In the thesis, the results of a comprehensive clinical examination and laboratory investigations in patients with recurrent tonsillitis (RT) are presented. RT is a chronic disease of the palatine tonsils and adenoids, according to data from the public institution “Centre for Medical Statistics of the Ministry of Health of Ukraine,” the incidence of RT in Ukraine is about 800000 cases annually. Currently, the prevalence of chronic diseases of the tonsils and adenoids in Ukraine is 1078.0 cases per 100,000.
120 patients with acute recurrent tonsillitis, who are being treated at the Private Pediatric Clinic No. 1 in the city of Ivano-Frankivsk were enrolled in the study. To examine the patients clinical, instrumental, and morphological methods were used. Obtained data were analysed using various biostatistical methods.
The overall sample (n=120) included 37 (61.7%) males and 23 (38.3%) females in the intervention group (n=60) and 29 (48.3%) males and 31 (51.7%) females in the control group (n=60). The age of patients in the groups ranged from 3 to 17 years.
All patients received treatment according to the clinical recommendations from the first day which included: antipyretics, topical analgesics, and broad-spectrum antibiotics (when necessary).
It has been noted that administration of the phytoneering drug BNO 1030 in addition to standard therapy for recurrent tonsillitis during the acute episode has a significant therapeutic effect reported already in the first days of treatment. Significantly better dynamics of RT symptoms regression were noted in the intervention group: pain when swallowing and at rest, sore throat at rest, and tonsillar hyperaemia on V2, V3, and V4 (p<0.05). On V2, antibiotic therapy was prescribed to 5 patients out of 60 in the intervention group, constituting 8.3% of patients, and to 10 patients out of 60 in the control group, or 16.7%. The use of phytoneering drug BNO 1030 from the first day of treatment as part of the strategy of delayed antibiotics prescription in patients with an acute episode of RT allowed to reduce in the prescription of antibacterial drugs in the main group more than two-fold compared to the control group - from 16.7% to 8.3% (p <0.005).
For the first time, it was determined that prescription of the phytoneering drug BNO 1030 in addition to the standard RT therapy provides a clinically significant, reliable reduction of symptoms severity in patients with acute RT which becomes apparent as soon as day 3 of the treatment compared to standard therapy of delayed antibiotic prescribing (p<0.05).
It was proven that the delayed antibiotic prescription in RT treatment allowed to reduce the frequency of antibiotics administration in the study group by more than 2 times compared to the control - from 16.7% to 8.3%; (p<0.005).
The high diagnostic value of multiparametric ultrasound (elastography and shear wave elastometry) in the diagnosis of RT as a method to objectively evaluate disease symptoms was determined.
Updated the current evidence regarding the value of the histomorphological investigation of the palatine tonsils of patients with RT.
The following improvements were made:
- the process of determining treatment for the acute episode of RT and inter-relapse period, by adding the phytoneering drug BNO 1030 to the standard treatment, this resulted in the reduction of the antibiotic prescription during acute episodes by 8.3% (p<0.005);
- the process of choosing methods to diagnose RT by conducting multiparametric ultrasound (elastometry and shear wave elastography) in the inter-relapse period to objectify RT symptoms and choose the most appropriate treatment;
- histomorphological and immunohistochemical analysis of the palatine tonsils of patients with RT, by determining the index of connective tissue constituent in the tonsillar tissue, the average percentage of the area of follicles in patients with RT and the number of T-lymphocytes in the tonsil tissue.
Key words: recurrent tonsillitis, recurrent infections, diseases of ENT organs, obstructive sleep apnea syndrome, diseases of the tonsils, elastometry and shear wave elastography, stiffness of the peritonsillar space, histomorphological examination, fibrosis, prevention, treatment. Branch-Medicine.
