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Concept: Tonsillitis


BACKGROUND: Nanotechnology is receiving enormous funding. Very little however is known about the health dangers of this technology so far. Chronic tonsillitis is one of a number of diseases called idiopathic. Among other factors, the tonsils are exposed to suspended particles in inhaled air including nano particles. The objective of this study was to detect and evaluate metallic particles in human tonsil tissue diagnosed with chronic tonsillitis and in amniotic fluid as a comparison. METHODS: Scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM-EDX) was used for identification of solid particles in a total of 64 samples of routinely analyzed biopsy and cytologic material. RESULTS: Almost all samples were found to contain solid particles of various metals. The most frequent, regardless of diagnosis, were iron, chromium, nickel and aluminium. The size, determined using SEM, varied from around 500 nm to 25 µm. The majority formed aggregates of several micrometers in size but there were a significant number of smaller (sub-micrometer or nano-sized) particles present. The incidence of metallic particles was similar in child and adult tissues. The difference was in composition: the presence of several metals in adults was due to occupational exposure. CONCLUSIONS: The presence of metallic particles in pathologically altered tissues may signal an alternative causation of some diseases. The ethiopathogenic explanation of these diseases associated with the presence of nano-sized particles in the organism has emerged into a new field of pathology, nanopathology.

Concepts: Iron, Metal, Scanning electron microscope, Energy-dispersive X-ray spectroscopy, Tonsil, Tonsillectomy, Tonsillitis, Tonsillolith


OBJECTIVES: It has been suggested that bacterial biofilms are involved in chronic tonsillar disease, but there is a lack of strong evidence concerning their etiopathogenic role in childhood chronic tonsillar infections. The aim of this study was to assess the presence of biofilm-producing bacteria (BPB) in tonsillar bioptic specimens taken from children with recurrent exacerbations of chronic hyperplastic tonsillitis, and to evaluate the possible relationship between them and the patients' demographic and clinical characteristics. METHODS: 22 children (68.2% males; median age 6.5 years, range 3-13) with recurrent exacerbations of chronic hyperplastic tonsillitis were included. The presence of tonsillar BPB was assessed by means of the spectrophotometric analysis of tonsillar bioptic specimens taken during tonsillectomy between episodes of tonsillar infection. RESULTS: BPB were found in 50.0% of the 44 tonsillar specimens, and Staphylococcus aureus was the most frequent pathogen (81.8%). There was a significant relationship (p=0.02) between the grade of tonsillar hyperplasy (GTH) and the presence of tonsillar BPB, with an increased relative risk (RR=4.27, standard error=2.57, p<0.01) of tonsillar BPB development in children with GTH scores of >2. CONCLUSIONS: The findings of this study: (1) confirm the presence of tonsillar BPB in children with recurrent exacerbations of chronic tonsillar infections; (2) suggest that GTH is an important indicator of the presence of tonsillar BPB; and (3) raise the question as to whether tonsillar biofilm is a causative factor or just a consequence of recurrent exacerbations of chronic hyperplastic tonsillitis.

Concepts: Bacteria, Staphylococcus aureus, Infection, Staphylococcus, Biofilm, Tonsil, Tonsillectomy, Tonsillitis



To compare azithromycin (AZT) and benzathine penicillin (BP) in the treatment of recurrent tonsillitis in children.

Concepts: Penicillin, World Health Organization essential medicines, Tonsillitis, Benzathine benzylpenicillin


Recent studies suggest that tonsilloliths are clinically related to halitosis and tonsillar abscess. Based on our empirical knowledge, tonsilloliths are relatively commonly encountered in daily clinical practice. It has been reported that the detection rate of tonsilloliths was under 24% in previous reports, although experience suggests otherwise. The purpose of the study was to evaluate the prevalence and characteristics of tonsilloliths using computed tomography (CT). In addition, the possible causes of low detection rates on panoramic radiographs were evaluated based on comparisons between CT images and panoramic radiographs in order to elucidate the limitations of visualizing the area around the palatine tonsils on panoramic radiographs.

Concepts: Medical imaging, Radiography, Report, Rates, Clinical death, Tonsil, Tonsillitis, Tonsillolith


IMPORTANCE Tonsillectomy is one of the most commonly performed otolaryngology procedures. The safety of this procedure in adults is based on small case series. To our knowledge, we report the first population-level analysis of the safety of adult tonsillectomies in the United States. OBJECTIVE To characterize the mortality, complication, and reoperation rate in adult tonsillectomy. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 5968 adult patients who underwent tonsillectomy with records in the database of the American College of Surgeons National Surgical Quality Improvement Program (2005 to 2011). INTERVENTION Tonsillectomy. MAIN OUTCOMES AND MEASURES Outcomes of interest included mortality, complications, and reoperation in the 30-day postoperative period. Statistical analysis included χ2 test, t test, and multivariate logistic regression. RESULTS The 30-day mortality rate was 0.03%, the complication rate was 1.2%, and the reoperation rate was 3.2%. Most patients had a primary diagnosis of chronic tonsillitis and/or adenoiditis (82.9%), and the most common complications were pneumonia (27% of all complications), urinary tract infection (27%), and superficial site infections (16%). Patients who underwent reoperation were more likely to be male (54.0% vs 32.4%; P < .001), white (84.8% vs 75.3%; P = .02), or inpatients (24.3% vs 14.3%; P < .001) and to have postoperative complications (5.3% vs 1.1%; P < .001) than those who did not return to the operating room. On multivariate analysis, male sex (odds ratio [OR], 2.30 [95% CI, 1.67-3.15]), inpatient status (OR, 1.52 [95% CI, 1.04-2.22]), and the presence of a postoperative complication (OR, 4.58 [95% CI, 2.11-9.93]) were independent risk factors for reoperation. CONCLUSIONS AND RELEVANCE In the United States, adult tonsillectomy is a safe procedure with low rates of mortality and morbidity. The most common posttonsillectomy complications were infectious in etiology, and complications were independently associated with the need for reoperation.

Concepts: Cohort study, Epidemiology, Urinary tract infection, Medical statistics, Actuarial science, Tonsil, Tonsillectomy, Tonsillitis


The incidence of oropharyngeal carcinoma, involving palatine and lingual tonsils, is increasing globally. This significant rise is driven by human papillomavirus. Whether palatine tonsillectomy affects risk of diagnosis with oropharyngeal carcinoma is unknown. The association between tonsillectomy and incidence of oropharyngeal carcinoma was explored in the Danish Cancer Registry. The association between tonsillectomy and oropharyngeal carcinoma was analyzed by time since first registration of tonsillectomy. Tonsillectomy was a time-dependent variable. Individuals were censored for death, emigration, or tonsillectomy within incident year of diagnosis. Incidence rate ratios (RR) were estimated by Poisson regression models and adjusted for confounders. Kaplan-Meier survival analyses were compared by the log-rank test, and HRs were estimated by Cox proportional hazards models. From 1977 to 2012, the incidence of tonsillectomies significantly decreased, whereas the incidence of oropharyngeal carcinoma significantly increased. Tonsillectomy was not associated with risk of oropharyngeal carcinoma or malignancies of other anatomic sites, including base of tongue. However, tonsillectomy significantly reduced risk of diagnosis with tonsil carcinoma [RR, 0.40; 95% confidence interval (CI), 0.22-0.70]. The risk of diagnosis with tonsil carcinoma at age <60 years was significantly decreased (RRadj, 0.15; 95% CI, 0.06-0.41) after tonsillectomy. Tonsillectomy within 1 year of diagnosis with tonsil carcinoma was associated with significantly improved overall survival (HR, 0.53; 95% CI, 0.38-0.74). In conclusion, remote history of tonsillectomy reduces the risk of diagnosis with tonsil carcinoma. These data inform risk and benefit of tonsillectomy, a common procedure and design of secondary prevention trials. Cancer Prev Res; 1-7. ©2015 AACR. See related article by Anil K. Chaturvedi, p. xxx.

Concepts: Regression analysis, Cancer, Lung cancer, Proportional hazards models, Survival analysis, Poisson regression, Tonsillectomy, Tonsillitis


Tonsillolith is a calcified mass in the tonsil and/or its surrounding tissue considered to be caused by chronic tonsillitis. However, here we hypothesised that a tonsillolith can also be formed by chronic saliva stasis in the tonsillar tissue, without any signs of chronic inflammation. We present a case of 32-year-old male patient with large tonsillolith. We reviewed his medical files, preoperative imaging and intraoperative findings. During a standard tonsillectomy we encountered a large tonsillolith measuring 3.1 x 2.6 cm. Additionally, a careful dissection of the lower pole of the remaining tonsillar tissue revealed a large fistulous tract filled with saliva. Postoperative examination of the preoperative computerized tomography scan found a hypodense fistulous tract extending from the lower tonsillar pole toward the left submandibular gland, measuring 36 mm in length, which was diagnosed as accessory duct of the submandibular gland. To our knowledge, this is the first case of a large tonsillolith associated with the accessory duct of the ipsilateral major salivary gland. Furthermore, from the aetiopathological view, this finding supports the saliva stasis hypothesis for formation of the tonsillolith. However, larger studies including a detailed radiological analyses as in our case, are needed to further investigate this possible aetiology of tonsilloliths.

Concepts: Saliva, Salivary gland, Submandibular gland, Sublingual gland, Tonsil, Tonsillectomy, Tonsillitis, Tonsillolith


INTRODUCTION: Tonsillectomy is a common operative procedure performed for tonsillar hypertrophy complicates with recurrent tonsillitis. Among the post tonsillectomy morbidities, post operative wound healing is of utmost importance to be effectively managed as it will interfere with patient recuperation from surgery. Tualang honey has been shown to accelerate wound healing in postoperative patients. OBJECTIVE: The aim of this study was to investigate the effect of Tualang honey in enhancing healing process in post tonsillectomy patients. METHODOLOGY: In this open labelled prospective study, the selected paediatric patients were randomized into two groups. The 35 subjects in the Tualang honey-antibiotic group received 3mls of Tualang honey intraoperatively followed by 4mls of oral Tualang honey three times daily for seven days. Concurrently, 25mg/kg of intravenous Sultamicillin was given three times daily for two days followed by oral Sultamicillin twice daily for five days. The 28 subjects in the antibiotic only group received intravenous at 25mg/kg Sultamicillin kg for two days followed by oral Sultamicillin twice daily for five days. The healing process was assessed at day 1, day 3, day 7 and day 14 postoperatively by semiquantitative endoscopic photograph examination of both tonsillar fossae. RESULTS: The average ages for the treatment group and the control groups were 9 and 11 years old respectively. Wound healing was significantly faster in the treatment group in both tonsillar fossae compared to the control group (left: p-value=<0.001; right: p-value=<0.001). CONCLUSION: Tualang honey has positive effect in enhancing healing process in post tonsillectomy patient. It is easy to use topically, safe to consume orally and available at low cost locally. Overall it can be used as an excellent adjunct therapy for post operative patients.

Concepts: Controlling for a variable, Scientific control, Scientific method, Wound healing, Healing, Physician, Tonsil, Tonsillitis


Recurrent tonsillitis might reduce the immunological capability of fighting against the infection of tonsil tissue. Polypodium leucotomos (Anapsos) immunomodulating effect has been subject of research in the last years. The aim of this research is to test the in vitro immunomodulating capacity of Anapsos in a child palatine tonsil explants model.

Concepts: Immunology, In vitro fertilisation, In vitro, Tonsil, Tonsillitis, Tonsillolith