Effects of osteopathic T9-T10 vertebral manipulation in tonsillitis, a randomized clinical trial

Participants

• Number: 120 people (70 female and 50 male)
• Criteria of inclusion: age 3-65 years, diagnosed with acute or recurrent tonsillitis for less than 48 hours, or with chronic tonsillitis in the symptomatic phase.
• Criteria of exclusion: people vaccinated or treated with immunomodulatory drugs during the three years prior to recruitment; presence of pharyngitis or adenoiditis without palatine tonsils (ie, who has undergone a tonsillectomy); treatment with antibiotics immediately before the onset of tonsillitis; people who have not left contact details to be recontacted; people who had contraindications to spinal treatment (osteoporosis, active tumors, spinal surgery, spinal fractures, acute rheumatic diseases, ongoing tuberculosis, pregnancy, active infections in the vertebrae or intervertebral discs, stenosis in the spinal canal, haemorrhagic diseases, or recent thrombosis in deep veins).
• Study groups: two groups obtained by randomization
  • Group 1: OMT, 80 people (47 female and 33 male, mean age 23)
    • 14 people were excluded from the analysis of the number of tonsillitis episodes in the following year
  • Group 2: sham treatment, 40 people (23 female and 17 male, mean age 25)
    • 5 people were excluded from the analysis of the number of tonsillitis episodes in the following year

Interventions and evaluations

• Initial questionnaire to gather information on: age, sex, season of the year, degree of tonsil hypertrophy, use of NSAIDs, paracetamol or antibiotics, tonsillitis episodes in the two years preceding the study, eventual tonsillectomies planned to resolve tonsillitis, presence of fever, odinophagia, cough, poltaceous tonsillitis, mucus in previous days, ear pain, infection, habitual nasal voice, nasal voice during the episode of tonsillitis, habitual snoring, snoring during the episode of tonsillitis, adenitis larger than 2cm
• The duration of tonsillitis in days and the number of episodes of tonsillitis experienced during the following year were collected through telephone interviews. The duration would be collected 7 days after treatment, while the number of tonsillitis episodes was collected through monthly calls
• 1 therapy session applied immediately after the recruitment and within 48 hours from the beginning of the tonsillitis episode
• All patients continued their ongoing pharmacological treatments (eg NSAIDs and/or antibiotics)
• OMT: high-velocity low-amplitude (HVLA or thrust) techniques applied to the T9-T10 vertebrae with the patient in a sitting position with arms crossed and with the osteopath’s knees in contact with the above-mentioned vertebrae
• Sham treatment: cautious 150° passive flexion of the shoulders, with gentle contact of the osteopath’s knees with the thoracic vertebrae, without pushing or other stimuli

Results

• Primary outcomes: in adults the OMT has favored more than sham treatment the resolution of tonsillitis in less than 48 hours, as well as a reduction in the average duration of tonsillitis. Similar results were obtained in children, but without particular difference between the OMT and sham.
• Secondary outcomes: in both children and adults, the OMT favored a reduction in the number of tonsillitis episodes in the year following the treatment: less than 1 episode per year for the group receiving OMT versus 2 episodes per year for the group that received the sham. Neither the OMT nor the sham treatment caused any adverse effects.

Discussion

Whereas the episodes of tonsillitis had increased over time – on average, all the people recruited had had more episodes of tonsillitis the year before the study than two years earlier – the result obtained with the OMT is particularly promising, also taking into account its brevity, namely, a single session.

In adults, the OMT helped to resolve tonsillitis in a short time – less than 48 hours, if not even less than 24 hours – while in the sham group more than half of people took more than 48 hours to heal, with 1 person in 4 who didn’t even notice any improvement in the first 24 hours after the sham treatment. Furthermore, 2 out of 3 people treated with OMT no longer had episodes of tonsillitis during the year following the treatment, while a good 4 out of 5 people in the sham group continued to suffer from tonsillitis.

The OMT also produced a reduction of tonsillectomies: as many as 5 tonsillectomies were avoided (compared to only one in the shamgroup), which could indicate OMT as a possible non-invasive practice to resort to before a tonsillectomy (which, among other things, is one of the interventions recommended more often as a routine than for an actual need).

In this regard, manipulations of the thoracic vertebrae can be safer than the classic manipulations of the cervical vertebrae used in the case of tonsillitis, especially in children. Given that the T9-T10 vertebrae innervate the adrenal glands, which release cortisol in the blood, which is one of the main anti-inflammatory hormones in our body, the authors hypothesized that OMT could work through this pathway.

In other words: HVLA techniques on the T9-T10 vertebrae could stimulate the adrenal glands to release cortisol which, once in the blood, could reach the tonsils to reduce inflammation.

A small note: both the fast resolution of current episodes of tonsillitis and the reduction in the number of episodes in the sham group may have been due to a placebo effect, an effect that may have also acted in the OMT group. We therefore need more in-depth analyses in this sense.