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Concept: Tonsillitis

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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

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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

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The association of tonsillectomy, a common surgical procedure involving the removal of a majority of the palatine tonsillar tissue, with risk of tonsil cancer specifically or oropharyngeal cancers overall is not known. In this issue of Cancer Prevention Research, Fakhry and colleagues conduct an analysis within the Danish Cancer Registry and show that tonsillectomies were associated with significantly reduced risk of tonsil cancer, but were unrelated to risk of base of tongue cancers. This editorial discusses the implications of the results by Fakhry and colleagues for key prevailing questions in the field related to risk, rising incidence, secondary prevention, and treatment of oropharyngeal cancers. Cancer Prev Res; 1-3. ©2015 AACR. See related article by Fakhry et al., p. xxx.

Concepts: Chemotherapy, Oral cancer, Tonsil, Tonsillectomy, Tonsillitis

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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

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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

0

Tonsillar stones are the products of calcified accumulates of cellular debris and microorganisms, in the crypts of palatine tonsils. Tonsillar stones are common findings and the known cause of bad breath (halitosis). Development of large tonsillar stones, however, is rare with only a few cases reported in the literature. We present the case of a 45-year-old man with a history of recurrent sore throat and tonsillitis for a long period, and snoring with other unremarkable ears, nose and throat findings. A large-sized tonsillar stone detected in the left tonsil measured 3.1 × 2.3 cm. The patient underwent elective stone removal and tonsillectomy.

Concepts: Oral hygiene, Stone, Tonsil, Tonsillectomy, Halitosis, Tonsillitis, Tonsillolith, Lymphatics of the head and neck

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The Scottish Intercollegiate Guidelines Network (SIGN) developed guidelines for the management of sore throat and indications for tonsillectomy in 1999 to address concerns of unnecessary surgery. Emergency admissions to hospital for tonsillitis have since increased. Adults experience an average of 27 episodes of tonsillitis before undergoing tonsillectomy. We wished to explore the appropriateness of the guidance and/or its implementation in primary care.

Concepts: Hospital, United Kingdom, Qualitative research, General practitioner, Tonsillectomy, Sign, Tonsillitis, National Film Registry

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To determine if there is a correlation between falling tonsillectomy numbers and increasing numbers of tonsillitis admissions and invasive Group A β-haemolytic streptococcus (iGAS) infection in children aged 14 and under in England.

Concepts: Bacteria, Infection, Streptococcus pyogenes, Streptococcus, Group A streptococcal infection, Osteomyelitis, Tonsillectomy, Tonsillitis

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Benign enlargement of the lingual tonsils due to various causes may cause symptoms that warrant treatment. Conventional lingual tonsillectomy remains a challenging procedure, and there is no established standard procedure. We aimed to review the patients receiving different methods of lingual tonsil surgery for various indications at our institute.

Concepts: Tonsil, Tonsillectomy, Tonsillitis, Tonsillolith