Why do palatine tonsils grow back after partial tonsillectomy in children?

Within the last decade, adenoidectomy with partial tonsillectomy has been revived in children with obstructive sleep-disordered breathing caused by adenotonsillar hyperplasia, generating debate about remaining tonsillar tissue regrowth. The study examined potential risk factors of the regrowth. Prospective, nonrandomised, case series feasibility study of children meeting the criteria for palatine tonsils regrowth after partial tonsillectomy performed in patients with obstructive sleep-related breathing disorder was carried out. Out of 793 operated children, 294 after adenoidectomy and 373 after adenotonsillotomy were followed up for 4 years in 12-month intervals. In 27 children after adenotonsillotomy, regrowth of tonsillar tissue was observed. In 22 individuals after adenoidectomy alone, hyperplasia of palatine tonsils was noted. The children had bacterial cultures of pharyngeal smears and blood samples tested for anti-streptolysin O, C-reactive protein and total IgE. Caregivers completed a questionnaire reporting on: their child’s breathing after surgery; frequency, severity and treatment of upper respiratory tract infections; diet; family history of adenoidal and/or tonsillar hyperplasia; and history of allergy. As controls, 272 participants after adenoidectomy alone and 346 after adenotonsillotomy were examined. The amount of sugar in the diet and the incidence of upper respiratory tract infections after surgery differed between the groups of patients and controls. Other differences were insignificant. The tonsillar tissue remaining after partial tonsillectomy in children has a remarkable tendency to grow back, related to a diet abundant in sugar and numerous upper respiratory tract infections. Tonsillar regrowth was age related and occurred most frequently in individuals older than 7 years.     

Professional dysphonia and its risk factors in the material of the outpatient clinic of the Department of Otolaryngology, Medical Academy of Białystok

Occurrence of professional dysphonia was analysed in a group of 309 patients treated in the Phoniatric Outpatient Clinic, Department of Otolaryngology, Medical Academy in Bia?ystok through the period of 1999-2001. In a group of professional voice users female teachers of primary schools and lower secondary schools predominated. Obtained results were compared with those from a group of 65 persons of other occupations. In the both groups other harmful factors affecting the voice organ were excluded. The clinical assessment included subjective and objective laryngological examination using videolaryngostroboscopy. The clinical material was evaluated in a view of functional and organic disorders of the voice organ. Early occurrence and aggravation of functional changes in the larynx was recorded in non professional voice users in the course of their seniority. In professional patients organic changes were more common and occurred earlier than functional disorders. Severity of dysphonia was related to the larynx pathology, especially of a functional character.     

Does subjective tonsillar grading reflect the real volume of palatine tonsils?

Objectives

The aim of this prospective clinical study was to compare the subjective tonsil size (grade) with real palatine tonsil volume, body mass index, body surface area, age, and gender.

Patients and methods

Two hundred and ninety-two patients with the diagnosis of recurrent acute tonsillitis, ages 3-15 years, (156 male and 136 female) who underwent tonsillectomy were enrolled into this study. The correlation of subjective tonsil size to objective tonsil volume, body mass index, body surface area, age, and gender size was investigated. The statistical correlations were evaluated by Pearsons’ bivariate correlation method.

Results

There was statistically significant correlation between objective volume of tonsils and subjective grading of tonsils (p < 0.001). There was statistically significant correlation between objective volume of tonsils (both right and left tonsil) and body mass index (p = 0.008 and 0.013) respectively. There was statistically significant correlation between objective volume of tonsils and body surface area (p = 0.009). There was statistically significant correlation between volume of tonsils and age (p = 0.017).

Conclusions

Objective tonsil volume is correlated with subjective tonsil size, body mass index, body surface area and age in patients with recurrent acute tonsillitis. Follow-up of palatine tonsil status (volume) of patients with recurrent acute tonsillitis may be decided according to the subjective tonsil size. The correlations of aforementioned parameters to objective tonsil volume should be searched for other pathologies of palatine tonsils.     

Pleomorphic adenomas in the materials of the Department of Otolaryngology of the Academy of Medical Sciences in Poznań

In the years 1958-1997 were surgically treated in the Department of Otolaryngology Karol Marcinkowski University of Medical Sciences in Poznań 365 patients with pleomorphic adenomas. Majority of the tumors originated of the major salivary glands was parotid gland (273 cases). The given materials confirms the viewpoint that enucleation in the pleomorphic adenomas of the parotid salivary gland--based on total removal of the tumor together with the capsule and pouch constitute a completely sure surgical procedure.     

The correlation between EBV viral load in the palatine tonsils of patients with recurrent tonsillitis and concurrent serum titers of VCA–IgG

Epstein–Barr virus (EBV) infection usually occurs in early childhood and can persist in palatine tonsil lymphocytes to induce tonsillitis at a later date. We have examined the presence of EBV in palatine tonsils and relationship between EBV-DNA quantity in tonsil tissues and VCA–IgG quantity in autologous sera. Tonsils were obtained from 36 patients, male 20 (55.6%), female 16 (44.4%) (mean age 7.96 ± 6.97 years), who underwent tonsils removal because of recurrent tonsillitis. Tissues were processed for real-time PCR and patient’s sera were assayed to determine VCA–IgG by VCA–IgG ELISA. In 27 out of 36 cases (75%), positive EBV-DNA reaction was found. However, statistical analysis showed no correlation between EBV-DNA quantity and VCA–IgG quantity. We conclude that tonsils of children can be colonized by EBV and that virus may have a direct and indirect role in recurrent tonsillitis and nasopharyngeal carcinoma.     

Simultaneous enucleation of the tonsils in “Pickwickian patients”

Tonsillar surgery was, from the 19th century, the reference treatment for apneic patients. Adapting to the technical limitations of the time, surgeons devised ingenious procedures. The purpose of this historical note is to travel back to that time and rediscover one of the techniques favored by Chassaignac: “simultaneous enucleation” of the tonsils.     

Localisation and direction of spread in oral and oropharyngeal cancer in the material of Head and Neck Oncological Surgery Department, University of Medical Sciences in Poznań

The directions of tumor spread are determined by the anatomy of the affected organ. The vessel, nerve anatomy and presence of structures, that may potentially constitute a barrier for spread out of the tumor are of crucial importance. The aim of this paper was to presentation of the spreading directions of oral cavity and oropharyngeal squamous cell cancer based on the own experience. Material include 163 patients surgically treated between 2003-2003 in Department of ENT, Head and Neck Oncological Surgery Department in Poznań. The examination was conducted on the base of retrospective analysis of ambulatory charts and the hospital files. Results: 163 (90%) patients were operated for primary oral and oropharyngeal cancer. The primary localization included in the palatine tonsil (82 patients), trunk of the tongue (48 patients) and floor of the mouth (20 patients) were predominated. The spread directions included: floor of the mouth (36) soft palate (35), base of tongue (33), hypopharynx (20) and trunk of tongue (16). The 31 crossed the midline, 27 infiltrated the tonsillopalatine angle, 9 retromolar area and 3 the mucosa of the cheek. Knowledge of anatomy facility in clinical evaluation of spreading malignancy. It helps in proper qualification to surgery or radiotherapy.     

Tadeusz Antowski Ph.D. (1919-1966), from ENT Unit in Dachau to the lectureship in Otolaryngological Clinic of Poznań University

The authors present the biography of the laryngologist Tadeusz Antowski Ph.D. (1919-1966). The medical studies at the University of Poznań, which he started with his brother Marian (1915-1943), were interrupted by World War II. During the Nazi occupation both students were imprisoned in the concentration camp in Dachau, where Marian died in a tragic accident. Tadeusz Antowski was appointed to work in the Laryngological-Eye Station in this camp. After the liberation of Poland he continued his study and work in Otolaryngological Clinic at Poznań University. Having done the PhD thesis he took over the lectureship in this clinic. Soon he was called up to the military service and in 1951 became the chief of Otolaryngological Department in the 8-th Army Hospital in Toruń. He was an active member of Polish Medical Association and the president of the Toruń branch. Tadeusz Antowski died on 02.11.1966 in Gdańsk.     

Analysis of vocal fold paresis in the patient material of the Department of Otolaryngology in Wrocław from 1993 to 2002

The aim of this paper was analysis of vocal fold paresis in the patients referred to ENT Department in Wroc?aw in the years 1993-2002. The study was performed on the base of 304 patients--209 women and 131 men. The average patient's age was 56 years. In all patients phoniatric examination and videostroboscopy were carried out. There were 38% cases of iatrogenic paresis mainly caused by thyroid surgery and cardiosurgery. In 30% causes we found the diseases which caused paresis (mainly infections, cancers, lesions of the central nervous system and injury of head, neck and chest). In about 30% causes we have not found the cause of paresis. Both vocal fold paresis in 98% was caused by thyroid surgery. Left vocal fold paresis was more often then paresis of the right side of vocal fold.     

100 years of the Otto Körner ENT Clinic, Rostock. The merits of Christian Lemcke and Otto Körner in the development of ENT specialty

BACKGROUND: The first special ENT hospital in Germany and northern Europe, the Department of Otorhinolaryngology, Head- and Neck-Surgery "Otto K?rner" in Rostock is celebrating its 100th anniversary on October 25, 1999. METHODS: There is a presentation on the efforts in the ENT-specialty from the beginning considering the special situation at the university of Rostock. RESULTS: The efforts of Christian Lemcke (1850-1894), who associated the three sections Otology, Laryngology and Rhinology are appreciated, Otto K?rner (1859-1935) continued this development. He achieved the building of a special ENT-hospital by his excellent knowledge and surgical skills. The opening date was October 25, 1899, K?rner became the first full professor in Otology and Laryngology in Germany in 1901. His "Textbook Of Otology And It's Bordering Specialties" was published in 1906. As one of the first, he supported the independence of ENT-medicine as a separate field in the course of medicine. CONCLUSION: Today, Otto K?rner's claims are more relevant than ever before, because the today's students in their practical course of medicine and even young doctors at the hospitals obviously show a lack of knowledge in the ENT-field. The current "multiple choice" type of examinations could be one of the main reasons.     

16 years of experience in laryngeal microsurgery with use laser CO₂: cooperation between laryngologist and anesthesiologist - in material of ENT Department of Silesian Medical University

Laryngeal microsurgery is currently the primary method of treatment of many diseases of the larynx. Breakthrough for the development of laryngeal microsurgery was the introduction of laser technology. The laryngeal microsurgery is used mainly laser CO?. Endoscopic laryngeal microsurgery using the laser poses a unique challenge to the anesthesiologist, ensuring safe conditions of anesthesia, the patient and simultaneously appropriate operating conditions for the surgeon for precisely perform the procedure. MATERIAL AND METHODS: Between 1995 and 2010 carried out in the Department of Otolaryngology SUM 832 microsurgical operations of the larynx using a CO? laser. CONCLUSION:The perioperative management and close cooperation with the surgeon and anesthesiologist are essential for safe and efficient conduct of the operation the larynx using a microsurgical CO? laser.