The thesis deals with the scientific problem of objectifying the diagnosis of the pathology of palatine tonsils in children and the surgical indications. We studied immunological and morphological differences of the pathology of palatine tonsils in case of hypertrophy and chronic inflammation, the functional state of the tonsils in these types of the pathology. The objective immunological and clinical criteria for indications for surgical and conservative methods of treatment were determined. A new method of conservative treatment was developed and the most optimal method of surgical treatment was identified.
The obtained epidemiological data indicate a significant difference in the number of operated patients with chronic tonsillitis and hypertrophy of palatine tonsils. The obtained results allowed us to suggest that there are differences in diagnosing the pathology of palatine tonsils, as well as in the interpretation of indications for surgical or conservative treatment of this pathology at an early age.
A comparative study of the state of local and systemic immunity of patients with chronic tonsillitis and hypertrophy of palatine tonsils was performed to identify the features and the differences in the immunological status. The concentration of cytokine TNF-α in the lysates of the cells of palatine tonsils in the group of patients with hypertrophy was twice (P<0.05) higher than in the group of patients with chronic tonsillitis. The study of allergy factors, namely LIF in oropharyngeal secretion by inhibiting the migration of leukocytes from capillaries, and immunoglobulin E class and G4 subclass in the lysates of palatine tonsils by the enzyme immunoassay, showed that IgE was detected in cells of palatine tonsils of children with hypertrophy significantly more (P<0.05) than in children with chronic tonsillitis.
The electron microscopic study of the surface epithelium showed the loose connection between cells by intercellular bridge. The lymphoid tissue of patients with hypertrophy was represented by hyperplastic secondary follicles, located close to each other with large light centers and surrounded by a lymphoid rim, often forming a “half-moon”, and only in individual cases they were placed evenly in a circle.
We compared the old test and the new one where the lacunae of palatine tonsils were washed with a solution of OM-85 with subsequent effects of ultrasound at a frequency of 880 kHz directly on palatine tonsils for a week and sIgA and α-IFN levels were determined in the oropharyngeal secretion before the test and 7 days after it. According to the new method, the number of cases with a positive result of stimulation of cytokine levels was significantly (P<0.05) lower, which indicates a more selective effect of the test on determining the functional state of palatine tonsils in their pathology.
The experiment in vitro was performed at the next stage of the research to substantiate the initial conservative therapy. It was found that the co-cultivation of plant-derived immunomodulators with Lizak increased the percentage of viable cells, especially when co-cultivated with Esberitox and Lizak (P=0.05).
A comparative study of the effectiveness of various surgical techniques to restore local immunity in patients with pathology of palatine tonsils was performed. There were used classical tonsillectomy, classical tonsillotomy, coblation, shaver tonsillotomy and tonsilloplasty. One month after the surgery, the levels of sIgA, α-IFN, IL-β, TGF were identified in the oropharyngeal secretion of patients. It was found that the indicators of local immunity were most likely to be restored with the use of shaver tonsillotomy and tonsilloplasty (P<0.05).
The modern immunological criteria of the pathological condition of palatine tonsils, which are most characteristic for hypertrophy and chronic tonsillitis at an early age, were defined in the dissertation for the first time. Based on these studies, a point analogue scale for the diagnosis of pathological conditions of palatine tonsils was developed. Modern immunologically-substantiated surgical (new modern criteria for surgical indications) and conservative tactics of treatment of the pathology of palatine tonsils in children were offered.
The scientific importance of the study lies in the fact that the revealed immunological factors and criteria change the beliefs about the pathogenesis of the pathology of palatine tonsils in children, and new methods of diagnosis of these conditions, indications for surgical and conservative treatment and the choice of the method of surgical treatment will improve the treatment outcomes and decrease the prevalence of hypertrophy of palatine tonsils and chronic tonsillitis at an early age.
