Treatment of chronic tonsillitis: a personalized approach to prevent metatonsillar complications

Мұқаба

Дәйексөз келтіру

Толық мәтін

Ашық рұқсат Ашық рұқсат
Рұқсат жабық Рұқсат берілді
Рұқсат жабық Рұқсат ақылы немесе тек жазылушылар үшін

Аннотация

Modern science has the latest theoretical data on the function and structure of the tonsillar apparatus, which are able to detail the issues of the occurrence and development of chronic tonsillitis (CT) taking into account the rich and diverse material accumulated by modern clinics. CT caused by BHSA-infection has the most unfavorable course, accompanied by frequent relapses of acute tonsillitis and the development of severe complications (peritonsillar abscess, purulent lymphadenitis, etc.) from the first days, as well as diseases associated with CT (glomerulonephritis, rheumatic fever, etc.). An important role in the occurrence of CT belongs to the interaction of microorganisms located in the crypts of the palatine tonsils with the macroorganism. Given the increased activity of the tonsils in childhood and their impact on the normal development of the immune system, approaches to surgical treatment should be very thoughtful and balanced. One of the urgent problems of otolaryngology remains the search for pathogenetically substantiated, effective and safe methods of treating CT. The emergence of new strains of antibiotic-resistant microorganisms is a serious clinical problem that is associated with a more severe course of diseases. Exacerbation of CT and sore throat remains a common reason for the unjustified prescription of systemic antibacterial therapy. In most cases, with the exception of streptococcal tonsillitis, antibiotics can be considered excessive treatment, since they are a completely inappropriate solution for the treatment of viral infections. In conservative therapy, agents that can, on the one hand, restrain the inflammatory reaction, and on the other, are able to modulate the immune response are of great interest. The article highlights the possibilities of modern herbal medicine in the conservative treatment of CT, promoting a balanced and scientifically substantiated personalized approach in the interests of the patient. The presented herbal remedies are included in clinical guidelines, their use is pathogenetically substantiated.

Толық мәтін

Рұқсат жабық

Авторлар туралы

Vladimir Belov

Veltischev Research Clinical Institute of Pediatrics and Pediatric Surgery, Pirogov Russian National Research Medical University; Russian Medical Academy of Continuous Professional Education

Хат алмасуға жауапты Автор.
Email: info@eco-vector.com
ORCID iD: 0000-0002-2955-2015

Cand. Sci. (Med.), Teaching Assistant, Department of Pediatric Otolaryngology named after prof. B.V. Shevrygin, Head of the Otolaryngology Department

Ресей, Moscow; Moscow

Elena Karpova

Russian Medical Academy of Continuous Professional Education

Email: info@eco-vector.com
ORCID iD: 0000-0002-8292-9635

Dr. Sci. (Med.), Professor, Head of the Department of Pediatric Otolaryngology named after prof. B.V. Shevrygin

Ресей, Moscow

Alan Asmanov

Veltischev Research Clinical Institute of Pediatrics and Pediatric Surgery, Pirogov Russian National Research Medical University

Email: info@eco-vector.com
ORCID iD: 0000-0002-3116-6447

Cand. Sci. (Med.), Head of the Department of Acute and Chronic Pathology of the Ear, Throat and Nose, Assistant Professor, Department of Otolaryngology, Faculty of Pediatrics

Ресей, Moscow

Olga Belova

Veltischev Research Clinical Institute of Pediatrics and Pediatric Surgery, Pirogov Russian National Research Medical University

Email: info@eco-vector.com
ORCID iD: 0009-0003-2893-1413

Cand. Sci. (Med.), Pulmonologist, Consultative and Diagnostic Department

Ресей, Moscow

Denis Tulupov

Russian Medical Academy of Continuous Professional Education; Filatov Children’s City Clinical Hospital No. 13

Email: info@eco-vector.com
ORCID iD: 0000-0001-6096-2082

Cand. Sci. (Med.), Associate Professor, Department of Pediatric Otolaryngology named after prof. B.V. Shevrygin, Otolaryngologist, Department of Otolaryngology

Ресей, Moscow; Moscow

Oleg Naumov

Russian Medical Academy of Continuous Professional Education; Filatov Children’s City Clinical Hospital No. 13

Email: info@eco-vector.com
ORCID iD: 0000-0002-8243-8385

Cand. Sci. (Med.), Associate Professor, Department of Pediatric Otolaryngology named after prof. B.V. Shevrygin, Otolaryngologist, Otolaryngology Department

Ресей, Moscow; Moscow

Әдебиет тізімі

  1. Крюков А.И., Изотова Г.Н., Захарова А.Ф. и др. Актуальность проблемы хронического тонзиллита. Вестник оториноларингологии. 2009;5:4–6. [Kryukov A.I., Izotova G.N., Zakharova A.F., et al. The relevance of the problem of chronic tonsillitis. Vestnik Otorinolaringologii. 2009;5:4–6. (In Russ.)].
  2. Салтанова Ж.Е. Хронический тонзиллит, этиологические и патогенетические аспекты развития метатонзиллярных осложнений. Вестник оториноларингологии. 2015;80(3):65–70. [Saltanova Zh.E. Chronic tonsillitis, etiological and pathogenetic aspects of the development of metatonsillar complications. Vestnik Otorinolaringologii. 2015;80(3):65–70. (In Russ.)].
  3. Пальчун В.Т., Магомедов М.М., Лучихин Л.А. Оториноларингология: учебник. М., 2011. 656 с. [Palchun V.T., Magomedov M.M., Luchikhin L.A. Otolaryngology: textbook. Moscow, 2011. 656 p. (In Russ.)].
  4. Машкова Т.А., Чиркова И.И., Ямщиков О.Н. и др. Эндогенная интоксикация при хронической патологии глотки у детей. Российская оториноларингология. 2021;20(3):94–101. [Mashkova T.A., Chirkova I.I., Yamshchikov O.N., et al. Endogenous intoxication in chronic pharyngeal pathology in children. Russian otorhinolaryngology. 2021;20(3):94–101. (In Russ.)]. Doi: https://doi.org/10.18692/1810-4800-2021-3-94-101
  5. Крюков А.И. Клиника, диагностика и лечение тонзиллярной патологии. Методические рекомендации. М., 2011. [Kryukov A.I. Clinic, diagnostics and treatment of tonsillar pathology. Guidelines. M., 2011. (In Russ.)].
  6. Хронический тонзиллит и ангина. Иммунологические и клинические аспекты. Под ред. С.А. Карпищенко, С.М. Свистушкина. 3-е издание. СПб., 2017. 264 с. [Chronic tonsillitis and angina. Immunological and clinical aspects. Ed. by S.A. Karpishchenko, S.M. Svistushkin. 3rd ed. St. Petersburg, 2017. 264 p. (In Russ.)].
  7. Федотова М.М., Акперов Э.Г., Елисеев В.Ю. и др. Антибиотикотерапия при острых респираторных вирусных инфекциях у детей: что знают родители об антибиотиках и антибиотикорезистентности? Вопросы практической педиатрии. 2022;17(2):85–92. [Fedotova M.M., Akperov E.G., Eliseev V.Y. et al. Antibiotic therapy for acute respiratory viral infections in children: what do parents know about antibiotics and antibiotic resistance? Voprosy prakticheskoy pediatrii. 2022;17(2):85–92. (In Russ.)]. Doi: https://doi.org/10.20953/1817-7646-2022-2-85-92
  8. Popovych V.I., Koshel I.V. Delayed prescription of antibiotics and the capabilities of herbal medicine when used in respiratory infections. Clin Phytosci 2024;10:1. Doi: https://doi.org/10.1186/s40816-023-00364-5
  9. Kalil J., Bowes J., Reddy D., et al. Pediatric Inpatient Antimicrobial Stewardship Program Safely Reduces Antibiotic Use in Patients with Bronchiolitis Caused by Respiratory Syncytial Virus: A Retrospective Chart Review. Pediatr Qual Saf. 2019;4(5):e211. Doi: https://doi.org/10.1097/pq9.0000000000000211
  10. Fleming-Dutra K.E., Hersh A.L., Shapiro D.J., et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. JAMA. 2016;315(17):1864–73. Doi: https://doi.org/10.1001/jama.2016.4151
  11. van Houten C.B., Cohen A., Engelhard D., et al. Antibiotic misuse in respiratory tract infections in children and adults – a prospective, multicentre study (TAILORED Treatment). Eur J Clin Microbiol Infect Dis. 2019;38(3):505–14. Doi: https://doi.org/10.1007/s10096-018-03454-25
  12. Hashimoto H., Matsui H., Sasabuchi Y., et al. Antibiotic prescription among outpatients in a prefecture of Japan, 2012–2013: a retrospective claims database study. BMJ. Open. 2019;9(4):e026251. Doi: https://doi.org/10.1136/bmjopen-2018-026251
  13. Клинические рекомендации. Хронический тонзиллит. Министерство здравоохранения Российской Федерации. Национальная медицинская ассоциация оториноларингологов. 2024. [Clinical guidelines. Chronic tonsillitis. Ministry of Health of the Russian Federation. National Medical Association of Otolaryngologists. 2024. (In Russ.)]. URL: https://cr.minzdrav.gov.ru
  14. Абдулкеримов Х.Т., Гаращенко Т.И., Кошель В.И. и др. Тонзиллофарингиты. Под ред. С.В. Рязанцева. СПб., 2014. 40 с. [Abdulkerimov Kh.T., Garashchenko T.I., Koshel V.I. et al. Tonsillopharyngitis. Ed. by S.V. Ryazantsev. SPb., 2014. 40 p. (In Russ.)].
  15. Караулов А.В., Афанасьев С.С., Алешкин В.А. и др. Микрофлора, колонизационная резистентность слизистых и мукозальный иммунитет. Иммунология. 2015;36(5):290–5. [Karaulov A.V., Afanasyev S.S., Aleshkin V.A. et al. Microflora, colonization resistance of mucous membranes and mucosal immunity. Immunologiya. 2015;36(5):290–5. (In Russ.)].
  16. Карпова Е.П., Тулупов Д.А., Вагина Е.Е. Возможности профилактики и лечения лимфаденотонзиллярной патологии. Русский медицинский журнал. 2014;22(25):1842–5. [Karpova E.P., Tulupov D.A., Vagina E.E. Possibilities of prevention and treatment of lymphadenotonsillar pathology. Russian Medical Journal. 2014;22(25):1842–5. (In Russ.)].
  17. Белов В.А. Континуум хронического тонзиллита с общепатологических позиций. Ученые записки Первого Санкт-Петербургского государственного медицинского университета им. акад. И.П. Павлова. 2024;31(3):11–8. [Belov V.A. Continuum of chronic tonsillitis from general pathological positions. Scientific notes of the First St. Petersburg State Medical University named after academician I.P. Pavlov. 2024;31(3):11–8. (In Russ.)]. Doi: https://doi.org/10.24884/1607-4181-2024-31-3-11-18
  18. Byars S.G., Stearns S.C., Boomsma J.J. Association of Long-Term Risk of Respiratory, Allergic, and Infectious Diseases With Removal of Adenoids and Tonsils in Childhood. JAMA. Otolaryngol Head Neck Surg. 2018;144(7):594–603. Doi: https://doi.org/10.1001/jamaoto.2018.0614
  19. Стремоухов А.А., Заплатников А.Л., Власова Н.Л., Смирнова М.А. Фитотерапия инфекционно-воспалительных заболеваний верхних дыхательных путей в амбулаторной терапевтической и общей врачебной практике. Русский медицинский журнал. Медицинское обозрение. 2022;6(8):419–26. [Stremoukhov A.A., Zaplatnikov A.L., Vlasova N.L., Smirnova M.A. Phytotherapy of infectious and inflammatory diseases of the upper respiratory tract in outpatient therapeutic and general medical practice. Russian Medical Journal. Medical Review. 2022;6(8):419–26. (In Russ.)]. Doi: https://doi.org/10.32364/2587-6821-2022-6-8-419-426
  20. Wosikowski K., Seifert S., Melnykov O., Haunschild J. Imupret inhibits respiratory syncytial virus replication and displays in vitro and in vivo immunomodulatory properties. Planta Medica. 2013;79:1152–1152. Doi: https://doi.org/10.1055/s-0033-1351993
  21. Hostanska K., Melzer J., Amon A., Saller R. Anti-inflammatory abilities of Imupret: Inhibition of IL8 and human β-defensin 2 induced by LPS and IL1 β in lung epithelial A549 cells. Eur J Integrat Med. 2008;1:12. Doi: https://doi.org/10.1016/j.eujim.2008.08.105
  22. Дрынов Г.И. Клинико-иммунологическая характеристика и эффективность консервативного лечения хронического тонзиллита у детей. Современная педиатрия. 2013;6(54):116–20. [Drynov G.I Clinical and immunological characteristics and effectiveness of conservative treatment of chronic tonsillitis in children. Sovremennaya pediatriya=Modern pediatrics. 2013;6(54):116–20. (In Russ.)].
  23. Бойко Н.В., Летифов Г.М., Ким А.С., Стагниева И.В. Оценка эффективности лечения острого тонзиллофарингита при острых респираторных вирусных инфекциях у детей. Педиатрия. Журнал им. Г.Н. Сперанского. 2018;97(4): 212–6. [Boyko N.V., Letifov G.M., Kim A.S., Stagnieva I.V Evaluation of the effectiveness of treatment of acute tonsillopharyngitis in acute respiratory viral infections in children. Pediatrics. Journal named after G.N. Speransky. 2018;97(4):212–6. (In Russ.)].
  24. Белов В.А., Карпова Е.П., Заплатников А.Л. и др. Острые инфекции органов дыхания: современные клинические рекомендации. В фокусе – вопросы фитотерапии. Русский медицинский журнал. Медицинское обозрение. 2022;6(7):376–86. [Belov V.A., Karpova E.P., Zaplatnikov A.L., et al. Acute respiratory infections: modern clinical guidelines. Focus on herbal medicine. Russian Medical Journal. Medical Review. 2022;6(7):376–86. (In Russ.)]. Doi: https://doi.org/10.32364/2587-6821-2022-6-7-376-386
  25. Пискунов В.С., Никитин Н.А. Опыт применения препарата Тонзилгон® Н в комплексном лечении хронического тонзиллита с промыванием небных миндалин у взрослых. Consilium Medicum. 2018;20(3):24–8. [Piskunov V.S., Nikitin N.A. Experience of using Tonsilgon® N in the complex treatment of chronic tonsillitis with rinsing of the palatine tonsils in adults. Consilium Medicum. 2018;20(3):24–8. (In Russ.)].
  26. Абдулкеримов Х.Т., Карташова К.И., Давыдов Р.С. и др. Сравнительная оценка эффективности лечения пациентов с субкомпенсированной формой хронического тонзиллита антисептическим средством растительного происхождения в комплексе со стандартной консервативной терапией: результаты открытого рандомизированного исследования. Вестник оториноларингологии. 2018;3:45–9. [Abdulkerimov Kh.T., Kartashova K.I., Davydov R.S., et al. Comparative evaluation of the effectiveness of treating patients with subcompensated chronic tonsillitis with an antiseptic agent of plant origin in combination with standard conservative therapy: results of an open randomized study. Vestnik Otorinolaringologii. 2018;3:45–9. (In Russ.)]. Doi: https://doi.org/10.17116/otorino201883345
  27. Вавилова В.П., Вавилов А.М., Черкаева А.Х., Нечаева И.А. Эффективность экстракта из корня алтея, цветков ромашки, травы хвоща, листьев грецкого ореха, травы тысячелистника, коры дуба и травы одуванчика у детей дошкольного возраста с патологией глоточной и/или небных миндалин и частыми рецидивирующими респираторными инфекциями. Педиатрия. Consilium Medicum. 2022;2:160–5. [Vavilova V.P., Vavilov A.M., Cherkaeva A.Kh., Nechaeva I.A. Efficiency of the extract from marshmallow root, chamomile flowers, horsetail herb, walnut leaves, yarrow herb, oak bark and dandelion herb in preschool children with pathology of the pharyngeal and/or palatine tonsils and frequent recurrent respiratory infections. Pediatrics. Consilium Medicum. 2022;2:160–5. (In Russ.)]. Doi: https://doi.org/10.26442/26586630.2022.2.201719
  28. Butler A.M., Brown D.S., Durkin M.J., et al. Association of Inappropriate Outpatient Pediatric Antibiotic Prescriptions With Adverse Drug Events and Health Care Expenditures. JAMA. Netw Open. 2022;5(5):e2214153. Doi: https://doi.org/10.1001/jamanetworkopen.2022.14153

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