慢性扁桃体炎与扁桃体肥大患者扁桃体中铁和锌含量的研究

目的　通过测定扁桃体组织中铁和锌元素的含量来研究这两种元素在慢性扁桃体炎和扁桃体肥大发病机制中扮演的角色。方法　选取40例在我院行扁桃体切除术的患者,根据病史、临床特征和病理学表现分为扁桃体肥大组和慢性扁桃体炎组。用微波消解-石墨炉原子吸收法测定其扁桃体组织中铁和锌的含量。结果　铁和锌的含量在扁桃体肥大组和慢性扁桃体炎组中均有显著性差异（t 铁=3.89,t 锌=3.63,P 均＜0.001）。扁桃体肥大组中铁和锌的含量均高于慢性扁桃体炎组。结论　扁桃体组织中铁和锌含量的降低会导致扁桃体炎反复发作。     

Tonsillotomy or tonsillectomy?—a prospective study comparing histological and immunological findings in recurrent tonsillitis and tonsillar hyperplasia

We evaluated the differences in histological and immunological findings in children with recurrent tonsillitis and tonsillar hyperplasia and assessed the risk for relapsing tonsillar hyperplasia or recurrent tonsillitis after tonsillotomy in a prospective clinical study. Sixty-four children with recurrent tonsillitis underwent traditional (total) blunt dissection tonsillectomy between October 2003 and July 2004. Partial tonsillectomy (tonsillotomy) using CO₂-laser technique was performed on 49 children with tonsillar hyperplasia and no history of recurrent tonsillitis between August 2003 and March 2005. The present study compares preoperative serum anti-streptolysin-O antibody and immunoglobulin levels (IgG, IgA and IgM), C-reactive protein levels (CRP) and blood leukocyte counts of the two study groups. Additionally the tonsillar tissue removed by tonsillotomy or tonsillectomy was histologically examined in order to determine the grade of hyperplasia, chronic inflammation and fibrosis. Furthermore, the grade of fresh inflammation within the tonsillar crypts of the specimens was analysed. The parents of 40 patients treated by laser tonsillotomy were surveyed in average 16 months. There was no statistically significant difference in preoperative serum anti-streptolysin-O antibody and immunoglobulin levels, C-reactive protein levels and blood leukocyte counts between the two study groups. All specimens showed the histological picture of hyperplasia. There was no statistically significant difference in the grades of hyperplasia between the two study groups. Signs of fresh but mild inflammation within the tonsillar crypts could be found in over 70% of both study groups. Fibrosis only occurred in children with recurrent tonsillitis (9%). In all specimens signs of chronic inflammation could be detected. The histological examinations of specimens from children with repeated throat infections more frequently showed a moderate chronic inflammation of the tonsillar tissue. Two of forty patients treated by tonsillotomy required a subsequent tonsillectomy due to a recurrence of tonsillar hyperplasia but no recurrent tonsillitis occurred. Tonsillotomy with CO₂-laser technique is an effective surgical procedure with a long-lasting effect in patients with tonsillar hyperplasia. The benefits over conventional tonsillectomy are a lower risk for postoperative haemorrhage, reduced postoperative morbidity and accelerated recovery. Even in children with no history of recurrent tonsillitis signs of chronic inflammation histologically can be found in specimens after tonsillotomy. The occurrence of recurrent tonsillitis after tonsillotomy is rare, however. A low incidence of relapsing tonsillar hyperplasia after tonsillotomy should be expected. Preoperative laboratory investigations show few differences in patients with tonsillar hyperplasia and recurrent tonsillitis. Components of the antimicrobial defense system are also produced by chronically infected tonsils. Therefore tonsillotomy with CO₂-laser could also be an option in some patients with mild symptoms of recurrent tonsillitis.     

High recovery of Haemophilus influenzae and group A streptococci in recurrent tonsillar infection or hypertrophy as compared with normal tonsils

One hundred and twenty-six patients who underwent tonsillectomy because of recurrent acute tonsillitis, tonsillar hypertrophy or sleep apnoea were evaluated by tonsillar core culturing. The sleep apnoea patients served as controls, since none of them had tonsillar hypertrophy at ENT examination or any history of recurrent acute tonsillitis, and thus their tonsillar core flora could be regarded as normal. The isolation rate of H. influenzae was much lower among sleep apnoea controls (2.7 per cent) than among either the patients with recurrent acute tonsillitis (20.3 per cent) or those with tonsillar hypertrophy (36.7 per cent) (p less than 0.05), as was that of group A streptococci, 5.4 per cent versus 16.9 and 20 per cent, respectively (though the latter differences were not statistically significant). The isolation frequencies of B. catarrhalis, pneumococci, group C and G streptococci did not differ between the three groups. The high tonsillar core recovery rates of H. influenzae and group A streptococci both in patients with recurrent acute tonsillitis and in those with tonsillar hypertrophy, as compared with normal controls, suggests the possible involvement of these bacteria in both conditions.     

An investigation of the significance of Actinomycosis in tonsil disease

OBJECTIVES: The objective of the study was to establish the incidence of Actinomycosis in the tonsils of children undergoing tonsillectomy or adenotonsillectomy, and to evaluate its role in clinical tonsillar disease. METHODS: This was a prospective controlled study done at the Red Cross Children's Hospital in Cape Town, South Africa over an 8-month period and included all children undergoing tonsillectomy or adenotonsillectomy. All resected tonsils were examined for the presence of Actinomycosis and any signs of significant cryptitis or active tonsillitis. A comparison was made in the incidence of Actinomycosis in children with obstructive sleep apnoea, recurrent tonsillitis or obstructive sleep apnoea and recurrent tonsillitis. The data was further analysed to determine the statistical significance of the association between Actinomycosis of the tonsils and age, sex and histopathological and clinical diagnosis. RESULTS: A total of 344 tonsils were analysed on 172 patients. We found 20 patients (11.6%) with Actinomycosis in the tonsils. The mean age of patients with Actinomycosis was 7.25 years and without Actinomycosis was 5.4 years (p=0.002). Most specimens (16) had no evidence of tissue reaction to Actinomyces, and their presence was found to be due to colonisation of the tonsils only. Actinomycosis was present in 11% of patients with obstructive sleep apnoea, 11% of patients with recurrent tonsillitis and in 9% with obstructive sleep apnoea and recurrent tonsillitis. The difference in incidence of Actinomycosis between these three groups (p=0.94), and between the recurrent tonsillitis group alone compared to the obstructive group (p=0.83), was not statistically significant. There was therefore no statistical significance found between Actinomyces and OSA+/- recurrent tonsillitis. CONCLUSIONS: There was no correlation found between the presence of tonsillar Actinomycosis and recurrent tonsillitis and/or obstructive tonsillar hypertrophy. Histopathologic findings showed no evidence of tissue reaction to Actinomyces and its presence was found to be due to colonisation of the tonsils only. The series did however show a statistically significant correlation between Actinomycosis colonisation and age with Actinomycosis being more common in older children, especially those over 5 years of age.     

Does Helicobacter pylori play a role in the development of chronic adenotonsillitis?

OBJECTIVE: Evaluation of the possible relationship between chronic adenotonsillitis and Helicobacter pylori (HP). PATIENTS AND METHODS: The study was performed prospectively on 91 pediatric patients who underwent tonsillectomy, adenoidectomy or adenotonsillectomy due to chronic tonsillitis and/or adenoiditis. The adenotonsillectomy specimens were examined for HP colonization by rapid urease test (RUT) and immunohistochemical evaluation. Before surgery, anti-HP IgG and IgA antibody titers were detected by enzyme linked immunosorbent assay (ELISA) test in venous blood samples of the patients. RESULTS: The RUT was positive in only two of the adenoidectomy specimens (2.2%) and in none of the tonsillectomy specimens. A positive result was not detected in any tonsillectomy specimens using immunohistochemical examination. Serum IgG antibody was positive in 21 (23%) patients, IgA antibody was detected in 7 (7.69%) patients and both tests were positive only in 3 (3.29%) patients. CONCLUSION: The results of this study suggested that HP would not colonize in tonsil tissue of patients with chronic tonsillitis.     

Tonsillar size is an important indicator of recurrent acute tonsillitis

This prospective study was designed to identify important clinical features in patients with recurrent acute tonsillitis. A total of 195 consecutive children aged from 1 to 16 years were examined and a history of recurrent acute tonsillitis recorded. Patients with obstructive sleep apnoea or recent acute tonsillitis were excluded. Tonsil size was measured on the Brodsky scale [Brodsky L. (1989) Paediatr Clin N Am 36, 1551], tonsil symmetry, cervical lymphadenopathy, and hyperaemia of the anterior pillars was recorded. Patients with a history of recurrent tonsillitis had larger tonsils than those without tonsillitis (P < 0.001). Tonsil asymmetry and cervical lymphadenopathy were more common in patients with recurrent tonsillitis (P < 0.001). Anterior pillar hyperaemia was also more frequent in recurrent tonsillitis (P < 0.01). In addition to the frequency and severity of tonsillitis it is suggested that the size and symmetry of the tonsils, plus cervical lymphadenopathy and anterior pillar hyperaemia should be taken into account when deciding which patients would benefit from tonsillectomy.     

The natural history of recurrent acute tonsillitis and a clinical trial of azithromycin for antibiotic prophylaxis

The pharmacokinetics of azithromycin (Zitromax), Pfizer Inc., USA) in tonsil tissue warranted the present trial. In 110 patients eligible for tonsillectomy because of recurrent acute tonsillitis, surgery was replaced by randomized medication with azithromycin 500 mg or placebo once per week for 6 months. Subsequently, their clinical condition and microbiology was monitored for 12 months. Acute tonsillitis developed in 40% of the patients who received azithromycin and in 49% of the patients in the placebo group (P > 0.05). Accordingly, 45% of all patients developed acute tonsillitis. Resistance to azithromycin was not detected. In this trial long-term medication with azithromycin was not efficacious in recurrent acute tonsillitis. As all patients were eligible for tonsillectomy according to current criteria, it is surprising that only 45% developed acute tonsillitis during the trial period. Therefore, the criteria for tonsillectomy in recurrent acute tonsillitis must be revised.     

Neutrophils are hyperactive in recurrent tonsillitis

The pathogenesis of recurrent tonsillitis has not been fully explored. Most studies in this field have focused on pathogenic bacteria whereas less research has been done concerning the host defense. In earlier studies it was shown that there is an active cellular defense in the tonsillar surface secretion, consisting of phagocytes, and therefore in this study the possibility that this defense is altered in patients with recurrent tonsillitis was explored. Neutrophils were obtained from tonsillar surface secretions in eight patients with recurrent tonsillitis and eight healthy volunteers and the capacity of the neutrophils to respond to chemotactic stimuli was examined in an in vitro system. A significantly higher fraction of the neutrophils obtained from the patients with recurrent tonsillitis responded to chemotactic stimuli compared to those obtained from the healthy volunteers. It is concluded that there is a hyperactive cellular defense in the tonsillar surface secretion in patients with recurrent tonsillitis. This finding and its significance in the pathogenesis of recurrent tonsillitis are discussed.     

Outpatient laser tonsillar ablation under local anaesthetic

Outpatient laser ablation of the palatine tonsils under local anaesthetic is an alternative technique to capsular tonsillectomy for recurrent tonsillitis under general anaesthetic. Laser tonsillotomy ablates up to 70% of the tonsillar tissue and is performed when patients choose not to have a conventional tonsillectomy, or are unfit for a general anaesthetic. The technique described here is an adaptation of Krespis laser-assisted serial tonsillectomy (LAST) whereby only one sitting is required. Krespis technique effectively eliminates recurrent tonsillitis in 96% of the cases over a 4-year follow-up period and represents the only substantial study looking at treating recurrent tonsillitis with outpatient laser ablation. This study is a retrospective postal survey of 19 patients who underwent laser tonsillar ablation under local anaesthetic for recurrent chronic tonsillitis from 1997 to 2001 and was performed in liaison with the clinical audit department at Basildon Hospital. We had a response rate of 74% and an admission rate of 0%, which compares favourably with day case tonsillectomy surgery. Of the patients, 75% did not experience further episodes of tonsillitis 12 months after the procedure and 77% of the patients were glad they had the operation. Although this technique does not completely eliminate tonsillitis, it offers an alternative for those patients who prefer a procedure that is done quickly in an outpatient setting without the additional problems of general anaesthesia, overnight hospital admission and long waiting lists.     

Neutrophils are Hyperactive in Recurrent Tonsillitis

The pathogenesis of recurrent tonsillitis has not been fully explored. Most studies in this field have focused on pathogenic bacteria whereas less research has been done concerning the host defense. In earlier studies it was shown that there is an active cellular defense in the tonsillar surface secretion, consisting of phagocytes, and therefore in this study the possibility that this defense is altered in patients with recurrent tonsillitis was explored. Neutrophils were obtained from tonsillar surface secretions in eight patients with recurrent tonsillitis and eight healthy volunteers and the capacity of the neutrophils to respond to chemotactic stimuli was examined in an in vitro system. A significantly higher fraction of the neutrophils obtained from the patients with recurrent tonsillitis responded to chemotactic stimuli compared to those obtained from the healthy volunteers. It is concluded that there is a hyperactive cellular defense in the tonsillar surface secretion in patients with recurrent tonsillitis. This finding and its significance in the pathogenesis of recurrent tonsillitis are discussed.     

Asymptomatic Group A Streptococcus carriage in children with recurrent tonsillitis and tonsillar hypertrophy

BackgroundGroup A Streptococcus (GAS) is the most important bacterial cause of acute tonsillitis in children. Some children are chronic GAS carriers, and this carriage is poorly understood. We determined the frequency of GAS detection using a rapid antigen detection test in pediatric patients with indications for tonsillectomy due to adenotonsillar hypertrophy or recurrent GAS infections.MethodsSeventy-two patients underwent a tonsil swab for a rapid antigen detection test.ResultsThe GAS rapid antigen detection test was positive in 18.1% of children. GAS was not associated with sex, age or previous history of recurrent tonsillitis. Also, the prevalence of GAS was similar between patients with either recurrent tonsillitis or tonsil hypertrophy.ConclusionIn our study, the GAS carriage rate was similar to other reports, and GAS carrier state was not correlated with recurrent tonsillitis.     

Bacteriology of normal and diseased tonsils assessed by fine-needle aspiration: Haemophilus inf luenzae and the pathogenesis of recurrent acute tonsillitis

The pathogenesis of recurrent tonsillitis is largely unknown. Selection of appropriate antibiotic therapy for patients with recurrent tonsillitis is difficult because of the limitations of traditional methods of sampling tonsillar microflora and the increasing incidence of β-lactamase producing bacteria in the tonsil. In addition, little attention has been paid to the bacteriology of normal tonsils. The tonsil core bacteria was assessed in 124 patients with recurrent acute tonsillitis. Fifty-five of these patients were randomly selected for fine-needle aspiration which revealed a similar profile of bacteria in 85%. Fine-needle aspiration of 10 normal tonsils found few pathogens; the predominant organisms being normal flora. No Haemophilus influenzae were detected in this control group. This study demonstrates the accuracy of fine-needle aspiration in identifying tonsil core bacteriology and its suitability in the clinical setting. It reports on the flora of normal healthy tonsils and it highlights the association between H. influenzae and recurrent acute tonsillitis.     

Comparison of histology between recurrent tonsillitis and tonsillar hypertrophy

To elucidate the aetiology of tonsillar hypertrophy and recurrent tonsillitis, it is important to determine whether a difference exists between these two conditions in microanatomical architecture. The aim of this study was to investigate the difference in follicle size and numbers in tonsils for patients with tonsillar hypertrophy and recurrent tonsillitis using an image analysis method. Our results showed that there was no significant difference in the mean follicle numbers per counting field (40x magnification) between recurrent tonsillitis (4.5 +/- 2.1) and tonsillar hypertrophy (3.8 +/- 0.5). However, the mean follicle area in the tonsillar hypertrophy group (0.23 +/- 0.02 mm2) is significantly (P < 0.01) larger than in the recurrent tonsillitis group (0.15 +/- 0.02 mm2). Our study demonstrates that tonsillar hypertrophy is characterized histologically by an enlargement of follicles compared with chronic tonsillitis, indicating a hyperplastic condition of lymphoid cells in the germinal centres. It may also explain the difference in aetiology and/or immune defence mechanism underlying these two conditions.     

Colonization by Haemophilus influenzae and group A streptococci in recurrent acute tonsillitis and in tonsillar hypertrophy

One hundred patients subjected to tonsillectomy because of recurrent acute tonsillitis or tonsillar hypertrophy were evaluated bacteriologically both with ordinary throat culturing and cultures from tonsillar cores. In 26% of the patients H. influenzae was isolated and in 20% beta-haemolytic group A streptococci. Growth of B. catarrhalis was obtained in 10% and group C-, group G streptococci or pneumococci in less than 5% each. None of the group A streptococcal strains proved tolerant to penicillin. A much higher isolation rate of H. influenzae was found in cultures obtained from tonsillar core tissue (23%) than from ordinary throat cultures (2%). This was also the fact, though to a lower extent, regarding group A streptococci. H. influenzae and group A streptococci were isolated as often in patients with tonsillar hypertrophy as in patients suffering from recurrent acute tonsillitis, suggesting a role of these bacteria in both conditions.     

睡眠呼吸障碍儿童扁桃体及腺样体组织细菌学分析

目的　探讨睡眠呼吸障碍（sleep disordered breathing,SDB）儿童扁桃体及腺样体组织的细菌学特点。方法　经多导睡眠图监测确诊的163例SDB患儿纳入研究,其中120例同时接受扁桃体及腺样体切除术,4例接受单纯扁桃体切除术,39例接受单纯腺样体切除术,124例接受扁桃体切除术的患儿按照有无扁桃体炎反复发作的病史分为两组,扁桃体炎组71例和无扁桃体炎组53例。术中取部分扁桃体和（或）腺样体组织进行细菌学检查。结果　120例患儿中的114例（95.00%）两个部位分离出的细菌种类相同,120例中有17例（14.17%）两个部位均感染了两种细菌,混合感染的细菌种类均相同。在各个季节两个部位中金黄色葡萄球菌和流感嗜血杆菌的检出率无显著性差异（扁桃体：χ2=8.538,P =0.201;腺样体：χ2=5.427,P =0.490）。有无慢性扁桃体炎病史的扁桃体组织内的各种细菌检出率无显著性差异（χ2=3.028,P =0.387）。结论　同一个SDB患儿的扁桃体和腺样体组织检出的细菌种类几乎相同,有无慢性扁桃体炎病史的扁桃体组织内的不同细菌检出率无显著性差异。     

Tonsillar microbial flora: comparison of recurrent tonsillitis and normal tonsils

Tonsillar microbial flora was studied in cultures of tonsillar core specimens from 34 patients tonsillectomized due to recurrent group A streptococcal pharyngotonsillitis (n = 17) or sleep apnoea (n = 17). Patients in the sleep apnoea subgroup, who had no history of recurrent tonsillitis and manifested no tonsillar hypertrophy at ENT examination, served as controls. Tonsillar core specimens were cultured for semi-quantitative estimation of growth of aerobic, anaerobic and facultative organisms. The recurrent tonsillitis and apnoea subgroups did not differ significantly in the mean number of isolates per patient, either of aerobic spp. (3.8 vs. 4.3) or anaerobic spp. (5.2 vs. 4.7). Nor did the two subgroups differ significantly in the proportion of patients whose specimens manifested beta-lactamase producers (71% vs. 59%), in the isolation frequency of viridans (alpha) streptococci, or in the occurrence of semi-quantitative growth estimates of 3-4+ for aerobic, anaerobic or beta-lactamase-producing spp. Thus, the study provided no support for the hypothesis that inactivation of penicillin V by beta-lactamase-producing bacteria in oral or throat flora, or the eradication of viridans streptococci with their GAS-inhibitory capacity, is an important factor with regard to recurrent group A streptococcal tonsillitis. Other possible explanations, such as poor antibiotic penetration at the site of infection, are discussed.     

Immunodiagnosis of chronic tonsillitis]

Current methods of allergo- and immunodiagnosis of chronic tonsillitis are reviewed. Among them, attempts to use serological tests and reactions of cell type for defining course and form of chronic tonsillitis. Single tests, especially those basing on the suggested etiological factors, are thought uneffective. The available knowledge on functional characteristics of the lymphopharyngeal ring allows to offer some immunological tests for development of the laboratory-diagnostic algorithm aimed primarily at assessing feasibility of tonsil tissue repair for decisions on therapeutic policy rather than determination of the tonsillitis form.     

The role of bacteriological examination in diagnosis of chronic tonsillitis

A bacteriological examination was made in 105 patients with various forms of chronic tonsillitis. Eighteen cultures of beta-hemolytic streptococcus (BHSA) were isolated from 36 patients with paratonsillar abscesses. BHSA seeding in paratonsillar abscess was 50.0%. Eight BHSA cultures were isolated from 69 patients with chronic tonsillitis. BHSA seeding in chronic tonsillitis was 11.6%. Adequate set of culture media for BHSA growth was optimized. The technique of the sample collection from tonsillar lacunes was improved. The significance of bacteriological diagnosis of chronic tonsillitis increases considerably due to optimization of out- and intralaboratory tests at the preanalytic stage of the study.     

腭扁桃体中β-防御素的表达及意义

目的 :检测人β 防御素 (hBD) 1,2mRNA在慢性扁桃体炎组织和正常对照组织中的表达 ,分析腭扁桃体在天然免疫中的作用。方法 :应用逆转录聚合酶链反应技术检测 10例扁桃体炎组和 8例正常对照组中hBD 1和hBD 2mRNA的表达。结果 :hBD 1mRNA在扁桃体炎组和正常对照组中均有表达 ,且两组间差异无统计学意义 (P >0 .0 5 )。hBD 2mRNA在正常对照组中仅有微弱表达 ,而在扁桃体炎组中表达明显增强 (P <0 .0 5 )。结论 :扁桃体通过表达hBD在天然免疫中发挥重要作用。     

Comparison of tonsillar biofilms between patients with recurrent tonsillitis and a control group

Abstract Conclusion: The results of the study suggest that biofilms play a causative role in recurrent tonsillitis. Objective: To analyze the association between tonsillar biofilms and recurrent tonsillitis. Methods: The recurrent tonsillitis group comprised patients with a history of at least five episodes of tonsillitis per year over the previous 2 years. The control group comprised volunteers scheduled for laryngeal microsurgery with no history of tonsillitis over the previous 2 years. Between October 2009 and August 2010, specimens were obtained from 20 patients with recurrent tonsillitis and 20 volunteers (controls). Scanning electron microscopy (SEM) was used to confirm the presence of biofilms. Biofilms were graded at a magnification of ×500 by SEM and classified into five grades. The percentages of subjects affected and biofilm grades were compared between the recurrent tonsillitis and control groups. Results: The two groups were matched for age and sex. SEM revealed that biofilms were significantly more prevalent in the recurrent tonsillitis group than in the control group. Furthermore, the biofilms in the recurrent tonsillitis group were of significantly higher grade than those in the control group.