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Liao CK. Tonsillectomy for recurrent tonsillitis: the NATTINA trial. Lancet 2024; 403:1633. [PMID: 38677856 DOI: 10.1016/s0140-6736(24)00189-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 01/29/2024] [Indexed: 04/29/2024]
Affiliation(s)
- Chun-Kang Liao
- Department of Otolaryngology, National Taiwan University Hospital Yunlin Branch, Yunlin 632, Taiwan.
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Mughal Z, Jangan A, Ahmad A, Turner N, Mughal F. Assessing asymmetrical tonsils in children: an evidence-based review for primary care. Br J Gen Pract 2024; 74:93-94. [PMID: 38272689 PMCID: PMC10824352 DOI: 10.3399/bjgp24x736377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
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Kim MS, Choi HG, Park EK, Kim SY, Kim JH, Park B. Natural course of tonsillectomy pain: A prospective patient cohort study. Auris Nasus Larynx 2018; 45:508-513. [DOI: 10.1016/j.anl.2017.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 07/07/2017] [Accepted: 07/24/2017] [Indexed: 10/18/2022]
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Yenigun A, Dogan R, Ozturan O, Meric Hafiz A. RGB Measurements From Endoscopic Photography as a New and Objective Diagnostic Method for Chronic Tonsillitis. Clin Ther 2016; 38:625-30. [PMID: 26895768 DOI: 10.1016/j.clinthera.2016.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/26/2016] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE This study assessed the diagnostic role of a digital photographic assessment of chronic tonsillitis. This study was performed at a tertiary referral center. METHODS Three cohorts of children were studied based on their diagnoses: current chronic tonsillitis (before tonsillectomy), previous chronic tonsillitis (3 months after tonsillectomy), and healthy children (control group). Oropharyngeal regions of all subjects were examined and photographed endoscopically. Red/green/blue (RGB) values of particular oropharyngeal points were then measured. FINDINGS The current chronic tonsillitis group differed significantly from the other 2 groups. The RGB values of the current chronic tonsillitis group were significantly higher than those of the previous chronic tonsillitis group (3 months after tonsillectomy) and the control group (P = 0.018 (red), P = 0.024 (green), and P = 0.004 (blue)). The RGB values did not differ significantly between the previous chronic tonsillitis group and the control group (P = 0.684 [red], P = 0.890 [green], and P = 0.672 [blue]). The RGB values of the previous chronic tonsillitis group decreased significantly 3 months after tonsillectomy (P = 0.015 [red], P = 0.033 [green], and P = 0.001 [blue]). Sensitivity was 80%, specificity was 90%, the positive predictive value was 59%, the negative predictive value was 96%, and the general power of the test was 88.6% regarding the power and competence of the RGB test in the diagnosis of chronic tonsillitis. IMPLICATIONS Measuring RGB values may be an inexpensive and simple way to quickly provide objective and corroborative information on hyperemia of the anterior pillars in diagnosing chronic tonsillitis in conjunction with subjective methods.
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Affiliation(s)
- Alper Yenigun
- Bezmialem Vakif University, Faculty of Medicine, Department of Otorhinolaryngology, Adnan Menderes Bulvarı Vatan Caddesi 34093, Fatih, İstanbul, Turkey.
| | - Remzi Dogan
- Bezmialem Vakif University, Faculty of Medicine, Department of Otorhinolaryngology, Adnan Menderes Bulvarı Vatan Caddesi 34093, Fatih, İstanbul, Turkey
| | - Orhan Ozturan
- Bezmialem Vakif University, Faculty of Medicine, Department of Otorhinolaryngology, Adnan Menderes Bulvarı Vatan Caddesi 34093, Fatih, İstanbul, Turkey
| | - Aysenur Meric Hafiz
- Bezmialem Vakif University, Faculty of Medicine, Department of Otorhinolaryngology, Adnan Menderes Bulvarı Vatan Caddesi 34093, Fatih, İstanbul, Turkey
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Todorović MM, Zvrko EZ. Immunoregulatory cytokines and chronic tonsillitis. Bosn J Basic Med Sci 2014; 13:230-6. [PMID: 24289758 DOI: 10.17305/bjbms.2013.2330] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purposes of the present study were to determine the distribution of cells producing cytokines: tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) in different morphological sections of tonsils in patients with tonsillar hypertrophy (TH) and recurrent tonsillitis (RT), to analyze the level of production of these cytokines in TH and RT and evaluate the potential of peripheral blood lymphocytes for production of interferon-γ (IFN-γ) and interleukin 4 (IL-4). Analyzed materials consisted of the tonsils after tonsillectomy and blood taken from patients right before tonsillectomy (study group) and blood taken from healthy donors (control group).We used histological and immunohistochemical method, morphometric methods for the quantification of TNF-α and IL- 6 producing cells and immunological methods for determining the concentration of IFN-γ and IL-4. Most of TNF-α producing cells are settled in the subepithelial region (55%). Numerical density of TNF-α producing cells in the crypt epithelium, subepithelial and interfollicular region was significantly higher in RT compared with TH. The concentration of IFN-γ is three times higher in RT then in TH. After the stimulation of peripheral blood lymphocytes in culture there was no significant increase in concentrations of IL- 4. The index of stimulation of IFN-γ was the highest in the RT, and of IL- 4 in TH. The production of Th1-type cytokines (TNF-α and IFN-γ) is higher in RT compared with TH. In both forms of tonsillitis, production of Th1-type cytokines is higher in relation to the production of Th2-type cytokines (IL-6 and IL-4).
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Affiliation(s)
- Miroljub M Todorović
- General Hospital "Danilo I" University of Montenegro, Vojovode Boža 45, 81250, Cetinje, Montenegro
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Torretta S, Drago L, Marchisio P, Cappadona M, Rinaldi V, Nazzari E, Pignataro L. Recurrences in chronic tonsillitis substained by tonsillar biofilm-producing bacteria in children. Relationship with the grade of tonsillar hyperplasy. Int J Pediatr Otorhinolaryngol 2013; 77:200-4. [PMID: 23137856 DOI: 10.1016/j.ijporl.2012.10.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 10/19/2012] [Accepted: 10/22/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVES It has been suggested that bacterial biofilms are involved in chronic tonsillar disease, but there is a lack of strong evidence concerning their etiopathogenic role in childhood chronic tonsillar infections. The aim of this study was to assess the presence of biofilm-producing bacteria (BPB) in tonsillar bioptic specimens taken from children with recurrent exacerbations of chronic hyperplastic tonsillitis, and to evaluate the possible relationship between them and the patients' demographic and clinical characteristics. METHODS 22 children (68.2% males; median age 6.5 years, range 3-13) with recurrent exacerbations of chronic hyperplastic tonsillitis were included. The presence of tonsillar BPB was assessed by means of the spectrophotometric analysis of tonsillar bioptic specimens taken during tonsillectomy between episodes of tonsillar infection. RESULTS BPB were found in 50.0% of the 44 tonsillar specimens, and Staphylococcus aureus was the most frequent pathogen (81.8%). There was a significant relationship (p=0.02) between the grade of tonsillar hyperplasy (GTH) and the presence of tonsillar BPB, with an increased relative risk (RR=4.27, standard error=2.57, p<0.01) of tonsillar BPB development in children with GTH scores of >2. CONCLUSIONS The findings of this study: (1) confirm the presence of tonsillar BPB in children with recurrent exacerbations of chronic tonsillar infections; (2) suggest that GTH is an important indicator of the presence of tonsillar BPB; and (3) raise the question as to whether tonsillar biofilm is a causative factor or just a consequence of recurrent exacerbations of chronic hyperplastic tonsillitis.
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Affiliation(s)
- Sara Torretta
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
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Kheirandish-Gozal L, Kim J, Goldbart AD, Gozal D. Novel pharmacological approaches for treatment of obstructive sleep apnea in children. Expert Opin Investig Drugs 2012; 22:71-85. [PMID: 23126687 DOI: 10.1517/13543784.2013.735230] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The lymphadenoid tissues in the upper airway are sparse and organized lympho-epithelial structures playing an important role against foreign pathogens, with the palatine tonsils being the major components of the lymphoid tissues contained in the Waldeyer's ring. Obstructive sleep apnea (OSA) has emerged as a very frequent condition in the pediatric age range that is associated with substantial neurobehavioral, cardiovascular and metabolic morbidities. Adenotonsillar hypertrophy is the major pathophysiological contributor to OSA occurrence in children. AREAS COVERED Here, the authors provide a systematic review and summary of some of the known histological and pathological features of human lymphadenoid tissues and their fundamental immunological functions, provide insights into the pathophysiology of pediatric OSA, particularly focusing on inflammatory pathways and the available outcomes associated with targeting such pathways with compounds such as corticosteroids and leukotriene modifiers. Furthermore, they present findings from an unbiased approach to discovery of therapeutic targets and formulate constructs toward putative future interventional approaches for this highly prevalent condition. EXPERT OPINION Surgical approaches for pediatric OSA may not be as effective as previously anticipated. Accordingly, expanded use of existing systemic or topical anti-inflammatory agents or development of novel compounds targeting selected immune cell populations underlying pathophysiological determinants of OSA is needed.
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Affiliation(s)
- Leila Kheirandish-Gozal
- University of Chicago, Comer Children's Hospital, Pritzker School of Medicine, Biological Sciences Division, Department of Pediatrics, Chicago, IL 60637, USA
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Montgomery-Downs HE, Ramadan HH, Clawges HC, McBean AL, Insana SP, Santy EE. Digital oral photography for pediatric tonsillar hypertrophy grading. Int J Pediatr Otorhinolaryngol 2011; 75:841-3. [PMID: 21514678 DOI: 10.1016/j.ijporl.2011.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 03/18/2011] [Accepted: 03/24/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tonsillar hypertrophy contributes to pediatric disorders, including obstructive sleep apnea. The goal was to determine the utility of digital photographs for pediatric tonsillar grading. METHODS Using Brodsky's grading scale, 41 children (3.0-14.6 years) had in-person tonsil grading during a routine pediatric ENT physical examination. Oral photographs were obtained with a standard single-lens reflex digital camera and graded by the same ENT physician and by an independent Pediatrician. RESULTS In-person and photograph gradings were highly correlated, but also differed significantly. Yet photograph gradings did not differ between physicians, suggesting that photographs provide unique, consistent information to different clinicians. Discrepancies between in-person and photograph gradings were not explained by child age. CONCLUSION Static images may provide experts more time for mental calculations and may therefore provide a superior estimation of tonsil size. Photographs should be considered for remote use, as well as a potentially better alternative to current in vivo estimates.
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Kim J, Bhattacharjee R, Dayyat E, Snow AB, Kheirandish-Gozal L, Goldman JL, Li RC, Serpero LD, Clair HB, Gozal D. Increased cellular proliferation and inflammatory cytokines in tonsils derived from children with obstructive sleep apnea. Pediatr Res 2009; 66:423-8. [PMID: 19581829 PMCID: PMC2892472 DOI: 10.1203/pdr.0b013e3181b453e3] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Adenotonsillar hypertrophy is the major pathophysiological mechanism underlying obstructive sleep apnea (OSA) and recurrent tonsillitis (RI) in children. The increased expression of various mediators of the inflammatory response in tonsils of patients with OSA prompted our hypothesis that the enhanced local and systemic inflammation in children with OSA would promote tonsillar proliferation. Mixed cell cultures from tonsils recovered during adenotonsillectomy in children with OSA and RI were established, and proliferative rates were assessed. Cells were also cultured to determine the levels of proinflammatory cytokines and antioxidant protein levels and mRNA expression. Global cell proliferative rates from OSA tonsils were significantly higher than RI (p < 0.01), with CD3, CD4, and CD8 cell proliferation being higher in OSA (p < 0.05). Moreover, proinflammatory cytokines, such as TNF-alpha, IL-6, and IL-1alpha, were highly expressed in OSA-derived tonsils. Furthermore, thioredoxin (TRX), an antioxidant protein, was also highly expressed in OSA tonsils at the mRNA and protein levels (p < 0.01). Thus, T cells are in a highly proliferative state in the tonsils of children with OSA and are associated with increased production of proinflammatory cytokines and TRX, when compared with children with RI.
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Affiliation(s)
- Jinkwan Kim
- Department of Pediatrics, University of Louisville, Louisville, Kentucky 40202, USA
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Serpero LD, Kheirandish-Gozal L, Dayyat E, Goldman JL, Kim J, Gozal D. A mixed cell culture model for assessment of proliferation in tonsillar tissues from children with obstructive sleep apnea or recurrent tonsillitis. Laryngoscope 2009; 119:1005-10. [PMID: 19266584 DOI: 10.1002/lary.20147] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Recurrent infective tonsillitis (RI) and obstructive sleep apnea (OSA) are the major indications for adenotonsillectomy (T&A) in children. However, little is known on the determinants of lymphadenoid tissue proliferation in the pediatric upper airway. OBJECTIVES To develop an in vitro culture system allowing for assessment of tonsillar or adenoidal proliferation under basal or stimulated conditions. METHODS Tonsils surgically removed from pediatric patients with obstructive sleep apnea and recurrent tonsillitis during T&A, were dissociated using standard methods. Whole cell tonsillar cultures were either maintained in normal medium or stimulated with lipopolysaccharide (25 microg/mL) and concanavalin A (10 microg/mL) for 24 hours (stimulated conditions [STIM]). Cellular proliferation was evaluated by [3H]thymidine incorporation. In parallel, supernatants were collected after 48 hours, and concentration of cytokines was measured using standard enzyme-linked immunosorbent assay procedures. RESULTS Basal proliferative rates were increased in the OSA group (305.2 +/- 40.6 cpm; n = 31) compared to RI group (232.8 +/- 31.9 cpm; n = 26; P < .001). No significant differences in proliferative rates emerged after STIM between OSA and RI. Furthermore, basal TNF-alpha, IL-6, and IL-8 concentrations in the supernatant were increased in OSA-derived cultures compared to RI, but IL-8 was higher after STIM in RI, while IL-6 remained increased in OSA. CONCLUSIONS The proliferative rates and concentrations of inflammatory mediators in tonsillar cell cultures from children with OSA and RI suggest that lymphadenoid tissue proliferation in these two conditions may be regulated by different mechanisms. This novel method may allow for future development of specific therapeutic interventions aimed at curtailing and reversing tonsillar and adenoidal hypertrophy in children in a disease-specific manner.
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Affiliation(s)
- Laura D Serpero
- Division of Sleep Medicine, Kosair Children's Hospital Research Institute, Department of Pediatrics, University of Louisville, Louisville, Kentucky, USA
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Webb C, Osman E. Response to Cruise. Clin Otolaryngol 2005. [DOI: 10.1111/j.1365-2273.2005.00992.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cruise A. Tonsillar size is an important indicator of recurrent acute tonsillitis. Clin Otolaryngol 2005; 30:211-2; author reply 212. [PMID: 15839886 DOI: 10.1111/j.1365-2273.2005.00991.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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