Etiological aspects of chronic pathology of the lymphepithelial pharyngeal ring in children at the present stage

The lymphoepithelial pharyngeal ring is located in the entrance gate and is constantly exposed to infectious agents. Currently, chronic pathology of the lymphoepithelial pharyngeal ring remains one of the most common problems in the practice of a pediatric doctor. Hypertrophy of the pharyngeal tonsil, chronic adenoiditis, which occurs in 35.3% of children under the age of 7 years, and chronic tonsillitis, which occurs in 15-63% of cases, are among the most common diseases of childhood. Taking into account the wide range of infectious microbiota that contributes to the development of chronic pathology of the lymphoepithelial pharyngeal ring, the issue of differential diagnosis of the etiology of the disease and the selection of adequate treatment regimens remains relevant. In most cases, at the present stage, the approach to the treatment of patients with chronic inflammation of the lymphoid ring of the pharynx in children is reduced to replacing the surgical method with a conservative one with the appointment of immunocorrective and immunomodulatory drugs. The lack of a positive effect of the ongoing conservative treatment, clinical and laboratory signs of persistent streptococcal infection say us about the need for surgical treatment. At the same time, a group of frequently ill children requires special attention with the development of new regimens of the immunocorrecting and immunomodulating drugs usage.

Prospects for the use of bacterial lysates in the complex therapy of chronic adenoiditis

Introduction. Adenotomy is a common surgical procedure in childhood. In children with recurrent infections of the respiratory tract, hypertrophy of the pharyngeal tonsil, a sign of lymphoproliferative syndrome of a secondary immunodeficiency state, is characterized by reduced adaptive abilities of mucosal immunity with impaired biocenosis in chronic inflammation. Pharyngeal tonsil surgery is considered stressful in frequently ill children and therefore requires preoperative preparation. In this context, it is relevant to study the nature of changes in the factors of mucosal immunity in terms of cell destruction in the nasal secretion in the complex treatment of children with hypertrophy of the pharyngeal tonsil and chronic adenoiditis, as prevention of complications in the postoperative period of adenotomy.Aim. To increase the effectiveness of the treatment of chronic adenoiditis in children with recurrent infections of the respiratory tract using the combined effect of low-frequency ultrasonic cavitation with monochromatic unpolarized light and bacterial lysates.Materials and methods. In order to test the hypothesis about the possibility of canceling adenotomy in 77 children aged 3-6 years with hypertrophy of the pharyngeal tonsil, accompanied by chronic inflammation. The effectiveness of the complex treatment was assessed by the functional and metabolic status of nonspecific resistance factors in the nasal lavage.Results and discussion. The combined effect of low-frequency ultrasonic cavitation with photochromotherapy and bacterial lysates leads to the normalization of pathophysiological changes on the surface of the mucous membrane, leading to a balance of the qualitative and quantitative composition of the functional-metabolic status of NG, which makes it possible to postpone adenotomy. The best clinical result is observed when bacterial lysates are used in complex therapy in combination with physiotherapy in children with chronic adenoiditis and, to a certain extent, substantiate the advisability of a combined effect as a non-invasive and effective method.Conclusions. Topical bacteriolysate in a complex treatment regimen for children with recurrent infections of the respiratory tract against a background of chronic inflammation eliminates bacterial antigens and enhances the intrinsic defenses of the mucous membrane of the pharyngeal tonsil.

Diagnosis Issues and Management of Nasopharyngeal Non-Hodgkin Lymphomas

Background: Non-Hodgkin lymphomas (NHL) comprise a variety of lymphoproliferative malignancies with certain differences related to the morphological, clinical, immunohistochemical and hematological patterns, as well as the results of treatment. The patients with generalized and relapsed nasopharyngeal NHL experience marked disease burden and unfavorable impact on their life quality and working capacity. Objective: The aim of the study was to characterize the diagnosis issues of NHL with primary involvement of the nasopharynx and evaluate the short- and long-term results of management options. Materials and methods: This analytical and cohort study included 66 patients with different stages of nasopharyngeal NHL, who were managed at the Institute of Oncology from Moldova between 2014-2021. The diagnosis was confirmed by cytological, histopathological and immunohistochemical examinations. The histological types of NHL were verified and distinguished according to the 2017 Revision of WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues. The patients treatment, follow-up and researches were realized at the comprehensive cancer center. The study was related to the hospitalized care. The patients age ranged between 19-85 years (average age - 58.4±2,14 years). Males were 28 (42%), females - 38 (58%). Stage I NHL was diagnosed in 10 (15.2%) cases, stage II - in 36 (54.5%), stage III - in 8 (12.1%) and stage IV - in 12 (18.2%). The eligible NHL patients underwent combined chemotherapy (CChT) regimens (CVChlP, R-CVChlP, CHOP and R-CHOP), associated with radiotherapy locoregional treatment in cases of bulky disease or residual tumor masses. The ECOG-WHO score and complete response (CR) rate assessed the short-term results. The long-term results were asserted by the overall one- and 5-year survival. Results: Primary nasopharyngeal NHL occurred commonly in females (58%) and in patients over 60 years (42.4%). The ECOG-WHO score accounted 1-3 at diagnosis. The aggressive NHL were diagnosed mostly (76.1%) in stage I and II due to the earlier developed disease burden. The primary tumor site was localized in the palatine tonsils in 22 (33.3%) patients, in 33 (50%) patients in the pharyngeal tonsil, in 2 (3%) patients in the lingual tonsil. The palatine and pharyngeal tonsils were concomitantly involved in 9 (13.7%) patients. Palatine tonsil involvement occurred mostly in patients over 60 years old, and pharyngeal tonsil involvement - in patients of 40-59 years. CR was achieved in 10 (100%) cases with stage I after combined chemotherapy (CChT) and radiotherapy locoregional treatment. CR occurred in 21 (67.7%), partial response (PR) - in 7 (22.6%) and response failure (RF) - in 3 (9.7%) in stage II NHL after CChT and radiotherapy locoregional treatment. In stage II NHL treated with CChT along, CR was achieved in 1 (25%), PR - in 2 (50%) and RF in 1 (25%). In stage III treated with CChT and radiotherapy locoregional treatment, CR was registered in 1 (20%), PR - in 2 (40%) and RF - in 2 (40%). PR occurred in 2 (66.7%), RF - in 1 (33.3%) in stage III managed with CChT alone. In stage IV NHL, CR was obtained 1 (11.1%) case, PR - in 5 (55.6%), RF - in 3 (33.3%) after CChT and radiotherapy locoregional treatment. PR occurred in 1 (33.3%), RF - in 2 (66.7%) cases in stage IV patients managed with CChT alone. No significant differences of CR rate were found in stage III (12,5%) and stage IV (8.3%) NHL (P>0.05). Irrespective of the stage, the highest CR rate was registered after CChT and radiotherapy locoregional treatment (97.1% of all cases), as compared to CChT alone (2.9% of all cases). The ECOG-WHO score reached 0-1 under the management with CChT and radiotherapy locoregional treatment in all cases with CR and PR. The overall survival was 79.9% at one year and 34.5% at 5 years. One- and 5-year survival proved to be significantly higher în stage I and II NHL - 96.1% and 64.2% respectively. One- and 5-year survival was 79.9% and 34.5% in stage III and IV NHL. Conclusions: Primary nasopharyngeal NHL were outlined by the predominant involvement of females, patients over 60 years and frequent site in the pharyngeal tonsil. The aggressive NHL were revealed commonly in stage I and II due to the progressive disease burden. The rates of the indolent and aggressive NHL turned out to be statistically equal in stage III and IV. The response and overall survival rates proved to be superior after R-CHOP regimen followed by the radiotherapy locoregional treatment. Disclosures No relevant conflicts of interest to declare.

Treatment of acute nasopharyngitis in children

Acute nasopharyngitis in children is an inflammation of the nasopharyngeal mucosa. Recently, the use of saline solutions in the pathology of the nose and nasopharynx has become a leader in cleaning the mucous membrane. The main direction of modern pharmacotherapy of pathology of the nose and nasopharynx today is antiinflammatory therapy. There are a sufficient number of studies proving the effectiveness of mometasone furoate nasal spray in the treatment of inflammatory diseases of the nasopharynx in children. Our study examined the clinical efficacy of Etacid in the treatment of acute nasopharyngitis in children. Among the clinical symptoms were considered nasal breathing disorders, nasalness, snoring, cough during sleep. Endoscopy studied stagnant signs in the nasal cavity, nasopharyngeal discharge, enlargement of the pharyngeal tonsil. Proven sufficient clinical efficacy of the drug "Etacid" in the treatment of acute nasopharyngitis.

Elderly woman with acute necrotizing ulcerative gingivitis (Vincent disease): a case report

Acute necrotizing ulcerative gingivitis (Vincent disease) is an inflammatory disease also known as ulcerative gingivitis, necrotizing ulcerative gingivitis, fusospirochetal stomatitis, Plaut-Vincent stomatitis, and trench mouth. In case of gingival lesions the Vincent gingivitis is diagnosed; in case of simultaneous lesions of the gingivae and oral mucosa the disease is considered the Vincent stomatitis, and in case of pharyngeal tonsil it is considered the Vincent angina. Rare case of the elderly woman with the disease involving gingival and palatal mucosa is reported. Main causes of the disease are discussed, differential diagnoses are listed, and preventive measures are outlined.

Chronic diseases of the lymphopharyngeal ring in children: etiology, diagnosis, clinic, principles of treatment

Conservative therapy of chronic pathology of the pharyngeal tonsil allows achieving a clinical and immunological effect in 80 % of cases. It is recommended to adhere to the tactics of maximizing the preservation of the organs of the lymphoepithelial pharyngeal ring. Removal of adenoids up to the age of three is carried out only according to absolute indications.

Endogenous intoxication in chronic pathology of pharynx in children

A review of scientific Russian and foreign articles devoted to the development of endogenous intoxication in chronic inflammatory pathology of the lymphoepithelial pharyngeal ring is carried out. Chronic tonsillitis and adenoiditis in children are one of the unsolved issues in otorhinolaryngology. Chronic tonsillitis is a chronic inflammation of the palatine tonsils characterized by recurrent exacerbations in the form of tonsillitis and a general toxic-allergic reaction. Adenoid vegetation is a pathological hypertrophy of the pharyngeal tonsil. Chronic adenoiditis is a chronic polyetiologic disease, which is based on a violation of the physiological immune processes of the pharyngeal tonsil. In children, one cannot talk about an isolated inflammation of the pharyngeal tonsil, since as a result of exposure to antigens, an immune response arises, which involves all structures of the lymphoepithelial pharyngeal ring in the process, therefore some authors distinguish the term «adenotonsillitis». With pronounced activation of microflora in the nasopharynx and oropharynx, the body’s resistance to pathogenic microorganisms decreases, as a result of which decay products and toxins damage the vascular endothelium, disrupt their permeability and, penetrating through the epithelial barrier, contribute to the development of chronic intoxication and sensitization of the body. Endogenous intoxication is a polyetiologic and polypathogenetic syndrome characterized by the accumulation of endogenous toxins in tissues and biological fluids. Diagnostics of the endogenous intoxication severity includes a number of clinical and laboratory indicators and immunological markers. But, despite the constant improvement of the research methods, the issue of endotoxicosis diagnosis in chronic tonsillitis and adenoiditis remains insufficiently studied. As a result of the inadequate diagnosis, there is often a simultaneous removal of the pharyngeal and palatine tonsils, which in turn can lead to irreversible consequences.

Prevention and conservative treatment of nasopharyngeal tonsil hypertrophy

The aim of this work is to draw the attention of otorhinolaryngologists to the advantages of early conservative treatment of children with hypertrophy of the nasopharyngeal tonsil - adenoids. In childhood, a significant part of the protective and informational functions lies on the pharyngeal tonsil, since it is in the path of inhaled air. Unfavourable environmental conditions exacerbate its functional failure. Pathology of the lymphopharyngeal ring is highly prevalent and occupies a leading place among ENT diseases in children. Each person has a certain own microflora on the nasal mucosa from birth. In most cases, monoflora is determined on the mucous membrane of the nasal cavity, and only 2-3% is due to the combination of two types of microbial and fungal flora. For more than twenty years, we have been using the tactics of a sparing effect on the mucous membrane when using medicinal mixtures on a protective basis. Conservative treatment of 245 children aged 3 to 6 years with grade 1 – 2 adenoiditis was carried out, which made it possible to avoid surgical intervention in this group of children. When choosing a drug mixture, the sensitivity of the microflora of the patient’s nasal cavity was considered according to the results of a smear from the mucous membrane. Adenoidectomy is an operation with potentially undesirable consequences for the whole body, therefore, effective timely conservative therapy can reduce the risks and harms of surgery for pediatric patients.

Adenoid Hypertrophy, Craniofacial Growth and Obstructive Sleep Apnea: A Crucial Triad in Children

: Age-related (physiological) AH is an important problem in pediatric otorhinolaryngology. Since the beginning of the 70s, there has been an increase in the proportion of children with pharyngeal tonsil hypertrophy. Functional disorders of the oropharynx in children occupy the second place based on their incidence (after disorders of the musculoskeletal system). In the previous years there have been an increase in the incidence and prevalence of obstructive sleep apnea syndrome (OSAS) among children. In most cases of pediatric OSAS, upper airway obstruction occurs from the nasopharynx to the oropharynx, caused by upper airway stenosis. Consequences of untreated OSAS in children can be inattention and behavioral problems, daytime sleepiness, and in more severe cases are associated with a variety of comorbidities. The current review discussed the links between hypertrophied adenoids, craniofacial development and OSAS in children taking into account physiological and pathophysiological aspects as well as clinical evaluation of the problem.

Clinical and microbiological effectiveness of therapeutic and rehabilitation measures using a low-intensity laser in the practice of an otorhinolaryngologist

The article presents an analysis of the results of using a low-intensity laser in patients with chronic recurrent adenoiditis. Laser therapy was carried out using continuous exposure to red spectrum radiation (wavelength 632 nm, output power from 6 to 8 mW), exposure was performed endonasally for 60 s in each nostril, radiation dose 0.5 J / cm2, the course of treatment consisted of 10 s procedures. It was shown that in the group using laser therapy, the hypertrophy of the pharyngeal tonsil decreased, the number of pathobionts on its surface decreased, and the cellular factors of local antimicrobial defense normalized.