Investigation of oxidative stress in patients with chronic tonsillitis Tatjana Cvetkovic ´ a , Predrag Vlahovic ´ b, * , Miroljub Todorovic ´ c , Milan Stankovic ´ d a Institute of Biochemistry, Faculty of Medicine, Nis ˇ, Serbia b Clinic of Nephrology & Hemodialysis, Clinical Center Nis ˇ, Dr. Zorana Ðinpic ´a 48, 18000 Nis ˇ, Serbia c Clinic for Othorhinolaryngology, Cetinje, Montenegro d Clinic for Othorhinolaryngology, Clinical Center Nis ˇ, Serbia Received 20 May 2008; accepted 17 October 2008 Available online 25 December 2008 Abstract Objectives: Oxidative stress has been implicated in numerous pathological conditions including chronic tonsillitis. The aim of this study was to assess levels of lipid peroxidation, evidenced by formation of thiobarbituric acid reactive substance (TBARS), level of total sulfhydryl groups (TSH), and carbonyl content in patients with tonsillar hypertrophy (TH) and recurrent tonsillitis (RT), before and after tonsillectomy. Methods: In this study the serum and tonsillar tissue levels of TBARS, TSH and carbonyl content were investigated in 35 patients with TH and RT, before and 1 month after the operation, compared to 30 age-matched controls. Results: In both TH and RT groups, a significantly higher serum TBARS levels were observed before and 4 weeks after tonsillectomy in comparison with healthy subjects. The serum level in TH patients after operation was even higher compared to the levels before. There was statistically significant difference in serum TSH levels between patients with RT before operation compared to the control group. After tonsillectomy the serum levels of TSH were higher compared to control groups and TH and RT patients before operation. Carbonyl content was attenuated only in TH patients after tonsillectomy. In tonsillar tissue, significantly lower level of glutathione content (GSH) has been observed in RT related to TH patients. Conclusions: Oxidative stress, in patients with tonsillar hypertrophy and recurrent tonsillitis, is still present 1 month after the removal of tonsillar tissue. Antioxidant therapy, during the recovery period after tonsillectomy, could be optional treatment. # 2008 Elsevier Ireland Ltd. All rights reserved. Keywords: Oxidative stress; Palatine tonsil; Tonsillitis; Recurrent tonsillitis; Tonsillar hypertrophy 1. Introduction Palatine tonsils are reactive lymphoepithelial organs which are considered the first place of contact with variety of antigenic substances present in air and food. They are located at the entrance of respiratory and alimentary tracts and during recurrent upper respiratory tract infections tonsillar humoral and cellular immunity is altered. Recurrent tonsillitis (RT) and idiopathic (obstructive) tonsillar hypertrophy (TH) represent two different pathogenic entities with different morphology [1] and patterns of local immune response [2,3]. Tonsillar hypertrophy is characterized histologically by an enlarge- ment of lymphoid follicles and reduced extrafollicular tissue, indicating hyperplastic condition of lymphoid cells in the germinal centers. However, in the recurrent tonsillitis reduced number of follicles and fibrosis in extrafolicular tissue is demonstrable [4,5]. In addition, RT is caused by an immune response followed with strong inflammatory process compared to TH where environ- mental agents mediate local antigen stimulation without inflammation [6]. Although the pathophysiology of tonsillar disease processes remains still unknown, both TH and RT are the most common reasons for surgical tonsillectomy. Moreover, the benefit of tonsillar removal is still controversial. Oxidative stress has been implicated in numerous pathological conditions including cancer, cardiovascular diseases, rheumatoid arthritis, ischemia/reperfusion and www.elsevier.com/locate/anl Auris Nasus Larynx 36 (2009) 340–344 * Corresponding author. Fax: +381 18 53 01 27. E-mail address: predrag_vlahovic@yahoo.com (P. Vlahovic ´). 0385-8146/$ – see front matter # 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.anl.2008.10.004