O.V. Davydova

Patients who suffer from pharyngeal tonsil hypertrophy or inflammation are very common visitors in outpatient physicians’ practice. Hypertrophy of the pharyngeal tonsil may be accompanied by persistent difficulty in nasal breathing and complications whilst adenoditis in the absence of a significant impact on the child’s quality of life and associated complications had not been regarded as a ‘pathology’ in pediatric physicians’ practice until the patient is reached the age of 7 to 9 years old. The purpose of this research was to compare the regimens of the use of the homeopathic medications in patients with pharyngeal tonsil hypertrophy or inflammation. Materials and methods used: a single-center controlled randomized observation of the use of homeopathic medications of a single active substance had been conducted in pediatric patients aged 1 to 18 y/o with pharyngeal tonsil hypertrophy or inflammation. The study included patients with pharyngeal tonsil hypertrophy or inflammation who had previously taken homeopathic single-substance medications, including in combination with standard treatment. Depending on the choice of patients (repetition of the homeopathic single-substance medications intake or prophylactic regimen) the patients were then divided into comparison groups. All of the patients had undergone both the routine examination and the ENT endoscopy, the parents’/caregivers’ satisfaction with the treatment results was then assessed using the 5-point Likert scale as well as the incidence of acute respiratory infections (ARI) in children while taking homeopathic medicines (compared to the period without taking them) and the willingness to use homeopathic medicines in the future. Results: after the ENT endoscopy (reduction in the size of the pharyngeal tonsil in 38% of cases, p≤0.001) and the parents’/caregivers’ survey (reduction in the ARI frequency in 62% of cases and high satisfaction with the treatment results), the majority of parents/caregivers have assessed the repetition of the repetition of the homeopathic single-substance medications intake as rather more effective in treatment of patients with inflammation of the pharyngeal tonsil of varying degrees of hypertrophy. Conclusion: the use of homeopathic medicines in patients with pharyngeal tonsil hypertrophy or inflammation has showed good effectiveness. According to the ENT endoscopy results before v. after the treatment and the parents’/caregivers’ survey it is preferable to repeat the homeopathic single-substance medications intake in the next adenoiditis episode. The parents’/caregivers’ readiness to go on with the homeopathic medicines’ intake ranges from 50% to 78%.

Objective. To evaluate the effect of inosine pranobex (Normomed®, 500 mg tablets) used as part of complex therapy of acute respiratory viral infections in children with recurrent respiratory infections, adenoiditis and persistence of herpes viruses on the severity of complaints and symptoms, as well as on the persistence of herpes viruses on the nasopharyngeal mucosa. Patients and methods. An observational comparative prospective study with 50 children aged 3 years and older, with confirmed persistence of herpes viruses (by PCR) was performed. All children received elimination and irrigation therapy and topical antimicrobials. Patients of group 1 additionally received inosine pranobex (Normomed®, 500 mg tablets) in 3 courses of 10 days with a break of 8 days. The children were monitored during 3 face-to-face visits, during which routine ENT examination, endoscopic examination, repeated PCR-diagnostics were performed (Visit 1 – baseline/Day 0, Visit 2 – on day 10 ± 1 and Visit 3 – day 47 ± 1 from the beginning of observation). We evaluated the presence and severity of adenoiditis symptoms, the size of the nasopharyngeal tonsil (NT), the presence of herpes-virus DNA according to repeated PCR, as well as the proportion of patients who achieved herpes-virus elimination on the background of marked and maximum clinical improvement (complete therapeutic result). Results. DNA of human herpes virus type 6 (HHV-6) and Epstein-Barr virus – EBV were detected most frequently in the groups (96% and 37% and 87% and 43% in groups 1 and 2, respectively). Simultaneous DNA detection of viruses 2 and 3 was observed in 33% and 11% in group 1, and in 30% and 9% of patients in group 2. Grade 2 NT hypertrophy was observed in 33% and 35% and grade 3 hypertrophy in 67% and 61% of children in groups 1 and 2, respectively. By visit 3, EBV elimination was achieved in 40% and HHV-6 in 23% of patients in group 1 versus 20% and 23% in group 2, respectively (difference statistically significant, p < 0.01. In group 2, there was a ‘relapse’ of EBV (20%) and HHV-6 (15%) detection. The risk of herpes virus DNA detection by the 3rd visit was significantly higher in group 2 compared with group 1 (RR = 1.5 [1.1-2.1]). Reduction in the degree of NT hypertrophy was achieved more than 7 times more often in group 1 (30%) than in group 2 (4%), p = 0.028. While the size of the nasopharyngeal tonsil was maintained, 48% of patients in group 1 did not have block of the pharyngeal auditory tube orifices (vs 4% in group 2, p = 0.001). Five (22%) patients in group 2 had an increase in the degree of nasopharyngeal tonsil hypertrophy or the appearance of block of the pharyngeal auricular orifices (6/26%) between visits 2 and 3 (p = 0.026). Group 1 was statistically significantly more likely to achieve a complete therapeutic result (p < 0.0001). The proportion of patients who never had an acute respiratory infection during the follow-up period in group 1 was statistically significantly higher (81% vs. 35%, p = 0.0021). Conclusion. Inclusion of inosine pranobex (Normomed®) in therapy contributes to the achievement of a complete therapeutic result (marked and maximum clinical improvement of clinical picture against the background of absence of virus DNA isolation according to PCR-diagnostics) and reduction of propensity to recurrent respiratory infections in the majority of patients. Key words: adenoiditis, recurrent respiratory infections, herpes viruses, inosine pranobex, children

The problem of hyperplasia/inflammation of the structures of the Pirogov-Waldeyer lymphoid-pharyngeal ring and related complications is one of the most frequently discussed in pediatric practice, in particular in matters of methods and expediency of conservative treatment. The article describes the effectiveness of various regiment of conservative treatment of pediatric patients with inflammation of the pharyngeal tonsil (adenoiditis) based on the results of an open comparative observational study. To compare the effectiveness of various schemes of conservative therapy of adenoiditis in children. 154 patients were divided into three groups: group I - standard therapy; group II - standard therapy + a specially developed homeopathic protocol; group III - a specially developed homeopathic protocol. At each of the visits (day 0th, 7th, 30th, and 90th), ENT-organs endoscopy and a 10-point visual assessment of symptoms were performed by analog score. The effectiveness of treatment (day 7th, 30th, and 90th) was evaluated by both doctors and patients. Analysis of the results showed that the symptoms of adenoiditis were stopped most quickly (day 7th) in patients of group I, but more pronounced and prolonged positive dynamics was noted in comparison groups II and III (only in these groups parents/legal representatives of patients rated the effectiveness as recovery in 25% and 35%, respectively). Conservative treatment of adenoiditis: has a positive effect (the severity and duration depends on the therapy regimen); avoids adenotomy, especially in patients who have taken homeopathic medications as a part of combined therapy. The use of a standardized homeopathic protocol is possible, both in combination with the use of other medications, and as monotherapy. Against the background of taking homeopathic medications, undesirable side effects may occur, which the parents of patients should be informed about in advance.