Treatment of non-streptococcal tonsillitis with metronidazole

The potential role of anaerobic bacteria in acute tonsillitis was investigated in a retrospective study that evaluated the efficacy of antimicrobial therapy with metronidazole on the management of acute episodes of non-beta-hemolytic streptococcal tonsillitis (NST). Forty children suffering from NST were included, 20 that were treated with metronidazole 250 mg b.i.d. for 10 day, and 20 that had received no therapy. The efficacy of therapy was evaluated by the ability to alleviate the symptoms of acute infection. As compared with the untreated group, the group that received metronidazole, had a significant reduction in fever and sore throat one day after initiation of therapy, a significant reduction in the presence of fever, pharyngeal injection and sore throat within 2 days, and reduction in pharyngeal injection and tonsillar size at day 3. These findings illustrated that metronidazole therapy was more efficacious than no therapy in relieving the signs and symptoms of acute episodes of NST. These findings should encourage further studies that are prospective and blinded that are needed to evaluate the use of antimicrobials effective against anaerobic bacteria in the treatment of non-GABHS (group A-beta-hemolytic streptococcus) tonsillitis.     

The use of long-acting penicillin in the prophylaxis of recurrent tonsillitis

The authors report a study designed to explore the usefulness of long-acting penicillin in the management of recurrent tonsillitis. The trial, conducted in Sri Lanka, involved 179 patients aged 2 to 20 who had suffered multiple attacks of tonsillitis annually. The results showed a significant reduction in the number of attacks of tonsillitis experienced by the treated group, especially those aged 5 to 11, resulting in a drop in the number requiring tonsillectomy.     

双黄连粉针剂治疗急性扁桃体炎疗效观察

目的 :观察双黄连治疗急性扁桃体炎的疗效。方法 :急性扁桃体炎患者 95例 ,随机分为双黄连组和青霉素组 ,分别采用双黄连粉针剂和青霉素治疗 ,并比较两组疗效。结果 :双黄连治疗急性卡他性扁桃体炎和急性化脓性扁桃体炎的有效率分别为 90 .6 %和 81.2 % ;青霉素的有效率分别为 75 .9%和 94 .4 %。双黄连组和青霉素组的总治愈率和总有效率差异无显著性意义 (P >0 .0 5 )。结论 :中药双黄连是治疗急性扁桃体炎的有效药物 ,对病毒感染亦有效     

Sudden sensorineural hearing loss following intramuscular administration of penicillin

We report a case of sudden hearing loss in a patient with acute exudative tonsillitis, occurring 15 minutes after the intramuscular administration of penicillin. Audiological evaluation documented a profound sensorineural hearing loss of the cochlear type. The mechanism of the hearing loss was probably an immediate hypersensitivity (type I) allergic drug reaction. Penicillin is used frequently for the treatment of several infections. Allergic reactions to penicillin are well known and include urticaria, maculopapular exanthems, angio-oedema, bronchospasm and anaphylaxis, but sudden hearing loss has never been recorded.     

Failure of penicillin to eradicate group A beta-hemolytic streptococci tonsillitis: causes and management.

Despite the fact that group A beta-hemolytic streptococci (GABHS) is always susceptible to penicillin, bacteriologic failure occurs in up to 20% of the patients treated with penicillin, and half of these cases are also a clinical failure. Various theories have been offered to explain this phenomenon. One explanation is that beta-lactamase-producing bacteria (BLPB) "shield" GABHS by inactivating penicillin. Beta-lactamase-producing bacteria were recovered from over 75% of the tonsils of patients who had tonsillectomy for recurrent infection. The absence of interfering aerobic and anaerobic organisms in many patients may also lead to failure of penicillin therapy in these individuals. Other explanations include noncompliance with a 10-day course of therapy, carrier state, re-infection, bacterial interference, GABHS intracellular internalization, and penicillin tolerance. Penicillin is still considered the antibiotic of choice for the therapy of GABHS tonsillitis. However, antibiotics other than penicillin were found to be more effective in eradicating the infection. These included cephalosporins (of all generations), clindamycin, macrolides, and amoxicillin-clavulanate. These agents were more effective than penicillin, especially in treating patients who failed previous penicillin therapy. Treatment of tonsillitis in patients who failed penicillin therapy is aimed at the eradication of the the BLPB that protect GABHS from penicillin, while preserving the oropharyngeal "protective" organisms. This review will describe the scientific and clinical data that demonstrate and explain the phenomena of beta-lactamase production and bacterial interference.     

Treatment of chronic tonsillitis: prognostic criteria of efficacy

An original method of wedge dehydration of biological fluids assessing the ability for separation of organic and mineral constituents was for the first time used in patients with different forms of chronic tonsillitis (CT). The method was used in 102 patients aged 8-68 years with chronic inflammation of the palatine tonsils out of exacerbation. A dehydrated drop of tonsillar lacuna discharge (TLD), facia, was studied morphologically under microscope at small magnification (x10--x50). Three types of TLD facia were identified in CT patients. These types characterized severity of the pathological process in the palatine tonsils. Changes of facia type in patients with different CT forms were compared. Basic regularities in the disease progress were determined. This enabled prognosis of a further course of CT in an individual patient and, therefore, planning treatment policy for each case.     

Treatment of recurrent acute tonsillitis with clindamycin. An alternative to tonsillectomy?

The failure of treatment with penicillin in patients suffering from acute beta-haemolytic streptococcus Group A tonsillitis, may be due to the presence of beta-lactamase-producing bacteria. Several studies indicate that treatment with clindamycin may prevent recurrence and thereby eliminate the need for tonsillectomy. In this prospective study, 54 patients with recurrent acute tonsillitis were investigated. 29 patients were treated with clindamycin, 150 mg 4 times daily for 10 days, while 25 patients received no antibiotic treatment and served as a control group. A significantly reduced number of episodes of acute tonsillitis (P less than 0.01) and of tonsillectomy (P less than 0.001) was found in the group of patients treated with clindamycin.     

Treatment of lingual tonsillitis by transoral CO2 laser endoscopy

The authors report on their clinical experiences concerning 100 cases of chronic lingual tonsillitis. The surgical treatment employed was endoscopic vaporization of affected tissues with the CO₂ laser. Prior to surgical intervention, predisposing conditions such as allergy, rhinosinusitis, and gastroesophageal reflux were identified and treated. The surgical technique consisted of progressive vaporization of the lymphoid tissue at the base of the tongue until the lingual fascia was reached. A slightly defocused (700 mm) continuous 10–15W laser beam was used at a working distance of 400 mm. Following surgery, no dyspnea was observed secondary to epiglottis edema and only one patient required postoperative hemostasis. Symptoms related to tonsil or tongue inflammation were eliminated or alleviated in 87 patients, remained unchanged in 12 patients and were worse in 1 patient.     

Changes of hearing in photon hemotherapy of patients with neurosensory hearing loss]

Results of photon hemotherapy (PH) of 63 patients with acute and 97 patients with chronic neurosensory hypoacusis (NH) are available. Hearing correction was made in 23 patients. Changes in the patients' hearing were registered by up-to-date audiological methods. Noise changes in the course of the treatment were examined using visual analogue scale. PH returned hearing to normal age-specific values in 74% of patients with acute NH. In chronic NH and in better speech intelligibility, hearing of pure tones decreased by 20.3 dB. Lowering of noise intensity enabled electroacoustic hearing correction in patients whose hearing had been thought uncorrectable.     

Correction of abnormal hepatic metabolism in sensorineural hypoacusis with photon hemotherapy]

Hepatic metabolism, blood rheology and lipid peroxidation were studied in 160 patients with neurosensory hypoacusis (NSH) at the age of 35 to 74 years. Of them, 63 patients had acute NSH and 97 ones had chronic NSH. Lipid metabolism was involved in the revealed disorders. Photon hemotherapy was effective in correction of hepatic disbolism.