Vol 30, No 2 (2024)

IgA nephropathy and hemorrhagic vasculitis are IgA-mediated meta-tonsillar diseases. The literature on their pathogenesis, association with chronic tonsillitis, and effects of tonsillectomy on their progression was reviewed. In patients with IgA nephropathy, tonsillectomy is associated with higher rates of clinical remission, suppressing progression of renal failure as a result of decreased mucosal production of abnormally galactosylated IgA1 molecules. This finding is supported by high-quality studies in Asian populations and isolated comparative studies in Caucasians. For this reason, Asian guidelines, especially Japanese, include tonsillectomy as a treatment option for this group of patients.

In hemorrhagic vasculitis, tonsillectomy is only effective in clinical forms with renal impairment. For other forms, symptomatic treatment is preferred, and tonsillectomy is indicated when there is a proven association between attacks of chronic tonsillitis and deterioration of kidney function. Further research is needed in this area with a larger population of patients with IgA-mediated diseases and with the ability to evaluate the impact of genetic characteristics on treatment outcome.

The association between chronic tonsillitis and neurological and neuropsychiatric disorders is well described in the literature. The role of streptococcal infections is considered obvious, although there is no clear understanding of the pathophysiological mechanism. A cross autoimmune reaction with basal ganglia antigens is thought to play a key role in the development of this group of disorders.

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are the most studied of these groups. Antibacterial therapy is the main treatment option, but there are no reliable recommendations for its use.

No significant changes in the clinical manifestations were observed after tonsillectomy, and the positive results described in some observational studies could have been caused by postoperative treatments.

The paper suggests that chronic tonsillitis may have an effect on the risk of other mental disorders, such as obsessive-compulsive disorder, bipolar disorder, attention-deficit/hyperactivity disorder, autism spectrum disorder, anxiety disorders, and migraines.

Large randomized trials are needed to make definitive conclusions about the advisability of tonsillectomy in patients with PANDAS and other disorders. One of the most promising areas is to study the microbiota of the palatine tonsils and its contribution to migraine. If confirmed, these data will increase importance of nonsurgical treatment of palatine tonsils by their thorough irrigation.

BACKGROUND: Postoperative packing of the external auditory canal is still controversial. The shape of a wick, its material, the time of its presence in the ear canal and in the postoperative cavity, and the type of packing depending on the type of surgery are still under discussion. There are many different packing techniques, but there is no single standardized one.

AIM: The aim of the study was to evaluate characteristics of split cellulose compared to other materials for ear canal packing after ear surgery in an animal experiment based on postoperative clinical and microbiological observations.

MATERIALS AND METHODS: For the experiment, 36 chinchilla rabbits were used. The animals were divided into three groups according to the material of the ear canal wick: cellulose, microporous sponge of hydrolyzed polyvinyl acetate; medical gauze. The condition of the postoperative wound, the condition of the wicks for the presence of ear discharge, and the inflammatory response of the ear canal tissues were assessed. A microbiological study involved isolation and identification of pure bacterial cultures. Microbial growth was assessed based on the count of colony forming units (CFU).

RESULTS: The study showed that the presence and degree of clinical response did not correlate with the type of packing material in the ear canal. The ear canal packing with split cellulose, microporous hydrolyzed polyvinyl acetate sponge, medical gauze did not cause the growth of pathogenic microflora during the experimental period up to 21 days, and the absence of significant local reaction of the tympanic membrane and ear canal in rabbits suggests that split cellulose can be used as one of the promising import-substituting packing materials for ear canal and trepanation cavities after middle ear surgeries.

BACKGROUND: COVID-19, caused by SARS-CoV-2, is a highly contagious infectious disease associated with a risk of severe complications. In Russia, the COVID-19 incidence has exceeded 24 million, with new strains raising the incidence in children up to 18%. The prevalence of long COVID is rising. In children, the adaptive immune system, including the lymphoepithelial ring of the throat, plays a key role in determining the severity of COVID-19. The lymphoid tissue of the Waldeyer’s ring is one of the first immune barriers against coronaviruses and other respiratory infections. The high incidence of co-infection worsens the course of the disease. A chronic adenotonsillar disease has incidence of 32%–35% in children. However, impact of this disease on the severity of COVID-19 and the incidence of co-infection in children is poorly understood.

AIM: The aim of the study was to evaluate impact of the chronic adenotonsillar disease on COVID-19 progression and the incidence of co-infections in children.

MATERIALS AND METHODS: Conducted in St. Petersburg from January 2022 to March 2023, the study included 493 children (300 with COVID-19 and 144 with chronic adenotonsillar disease). Patients were divided into four groups to evaluate impact of chronic adenotonsillar disease on COVID-19 progression. Non-parametric statistical methods were used to analyze the clinical data.

RESULTS: Children with both COVID-19 and chronic adenotonsillar disease demonstrated a more severe course of disease compared to those without chronic adenotonsillar disease. The first group showed an increased incidence of bronchitis, bacterial co-infections, longer hospitalization and disease duration, longer fever duration, and higher maximum temperature. Laboratory data showed higher white blood cell counts in patients with COVID-19 and chronic adenotonsillar disease compared to those without chronic adenotonsillar disease.

CONCLUSIONS: Chronic adenotonsillar disease significantly complicates the course of COVID-19 in children. Further research is needed to elucidate the pathophysiological mechanisms and optimize treatment strategies for children with chronic adenotonsillar disease.

BACKGROUND: The paper outlines stages of decannulation in tracheostomized infants with congenital choanal atresia following a stentless surgery using upper septal flaps fixed with fibrin glue.

AIM: The aim of the study was to optimize preparation, timing, and prognostic factors for successful decannulation in infants after choanoplasty.

MATERIALS AND METHODS: The study included 11 tracheostomized children under 1 year of age with congenital choanal atresia. The treatment group included tracheostomized children who undergone standard choanoplasty with stents (n = 5). The comparison group included tracheostomized children admitted for primary surgery (n = 6). Endoscopic examination and tracheobronchoscopy were performed to evaluate treatment outcomes, and saturation was measured with a closed tracheostomy.

RESULTS: In group 1, endoscopic examination of the nasal cavity and nasopharynx revealed that neochoanae were too small (less than 50% of the norm) for decannulation; revision surgery was required using a stentless technique. In group 2, patients after the stentless choanoplasty showed no signs of re-stenosis during the follow-up period (3–6 months). They underwent successful decannulation at different time points after surgery. Over the one-year follow-up, no re-stenosis was observed in either group. In 9 patients, successful decannulation was performed at various time points after surgery. In 2 patients, decannulation was delayed.

CONCLUSIONS: Long-term mechanical ventilation is unsuitable in patients with bilateral choanal atresia, and tracheostomy is a common solution for respiratory failure. However, tracheostomy can have many early and late postoperative complications, so decannulation should be performed as soon as possible after nasal breathing is restored. The proposed endoscopic approach using a vascularized mucosal flap and fibrin glue appears to be the method of choice for choanoplasty in tracheostomized children. The process of decannulation in children, even with the restoration of nasal breathing after choanaplasty, is extremely complex and is associated with many risks.