The most important throat-related symptoms suggestive of chronic tonsillitis as the main indication for adult tonsillectomy.

BACKGROUND AND OBJECTIVE: The literature lacks data about the evaluation of throat-related symptoms proving chronic tonsillitis as the most common indication for adult tonsillectomy. Therefore, the aim of this study was to assess the most important throat-related symptoms suggestive of chronic tonsillitis in adults. MATERIAL AND METHODS: A prospective cohort study was carried out. The analysis of throat-related symptoms (complaints, tonsillitis rate, pharyngeal signs, and antistreptolysin-O titer) in 81 adults with histologically confirmed chronic tonsillitis was conducted. RESULTS: Recurrent tonsillitis was the most common complaint (74.1%). The mean number of tonsillitis episodes was 3.6 (SD, 1.9) times per year. There were no significant differences comparing the frequencies of all the analyzed pharyngeal signs (P>0.05). The antistreptolysin-O titer (mean, 279.8; SD, 211.6 UL) was pathological in 33.3% of patients. The study identified the most important throat-related symptoms revealing chronic tonsillitis: tonsillar cryptic debris (OR, 8.84; 95% CI, 1.93-40.53; P=0.005) and enlarged anterior cervical lymph nodes along with the frequency of tonsillitis episodes exceeding 3 times per year (OR, 8.27; 95% CI, 1.33-51.57; P=0.024). The classification accuracy of 85.2% was obtained. CONCLUSIONS: Tonsillar cryptic debris and enlarged regional lymph nodes along with recurrent tonsillitis could support the diagnosis of chronic tonsillitis in adults when considering tonsillectomy.

[Classification and therapeutic strategy for chronic tonsillitis].

The objective of the present study was to further develop and substantiate classification of chronic tonsillitis with due regard for etiology and pathogenesis of this disease. The author pays special attention to the fact that the toxico-allergic effect of focal infection of palatine tonsils (chronic tonsillitis, CT) is significantly more pronounced than that of focal infections of a different localization. The toxico-allergic manifestations of chronic tonsillitis are not infrequently realized through the associated non-specific infectious local and general complications and catalyze pathogenesis of the concomitant diseases. The classification developed taking into consideration etiology and pathogenesis of CT distinguishes two forms of chronic tonsillitis, viz. simple and toxico-allergic (TAF) CT, the latter being subdivided into two variants differing in the character of manifestations (TAF-1 and TAF-II). The clinical, morphological, and immunological characteristics of either form are described. It is emphasized that the most informative signs and symptoms of CT include the recurrence rate of tonsillitis in the medical history, purulent discharge from the tonsillar crypts apparent upon compression of their anterior surface with a spatula, and toxico-allergic reactions in combination with local signs and tonsillitis in the medical history. The therapeutic strategies for each forms of CT are specifies. The use of conservative therapy is recommended as the principal method for the treatment of the simple form, the strict compliance with the prescribed therapeutic modalities and repetition of the second therapeutic course within 3-4 months after the initial one being of primary importance. The treatment of TAF-1 should be started from conservative therapy the duration of which needs to be reduced in the absence of the marked desired effect bearing in mind the possibility of development of local and systemic complications. TAF-II requires urgent tonsillectomy because this condition is fraught with immediate severe complications.

A retrospective study of the eligibility for tonsillectomy.

BACKGROUND: The criteria for tonsillectomy for recurrent tonsillitis were established by prospective studies in the pediatric population and are applied to adults as well. No studies have been conducted to assess whether these guidelines are followed. OBJECTIVES: To examine the eligibility for tonsillectomy of tonsillectomized patients who were referred because of recurrent acute tonsillitis. METHODS: A retrospective case series in an ambulatory military otolaryngology clinic was conducted, and the medical records of 44 tonsillectomized patients who suffered from throat infections during the year before surgery were analyzed. The number of tonsillar infections that met the referral criteria was counted. RESULTS: The average number of throat infections that met the referral criteria was 1.89 per year. The average number of visits to the clinic due to upper respiratory tract infection was 12.92 (range 2-36) per year. The average number of visits for any cause was 45.13 (range 6-64) per year. One patient with eight documented throat infections met the criterion of more than six infections in the last year. CONCLUSION: Although the referral criteria were not strictly met, we speculate that surgery was probably beneficial. This study shows that the indications for tonsillectomy referral are not strictly followed, and that new criteria for referral of adults for tonsillectomy need to be established.

[Chronic tonsillitis: therapeutic and diagnostic approaches]. / Lechebno-diagnosticheskie podkhody k probleme khronicheskogo tonzillita.

The article is a brief review of clinical and topographic anatomy of the palatine tonsils. Their role in formation of general and local immunity is shown. Etiological and pathogenetic aspects of chronic tonsillitis are considered: most frequent causing agents, underlying pathogenetic and immunological mechanisms. B.S. Preobrazhensky's and V.T. Palchun's clinical classification of chronic tonsillitis is presented. New approaches to etiopathogenetic treatment of chronic tonsillitis are described.

Evolución e historia de la técnica quirúrgica de la amigdalectomía infantil / Evolution and history of infantile tonsillectomy surgery

La amigdalectomía es una de las técnicas quirúrgicas más antiguas documentadas, teniendo certeza de su realización desde un siglo antes de al era cristiana1-2, desde esa época hasta nuestros días ha sido una cirugía controvertida por sus bases científicas, sus indicaciones y sus constantes cambios tecnológicos en busca de una menor morbimortalidad infantil. El objeto del presente trabajo es analizar esta evolución histórica y su repercusión en la moderna otorrinolaringología (AU)

[Blast transformation activity of autologous saliva in patients with different clinical forms of chronic bronchitis]. / Blasttransformiruiushchaia aktivnost' autologichnoi sliuny u bol'nykh s razlichnymi klinicheskimi formami khronicheskogo tonzillita.

The study of mitogenic effect of autologous saliva in respect to peripheral blood lymphocytes of patients with different clinical forms of chronic tonsillitis (CT) discovered that saliva from all the examinees was highly active as regards blast-cell transformation. The intensity of lymphocyte blast-transformation in the presence of autologous saliva grows with CT transformation from compensated to decompensated form and insignificantly declines in clinical symptoms of autoimmune disease. The saliva mitogenic effect is probably stimulated by the whole complex of biologically active substances which by provoking hypertrophy of the lymphoid tissue contributes to autoimmunization of the body. It is proposed to use lymphocyte blast-transformation with autologous saliva for diagnosis of subclinical autoimmune diseases.

Infecciones respiratorias agudas en la parroquia de Tabacundo (c.s. Tabacundo) 1991-1994

El presente estudio se realizó en el Centro de salud de Tabacundo, con el fin de determinar la incidencia de las infecciones repiratorias agudas en dicha área. Se revisaron los registros vitales de los pacientes de Tabacundo, registro estadísticos, historias clínicas y partes diarios. Teniendo como antecdeente que para el año de 1993 la principal causa de mortalidad en menores de cinco años constituyeron las infecciones repiratorias aguda, despertó el interés de uan investigación sistematizada en el área 13. Se determinó que durante los años 1991-1994 las principales caussas de morbilidad por infección respiratoria aguda son: el síndrome gripal (43.1 por ciento), bronquitis (24.8 por ciento) y la bronconeumonía (7.9 por ciento). Durante 1993 existió (28.9 por ciento y morbilidad por infeción respiratoria, la misma que disminuyó en un 5.7 por ciento para el años 1994. En referencia al tratamiento se observó que en un 56.3 por ciento se utilizó antibióticos, en un 30.4 por ciento apoyo más antipiréticos y en el 12.4 por ciento solamente terapia de apoyo. Concluímos entonces que la correcta aplicación de medidas preventivas y terapéuticas serán en lo futuro las que disminuyan la incidencia de morbi-mortalidad por infecciones respiratorias agudas...