Morphometric and immunohistochemical reorganisation of the palatine tonsil in chronic tonsillitis and its response to combined ozone-ultrasound therapy

Background Chronic tonsillitis is a common upper respiratory tract disease for which there is no objective tissue-level basis for judging conservative treatment. We characterised the morphometric and immunohistochemical reorganisation of the palatine tonsil in chronic tonsillitis and its response to a combined ozone-ultrasound protocol. Methods In a single-centre observational study with a pre-post design and no randomised comparator group, we examined 480 palatine tonsil specimens: histologically normal controls ( n = 160), chronic tonsillitis ( n = 180) and post-treatment specimens ( n = 140). Sections underwent haematoxylin-eosin and Masson's trichrome staining and immunohistochemistry for Ki-67, CD68 and BCL-2 (Ventana BenchMark XT, Roche; 1:100), with immunopositive cells counted in 5–10 high-power fields at x400. The multi-stage ozone-ultrasound protocol (patent FAP20230057) was applied to 180 patients aged 4–40 years assessed before and after treatment. Results Chronic tonsillitis showed deepened crypts (+412.3%), capsular thickening (+252.6%), epithelial erosion (+152.5%) and stromal fibrosis (+54.0%), whereas epithelial thickness changed marginally (+6.6%). Follicle density fell by 54.7% and germinal centre number by 22.1%, while germinal centre area was preserved (−4.3%; p = 0.09), pointing to loss of follicles rather than involution of individual centres. Ki-67, CD68 and BCL-2 rose in every compartment and fell after therapy (all p < 0.05). The clinical severity index dropped from 4.28 to 2.78 points (mean change 1.50; 95% CI 1.17–1.83). Conclusion Chronic tonsillitis produces a reproducible pattern of morphometric and immunohistochemical reorganisation that responds in a coordinated way to combined ozone-ultrasound therapy, giving an objective tissue-level framework for judging conservative treatment.