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PubMed1993

[Polymicrobial infections in recurrent tonsillitis and adenoiditis in children].

Bacteriological examination focused on the aerobic and anaerobic flora from ectomized tonsils in 17 patients with recurrent tonsillitis, in 8 patients with hypertrophy of the tonsils and 122 children with an adenoid vegetation confirmed microbial aetiology. In ectomized tonsils and adenoids aerobic gram-positive bacteria comprised most frequently staphylococci, and gram-negative bacteria H. influenzae. As to anaerobic gram-positive bacteria, they isolated most frequently peptostreptococci, and as to gram-negative ones B. fragilis from tonsils and Bacteroides sp. from adenoids. In the treatment of recurrent infections of the upper respiratory pathways it is important to use preferentially aminopenicillins combined with beta-lactamase inhibitors and lincosamides.

Adenoids↗
PubMed1995

Tuberculous tonsillitis.

The epidemiology of tuberculosis has changed recently with an increasing incidence of unusual presentations. A case of tuberculous tonsillitis, which is a rare condition, is presented in this report. The manifestations of this entity are tonsillar hypertrophy and painful ulceration. Final diagnosis of tuberculous tonsillitis is usually made after histopathologic examination of tonsillectomy material. Cultures should be obtained from the tissue specimens, and acid-fast bacilli must be investigated to confirm the diagnosis. Systemic signs of tuberculosis may not be seen in this clinical form. These features may confuse tuberculous tonsillitis with malignancies. In this article, general information and literature about tuberculous tonsillitis are reviewed, and a case of tuberculous tonsillitis is reported to draw attention to this rare clinical form of tuberculosis.

Aged↗
PubMed1996

Are recurrent and chronic tonsillitis different entities? An immunological study with specific markers of inflammatory stages.

It seems that there are clinical differences between tonsillitis in children and adults. In order to verify whether such a supposed clinical subdivision be true, tonsillar mononuclear cells from 20 children operated on for recurrent tonsillitis caused by a common flora and 20 adult patients with an indication for surgery for chronic tonsillitis were studied by means of monoclonal antibodies (MoAbs) specific for the antigens associated with each stage of the inflammatory response. BMA 4D10 and BMA 27E10 MoAbs were used as markers for the early stages, BMA RM 3/1 for the intermediate stage. BMA 25 F 9 for the late stage, and BMA G 16/1 for the chronic stage. The results indicate that chronic tonsillitis in the adult should be considered as such (higher expression of antigens associated with the chronic stages (p = 0.039), low and even lower expression of those associated with the intermediate and acute stages, respectively), whereas tonsillitis in children could perhaps be more correctly regarded as an expression of recurrent inflammation (higher expression of antigens associated with the acute stages (p = 0.022)). Results are presented and discussed.

Adolescent↗
PubMed1996

Histopathology of the palatine tonsil in the newborn infant.

We studied 13 tonsils from newborn infants in order to understand the evolution of the microscopical alterations in tonsils of children with recurrent infections. The weight of the newborns ranged from 0.540 to 3.250 kg. All tonsils had a similar histopathological pattern, independent of the weight of the newborn. The epithelium of the crypt showed no or slight infiltration of lymphocytes. All cases had some dilated crypts with formation of cysts lined by squamous epithelium and filled with squamous debris. The lymphoid tissue was poorly developed and with no differentiation into primary follicles. Similar cysts have been described in recurrent tonsillitis as a result of focal compression of the lumen of crypts by enlarged lymphoid follicles or abscess. However, our narrowing of the lumen of the crypts was near the surface of the tonsils.

Cysts↗
PubMed1996

The role of tissue colonization and bacterial resistance in recurrent tonsillitis.

Unsuccessful medical therapy for treatment of acute tonsillitis frequently results in onset of recurrent or chronic forms rendering surgical treatment necessary. We have studied some of the factors involved in the evolution of these chronic or recurrent forms and, in particular, the distribution of different bacterial strains in tonsillar tissue, their response to treatment with antibiotics and mechanisms of bacterial resistance. The distribution of bacterial flora (saprophytic and pathogenic) present on the surface of the tonsils, in the crypts and in the tonsillar tissue was studied in a control population of 30 children (20 boys and 10 girls) aged between 2-13 years, all affected with chronic tonsillitis and submitted to tonsillectomy. The same study was performed in a group of 80 sex and aged matched children, also presenting with chronic or recurrent tonsillitis and treated with amoxicillin or amoxicillin-clavulanic acid or cefaclor or clarithromycin 72 h before surgery. The 80 subjects were randomly divided into four groups so that each antibiotic was tested on 20 subjects. The distribution of the bacterial population on the surface of tonsillar tissue, in the crypts and in the deeper tonsillar tissue is of particular interest concerning the affinity of bacteria to the different tissue areas. In particular the interaction between crypt and tonsillar core, which could be a factor involved in the process of worsening of bacterial infection in the tonsils, is evidenced. The four antibodies tested showed different abilities to eradicate infection: Haemophilus influenzae was found to be the most resistant germ to antibiotic therapy and was thus the most frequent cause of recurrent infections. The characteristics and the mechanisms of adherence and resistance to beta lactam antibiotics were also analysed.

Adolescent↗
PubMed1996

Histopathological comparison between tonsil and adenoid responses to allergy.

In a previous study of adenoid tissue from allergic and non-allergic patients, we concluded that in allergic children edema of the "chorium" was present in 80.4% and that treatment with antihistamine drugs may reduce this edema. The purpose of the present study was to compare the histopathology of the palatine tonsil and adenoid from allergic patients. Tissue samples were obtained from 153 patients (56 tonsils and 97 adenoids from allergic children). We analysed the intensity of the edema and its cellular components in the chorium of palatine tonsils and adenoids. The frequently seen edema in the adenoids was significantly different from that in the tonsils. The squamous epithelium of the tonsils was thicker and bad stronger intercellular junctions than the columnar epithelium of the adenoids. This fact probably makes difficult the contact of the antigen with the chorium.

Adenoids↗
PubMed1996

Preference of lymphocyte-homing to high endothelial venules in palatine tonsils of musk shrew (Suncus murinus).

We studied the lymphocyte-homing to palatine tonsils of the musk shrew, a new experimental animal originally developed in Japan. The tonsils of the animals have typically high endothelial venules (HEV) in the parafollicular region. The in vivo migration test showed that blood-circulating lymphocytes were able to home to the tonsils through the HEV. The in vitro lymphocyte-HEV binding assay clearly indicated the binding preference of the lymphocytes to be the tonsillar HEV. First, binding of B cells to the tonsillar HEV was seen to a greater extent than that of T cells, which was consistent with the result in the assay of Peyer's patch. Second, binding of lymphocytes from axillar and inguinal lymph nodes was similar to that of lymphocytes from the mesenteric lymph nodes, which differed from the result in the assay of Peyer's patch. These findings suggest that, in the musk shrew, the regulation of lymphocyte-homing through the HEV is different in the tonsil and Peyer's patch, at least in part. These homing properties of musk shrew tonsils may reflect their immunological role in the local response against oral antigens.

Animals↗
PubMed1996

Expression of E- and P-selectins by vascular endothelial cells in human tonsils.

Selectins play an important role in the adhesion between vascular endothelial cells and leukocytes in immuno-inflammatory events. We investigated the immunohistochemical localization of E- and P-selectins in the human palatine tonsils at light and electron microscopic levels. E-selectin was expressed by high endothelial venules (HEV) in a linear pattern in heavily inflamed tonsils with focal infection and extensive neutrophilic infiltration, and much less in hypertrophic tonsils without focal infection. P-selectin expression was found on HEV to the same extent in both disease states in a dot pattern in the cytoplasm. Immunoelectron microscopically, E- and P-selectins were localized along the luminal plasma membrane and in the perinuclear space in HEV endothelial cells. The present study suggests that increased expression of E- and P-selectin in vascular endothelial cells is a significant feature of inflamed tonsils induced by focal infection. E- and P-selectins may participate in different roles in the inflammatory process of the tonsils.

Cell Adhesion Molecules↗
PubMed1996

Immunohistochemical localization of cytokines and receptor-associated molecules in human tonsils and skin.

Human tonsilla palatina and skin were investigated by means of light microscopical and electron microscopical immunohistochemistry using monoclonal antibodies (Mab) against some cytokines. In both tonsils and skin we found intracellular immunoreactivity for interleukin-1-beta in macrophages and interdigitating cells. Also some, but not all crypt-epithelial cells were positive, while keratinocytes in the skin were negative. Interleukin-2-immunoreactivity was found in a subpopulation of lymphocytes (probably T-cells) and unexpectedly also in some antigen-presenting cells (APCs). A Mab against interleukin-4 revealed weak labelling of lymphatic cells in the T-cell area of tonsils. The human skin was negative. A Mab that recognizes a molecule associated with the interleukin-4-receptor gave strong surface labelling in tonsils and skin on APCs and weak immunoreactivity on lymphoid cells. Frequently these APCs formed rosettes with weakly labeled lymphocytes. Mabs against interleukin-8 stained starry sky macrophages in the germinal centers of the tonsil and different APCs in the T-cell region. IL-8 is stored in keratinocytes of normal skin, but becomes mobilized under inflammatory conditions. Our results expand the understanding of cell cell-interactions under normal and inflammatory conditions in tonsil and skin.

Antibodies, Monoclonal↗
PubMedDate not supplied

Relationship of tonsil size on an airway blockage maneuver in children during sedation.

A previous report suggested that airway compromise without self-correction may occur in pediatric dental patients sedated with chloral hydrate (CH) and nitrous oxide (N2O) and may be interpreted as "deep" sedation. The purpose of this institutionally approved study was to determine 1) the association between the size of the tonsils and 2) the degree of expired carbon dioxide (CO2) and oxygen saturation (SaO2) changes to simulated airway obstruction using the Moore head-tilt maneuver for 30 sec or less. Thirty healthy children (ASA I), aged 22-40 months, were evaluated for tonsil size and sedated with CH (50 mg/kg) and hydroxyzine (2 mg/kg) and supplemented with N2O. Pulse oximetry and capnography were used to monitor the child. During the restorative phase when the patient appeared asleep, the head was rolled forward with the chin touching the chest for a period of 30 sec. Changes in SaO2 and CO2 waveform were observed during this period. The results indicated that seven children who had enlarged tonsils had blocked airways (as determined by capnography) lasting approximately 15 sec. The remaining children did not have enlarged tonsils and continued to exchange air appropriately. O2 levels did not change during this period. The results suggest that the likelihood of airway blockage increases with enlarged tonsils. In children without airway blockage, ventilation occurs unimpeded, and attempts to readjust the head may not occur. The association between airway blockage and patient responsiveness is discussed in relation to sedation levels.

Airway Obstruction↗
PubMedDate not supplied

Upper airway obstruction during midazolam/nitrous oxide sedation in children with enlarged tonsils.

PURPOSE: The purpose of this nonrandomized, case-control study was to examine the incidence and severity of upper airway obstruction (UAO) in children with enlarged tonsils during inhalation of nitrous oxide (N2O). METHODS: Following premedication with oral midazolam, 0.5 mg/kg, measurements were collected during a 3-minute control period followed by 3 minutes of breathing 50% N2O in oxygen. An unblinded anesthesiologist held a facemask over the child's mouth and nose without supporting the head or neck, or attempting to maintain airway patency. Every 20 seconds, the degree of airway obstruction was graded as none, partial, or complete. Twenty-five children presenting for tonsillectomy and 25 controls without enlarged tonsils participated. RESULTS: During 50% N2O inhalation, 14 children (56%) in the tonsillectomy group, and four children (16%) in the control group demonstrated partial UAO. One child in the tonsillectomy group with partial UAO developed hypoxemia (SpO2 72%). One child in the tonsil group developed complete UAO during inhalation of 50% N2O. CONCLUSION: Children who receive sedation with oral midazolam and 50% N2O inhalation may exhibit significant UAO, especially in the presence of enlarged tonsils. Presedation physical exams should evaluate the presence of tonsil size during examination of the mouth and airway.

Administration, Oral↗
PubMed2000

Primary surgery as treatment for early squamous cell carcinoma of the tonsil.

BACKGROUND: The management of tonsil carcinoma has gradually evolved such that the literature is replete with outcome summaries of this disease treated with primary RT and chemotherapy. Recently there have been no reports of patient outcomes with primary surgical therapy. Nonsurgical treatment is warranted when tumors are unresectable or if the patient refuses surgery. Our policy has been to treat operable squamous cell carcinoma (SCCA) of the tonsil with surgery. The decision to use adjuvant therapy is based on the surgical and histologic findings. We herein report our results with this treatment protocol. METHODS: A retrospective review of 162 patients with SCCA of the tonsil was performed. Eighty-four patients were treated with surgery, which was followed by RT and/or chemotherapy if histologic signs of aggressive behavior were identified. Patients were followed 2 to 15 years after treatment. RESULTS: Of the 9 patients with stage I disease, 89% are without evidence of recurrent disease and 91% of patients with stage II tonsil cancers are also disease free. The survival rates for stage III and stage IV cancer patients are 79 and 52%, respectively. CONCLUSION: Our data suggest that patients with early tonsil cancer can be effectively treated with surgery. Surgery allows pathologic staging so that patients with advanced tumors can be treated with adjuvant therapy.

Carcinoma, Squamous Cell↗
PubMed2005

Longitudinal evaluation of patients with cancer in the oral tongue, tonsils, or base of tongue--does interstitial radiation dose affect quality of life?

PURPOSE: To evaluate health-related quality of life (HRQL) in patients with oral tongue, tonsil, or base of tongue cancer in a prospective longitudinal study and explore correlations between HRQL scores and interstitial radiation dose, dose rate, and volume of implant. METHODS AND MATERIALS: Ninety patients with oral tongue cancer (n=30) and tonsil or base of tongue cancer (n=60) were assessed with the European Organization of Research and Treatment of Cancer Quality of Life Questionnaire Core-30 and the European Organization of Research and Treatment of Cancer Head and Neck module at diagnosis, and after 3, 12, and 36 months of starting treatment. RESULTS: The HRQL of all patients decreased during treatment. Most HRQL scores returned to baseline values after 3 years; however, 60% of patients with oral tongue cancer and 80% with tonsil and base of tongue cancer reported problems with dry mouth and half of the patients with tonsil and base of tongue cancer reported problems with swallowing solid food at the 3-year followup. No correlations between brachytherapy quality indices and HRQL scores were found. CONCLUSIONS: Patients with oral tongue, tonsil, or base of tongue cancer reported significant problems with dry mouth and swallowing solid food throughout this 3-year followup study.

Adult↗
PubMed2001

Light and electron microscope studies on the nasopharynx and nasopharyngeal tonsil of the horse.

Light and electron microscope studies were conducted on the nasopharynx and the nasopharyngeal tonsil of 15 young horses. The nasopharynx and nasopharyngeal tonsil was lined with pseudostratified columnar ciliated epithelium and goblet cells. The lymphoepithelium of the nasopharyngeal tonsil was folded forming crypts, the mucosa of which was modified into follicle associated epithelium characterized by stratified cuboidal epithelium, loss of cilia, absence of goblet cells and infiltration of lymphocytes. The lamina propria mucosae of the nasopharyngeal tonsil contained well-developed lymphoid tissue and clusters of seromucus acini. Scanning electron-microscopy revealed a dense mat of cilia covering the nasopharynx and nasopharyngeal tonsil. The follicle-associated epithelium consisted of different populations of microvillus cells in addition to M cells with very short microvilli and a few squamous and intermediate cells. Microvillus cells in the deeper part of the FAE had larger microvilli and their cytoplasm contained a dense population of mitochondria, smooth and rough endoplasmic reticulum, Golgi complexes and lysosomes. The flat surfaced M cell had a more electron-dense cytoplasm and contained small supranuclear vacuoles in addition to the organelles seen in microvillus cells.

Adenoids↗
PubMed2003

[Treatment of early stage primary tonsil non-Hodgkin's lymphoma].

OBJECTIVE: To investigate the treatment for patients with early stage primary tonsil non-Hodgkin's lymphoma (NHL). METHODS: Two hundred and thirteen patients with previously untreated early stage primary tonsil NHL were reviewed. All patients were pathologically confirmed. According to Ann Arbor classification, 35 patients were stage I, 178 stage II. The primary treatment for stage I was radiotherapy alone in 12 and combined modality therapy (CMT) in 23 patients. The primary treatment for stage II was radiotherapy alone in 57,chemotherapy alone in 2, and CMT in 119 patients. RESULTS: The 5-year overall survival, cancer specific survival (CSS) AND disease-free survival (DFS) for the early stage primary tonsil non-Hodgkin's lymphoma were 65%, 70% and 61%, respectively. The 5-year CSS was 63% for the radiotherapy alone group and 72% for the CMT group (p = 0.064), and the 5-year DFS were 56% for the radiotherapy alone group and 62% for the CMT group. For patients with stage I disease, The 5-year CSS were 100% in both radiotherapy alone and CMT groups, and the 5-year DFS were 100% and 80% in these two groups (p = 0.148), respectively. There was no significant difference of efficacy between the two treatment s for the patients with stage I disease. For the patients with stage II disease, the 5-year CSS was 58% in radiotherapy alone group and 66% in CMT group (p = 0.051). However, CMT significantly improved DFS in stage II disease, with a 5-year DFS of 46% for radiotherapy alone and 60% for CMT (P = 0.046). CONCLUSION: Patients with stage I tonsil non-Hodgkin's lymphoma treated with radiotherapy alone or CMT can achieve an excellent outcome. CMT significantly improve the DFS in stage II patients. There was a trend that CMT improved the survival rates in the patient with early stage disease. It was suggested that CMT should be used for the patients with early stage primary tonsil non-Hodgkin's lymphoma.

Adolescent↗
PubMed2005

The "small, dark tonsil" in patients presenting with metastatic cervical lymphadenopathy from an unknown primary.

When squamous cell carcinoma (SCC) involves the palatine tonsils, they are generally enlarged and demonstrate intermediate to high signal intensity on T2-weighted MR images and enhance after gadolinium administration. We have identified two patients with SCC of the tonsil where the affected tonsil has low signal intensity on T2-weighted MR images and is smaller than the contralateral normal tonsil. We present the "small, dark tonsil" as an alternative imaging presentation of SCC and a new sign to look for when evaluating the patient with metastatic lymphadenopathy from an unknown primary tumor.

Adult↗
PubMed1981

Tonsillitis due to neisseria meningitidis. Its treatment with rifampin.

The Neisseria species with which most otolaryngologists are familiar is N gonorrhoeae, which can cause acute pharyngitis or tonsillitis. Less well known is N meningitidis, responsible for potentially fatal meningococcal meningitis and meningococcemia. Although present in the carrier state in the pharynx of asymptomatic individuals, N meningitidis previously has not been associated with symptomatic pharyngeal or tonsillar disease. Its isolation from a patient with acute tonsillitis and failure to eliminate the symptoms and organism with penicillin led to use of rifampin. Disappearance of sore throat following use of this antibiotic and inability at completion of therapy to isolate the organism from a homogenate of excised tonsil would appear to implicate the organism as a cause of acute pharyngeal and tonsillar infection. It should be added to the list of organisms capable of producing acute tonsillitis, and rifampin should be considered a chemotherapeutic agent.

Adult↗
PubMed1984

Bacteriology of chronic tonsillitis in young adults.

Tonsils were obtained from 22 young adults (mean age, 23 years) suffering from chronic tonsillitis. Mixed aerobic and anaerobic flora was obtained from core tonsillar cultures in all patients, yielding an average of 9.0 isolates (5.3 anaerobes and 3.7 aerobes) per specimen. The predominant anaerobic isolates were Bacteroides sp, Fusobacterium sp, and gram-positive cocci. The predominant aerobic isolates were alpha-hemolytic streptococci, Staphylococcus aureus, Branhamella catarrhalis, beta-hemolytic streptococci, and hemophilus sp. beta-Lactamase-production was noted in 32 isolates recovered from 18 tonsils (82%). These included all eight isolates of S aureus and five B fragilis, and 11 of 24 B melaninogenicus group (46%). Our findings indicate the polymicrobial nature of deep tonsillar flora in young adults with chronic tonsillitis, and demonstrate the presence of beta-lactamase-producing organisms in most of the patients.

Adolescent↗