RESEARCH – August 2005

Study of the pathogenesis of chronic tonsillitis as a basis for establishment of objective criteria for tonsillectomy


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Background. The aim of the study was to find out the anamnestic data, the macroscopic oropharyngeal signs and the diagnostic laboratory tests used most frequently by ENT (ear, nose, and throat) surgeons when recommending tonsillectomy for recurrent tonsillitis (RT) in adults. Also, the association between the frequency of tonsillitis episodes, the length of the morbidity period and the macroscopic signs of sclerotic process in the tonsils was explored in order to select objective indicators of tonsillectomy (TE) in adults with RT.

Methods. The study involved 62 RT patients, admitted for TE, and 54 healthy volunteers. Multiplying the number of tonsillitis episodes per year by the morbidity period in years, the index of tonsillitis (IT) was calculated. 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.

Results. Besides the frequency of tonsillitis episodes per year, ENT surgeons paid great attention to the presence of systemic effects of RT, particularly comorbid diseases, when selecting candidates for tonsillectomy among adults. Less important were decreased life quality due to missed workdays, and increased number of health care visits. Among macroscopic oropharyngeal signs, the occurrence of severe cryptic debris and tonsillar sclerosis were considered the most valuable signs, followed closely by enlarged cervical lymph nodes. The two other signs of sclerotic process, presence of the scar tissue on the tonsils and obstruction of tonsillar crypts, were considered less important. Diagnostic laboratory tests are mostly performed in order to establish the occurrence of S. pyogenes in the throat flora, using culture analysis or determination of the antistreptolysin O (ASO) titre. The study revealed that the most common sclerotic signs in RT patients are tonsillar sclerosis and obstruction of tonsillar crypts. Their presence on oropharyngeal examination was in correlation with higher IT values (r = 0.325, p = 0.010). The constructed receiver-operating characteristic (ROC) curve showed that an IT score of 36 is an optimal cut-off point for prediction of sclerotic tonsils.

Conclusion. Assuming that the sclerotic process in the tonsils leads to their impaired defensive function, the IT scores ≥36 and sclerotic signs on oropharyngeal examination can both serve as indicators of TE in adults with RT.