Episodes Of Tonsillitis Research Articles

Pre-clinical training, technical adjustment and human case experience of transoral robotic surgery using Versius System

ObjectiveThis study describes the training experience with the Versius Robotic System (CMR Surgical) for Transoral Robotic Surgery (TORS), the setup of the robot and its applicability in a human case. MethodsA model mannequin with anatomical characteristics simulating the TORS working space was used for training purposes. Optimal docking, positioning of robotic arms and placement of instruments were defined using the mannequin. A human patient was selected based on the inclusion criteria, and a standardized protocol for robotic techniques was developed. The surgical procedure was conducted in accordance with ethical guidelines. ResultsThe synthetic polymer mannequin mimicking human tissues and anatomy was used to define the robot set up for TORS. The patient was indicated for bilateral tonsillectomy due to recurrent episodes of tonsillitis. Bipolar Maryland and monopolar scissors were used. The procedure was uneventful. The patient remained hospitalized for 1 day and returned to work activities within 6-days, with no complications. ConclusionThe specialized mannequin proved to be effective in the simulation, training proposal and set up standardization. Furthermore, the Versius robot was found to be safe and achieved excellent results during surgery. Despite being very promising, the Versius system is still in its developmental phase and requires larger-scale samples for a more comprehensive evaluation. Level of evidence4.

Endogenous endophthalmitis secondary to Lemierre’s Syndrome originating from pharyngotonsillitis

PurposeThe purpose of this article is to report a case of Lemierre’s Syndrome producing unilateral endogenous endophthalmitis in a healthy, young woman with a history of tonsillitis.Case report/observationsA 17-year-old healthy woman developed fever after a few days of sore throat. She later developed pneumonia with septic signs, leading to admission to the Intensive Care Unit. Lemierre Syndrome was diagnosed due to multiple septic pulmonary emboli and signs of sepsis following a recent episode of tonsillitis. During hospitalization, the patient complained of decreased visual acuity and floaters in her left eye. Ophthalmological examination revealed papillary edema, vitritis, foci of chorioretinitis in the macula and Roth’s spots, confirming the diagnosis of endogenous endophthalmitis. Subsequently, she underwent appropriate treatment, progressing satisfactorily.Conclusion and importanceAlthough ophthalmological manifestations are rare, due to the pathophysiological characteristics of Lemierre’s Syndrome, all patients should underwent standard ophthalmologic assessment, even in the absence of ophthalmic symptoms or visible findings, as part of a multidisciplinary management approach.

Role of OM-85 BV in the prevention of recurrent acute tonsillitis: a retrospective study and literature review

BackgroundThis study aims to assess the effectiveness of OM-85 BV in treating recurrent acute tonsillitis in children and adults during the first year after treatment, as well as to identify response predictors.ResultsThe study included 92 patients, and there was a significant decrease in the number of acute tonsillitis cases after OM-85 BV treatment (p < 0.001). Exposure to tobacco smoke predicts non-response or partial response to treatment (OR 5.24, p = 0.005, 95% CI 1.646–16.671/OR 4.57, p = 0.014, 95% CI 1.362–15.339).ConclusionsThe study concludes that OM-85 BV is effective in preventing new episodes of tonsillitis in patients with a history of recurrent acute tonsillitis. Patients exposed to tobacco smoke tend to have a poorer response to treatment.

370 Do Prolonged Surgery Waiting List Times Affect the Incidence of Post-Tonsillectomy Haemorrhage, in the Context of the COVID-19 Pandemic?

Abstract Aim The United Kingdom was affected by the COVID-19 pandemic with the reduction of many services within the NHS, including suspension of elective surgical procedures from March 2020. We hypothesised that delayed surgery caused by the pandemic may increase the risk of post-tonsillectomy haemorrhage due to increased episodes of tonsillitis. The aims of this review were to investigate the relationship between prolonged waiting times and post-tonsillectomy haemorrhage. Method We performed a single-site, retrospective review from March 2019 to August 2023, with data collected from electronic hospital records. Both adults and children were included in the analysis and only procedures performed for recurrent tonsillitis were included. Results We identified 234 cases: 184 adeno/tonsillectomies in the pre-COVID (March 2019-20) and 50 in the post-COVID (August 2020-21) cohort. In the pre-COVID cohort, 7.6% (n=14) experienced a post-tonsillectomy haemorrhage, with 1.1% (n=2) experiencing a primary haemorrhage and 6.5% (n=12) experiencing secondary haemorrhage. The return to theatre rate was 2.2% (n=4). Median waiting time for surgery was 78 days. In the post-COVID cohort, secondary haemorrhage occurred in 6.0% (n=3). No patients experienced a primary haemorrhage and return to theatre rate was 0%. Median waiting time was 345 days. Simple logistic regression was performed which showed no significant association between waiting times and post-tonsillectomy haemorrhage across the whole (p = 0.90, 95% CI [-0.0002, 0.0002]) cohort. Conclusions Our cohort demonstrated no significant relationship between prolonged waiting times and post-tonsillectomy haemorrhage. Small sample size was a significant limitation; we recommend a larger scale, multi-centre study to investigate this further.

The Safety, Tolerability, and Efficacy of DL-Lactic Acid Syrup (Tonsitin) in Children With Recurrent Tonsillitis: A Pilot Study.

To evaluate Tonsitin (10% DL-lactic acid) safety, tolerability, and efficacy, as a treatment for recurrent tonsillitis (RT) in children. This is a clinical prospective, randomized, double blind pilot study, to evaluate the safety, tolerability and efficacy of Tonsitin in healthy children with RT. Safety evaluated in terms of adverse events (AEs), tolerability in terms of compliance, and efficacy in terms of tonsils' size and frequency of tonsillitis, and quality of life. The study included 51 children. The treatment regimen was tolerable among the participants. Six children experienced AEs, but mostly mild. Tonsil size declined in both groups, but these results did not reach statistical significance. Tonsillitis episodes' frequencies were random and not significant. Tonsitin treatment was found to be feasible in the clinical setup and was well tolerated, and appears to be safe. Study efficacy results did not reach statistical significance.

Outcomes of abscess tonsillectomy in patients awaiting tonsillectomy: A comparison with interval tonsillectomy

PurposePeritonsillar abscesses (PTA) occasionally occur in patients who have a concurrent history of recurrent tonsillitis or prior PTA episodes. These patients sometimes meet the indications for elective tonsillectomy even prior to the current PTA event. Abscess (“Quinsy”) tonsillectomy (QT) could serve as definitive treatment in this specific subgroup, though it is not performed often. The purpose of this study was to compare the perioperative outcomes between immediate QT and tonsillectomy performed several days (delayed QT) or weeks (Interval tonsillectomy, IT) after incision and drainage (I&D) of the PTA in this specific subgroup. Materials and methodsA retrospective perioperative outcomes analysis of patients undergoing tonsillectomy (2002−2022) compared QT to delayed QT and IT in patients with PTA meeting AAO-HNS elective tonsillectomy criteria. Results110 patients were included: 55 underwent IT, 36 underwent delayed QT, and 19 underwent immediate QT. Postoperative hemorrhage rates were 14.5 %, 11.1 %, and 5.3 % for IT, delayed QT, and immediate QT, respectively (P = 0.08). Mean hospitalization durations were 7.98, 6.92, and 5.37 days for IT, delayed QT, and immediate QT, respectively (P < 0.01). IT had a higher readmission rate due to pain compared to QT (14.5 % vs. 1.9 %, p = 0.032). ConclusionImmediate QT in PTA patients eligible for elective tonsillectomy is associated with lower postoperative hemorrhage, shorter admission time, and potentially reduced postoperative pain compared to I&D and delayed or interval tonsillectomy. These findings suggest that immediate QT should be considered as a primary treatment in this subgroup of eligible patients.

Effect of the German tonsillitis guideline on indication for tonsil surgery in patients with recurrent acute tonsillitis: a population-based study

Evidence-based indication for tonsil surgery in patients with recurrent acute tonsillitis (RAT) is an ongoing matter of debate. Since introduction of the German tonsillitis guideline in 2015, the indication criteria for tonsil surgery have become much stricter. It is unclear, if this has changed the indication policy. A retrospective population-based study was performed including all 1398 patients with RAT admitted for tonsil surgery in all Thuringian hospitals in 2011, 2015, and 2019. Changes over the years concerning patients’ characteristics, number of tonsillitis episodes in the last 12 months treated with antibiotics (T12), and decision for tonsillectomy or tonsillotomy were analyzed using univariable and multivariable statistics. The surgical rates decreased from 28.56/100,000 population in 2011 to 23.57 in 2015, and to 11.60 in 2019. The relative amount of patients with ≥ 6 T12 increased from 14.1% in 2011 over 13.3% in 2015 to 35.9% in 2019. Most patients received a tonsillectomy (98% of all surgeries). Decision for tonsillotomy was seldom (1.2%). Multinomial logistic regression analysis with the year 2011 as reference showed that compared to the year 2015, the age of the patients undergoing surgery increased in 2015 (Odds ratio [OR] = 1.024; 95% confidence interval [CI] = 1.014–1.034; p < 0.001), and also in 2019 (OR 1.030: CI 1.017–1.043; p < 0.001). Compared to 2011, the number T12 was not higher in 2015, but in 2019 (OR 1.273; CI 1.185–1.367; p < 0.001). Stricter rules led to lower tonsil surgery rates but to a higher proportion of patients with ≥ 6 T12 before surgery. Tonsillectomy remained the dominating technique.

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

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

Coblation tonsillectomy versus conventional tonsillectomy

Objectives: The objective of this study was to compare the effectiveness of conventional tonsillectomy versus coblation tonsillectomy with respect to duration of surgery, amount of intraoperative bleeding, recovery time, and post-surgical pain. Material and Methods: Sixty patients were divided into two groups. One group underwent conventional tonsillectomy while coblation tonsillectomy was performed in the second group. Duration of surgery, amount of intraoperative bleeding, recovery time, and postsurgical pain were measured. All patients were followed for 24 months. Results: Comparing the coblation tonsillectomy group to the cold steel dissection tonsillectomy group, the mean duration of surgery was 6.92 versus 18 min, the amount of intraoperative bleeding was 2.75 versus 39.88 mL, and the difference on the post-operative pain scale between the two groups was statistically significant (P &lt; 0.005). There was no recurrence of tonsillitis episodes in either of the two groups during the 2-year follow-up period. Conclusion: After adequate training, the coblation technique is beneficial to both the surgeon and the patient, including the possibility to excise tissue and coagulate bleeding vessels with the same device. Post-operative morbidity and complications are lower as compared to the conventional cold dissection technique.

Tonsillectomy in adults—to do or not to do

Recurrent acute tonsillitis describes the repeated occurrence of acute bacterial infections of palatine tonsils with symptom-free intervals. Acute tonsillitis accounts for around a third of respiratory tract infections in primary care among people of all ages, 1 Petersen I Johnson AM Islam A Duckworth G Livermore DM Hayward AC Protective effect of antibiotics against serious complications of common respiratory tract infections: retrospective cohort study with the UK General Practice Research Database. BMJ. 2007; 335: 982 Crossref PubMed Scopus (210) Google Scholar with an estimated 600 million symptomatic cases of group A streptococcus tonsillitis worldwide annually. 2 Carapetis JR Steer AC Mulholland EK Weber M The global burden of group A streptococcal diseases. Lancet Infect Dis. 2005; 5: 685-694 Summary Full Text Full Text PDF PubMed Scopus (1995) Google Scholar Recurrent episodes occur in 12% of patients with tonsillitis—ie, around 12 000 per 100 000 people. 3 Kvestad E Kværner KJ Røysamb E Tambs K Harris JR Magnus P Heritability of recurrent tonsillitis. Arch Otolaryngol Head Neck Surg. 2005; 131: 383-387 Crossref PubMed Scopus (26) Google Scholar Beyond the relation to group A streptococcus infections, little is known about risk factors for the development of recurrent acute tonsillitis. 4 Roberts AL Connolly KL Kirse DJ et al. Detection of group A Streptococcus in tonsils from pediatric patients reveals high rate of asymptomatic streptococcal carriage. BMC Pediatr. 2012; 12: 3 Crossref PubMed Scopus (97) Google Scholar Recurrent acute tonsillitis could be a genetic immunosusceptibility disease because patients younger than 12 years show some subclinical antibody deficiency and aberrant T-cell function 5 Dan JM Havenar-Daughton C Kendric K et al. Recurrent group A Streptococcus tonsillitis is an immunosusceptibility disease involving antibody deficiency and aberrant TFH cells. Sci Transl Med. 2019; 11eaau3776 Crossref PubMed Scopus (1) Google Scholar and many undergo tonsillectomy. More than 30 000 tonsillectomies are performed annually in the UK. 6 Keltie K Donne A Daniel M et al. Paediatric tonsillectomy in England: a cohort study of clinical practice and outcomes using Hospital Episode Statistics data (2008–2019). Clin Otolaryngol. 2021; 46: 552-561 Crossref PubMed Scopus (16) Google Scholar Tonsillectomy can produce severe postoperative pain, complicated by postoperative bleeding which can result in death in rare cases. Clearly, we need evidence-based policies to guide health-care professionals for the indication of tonsillectomy. 7 Mandavia R Schilder AGM Dimitriadis PA Mossialos E Addressing the challenges in tonsillectomy research to inform health care policy: a review. JAMA Otolaryngol Head Neck Surg. 2017; 143: 943-947 Crossref PubMed Scopus (10) Google Scholar Unfortunately, not much has changed in the past 40 years. National guidelines are still based on the Paradise criteria from 1984, 8 Paradise JL Bluestone CD Bachman RZ et al. Efficacy of tonsillectomy for recurrent throat infection in severely affected children—results of parallel randomized and nonrandomized clinical trials. N Engl J Med. 1984; 310: 674-683 Crossref PubMed Google Scholar stating that a tonsillectomy is indicated when around seven or more treated tonsillitis episodes occur in 1 year. The Paradise criteria were based on paediatrics clinical trials and later extrapolated for adult guidelines without any justifying research in the adult population. Thus, the 2014 Cochrane Review concluded that the effectiveness of tonsillectomy is low. 9 Burton MJ Glasziou PP Chong LY Venekamp RP Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis. Cochrane Database Syst Rev. 2014; 2014CD001802 PubMed Google Scholar Until now, there was no basis to make confident decisions using national guidelines. 7 Mandavia R Schilder AGM Dimitriadis PA Mossialos E Addressing the challenges in tonsillectomy research to inform health care policy: a review. JAMA Otolaryngol Head Neck Surg. 2017; 143: 943-947 Crossref PubMed Scopus (10) Google Scholar Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA): a multicentre, open-label, randomised controlled trialCompared with conservative management, immediate tonsillectomy is clinically effective and cost-effective in adults with recurrent acute tonsillitis. Full-Text PDF Open Access

Evaluation of Guidelines For Tonsillectomy in Adults With Recurrent Acute Tonsillitis.

The criteria for selecting patients with recurrent acute tonsillitis (RT) for tonsillectomy remain unsettled and different guidelines are used internationally. We aimed to evaluate currently used guidelines for tonsillectomy in adults with RT and identify the best predictive parameters for improved throat-related quality of life (TR-QOL) after surgery. About 66 RT patients undergoing tonsillectomy was prospectively included and categorized into 3 groups based on which guideline(s) they met: Group 1: patients not meeting any of the Danish/Paradise/Scottish Intercollegiate Guideline Network (SIGN) guidelines. Group 2: patients meeting the Danish guidelines. Group 3: patients meeting the Paradise and/or the SIGN guidelines. TR-QOL was assessed using the Tonsillectomy Outcome Inventory 14 (TOI-14) before and 6 months after tonsillectomy as well as the Glasgow Benefit Inventory (GBI). Predictive parameters for improved TR-QOL were investigated using multiple linear regression. About 61 (92%) patients completed the questionnaires. Patients in all groups had significant TR-QOL improvements (Group 1 (n = 20): ΔTOI-14 31.1; GBI 29.4; Group 2 (n = 31): ΔTOI-14 32.0; GBI 36.4; Group 3 (n = 10): ΔTOI-14 45.6; GBI 39.7) and satisfaction rates were high (94%-100%). Preoperative TOI-14 score was the best predictor for improved TR-QOL (P < .001, R2 = .80), followed by the number of tonsillitis episodes with physician verification within the previous 12 months (P = .002, R2 = .25). Patients in all groups experienced massive TR-QOL improvements suggesting that currently used guidelines may be too restrictive. Preoperative TOI-14 score was the best parameter for predicting TR-QOL improvement, and this tool may be useful in the selection of adults with RT for tonsillectomy.

Association Between Vitamin D Deficiency and Recurrent Tonsillitis.

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

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

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

Recurrent Penicillin-Resistant Tonsillitis Due to Lactococcus garvieae, a New Zoonosis from Aquaculture

Zoonotic diseases are a group of infectious diseases that are transmitted naturally from animals to humans. L. garvieae is a Gram-positive bacterium which is present in the aquaculture of freshwater and marine fish. Some isolated cases of infection have been described, considering it an opportunistic agent in immunosuppressed patients. The most recent appearance of severe infections in immunocompetent patients or colonizing cardiac prostheses has set off the alarms. This manuscript presents the first two patients with recurrent tonsillitis due to L. garvieae. A 15-year-old male and an 8-year-old male had recurrent tonsillitis with more than three episodes per year. A culture of tonsillar exudate in both cases showed growth of L. garvieae with an antibiogram showing multi-resistance to antibiotics. Given the parents’ wish not to carry out surgery, an autovaccine regimen with lysed bacteria was proposed with good evolution and remission of tonsillitis episodes in both cases. The oral autovaccine produces an immunomodulatory effect and could be a therapeutic weapon in the prevention of this zoonosis. Further studies are needed to determine the importance of foodborne transmission in human L. garvieae infections and to find suitable treatments for this wide range of infections.

A clinical study on homoeopathic treatment of recurrent tonsillitis based on stuart close’s concept of susceptibility and it’s role in selection of potency

Tonsillitis is a common childhood infection and recurrent episodes have long term side effects and cause significant morbidity. It is a common cause of absenteeism from school. Like any other operation, tonsillectomy is not without risks and the rising resistance to antibiotics has led to a demand for alternative options. Recurrence of a disease shows a morbid susceptibility and homoeopathic medicines chosen according to the totality of symptoms in suitable potency can remove it. The scientific community now has called for extensive research in the study of genes involved in transferring susceptibility to certain diseases. The aim of my study is to study the effectiveness of homoeopathic medicines in treating recurrent tonsillitis and thereby evaluate Stuart Close’s concept that similimum can satisfy morbid susceptibility to a disease and hence reduce its recurrence. A prospective clinical study was conducted in Govt. Homoeopathic Medical College, Thiruvananthapuram. 30 cases satisfying the diagnostic criteria in the age group of 4-12 years were taken. Those who had minimum of 5 or more episodes in the last year were chosen and after detailed case taking homoeopathic medicine was administered. The period of study was 1 year. Study design is experimental before and after-one group. Outcome of the treatment was assessed by noting the reduction in the number of episodes of tonsillitis. Final evaluation of the data done by Wilcoxon signed rank test. 29 out of 30 cases showed reduction in the number of episodes of recurrent tonsillitis when homoeopathic medicines were administered. Exposure to cold, citrus fruits, chocolates, milk products and preservative containing food items were relevant exacerbating factors. The study shows statistical significance of p value

Dependent factors in the adult patient and their relationship with post-tonsillectomy bleeding and pain in an outpatient setting

Introduction and objectiveTonsillectomy performed on an outpatient basis in adult patients presents bleeding and pain as main postoperative complications.Following rules such as cold surgical technique, analgesic protocols, preoperative interview, and postoperative follow-up help to better control the process. However, there are patient-dependent factors such as sex, age, indication for tonsillectomy and the time elapsed between the last tonsil infection and surgical intervention that can influence postoperative complications and should be considered.The objective of this work is to evaluate the influence of age, sex, the indication for tonsillectomy and the period elapsed between the last tonsil infection and surgery on bleeding and pain control. MethodsA prospective, descriptive, and observational study was carried out in 96 adult patients who underwent outpatient surgery under general anaesthesia, using cold surgical technique, evaluating these complications based on age, sex, indication for tonsillectomy and time elapsed after the last tonsillitis. ResultsThe patients operated on during the 4 weeks after an episode of tonsillitis presented more postoperative pain. No relationship was found between this period and postoperative bleeding. ConclusionsMale patients had a higher incidence of bleeding than women.The period elapsed between the last tonsil infection and the surgical procedure was associated with greater postoperative pain, but not with greater postoperative bleeding.

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.

DIAGNOSTIC VALUE OF MULTIPARAMETRIC ULTRASOUND EXAMINATION IN PATIENTS WITH RECURRENT TONSILITIS

The problem of recurrent tonsillitis in the world is still highly relevant. A clear algorithm for the diagnosis and treatment of patients with this pathology is still being developed and improved. Thanks to the latest technologies, modernization of equipment and improvement of knowledge of medical workers, it is possible to diagnose this disease better and, consequently, to decide on further treatment.&#x0D; Aim. Determine the informative value of shear wave elastography as an additional objective method for the diagnostics of recurrent tonsillitis.&#x0D; Materials and methods. 24 participants were enrolled in the research. Age structure: children of primary school age (6-10 years) - 14 people, teenagers (10-15 years) - 6 people, high school age (15-17 years) - 2 people, adults (22-35 years) - 2 people. Criteria for inclusion in the research - from 4 to 6 episodes of tonsillitis per year for the last 2 years. The patients' anamnesis was carefully collected, and ENT examination, paying special attention to the presence of symptoms of "underactivity" of the tonsils, shear wave elastometry and elastography of the palatine and peritoneal tonsils were performed as one of the newest methods of ultrasound examination. Longitudinal and transverse scans of the palatine tonsils and surrounding structures were performed. The obtained data were recorded in the patient's examination card for further analysis.&#x0D; In general, the main indicators were identified, which were further analyzed - the size of the tonsils, transverse size and stiffness of the paratonsillar space, colors, which mapped the examined structures, the size of regional maxillary lymph nodes.&#x0D; Results. After collecting the participants’ anamnesis, the main common feature was identified - experiencing 4 to 6 episodes of tonsillitis per year for the past 2 years, and on ENT examination – fixation of the tonsils, which indicated fibrotic changes in the paratonsillar space, which became one of the main criteria for inclusion of patients in this research. It is an objective criterion for recurrent tonsillitis. Elastometry and elastography of peritonsillar structures revealed other important objective features of recurrent tonsillitis - the shear waves velocity (stiffness of the peritonsillar space) higher than 2.0 m/sec which is mapped in red and burgundy color. Mapping of the tonsils themselves was less informative due to insignificant clinical significance. More important was the mapping of paratonsillar spaces. An additional objective criterion was the size of the maxillary lymph nodes as regional lymph nodes for the palatine tonsils. They ranged from 10.5 mm to 20.5 mm, which is larger than normal values.&#x0D; Conclusions. According to the result of the research, the following signs of recurrent tonsillitis were identified: fixation of the palatine tonsils, increased shear wave velocity (stiffness index) in the peritonsillar space on elastometry (higher than 2 m/sec), that hypothetically, can be considered as indicating fibrosis of the peritonsillar space, mapping of peritonsillar space structures with colors from green and blue to red with areas of burgundy (in normal tissues green, blue, sometimes yellow colors are seen), enlarged maxillary lymph nodes, as regional for the palatine tonsils.&#x0D; Thus, we can confirm the high informative value of shear wave elastometry and elastography as an additional objective method of visualization in patients with recurrent tonsillitis.

Vitamin D Levels in Children with Recurrent Acute Tonsillitis in Jordan: A Case-Control Study.

Background: Vitamin D is essential for many functions of the body. In addition to its primary function of regulating the absorption of calcium in the small intestine, its role in the immune system has recently been studied. The current study aimed to test the impact of vitamin D deficiency on the rate of recurrent acute tonsillitis in children. Methods: According to Paradise criteria, two hundred forty-two children with recurrent acute tonsillitis were recruited. A group of healthy children (n = 262) was also recruited as controls. Poisson regression was run to predict the number of tonsillitis episodes per year based on vitamin D levels. The mean vitamin D level in the study group was lower than in the control group (p < 0.0001). Poisson regression of the rate of recurrent tonsillitis and vitamin D level (OR = 0.969 (95% CI, 0.962–0.975)) showed that for every single unit increase in vitamin D level, there was a 3.1% decrease in the number of tonsillitis episodes per year (p < 0.0001). Conclusions: Vitamin D deficiency is associated with higher rates of recurrent acute tonsillitis. Future controlled trials should investigate the role of vitamin D supplementation in reducing the rate of recurrent tonsillitis.

Some Pro and Anti-Inflammatory Cytokines in Children with Tonsillitis and their Correlations with Vitamin D Deficiency

Inflammation of the tonsils could be described as acute tonsillitis, mainly due to infection. Recurrent tonsillitis could be defined as 3-7 episodes during the first 3 years of age. Vitamin D, which is a neuro-hormone with pleiotropic biological activities may modulate the immune response by alleviation, and stimulation of Th1 and Th2 cell proliferation, respectively, that influence the stimulation, synthesis, and secretion of both pro and anti-inflammatory cytokines. In this study we aimed to shed light on the levels of vitamin D in children with different episodes of tonsillitis in association with levels of interleukins (TNFα, IL-2, IL-4, IL-10). Blood samples were collected from 48 participants in 3 groups: control, acute tonsillitis (1-2 episodes/year), chronic tonsillitis (more than 7 episodes/year), serum was separated and the levels of Vitamin D, TNFα, IL-2, IL-4 and IL-10 were estimated using ELISA technique. Vitamin D decreased significantly as the episodes of tonsillitis increased, with level of 16.38± 2.41ng/ml in acute and, 14.13± 2.15 ng/ml in chronic tonsillitis as compared to control (30.91± 2.31 ng/ml), while pro-inflammatory cytokines (TNFα and IL-2) significantly increased (46.88± 14.05 and 44.55± 9.24, 1267.25± 111.85 and 1191.72± 121.52 ng/ml, respectively) as compared to control (9.45 and 138.48 ng/ml respectively). Anti-inflammatory (IL-4, IL-10) cytokines in control group were (243.08± 28.72 and 24.27± 1.83 ng/ml, respectively), which increased non-significantly in acute and chronic tonsillitis (302.76± 38.93, 290.12± 44.69 and 28.16± 2.01, 26.29± 1.99 ng/ml, respectively). Significant direct correlation was observed between the levels of vitamin D and anti-inflammatory cytokines in chronic tonsillitis (P&lt;0.05). In conclusion, deficiency of vitamin D may affect the number of episodes of tonsillitis in children by modulation of the secretion of some cytokines.