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"Tonsillitis"
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Handy health guide to sore throats
\"An overview of what causes sore throats and other illnesses such as tonsillitis and strep throat\"-- Provided by publisher.
Book
Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA): a multicentre, open-label, randomised controlled trial
Tonsillectomy is regularly performed in adults with acute tonsillitis, but with scarce evidence. A reduction in tonsillectomies has coincided with an increase in acute adult hospitalisation for tonsillitis complications. We aimed to assess the clinical effectiveness and cost-effectiveness of conservative management versus tonsillectomy in patients with recurrent acute tonsillitis.
This pragmatic multicentre, open-label, randomised controlled trial was conducted in 27 hospitals in the UK. Participants were adults aged 16 years or older who were newly referred to secondary care otolaryngology clinics with recurrent acute tonsillitis. Patients were randomly assigned (1:1) to receive tonsillectomy or conservative management using random permuted blocks of variable length. Stratification by recruiting centre and baseline symptom severity was assessed using the Tonsil Outcome Inventory-14 score (categories defined as mild 0–35, moderate 36–48, or severe 49–70). Participants in the tonsillectomy group received elective surgery to dissect the palatine tonsils within 8 weeks after random assignment and those in the conservative management group received standard non-surgical care during 24 months. The primary outcome was the number of sore throat days collected during 24 months after random assignment, reported once per week with a text message. The primary analysis was done in the intention-to-treat (ITT) population. This study is registered with the ISRCTN registry, 55284102.
Between May 11, 2015, and April 30, 2018, 4165 participants with recurrent acute tonsillitis were assessed for eligibility and 3712 were excluded. 453 eligible participants were randomly assigned (233 in the immediate tonsillectomy group vs 220 in the conservative management group). 429 (95%) patients were included in the primary ITT analysis (224 vs 205). The median age of participants was 23 years (IQR 19–30), with 355 (78%) females and 97 (21%) males. Most participants were White (407 [90%]). Participants in the immediate tonsillectomy group had fewer days of sore throat during 24 months than those in the conservative management group (median 23 days [IQR 11–46] vs 30 days [14–65]). After adjustment for site and baseline severity, the incident rate ratio of total sore throat days in the immediate tonsillectomy group (n=224) compared with the conservative management group (n=205) was 0·53 (95% CI 0·43 to 0·65; <0·0001). 191 adverse events in 90 (39%) of 231 participants were deemed related to tonsillectomy. The most common adverse event was bleeding (54 events in 44 [19%] participants). No deaths occurred during the study.
Compared with conservative management, immediate tonsillectomy is clinically effective and cost-effective in adults with recurrent acute tonsillitis.
National Institute for Health Research.
Journal Article
Specific strains of Streptococcus mutans, a pathogen of dental caries, in the tonsils, are associated with IgA nephropathy
Streptococcus mutans
is known to be a major causative agent of dental caries, and strains expressing the cell surface collagen-binding Cnm protein contribute to the development of several systemic diseases. A relationship between tonsillar immunity and glomerulonephritis has been recognized in IgA nephropathy (IgAN), and specific pathogens may have effects on tonsillar immunity (mucosal immunity). Here, we present findings showing a relationship between the presence of Cnm-positive
S. mutans
strains in the tonsils of IgAN patients and IgAN condition/pathogenesis. Analyses of tonsillar specimens obtained from patients with IgAN (n = 61) and chronic tonsillitis (controls; n = 40) showed that the Cnm protein-positive rate was significantly higher in IgAN patients. Among IgAN patients, the tonsillar Cnm-positive group (n = 15) had a significantly higher proportion of patients with high urinary protein (>1.5 g/gCr) and lower serum albumin level than the Cnm-negative group (n = 46). Additionally, Cnm protein and CD68, a common human macrophage marker, were shown to be merged in the tonsils of IgAN patients. These findings suggest that Cnm-positive
S. mutans
strains in the tonsils may be associated with severe IgAN.
Journal Article
Specific Measures and Benefits of Comprehensive Nursing Model in Clinical Practice for Pediatric Purulent Tonsillitis
Pediatric purulent tonsillitis is a common infectious disease in children and can be difficult to cure and can recur with irritation of the throat. To improve treatment outcomes, alleviate symptoms, and promote recovery, an effective clinical-nursing intervention is often necessary.
The study aimed to explore the specific measures of the comprehensive nursing model for pediatric patients with purulent tonsillitis and to analyze its practical value in improving patients' treatment outcomes and quality of life (QoL) in clinical application, to provide feasible references and guidance for medical practice.
The research team conducted a randomized controlled trial.
The study took place at Mengcheng County First People's Hospital.
Participants were 80 pediatric patients who had received a diagnosis of purulent tonsillitis at the hospital between December 2020 and March 2022.
The research team randomly divided participants into two groups, with 40 participants in each group: (1) the intervention group, who received comprehensive nursing care in addition to routine nursing care, and (2) the control group, who received routine nursing care only.
The research team: (1) evaluated times to relief of throat pain and to improvement of hoarseness, (2) assessed times to recovery of body temperature, white blood cells, and tonsillar signs, (3) measured treatment compliance, and (4) conducted a health knowledge survey with the children' family members at baseline and postintervention using a visual analogue scale (VAS).
Compared to control group, the intervention group's (1) times to relief of throat pain and improvement time of hoarseness were significantly shorter (both P < .05); (2) times to recovery of temperature (P = .002), white blood cells (P = .006), and tonsillar signs (P = .024) were significantly shorter; (3) treatment compliance was significantly higher (P = .021); and (4) level of health knowledge of family members was significantly higher (P < .001).
The comprehensive nursing model for pediatric purulent tonsillitis can effectively improve pediatric patients' treatment outcomes, shorten their recovery times, enhance the health knowledge of family members, and provide a better focus on the overall health of pediatric patients. The model has a positive significance for pediatric patients' rehabilitation and is worth promoting.
pediatric purulent tonsillitis, clinical, comprehensive nursing model, measures, application value.
Journal Article
Difensil Immuno Reduces Recurrence and Severity of Tonsillitis in Children: A Randomized Controlled Trial
Oral supplements (OS) support the immune system in fighting upper airways infection. This study aimed to analyze the effect of Difensil Immuno (DI) on the recurrence of tonsillitis and fever in children. A multicentric randomized clinical trial was conducted. One-hundred and twenty children with chronic tonsillitis were randomly assigned to group A, B or control. Patients in group A were treated with 10 mL of DI for 90 consecutive days, patients in group B underwent treatment with 15 mL of DI for 45 consecutive days. The following data were collected at baseline (T0), T1 and T2: tonsillitis and fever episodes, tonsillar volume, blood test results. One-way ANOVA was used to analyze within and between variances. Patients in group A and B statistically improved their clinical parameters (episode of tonsillitis and fever, tonsillar volume) when compared to control group both at T1 and T2. However, T1 variances were more consistent in group A than in group B. All patients in the study groups improved their clinical outcomes. No statistically significant variances were observed in blood parameters both at T1 and T2. Our results suggest that children treated with DI had fewer episodes of tonsillitis and fever and a reduction in their tonsillar volume.
Journal Article
Total or partial tonsillar resection (tonsillectomy or tonsillotomy) to change the quality of life for adults with recurrent or chronic tonsillitis: study protocol for a randomised controlled trial
Background
Tonsillar surgery has been used for decades to treat recurrent and chronic tonsillitis in adults. Recurrent and chronic tonsillitis result in disturbing symptoms, treatment costs, sick leave, and impaired quality of life (QoL). Theoretically, removing all or part of the altered pathological palatal lymphoid tissue alleviates the symptoms and enhances the QoL. Whether this is true with total or partial tonsillar resection (tonsillectomy (TE) and tonsillotomy (TT), respectively) has not been reported in a randomised trial yet.
Methods
We conduct a multicentre, partly blinded, randomised, 6-month, parallel-group clinical study including 285 adult participants referred to surgical treatment for chronic or recurrent tonsillitis. The participants will either have TE, TT or watchful waiting (WW). The primary outcome will be the difference between the mean disease-specific Tonsillectomy Outcome Inventory-14 (QoL questionnaire) scores at 6 months. Comparison is made firstly between the combined TE+TT and WW groups (superiority analysis), and secondly between the TE and TT groups (non-inferiority analysis).
Discussion
This study will add significant new information to the effects and harms of TE and TT procedures in the treatment of adults with chronic or recurrent tonsillitis.
Trial registration
ClinicalTrials.gov:
NCT04657549
Journal Article
Expression of Serum Immune Inflammatory Factors in Children with Suppurative Tonsillitis Caused by Adenovirus Infection and its Correlation with Adenovirus Pneumonia
Adenovirus infection is a common cause of pediatric respiratory disease, often misdiagnosed as a bacterial infection. This study compared immune-inflammatory markers in children with adenovirus- vs bacterial-induced suppurative tonsillitis and evaluated their correlation with adenovirus pneumonia. A retrospective study of 275 children (145 with adenovirus, 130 with bacterial infections) admitted to The First People’s Hospital of Changde, China (January–June 2019), was conducted. Laboratory markers (white blood cell [WBC] count, C-reactive protein [CRP], serum amyloid A [SAA], procalcitonin [PCT], heparin-binding protein [HBP], tumor necrosis factor-alpha [TNF-α], and interleukin 6 [IL-6]) were analyzed. Adenovirus cases were stratified by pneumonia status (58 with pneumonia, 87 without pneumonia) via chest computed tomography. Compared with the bacterial group, the adenovirus group had lower WBC counts (14.97 [1.37] vs 18.86 [2.65] ×109/L), CRP levels (15.26 [3.44] vs 26.36 [3.18] mg/L), and PCT levels (15.06 [2.12] vs 42.53 [4.58] ng/L) but higher SAA levels (216.75 [39.23] vs 136.55 [28.66] mg/L). Among children with adenovirus, those with pneumonia had elevated SAA (236.39 [38.67] vs 203.65 [33.95] mg/L), HBP (44.30 [8.93] vs 35.62 [6.77] ng/mL), TNF-α (731.52 [99.21] vs 604.21 [95.53] ng/L), and IL-6 (96.86 [17.63] vs 76.55 [15.50] ng/L) levels. A combination of SAA, HBP, TNF-α, and IL-6 predicted pneumonia with an area under the curve of 0.927 (sensitivity, 87.93%; specificity, 88.51%). SAA, HBP, TNF-α, and IL-6 are strongly associated with adenovirus pneumonia, and their combined measurement improves diagnostic accuracy.
Journal Article
Tonsillectomy for recurrent tonsillitis: the NATTINA trial – Authors’ reply
Over a 20-year period to 2016, tonsillectomy rates in Scotland halved while admissions to hospital with tonsillitis increased by 136% and peritonsillar abscess hospital admissions by 167%.3 There is a need for translational research to explore predictive biomarkers to identify patients who might go on to have recurrent tonsillitis. Within the 2-year follow-up period, only 38 days were impacted by the national lockdown, with no routine COVID-19 testing available at that time. Reported symptoms might improve while patients wait for their surgery, but most patients still opt to have treatment.4 Guan-Jiang Huang and colleagues query the high bleeding rate found in NATTINA.
Journal Article