Balneo Research Journal, Vol. 10, No. 3, September 2019, p: 278–287
Lingual tonsils hypertrophy and possibility of its correction by physical factors
Alexander Andreev1, Sergey Puhlik1, Oleg Melnikov1, Irina Tagunova2, Sergey Gushcha2
1Odessa National Medical University, Ukraine
2State Institution “Ukrainian Research Institute of Medical Rehabilitation Therapy of Ministry of Health of Ukraine”, Odessa, Ukraine
Introduction: The component of the lymphopharyngeal ring is the lingual tonsil (LT), located on the root of the tongue. With pathological changes in the lymphoid tissue of the pharynx, surgical removal of the tonsils, as a result of increased antigenic load, a compensatory increase in LT is observed – «lingual tonsillar hypertrophy». This is observed against the background of age-related involutive changes, when the remaining elements of the lymphopharyngeal ring begin to perform anti-antigenic and adaptive activity. The processes taking place in, the structure of the LT, which is familiar to the body, changes – the receptor apparatus creates pathological impulses from the organ. The severity of clinical manifestations correlates with the degree of increase in LT. The emphasis on these manifestations, psychosomatic conditions, create a complex of pathological sensations that violate the quality of patients’ life. The goal and objectives of the study are aimed at improving the quality of patients’ life with lingual tonsil hypertrophy (LTH), by developing effective methods of diagnosis and treatment, assessing the role of the immunoregulatory shift in the pathogenesis of LTH of the possibility of their correction by the action of a physical factor (cold destruction).
Materials and methods: When examining 850 people who underwent complex research and instrumental diagnostics in connection with the pathology of ENT organs, 119 people (the main group) were diagnosed with different degrees of LTH, with control of 30 healthy people. Cryosurgical treatment was offered to 76 patients who used the method for treating of lingual tonsil hypertrophy by cryodestruction using a hook-shaped applicator with a heat-insulating nozzle on the back surface, an individual polyethylene cap, and a cryoapparatus.
Results and discussions: With LTH, an increase in the volume and mass of tissues forming the morphological basis of the tonsil was detected: the main substance was an increase in the number and size of layers of coarse fibrous fibers, fields of fat cells, and the growth of mucous glands. The mucous membrane, thinning, undergoes dystrophic-degenerative changes. The rate of proliferation correlates with the severity of inflammation, the causes of which are multifactorial, individual. There is an increased sensitivity reaction to microbial and household allergens, an increase in the content of antibodies in the blood to LT tissues, a change in microbiocinosis of the pharyngeal mucosa, and vegetation of non-resident microflora. As a result of cryosurgical treatment in 56 (73.68%) cases, a decrease in the volume of LT tissue was observed. The deep layers, partially absorbed, were replaced by healthy tissues, the surface layers were rejected with the formation of an atrophic scar or regenerate, the structure of which was close to organotypic. The cause of pathological impulse was eliminated, clinical indicators were normalized, the quality of life of patients was improved.
Conclusions: LTH should be considered as a continuation of the development of a productive process associated with immunoregulatory changes in chronic infectious and allergic conditions. Local cryogenicity on LTH was accompanied by normalization of the structure of its own substance, LT, and a decrease in inflammatory changes in surrounding tissues. The development of inflammatory changes in LT was a local manifestation of a general disturbance in the functioning of the immune defense system. Achieving a persistent positive effect in the treatment of LTH requires an integrated approach with mandatory systemic immune correction and hormonal correction.
Key words: lingual tonsil hypertrophy, cryosurgery, immunoregulatory shift, obstructive sleep apnea