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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.

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.

ABSTRACT OBJECTIVE To assess the impact of four patient information leaflets on patients’ behavior in primary care. DESIGN Cluster randomized multicenter controlled trial between November 2009 and January 2011. PARTICIPANTS French adults and children consulting a participating primary care physician and diagnosed with gastroenteritis or tonsillitis. Patients were randomized to receive patient information leaflets or not, according to the cluster randomization of their primary care physician. INTERVENTION Adult patients or adults accompanying a child diagnosed with gastroenteritis or tonsillitis were informed of the study. Physicians in the intervention group gave patients an information leaflet about their condition. Two weeks after the consultation patients (or their accompanying adult) answered a telephone questionnaire on their behavior and knowledge about the condition. MAIN MEASURES The main and secondary outcomes, mean behavior and knowledge scores respectively, were calculated from the replies to this questionnaire. RESULTS Twenty-four physicians included 400 patients. Twelve patients were lost to follow-up (3 %). In the group that received the patient information leaflet, patient behavior was closer to that recommended by the guidelines than in the control group (mean behavior score 4.9 versus 4.2, p  < 0.01). Knowledge was better for adults receiving the leaflet than in the control group (mean knowledge score 4.2 versus 3.6, p  < 0.01). There were fewer visits for the same symptoms by household members of patients given leaflets (23.4 % vs. 56.2 %, p  < 0.01). CONCLUSION Patient information leaflets given by the physician during the consultation significantly modify the patient’s behavior and knowledge of the disease, compared with patients not receiving the leaflets, for the conditions studied.

Probiotics are live microorganisms which, when administered in adequate amounts, confer a health benefit on the host. The probiotic Streptococcus salivarius has been shown to be effective in reducing the frequency of recurrent pharyngeal infections in children and adult populations. However, probiotics have not yet been evaluated in the treatment of acute pharyngotonsillitis in adults. We aimed to examine whether the addition of S. salivarius probiotics to the routine therapy of acute pharyngotonsillitis in adult patients may shorten disease duration and reduce symptom severity. This study was a prospective, randomized, placebo-controlled, double-blinded study comparing treatment with probiotics to placebo in addition to antibiotics in patients who were hospitalized with severe pharyngotonsillitis. Laboratory results, pain levels, body temperature, and daily volume of fluids consumed were recorded for both groups. Sixty participants were recruited, 30 for each group. No statistically significant differences between the two groups were observed regarding any of the major clinical and laboratory parameters examined. Supplement probiotic treatment with S. salivarius in patients with acute pharyngotonsillitis treated with penicillin is ineffective in relation to the parameters examined in this study and we cannot, therefore, recommend the use of S. salivarius during active pharyngotonsillar infection treated with penicillin.

To analyze the effect of adjuvant oral application of honey for treating postoperative pain after tonsillectomy. Single centre prospective cohort study. Two cohorts of patients after tonsillectomy. 56 patients treated with honey 8 times per day (honey group), 18 patients treated without honey (control group); baseline analgesia were non-steroidal anti-inflammatory drugs (NSAID) or coxibs; opioids were used as pro re nata (PRN) medication; mean age 34.4 ± 13.4 years; 36% women. On first to fifth postoperative day, patients rated their pain using the validated questionnaire of the German-wide project Quality Improvement in Postoperative Pain Treatment (QUIPS) including a numeric rating scale (NRS, 0-10) for determination of patient's pain. QUIPS allows standardized assessment of patients' characteristics andpain-associated patient-reported outcomes (PROs). The influence of preoperative and postoperative parameters on patients' postoperative pain were estimated by univariate and multivariate statistical analysis. Average pain in activity in the control group was greater than 4 (NRS 4.4 ± 2.4) during the first five postoperative days, with a renewed increase in pain intensity on the fifth day (4.3 ± 2.5). In the honey group, the pain in activity decreased without any further pain increase and was only higher than 4 on the first three postoperative days (4.3 ± 2.1, all p>0.05). However; neither minimal nor maximal pain were significantly different between both groups on the first postoperative day (p = 0.217, p = 0.980). Over the five postoperative days, the minimal and maximal pain in the honey group decreased continuously and faster than in the control group. With regard to pain-related impairments on the first day, the honey group reported less pain-related sleep disturbance (p = 0.026), as well as significantly fewer episodes of postoperative oral bleeding (p = 0.028) than the control group. Patients without honey consumption had on the first and fifth postoperative day a higher risk of increased minimal pain (OR = -2.424, CI = -4.075 --0.385). Gender was an independent factor for compliance of honey consumption on the second postoperative day (p = 0.037). Men had a lower probability for compliance of honey consumption (OR = -0.288, CI = -2.863 --0.090). There was a trend of reduced postoperative pain after oral honey application. Honey also seems to reduce pain-related impairments. The need for additional opioids on the first day could be reduced. A larger controlled trial is now needed to varify the effect of honey on pain after tonsillectomy. German Clinical Trials Register DRKS00006153. The authors confirm that all ongoing and related trials for this drug/intervention are registered.

A dietary supplement containing Pelargonium sidoides extract, propolis, zinc, and honey has been recently developed and proven to be an effective adjuvant in clinical practice for seasonal diseases and the treatment of respiratory tract disorders. This trial aims to verify the efficacy of the tested dietary supplement in a pediatric population with acute tonsillopharyngitis/rhinopharyngitis (ATR). The trial includes children aged between 3 and 10 years with ATR ≤48 h, a negative rapid test for beta-hemolytic streptococcus or culture identification of nasal and/or pharyngeal exudates, and SARS-CoV-2 infection. The dietary supplement tested is an oral solution already on the market based on Pelagon P-70 (equivalent to Pelargonium sidoides d.e. 133.3 mg/100 ml), propolis, zinc, and honey. The product is administered at 5 ml 3 times a day for 6 days for children younger than 6 years and 10 ml 3 times a day for 6 days for children older than 6 years. The study design is open label, randomized, and controlled, with the tested dietary supplement plus standard of care (SoC) versus SoC alone. Patients are enrolled from 3 sites in Romania. The change in Tonsillitis Severity Score and number of treatment failures (using ibuprofen or high-dose paracetamol as rescue medication) are the primary end points. Based on the Tonsillitis Severity Score and the 2-sample comparison of the means formula with a 5% significance level, 80% power, and a minimally clinically important difference of 2 (SD 3.85) points, 120 patients are required. To account for potential screening failures and dropouts, we need to screen a population of approximately 150 children. Patient enrollment began on June 3, 2021 (first patient's first visit), and ended on August 12, 2021 (last patient's last visit). The data collection period was from June 3, 2021, to September 16, 2021. The study was funded in February 2023. Data analysis is currently ongoing (April 2024). We expect the results to be published in a peer-reviewed clinical journal in the third quarter of 2024 and presented at scientific meetings in the last quarter of 2024. The data from this trial may help identify new adjuvant treatments for children with ATR when streptococcal infection is excluded by a negative rapid test, thereby avoiding unnecessary antibiotic administration. ClinicalTrials.gov NCT04899401 https://clinicaltrials.gov/study/NCT04899401. DERR1-10.2196/53703.

Background Necrotizing tonsillitis is rare and may lead to life-threatening upper airway obstruction in children, requiring emergency airway management. Case presentation An 8-month-old boy presented with unresolved fever and was diagnosed with acute tonsillitis. Despite prior treatment with amoxicillin and paracetamol, the fever persisted, accompanied by leukopenia. Intravenous C-penicillin was initiated, but respiratory distress ensued, necessitating non-invasive ventilatory support and subsequent intubation due to increased stridor. Intubation was challenging due to copious secretions and a floppy epiglottis, but successful intubation was achieved on the second attempt using a C-MAC ® video laryngoscope with a Miller blade size 0. Computed tomography (CT) revealed a large collection with mucosal involvement in the peritonsillar and tonsillar regions, extending to adjacent structures. Direct laryngoscopy, tissue sampling, and multiple surgical debridements were performed as the patient’s condition deteriorated. Perianal excoriation and diarrhea raised suspicion of primary immunodeficiency syndrome. Pseudomonas aeruginosa and Stenotrophomonas maltophilia were isolated from tissue cultures and effectively treated with targeted antibiotics. Serological testing showed positive IgG for herpes simplex virus 1 (HSV-1), while immune deficiency testing indicated a normal immune status, pending genetic testing results. After 21 days of ventilation, the patient was extubated, received non-invasive ventilatory support, and was discharged with oral antibiotics. Conclusion This case highlights the critical nature of necrotizing tonsillitis, especially in infants with suspected primary immunosuppressive disorders. Early recognition, prompt airway management, and surgical intervention are crucial for optimal outcomes.

Medical guidelines are an important basis for qualitative and cost-effective patient care. However, there is a lack of clinical recommendations in anthroposophic medicine (AM), an integrative medicine approach frequently practised in Europe. Acute tonsillitis, which includes tonsillopharyngitis, is a common childhood disease. that is mostly caused by a viral infection. Symptomatic treatment is therefore of high importance, and AM can offer several therapy options. 53 physicians from Germany, Spain, Netherlands, Switzerland, Austria, and Hungary with at least one year of experience in anthroposophic paediatric medicine were invited to participate in an online Delphi process. The process comprises five survey rounds starting with open-ended questions and ending with final statements, which need 75% agreement of experts to reach consensus. Expert answers were evaluated by two independent reviewers using MAXQDA and Excel. Response rate was between 28% and 45%. The developed recommendation included 15 subtopics. These covered clinical, diagnostic, therapeutic and psychosocial aspects of acute tonsillitis. Six subtopics achieved a high consensus (>90%) and nine subtopics achieved consensus (75–90%). The clinical recommendation for acute tonsillitis in children aims to simplify everyday patient care and provide decision-making support when considering and prescribing anthroposophic therapies. Moreover, the recommendation makes AM more transparent for physicians, parents, and maybe political stakeholders as well. •First consensus-based anthroposophic therapy recommendation for treating acute tonsillitis in childhood.•Further information about clinical, diagnostic, therapeutic and psychosocial aspects of tonsillitis.•Successful implementation of an online Delphi process among anthroposophic paediatricians.•Consensus (>75%) was reached for all subitems of the recommendation.

Coronavirus disease 2019 imposed dramatic changes on ENT service delivery. Pre-pandemic, such changes would have been considered potentially unsafe. This study outlines the impact of lockdown on the incidence and management of ENT emergencies at a large UK centre. After modification of pre-pandemic guidelines, ENT emergency referrals data during the UK lockdown were prospectively captured. A comparative analysis was performed with retrospective data from a corresponding period in 2019. An overall reduction (p < 0.001) in emergency referrals (n = 119) and admissions (n = 18) occurred during the lockdown period compared to the 2019 period (432 referrals and 290 admissions). Specifically, there were reduced admission rates for epistaxis (p < 0.0001) and tonsillar infection (p < 0.005) in the lockdown period. During lockdown, 90 per cent of patients requiring non-dissolvable nasal packing were managed as out-patients. Coronavirus disease 2019 compelled modifications to pre-pandemic ENT guidelines. The enforced changes to emergency care appear to be safe and successfully adopted. Arguably, the measures have both economic and patient-related implications post-coronavirus disease 2019 and during future similar pandemics and lockdowns.