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Selection of indicators for tonsillectomy in adults with recurrent tonsillitis

BACKGROUND: We aimed to find some new indicators for tonsillectomy (TE) in adults with recurrent tonsillitis (RT) by exploring whether the frequency of tonsillitis episodes and the length of morbidity period are associated with the macroscopic signs of sclerotic process in tonsils and microbiologica...

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Autores principales: Kasenõmm, Priit, Piirsoo, Andres, Kull, Mart, Mikelsaar, Marika
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2005
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1242222/
https://www.ncbi.nlm.nih.gov/pubmed/16159391
http://dx.doi.org/10.1186/1472-6815-5-7
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author Kasenõmm, Priit
Piirsoo, Andres
Kull, Mart
Kull, Mart
Mikelsaar, Marika
author_facet Kasenõmm, Priit
Piirsoo, Andres
Kull, Mart
Kull, Mart
Mikelsaar, Marika
author_sort Kasenõmm, Priit
collection PubMed
description BACKGROUND: We aimed to find some new indicators for tonsillectomy (TE) in adults with recurrent tonsillitis (RT) by exploring whether the frequency of tonsillitis episodes and the length of morbidity period are associated with the macroscopic signs of sclerotic process in tonsils and microbiological data assessed by culture, molecular (PCR) and transmission electron microscopy (EM) methods. METHODS: The study involved 62 RT patients admitted for TE (age range 15–35, median 22 years) and 54 healthy volunteers (age range 18–24, median 20 years). The index of tonsillitis (IT) was calculated by multiplying the number of tonsillitis episodes per year by the morbidity period in years. On oropharyngeal examination the presence or absence of three sclerotic signs was evaluated: tonsillar sclerosis, obstruction of tonsillar crypts and scar tissue on the tonsils. The occurrence of Streptococcus pyogenes was assessed by culture and PCR methods in 24 tonsillar core specimens. The samples for EM investigation of crypt epithelium were taken from 10 removed tonsils. RESULTS: The IT values were in positive correlation with the number of sclerotic signs on oropharyngeal examination (r = 0.325, P = 0.010). Based on the IT values and the presence or absence of tonsillar sclerosis and obstruction of tonsillar crypts the receiver-operating curve (ROC) was constructed. It revealed that an IT score of 36 is an optimal cut-off value for prediction of sclerotic type tonsils. S. pyogenes was never found by culture, but its presence by PCR in nearly one third (29%) of diseased tonsillar tissue specimens was tightly associated with longer morbidity. EM revealed coccoid forms of intracellular bacteria in the crypt epithelium, which was accompanied with the damage of tight junctions between epithelial cells. CONCLUSION: The index of tonsillitis ≥36, being a combination between the frequency of tonsillitis and the length of morbidity period, predicts the sclerotic process in recurrently inflamed tonsils. Therefore, the high IT values could serve as an indicator for TE in adults. The correlation between the longer morbidity period and the presence of S. pyogenes by PCR suggests that persistent infection may have a role in maintenance of recurrent inflammation in tonsils.
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spelling pubmed-12422222005-10-06 Selection of indicators for tonsillectomy in adults with recurrent tonsillitis Kasenõmm, Priit Piirsoo, Andres Kull, Mart Kull, Mart Mikelsaar, Marika BMC Ear Nose Throat Disord Research Article BACKGROUND: We aimed to find some new indicators for tonsillectomy (TE) in adults with recurrent tonsillitis (RT) by exploring whether the frequency of tonsillitis episodes and the length of morbidity period are associated with the macroscopic signs of sclerotic process in tonsils and microbiological data assessed by culture, molecular (PCR) and transmission electron microscopy (EM) methods. METHODS: The study involved 62 RT patients admitted for TE (age range 15–35, median 22 years) and 54 healthy volunteers (age range 18–24, median 20 years). The index of tonsillitis (IT) was calculated by multiplying the number of tonsillitis episodes per year by the morbidity period in years. On oropharyngeal examination the presence or absence of three sclerotic signs was evaluated: tonsillar sclerosis, obstruction of tonsillar crypts and scar tissue on the tonsils. The occurrence of Streptococcus pyogenes was assessed by culture and PCR methods in 24 tonsillar core specimens. The samples for EM investigation of crypt epithelium were taken from 10 removed tonsils. RESULTS: The IT values were in positive correlation with the number of sclerotic signs on oropharyngeal examination (r = 0.325, P = 0.010). Based on the IT values and the presence or absence of tonsillar sclerosis and obstruction of tonsillar crypts the receiver-operating curve (ROC) was constructed. It revealed that an IT score of 36 is an optimal cut-off value for prediction of sclerotic type tonsils. S. pyogenes was never found by culture, but its presence by PCR in nearly one third (29%) of diseased tonsillar tissue specimens was tightly associated with longer morbidity. EM revealed coccoid forms of intracellular bacteria in the crypt epithelium, which was accompanied with the damage of tight junctions between epithelial cells. CONCLUSION: The index of tonsillitis ≥36, being a combination between the frequency of tonsillitis and the length of morbidity period, predicts the sclerotic process in recurrently inflamed tonsils. Therefore, the high IT values could serve as an indicator for TE in adults. The correlation between the longer morbidity period and the presence of S. pyogenes by PCR suggests that persistent infection may have a role in maintenance of recurrent inflammation in tonsils. BioMed Central 2005-09-13 /pmc/articles/PMC1242222/ /pubmed/16159391 http://dx.doi.org/10.1186/1472-6815-5-7 Text en Copyright © 2005 Kasenõmm et al; licensee BioMed Central Ltd.
spellingShingle Research Article
Kasenõmm, Priit
Piirsoo, Andres
Kull, Mart
Kull, Mart
Mikelsaar, Marika
Selection of indicators for tonsillectomy in adults with recurrent tonsillitis
title Selection of indicators for tonsillectomy in adults with recurrent tonsillitis
title_full Selection of indicators for tonsillectomy in adults with recurrent tonsillitis
title_fullStr Selection of indicators for tonsillectomy in adults with recurrent tonsillitis
title_full_unstemmed Selection of indicators for tonsillectomy in adults with recurrent tonsillitis
title_short Selection of indicators for tonsillectomy in adults with recurrent tonsillitis
title_sort selection of indicators for tonsillectomy in adults with recurrent tonsillitis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1242222/
https://www.ncbi.nlm.nih.gov/pubmed/16159391
http://dx.doi.org/10.1186/1472-6815-5-7
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