First Pediatric Otorinolaryngology Conference

New concepts in the treatment of tonsillites were presented by leading Bulgarian otorhinolaryngologists

A Round table on the subject initiated Alpen Pharma Bulgaria in an international medical conference




From 1 to 3 December 2017, Sofia hosted the Sixth Bulgarian-Italian Rhinological Meeting and the First Pediatric Otorinolaryngology Conference. The two events took place under the aegis of the European Rhinological Association and European Association of Children’s Otorhinolaryngology, as well as the Bulgarian Association of Otorhinolaryngology, Head and Neck Surgery.

The invited 35 international guest speakers from 18 countries were leaders dictating the innovations in the diagnosis and treatment of ENT diseases in Europe and the world. The topics that have been affected are extremely relevant: from congenital larynx abnormalities in neonates, early auditory screening, cochlear implantation – difficult and rare clinical cases, otitis and rhinosinusitis in infancy to new operative techniques in the field of rhinoplasty, complications and the right approach to the treatment of chronic rhinosinusitis.

The event also comprised a round table discussing the modern concepts of treating recurrent tonsillitis with the homeopathic drug Tonsilotren. Prof. Dr. Rumen Benchev, Chair of the Bulgarian National Association of Otorhinolaryngology, Head and Neck Surgery, Prof. Dr. Dilyana Vicheva, Chair of the Bulgarian Rhinological Association, Assoc. Prof. Mario Milkov, Otorhinolaryngologist from Varna and Assoc. Prof. Dr. Hristo Zlatanov, Head of Department at the ENT Clinic of the Military Medical Academy (MMA) in Sofia.

The meeting exposed the problems associated with inflammatory processes of tonsils, with an emphasis on recurrent tonsillitis and the ways in which they could be treated.

The session moderator, Prof. Dr. Benchev, briefly recalled the main functions of the tonsils.

  • Immunological function of tonsils, which is associated with the production of interferons, cytokines, lysosomes involved in antibody production and formation of immune memory cells. They play an important role in the formation of local general defense reactions in the production of T- and B-lymphocytes in the formation of lymphocytes;
  • Nerve-reflection function of tonsils – they also have a connection with other internal organs.

Prof. Dr. Benchev also examined the major causes of tonsillites and pharyngitis: “The most common causes that can lead to these diseases are viral infections. In 70-80% of the cases in acute conditions, there are adeno, rhino and Epstein-Barr viruses. Only about 20-30% may initially be a bacterial infection, most commonly caused by beta-hemolytic streptococcus from group A leading to so-called “streptococcal tonsillitis”.

Prof. Dr. Benchev stressed that when there is viral tonsillitis, the changes occurring in the tonsils lead to an invasion of bacteria, which is secondary, i.e. a viral tonsillitis can pass into bacterial, which necessarily requires treatment with antibiotics.

A curious fact is that tonsilopharyngitis caused by beta-hemolytic strep throat is more common in children between 5 and 15 years of age. Statistics show that the viral agent affects people of all ages, and chronic tonsillitis is most prevalent in the age between 16 and 20 years.

What are the requirements for the major medications for the treatment of tonsilopharyngitis?

“The first requirement is to have a medication that has a pronounced anti-inflammatory effect. Only 20% of the cases are bacterial tonsilopharyngitis, i.e. tonsilopharyngitis treatment should not be started immediately with antibacterial therapy. Since this is an immunological lymphatic organ, another requirement for the preparations used to treat these cases is to have lymphotropic and immunomodulatory action. We must strive to improve the quality of life of our patients and offer treatment that has an excellent safety profile.

The drug, which meets all the criteria for the treatment of acute and chronic tonsillitis, increased volume of tonsils, and during the recovery period after tonsillectomy, is Tonsilotren. It is the only preparation in Bulgaria for prophylaxis of recurrent tonsillitis. Tonsilotren is a 5-component homeopathic medicine suitable for adults and children over 2 years of age.

Tonsilotren covers the main therapeutic goals, namely: it has anti-inflammatory action, which leads to rapid relief of symptoms. There is an analgesic effect, which improves the quality of life of the patient by reducing the intensity and duration of pain. It has an immunostimulatory effect, which is important in order not to get bacterial complications from a super infection with various bacterial agents and restore the physiological structure of the tonsils, “said Prof. Dr. Benchev.

The Round table participants introduced the medical professionals present with the latest clinical trials demonstrating the efficacy of Tonsilotren in acute and chronic tonsillitis.

In one of them, presented by Assoc. Prof. Dr. Hristo Zlatanov, 1368 adults and persons from 6 to 35 years of age are involved, the criteria being acute or exacerbated chronic recurrent tonsillitis, without antibiotic treatment and without taking other homeopathic and phytopreparations. The treatment in the acute phase is within 14 days. Patients received 1 tablet of Tonsilotren every hour, up to 12 tablets a day, to improve their symptoms. The maintenance dose is 1-2 tablets 3 times a day depending on the patient’s age (in children – 1 tablet, in adults – 2 tablets 3 times a day). To prevent recurrences, an additional 6 weeks were administered – 3 times a day 1 tablet. On the sixth day of the course of treatment, there is a sharp reduction in the typical symptoms of tonsillitis – difficulty in swallowing, pain, salivation, hyperemia. On the 14th day there was almost complete disappearance of all symptoms. After 14 days of treatment with Tonsilotren, 98.3% of the patients had no complaints and had significant or moderate improvement in the complaints. In chronic recurrent tonsillitis, 78.7% were without complaints after treatment with Tonsilotren. All this proves that the timely start of treatment is extremely important.

Prof. Zlatanov also emphasized his personal almost 10-year clinical experience with the drug. “Tonsilotren’s strength is in the initial phase of catarrhal inflammation. There it calms the pain, it leads to the mobilization of the local immune powers of the tonsillar mucosa, so as not to pass into the bacterial phase of the infection. In case of chronic tonsillitis, Tonsilotren’s biggest advantage is that it leads to dilution of relapses. With systemic use of Tonsilotren in the right dosage and for a long time, we achieve such a dilution of relapses that the tonsillectomy rule is dropped – we do not accumulate a sufficient number of illnesses in one year to get the surgeon a surgical intervention.

Assoc. Prof. Dr. Mario Milkov presented the results of a collaborative study with Alpen Pharma on the effectiveness of Tonsilotren in 30 patients after tonsillectomy and adenothynectomy. The study was conducted at the University of Medicine and Pharmacy “St. Marina” in Varna, in which 30 patients aged 4-36 years took part.

“In Varna, as well as in many places in Bulgaria, coblation is increasingly used to remove tonsils. Together with this technique and Tonsilotren, post-operative complications and pain syndrome were greatly reduced. In summary, I can say that the control on the 3rd, 7th and 14th day shows great positive results. In addition, we firmly declare that Tonsilotren can be taken in the early childhood as well as by adults throughout the winter season,” Assoc. Prof. Dr. Milkov said. And he added that, according to a study launched in the last two years, children with hypertrophic tonsils who have taken Tonsilotren for a long time have seen excellent results.

Prof. Dr. Dilyana Vicheva focused on a clinical study conducted in Germany, Ukraine and Spain between January 2013 and April 2015. The study covered 265 patients with chronic tonsillitis aged from 6 to 60 years. The criteris for diagnosis were “at least 3 acute throat infections for the last 12 months” or “at least 2 times a year acute throat infection manifestation for the last 2 years”. Patients were divided into 2 groups. Treatment of the first one involves only conventional symptom therapy (local antiseptic and / or throat anesthetics, antibiotic in the case of acute infection, etc.). In the second group of conventional symptomatic treatment, Tonsilotren is included – 3 treatment periods of up to 8 weeks, followed by a period of 8 to 12 weeks without the drug. Children up to 12 years of age received a 3×1 tablet daily, and patients over 12 years of age – 3×2 tablets per day. The results of the study are clear and show that 3 courses of Tonsilotren’s intake in the year with a 3×1 tablet per day leads to 3 times decrease of the acute throat infections, 3 times less usage ofantibiotics and 3 times better quality of life.

“The effective action of Tonsilotren is due to the unique combination of its five components that supports the organism to move peacefully through the pathogenesis of angina and tonsilopharyngitis. Atropinum sulfurium changes the gene expression of receptors that are responsible for the pain. Hepar sulphuris stimulates the response of immune cells to various viruses and especially to gonorrheic bacterial flora. Potassium bichromicum actually gives a signal in the body for such a change in the immune system that will lead to the coping with bacterial and viral flora that produces thick puddles and secretions. Silicea is a medicine that helps to spread the purulent exudate into the intracellular space when there is no exit aperture. A Mercurius solubilis since 200 years has been one of the most widely used homeopathic monocomponent ingredients that copes with the enormous intoxication of the known picture of the purulent angina,” said Dr. Nonna Petrova, director of Alpen Pharma Bulgaria.