The use of Decasan in the local treatment of chronic inflammatory diseases of the tonsils

The local sanitation in 40 patients with recurrent tonsillitis was carried out, using Decasan for washing of the lacunae of the palatine tonsils. Clinical observations and bacteriological studies have shown greater efficacy of Decasan in relation to the main pathogens of the tonsillar lacunae, compared to antibiotic solutions traditionally used for washing. Decasan is a highly effective and safe antiseptic for local treatment of patients with chronic inflammatory diseases of the tonsils, contributing to the restoration of local biocenosis, which is confirmed by an increase in the plaiting of normal microflora from the surface of the tonsillar lacunae.

Transoral Endoscopic Examination of the Oropharynx With Tongue Protrusion, Phonation, and Open Mouth

Background/Aim: We examined the diagnostic performance of the tongue protrusion with phonation and open mouth (TOPPOM) method for visualizing structures of the oropharynx. Patients and Methods: Transoral endoscopy was performed on 20 healthy participants to evaluate 12 oropharynx subsites under three conditions: open mouth (OM), phonation with open mouth (POM), and TOPPOM. Each subsite was scored from 0 to 2 depending on subsite visualization, and the scores were summed. Images of subsite-adjacent mucosa were similarly scored. Results: The total scores were significantly higher for TOPPOM than for POM and for POM than for OM. Such scores were observed for both the palatine arches, both palatine tonsils, the left lingual tonsillar sulcus, and the vallecula. Conclusion: TOPPOM enables visualization of the oropharynx through transoral endoscopic examination, and TOPPOM with conventional transnasal endoscopy may enable early detection of oropharyngeal carcinomas and lesions and improve the performance of pre- and post-treatment evaluations.

Sleep Endoscopy Findings in Children With Obstructive Sleep Apnea and Small Tonsils

Objective: Obstructive Sleep Apnea (OSA) in children is treated primarily with adenotonsillectomy (AT). When clinical exam demonstrates small tonsils, the success of AT in resolving OSA is uncertain. The purpose of this study is to determine the utility of Drug induced Sleep Endoscopy (DISE) for children with OSA and small tonsils (Brodsky scale 1+) and to identify what obstructive trends exist in this subset of patients and to determine the utility of DISE-directed surgical intervention in patients with small tonsils. Methods: A retrospective chart review was performed for patients who underwent DISE at a tertiary care center over a 2-year period. Inclusion criteria were 1+ tonsils and a positive sleep study. Data collected included DISE findings, BMI, comorbid conditions, and pre-op PSG data. Results: Forty children were included with a mean age of 5.0 years (range 8 months-16 years). Mean preoperative AHI was 5.46 and mean oxygen saturation nadir was 87.1%. The most common contributor to airway obstruction was the adenoid (29 patients, 72.5%), followed by the tongue base or lingual tonsil (21 patients, 52.5%). The palatine tonsils (10 patients, 25.0%), epiglottis (10.0%), or obstruction intrinsic to the larynx (10.0%) were significantly less frequently identified as contributors to OSA when compared to the adenoid ( P < .001). The majority of patients had multilevel obstruction (25 patients, 62.5%). Adenoidectomy (27 patients, 67.5%) was the most commonly performed procedure, followed by tonsillectomy (10 patients, 25.0%, P < .001) and tongue base surgery (9 patient 22.5%, P < .001). Conclusion: In this group, small palatine tonsils were infrequently identified as a contributor to airway obstruction and tonsillectomy was avoided in most cases. This study illustrates the utility of DISE as a tool to personalize the surgical management of pediatric patients with OSA and small tonsils on physical exam.

Genome of Helicobacter pylori and Serotype of HPV Detected in Oropharyngeal and Laryngeal Cancer and Chronic Inflammation Patients

Objective: Oropharyngeal/laryngeal carcinoma are common cancers of the upper aerodigestive system. Human papillomavirus (HPV) is described as the most frequent in the cancer of unknown primary. The presence of Helicobacter pylori (HP) in the oral cavity is discussed in some papers. The aim of study: To analyze the incidence of HPV and HP in oropharyngeal/laryngeal cancer persons versus persons with chronic tonsillar inflammation and healthy persons. Methods: The samples were taken in three groups: (1) tissue of oropharynx/larynx cancer (103 specimens); (2) tissue of palatine tonsils (85 specimens); and (3) healthy control group (50 specimens). We analyzed the presence of HP (PCR) and HPV genomic DNA (Sacace HPV High-Risk Screen Real-TM Quant) in the samples. Results: HP was detected in 86 samples (83.5%) and high-risk HPV in 62 samples (60.2%). We found a very high incidence of HP. In the cancer group, HP was detected in 82.5% cases and HPV positivity in 57.8%. In total, 7.2% of the cancer patients were negative for HP and HPV together. In turn, 53.6% of the cancer patients were positive for HP and HPV together. Four cases (4.2%) were positive for HPV only. VacA positivity was detected in 82 (79.6%) of the cancer cases and VacA negativity in 21 (20.4%) if the cancer cases. The incidence of HP in chronic inflammation (n = 85) was 65 cases (76.5%) and the incidence of HPV was 38 cases (44.7%). VacA positivity was detected in 59 (69.4%) of the chronic inflammation cases and VacA negativity was found in 26 (30.6%) of the chronic inflammation cases. Regarding the control group, we found HP positivity in 5 cases (11.1%) and HPV positivity in 19 cases (42.2%). There was VacA positivity in 6 cases (50.0%) of the control group. Statistically significantly lower prevalence of HP (p < 0.001) and HPV (p = 0.006) was found in the control group. Conclusions: We suggest that the palatine tonsils are colonized by HP. In our study, HP was present in oropharyngeal cancer in more cases in comparison with HPV infection. The presence of VacA from HP can have an influence on the human epithelial and immune cells’ regulation ways. Our results do not support idea that the CagA-positive HP is a primary carcinogen in oropharyngeal area.

CT texture analysis of tonsil cancer: Discrimination from normal palatine tonsils

The purposes of the study were to determine whether there are differences in texture analysis parameters between tonsil cancers and normal tonsils, and to correlate texture analysis with 18F-FDG PET/CT to investigate the relationship between texture analysis and metabolic parameters. Sixty-four patients with squamous cell carcinoma of the palatine tonsil were included. A ROI was drawn, including all slices, to involve the entire tumor. The contralateral normal tonsil was used for comparison with the tumors. Texture analysis parameters, mean, standard deviation (SD), entropy, mean positive pixels, skewness, and kurtosis were obtained using commercially available software. Parameters were compared between the tumor and the normal palatine tonsils. Comparisons were also performed among early tonsil cancer, advanced tonsil cancer, and normal tonsils. An ROC curve analysis was performed to assess discrimination of tumor from normal tonsils. Correlation between texture analysis and 18F-FDG PET/CT was performed. Compared to normal tonsils, the tumors showed a significantly lower mean, higher SD, higher entropy, lower skewness, and higher kurtosis on most filters (p<0.001). On comparisons among normal tonsils, early cancers, and advanced tonsil cancers, SD and entropy showed significantly higher values on all filters (p<0.001) between early cancers and normal tonsils. The AUC from the ROC analysis was 0.91, obtained from the entropy. A mild correlation was shown between texture parameters and metabolic parameters. The texture analysis parameters, especially entropy, showed significant differences in contrast-enhanced CT results between tumor and normal tonsils, and between early tonsil cancers and normal tonsils. Texture analysis can be useful as an adjunctive tool for the diagnosis of tonsil cancers.

Evolution of bronchial obstruction pattern in children of presсhool age

Introduction. The diagnosis of asthma presents objective difficulties in children aged less than 5 years. Not all children with recurrent virus-induced obstruction can further develop asthma.Aim. To assess the realization of different clinical and pathogenetic variants of bronchoobstructive syndrome in the child population.Materials and methods. Risk factors of 75 patients with bronchoobstructive syndrome in the first 5 years of life were retrospectively evaluated. 57 patients were surveyed using the “Asthma Prediction Tool” questionnaire. At the end of the follow-up period (one year), cases of bronchial asthma were evaluated.Results. A predictive contribution to the implementation of the recurrent variant of bronchoobstructive syndrome has a burdened hereditary allergic anamnesis (OR=5,4, CI 1,79-16,46, p<0,05) and the presence of atopic dermatitis (OR=7,7, CI 2,73-21,95, p><0,05). Symptoms of allergic rhinitis in combination with hypertrophy of the Palatine tonsils in 6,06 and 3,45 times, respectively, increase the risk of bronchial asthma (p><0.05). Conclusion. As a result of research, there are significant factors in the implementation of bronchial asthma such as concomitant allergic diseases in combination with a hereditary background and hypertrophy of the palatine tonsils. The>˂ 0,05) and the presence of atopic dermatitis (OR=7,7, CI 2,73-21,95, p˂ 0,05). Symptoms of allergic rhinitis in combination with hypertrophy of the Palatine tonsils in 6,06 and 3,45 times, respectively, increase the risk of bronchial asthma (p˂ 0.05).Conclusion. As a result of research, there are significant factors in the implementation of bronchial asthma such as concomitant allergic diseases in combination with a hereditary background and hypertrophy of the palatine tonsils. The “Asthma Prediction Tool” questionnaire allows you to predict the development of bronchial asthma in patients with episodic and recurrent bronchial obstruction. The article will be useful for both pediatricians and primary care professionals, as it allows to rationally influence the risks of bronchial asthma formation.

Bacterial adhesion of palatine tonsils epithelial cells in infectious mononucleosis

Aim. To evaluate the features of pharynx tonsils mucous membrane colonization by pathogenic and opportunistic microorganisms using electron microscopic examination of pharynx palatine tonsils epithelium in patients with infectious mononucleosis and acute streptococcal tonsillitis. Materials and Methods. Two patients, i.e. a patient P. (12 years old) with a confirmed diagnosis of infectious mononucleosis, and patient A. (8 years old) with acute streptococcal tonsillitis diagnosis were examined. A bacteriological examination of mucus and epithelium scraping from the surface of the pharyngeal tonsils was conducted. Tissue samples were examined in the electron microscopy laboratory of the Lviv National University. Results and Discussion. 36 tonsils epithelial tissue micro preparations of patient A. and 41 micro preparations of patient P. were studied. Streptococcus pyogenes, Str. pneumoniae, Str. viridans, Сandida albicans, as well as non-pathogenic bacteria, Diphtheroides sp., Neisseria sp., and Corynebacterium spp. were identified as result of the bacteriological examination of mucus from the surface of the pharyngeal tonsils of the patient P.. Staph. aureus, Str. Viridans, and Str. pneumoniae were identified during a bacteriological examination of the patient A. Eosinophils with a two-segmented nucleus, specific granularity, phagocytosed spherical bacteria in the cytoplasm were detected during the histological examination of the materials taken from the surface of the patient with acute tonsillitis tonsils. Research shows that bacteria accumulate not only in the structure of extracellular detritus. Numerous bacteria accumulations were found in the cytoplasm of the epithelial cells in the patient with infectious mononucleosis also. The cell's shape resembles a bunch of grapes. Conclusions. The electron microscopic examination showed differences in the coccal flora localization. The extracellular localization of bacteria in the patient with acute bacterial tonsillitis, and intraepithelial presence of the bacteria in the patient with tonsillitis during infectious mononucleosis were found.

Electron-Microscopic Studies on the Palatine Tonsil of the Buffalo (Bubalus bubalis)

The study examined the ultrastructural features of the palatine tonsils of the local mixed breed of adult buffaloes using scanning and transmission electron microscopy. The tissue samples collected from the palatine tonsils were fixed in 2% glutaraldehyde solution and processed for scanning and transmission electron microscopy. The scanning electron microscopy of the tonsil's surface epithelium presented folded mucosa consisting of folds divided by shallow grooves. The mucosal surface was having a squamous arrangement of cells that were delineated from the adjacent cells. These cells at higher magnification presented the microplicae, which appeared as if filled with material. A few small duct openings were irregularly placed throughout the mucosal surface. The transmission electron-microscopy elaborated structural details of the distinct strata of the surface and reticular epithelia, the cell organelles as well as the lymphocytes migration across the high endothelial venules. The vesiculo-vacuolar organelle was also observed. The study provided detailed ultramicroscopic features of the palatine tonsil, which might play a significant role in the induction of immunity against ingested antigens sampled at the mucosal surface.