treatment, 35% of them reported adequate BP control, 17% had diabetes mellitus and 25% dyslipidemia. A statistically significant reduction in BP was observed from admission to the ED and to the end of ENT evaluation (from 142 ± 21/84 ± 13 mmHg to 135 ± 21/81 ± 13 mmHg, p = 0.001), while no significant changes were observed in heart rate (from 76 ± 15 to 72 ± 13 b/min). Conclusions Conclusions: results obtained in this group of patients with primary epistaxis show a prevalence of hypertension similar to that of a general population. An accurate BP measurement shows a significant reduction at the end of the ENT specialist evaluation compared to baseline measurement, in both hypertensive and normotensive subjects.

Hearing Impairment Affects Dementia Incidence. An Analysis Based on Longitudinal Health Claims Data in Germany.

Recent research has revealed an association between hearing impairment and dementia. The objective of this study is to determine the effect of hearing impairment on dementia incidence in a longitudinal study, and whether ear, nose, and throat (ENT) specialist care, care level, institutionalization, or depression mediates or moderates this pathway. The present study used a longitudinal sample of 154,783 persons aged 65 and older from claims data of the largest German health insurer; containing 14,602 incident dementia diagnoses between 2006 and 2010. Dementia and hearing impairment diagnoses were defined according to International Classification of Diseases, Tenth Revision, codes. We used a Kaplan Meier estimator and performed Cox proportional hazard models to explore the effect of hearing impairment on dementia incidence, controlling for ENT specialist care, care level, institutionalization, and depression. Gender, age, and comorbidities were controlled for as potential confounders. Patients with bilateral (HR = 1.43, p<0.001) and side-unspecified (HR = 1.20, p<0.001) hearing impairment had higher risks of dementia incidence than patients without hearing impairment. We found no significant effect for unilateral hearing impairment and other diseases of the ear. The effect of hearing impairment was only partly mediated through ENT specialist utilization. Significant interaction between hearing impairment and specialist care, care level, and institutionalization, respectively, indicated moderating effects. We discuss possible explanations for these effects. This study underlines the importance of the association between hearing impairment and dementia. Preserving hearing ability may maintain social participation and may reduce the burden associated with dementia. The particular impact of hearing aid use should be the subject of further investigations, as it offers potential intervention on the pathway to dementia.

The relationship of enuresis nocturna and adenoid hypertrophy.

This study was organized to assess the relationship of enuresis nocturna (EN) and upper airway obstruction (UAO) in children. This study was multi-centrically and prospectively designed including 79 children who presented to a urology clinic with symptoms of EN between January 2013 and February 2014. Sixty-four age-matched children with no history of urological complaints were randomly recruited from children admitted to a pediatric clinic as a control group. All children and parents were asked to fill out a dysfunctional elimination syndrome (DES) questionnaire and children were examined by an ear, nose and throat (ENT) specialist to evaluate the UAO. Descriptive statistics, chisquare and Mann-Whitney-U tests were used to compare variables. The mean ages of the 79 children (48 male, 31 female) in the study group and the 64 children (41 male, 23 female) in the control group were 10.14+/-3.38 and 9.17+/- 2.85, respectively. Family history of the study showed that 19% of the children's mothers, 10% of the children's fathers and 37% of the children's siblings had experienced EN. There was a significant difference between the study and the control groups in terms of urge to urinate, bladder emptying, bowel symptoms and psychological stress. There was also a significant difference between rates of tonsillar hypertrophy and nasopharynx obstruction in the EN group (p = 0.009). In this study we found that half of the children with EN had tonsillar hypertrophy, which was significantly higher than in the control group. Further studies are needed to clarify the exact relationship between UAO and EN.

Investigating the Therapeutic Efficacy of Neurofeedback Treatment on the Severity of Symptoms and Quality of Life in Patients with Tinnitus

The present study examined the therapeutic efficacy of neurofeedback treatment (NFT) on the severity of symptoms and quality of life (QOL) in patients with chronic subjective tinnitus. 12 patients diagnosed with chronic tinnitus by an ear, nose and throat (ENT) specialist were selected by convenience sampling among the patients attending an ENT clinic in Ahvaz, Iran. The Patients were randomly assigned to the intervention and control groups. The intervention group received 15 sessions of neurofeedback treatment. All participants in this study completed severity of symptoms and quality of life symptoms questionnaires at three points in time: pre-test, post-test and 3-month follow-up. Using the Mann–Whitney U test, neurofeedback was found to significantly reduce the severity of tinnitus (z = −2.61, U = 0, and p < 0.009), and increase the quality of life (z = −2.62, U = 0, and p < 0.009) of participants. In addition, our findings show that NFT acts selectively on tinnitus with no side effects, and thus, can be used as an alternative or adjunctive treatment with medications and psychological therapies.

Asthma in ear, nose, and throat primary care patients with chronic rhinosinusitis with nasal polyps.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common inflammatory disorder associated with asthma. This association is well described in patients with CRSwNP undergoing endoscopic sinus surgery (ESS); however, some patients are never referred for surgery, and the frequency of asthma in this group is largely unknown. To determine the frequency of asthma in patients with CRSwNP treated in a primary care (PC) setting who have never been referred for surgery and to compare this with ESS patients. Fifty-seven patients with CRSwNP who had never undergone ESS were prospectively recruited from nine PC ear, nose, and throat clinics in the Copenhagen area. CRSwNP was diagnosed according to the European Position Paper on Chronic Rhinosinusitis and Nasal Polyps; severity was assessed by using a visual analog scale. Allergy, lung function, and asthma tests (reversibility to β2-agonist, peak expiratory flow variability, and mannitol challenge) were performed. Findings were compared with our previously published data from patients with CRSwNP referred for surgery. Asthma was diagnosed in 25 patients (44%) based on respiratory symptoms and a positive asthma test; of these, 12 (48%) had undiagnosed asthma prior to study onset. Furthermore, when using the same methods, we found a lower frequency of asthma in PC patients compared with ESS patients (44% versus 65%, p = 0.04). A high prevalence of asthma in PC patients with CRSwNP was found. Frequently, asthma was undiagnosed. However, asthma was significantly less prevalent in PC patients compared with patients referred for ESS. The frequent concomitance of asthma, i.e., united airways disease, in PC patients calls for closer collaboration between ear, nose, and throat specialists, and asthma specialists.

Effectiveness of caudal septal extension graft application in endonasal septoplasty

IntroductionSeptal deviation is a common disease seen in daily otorhinolaryngology practice and septoplasty is a commonly performed surgical procedure. Caudal septum deviation is also a challenging pathology for ear, nose, and throat specialists. Many techniques are defined for caudal septal deviation. ObjectiveTo evaluate the effectiveness of caudal septal extension graft (CSEG) application in patients who underwent endonasal septoplasty for a short and deviated nasal septum. MethodsForty patients with nasal septal deviation, short nasal septum, and weak nasal tip support who underwent endonasal septoplasty with or without CSEG placement between August 2012 and June 2013 were enrolled in this study. Twenty patients underwent endonasal septoplasty with CSEG placement. The rest of the group, who rejected auricular or costal cartilage harvest for CSEG placement, underwent only endonasal septoplasty without any additional intervention. Using the Nasal Obstruction Symptom Evaluation (NOSE) and Rhinoplasty Outcome Evaluation (ROE) questionnaires, pre- and post-operative acoustic rhinometer measurements were evaluated to assess the effect of CESG placement on nasal obstruction. ResultsIn the control group, preoperative and postoperative minimal cross-sectional areas (MCA1) were 0.44±0.10cm2 and 0.60±0.11cm2, respectively (p<0.001). In the study group, pre- and postoperative MCA1 values were 0.45±0.16cm2 and 0.67±0.16cm2, respectively (p<0.01). In the control group, the nasal cavity volume (VOL1) value was 1.71±0.21mL preoperatively and 1.94±0.17mL postoperatively (p<0.001). In the study group, pre- and postoperative VOL1s were 1.72±0.15mL and 1.97±0.12mL, respectively (p<0.001). Statistical analysis of postoperative MCA1 and VOL1 values in the study and the control groups could not detect any significant intergroup difference (p=0.093 and 0.432, respectively). In the study group, mean nasolabial angles were 78.15±4.26° and 90.70±2.38°, respectively (p<0.001). ConclusionEndonasal septoplasty with CESG placement is an effective surgical procedure with minimal complication rate for subjects who have a deviated, short nasal septum and weak nasal tip support.

Association of tinnitus and hearing loss in otological disorders: a decade-long epidemiological study in a South Indian population

IntroductionTinnitus is a common disorder that occurs frequently across all strata of population and has an important health concern. Tinnitus is often associated with different forms of hearing loss of varying severity. ObjectiveThe present study aimed to identify the association of tinnitus with hearing loss in various otological disorders of a South Indian population. MethodsA total of 3255 subjects referred to the MAA ENT Hospital, Hyderabad, from 2004 to 2014, affected with various otological diseases have been included in the present cross-sectional study. Diagnosis of the diseases was confirmed by an ear, nose, and throat (ENT) specialist using detailed medical and clinical examination. Statistical analysis was performed using the χ2 test and binary logistic regression. ResultsTinnitus was observed in 29.3% (956) of the total study subjects that showed an increased prevalence in greater than 40 years of age. There was a significant increase in risk of tinnitus with middle (OR=1.79, 95% CI=1.02–3.16) and inner (OR=3.00, 95% CI=1.65–5.45) inner ear diseases. It was noted that 96.9% (n=927) of the tinnitus subjects was associated with hearing loss. Otitis media (60.9%), presbycusis (16.6%) and otosclerosis (14.3%) are the very common otological disorders leading to tinnitus. Tinnitus was significantly associated with higher degree of hearing loss in chronic suppurative otitis media (CSOM) subjects. ConclusionThe present study could identify the most prevalent otological risk factors leading to development of tinnitus with hearing loss in a South Indian population.

Assessment of nasal airway patency during pregnancy and postpartum period: correlation between subjective and objective techniques.

This study aims to determine the physiological changes in a pregnant woman's nasal airway, the frequency of pregnancy rhinitis, and the correlation among anterior rhinoscopy (AnR), anterior rhinomanometry (ARM), and subjective nasal obstruction score as she progresses through pregnancy into the postpartum period (PPP). Twenty non-smoking healthy pregnant women aged 19-35 (average 27.5±4.7) without a history of either respiratory allergy or chronic nasal or sinus problems were included in the study. Detailed history taking, AnR, and ARM were performed by the same ear nose and throat specialist at each trimester and postpartum second week. From then on, the participants scored, subjectively, morning levels of nasal obstruction (0= none, 1= slight, 2= moderate, 3= severe, 4= total obstruction). The AnR scores were low and the ARM findings were in normal range in the first trimester. Increasing AnR scores through pregnancy and decreasing AnR scores at PPP were statistically significant. Similarly, the ARM findings increased through pregnancy and decreased to normal levels at PPP; however, these changes among trimesters and PPP were not statistically significant. Anterior rhinomanometry and AnR are useful tools in the determination of nasal physiological changes as pregnancy progresses to PPP.

Systematic Search for Present and Potential Portals of Entry for Infective Endocarditis

BackgroundLooking for and treating the portal of entry (POE) of infective endocarditis (IE) is important, but published research on this topic is nonexistent. ObjectivesThe goal of this study was to systematically search for the POEs of present and potentially new episodes of IEs. MethodsPatients were systematically seen by a stomatologist, an ear, nose, and throat specialist, and a urologist; women were systematically seen by a gynecologist; patients were seen by a dermatologist when there were cutaneous and/or mucous lesions. Colonoscopy and gastroscopy were performed if the microorganism came from the gastrointestinal tract in patients ≥50 years of age and in those with familial histories of colonic polyposis. Treatment of the POE was systematically considered. ResultsThe POEs of the present IE episodes were identified in 74% of the 318 included patients. The most frequent POE was cutaneous (40% of identified POEs). It was mainly (62% of cutaneous POEs) associated with health care and with intravenous drug use. The second most frequent POE was oral or dental (29%). A dental infectious focus was more often involved (59% of oral or dental POEs) than a dental procedure (12%). POEs were gastrointestinal in 23% of patients. Colonic polyps were found in one-half of the patients and colorectal adenocarcinomas in 14%. Performance was good regarding the search for an oral or dental or a colonic potential POE, which were found in 53% and 40% of patients, respectively. ConclusionsOur search for the POEs of present IEs was often successful, as was searching for an oral or dental or a gastrointestinal POE of a new IE episode. We advise the systematic performance of stomatologic examinations in patients with IE and performance of colonoscopy in patients ≥50 years of age or at high risk for colorectal cancer.

Integrative management of pediatric tonsillopharyngitis: An international survey

This survey investigated the management of pediatric tonsillopharyngitis, with a focus on natural remedies. 138 pediatricians, general practitioners and ear–nose–throat (ENT) specialists in 7 countries were surveyed by a dedicated questionnaire.A rapid strept test (RST) to diagnose acute tonsillopharyngitis was routinely used by 56/138 participants (41%). The use of RST allowed 200 diagnosis/year compared with 125 diagnosis/year for clinicians who did not use this tool. Homeopathy remedies were prescribed as a supportive therapy by 62% of participants (85/138). Among different homeopathic remedies, SilAtro-5-90 was the most frequently prescribed (53/138, 38%). In the chronic setting, homeopathy was suggested as a supportive therapy by 82/138 participants (59%), phytotherapy by 39 (28%) and vitamins/nutritional supplementation by 51 (37%).The management of tonsillopharyngitis in pediatric patients still remains empiric. Natural remedies, and homeopathy in particular, are used in the management of URTIs. An integrative approach to these infections may help reduce excessive antibiotic prescription.