A modern understanding of role of tonsillectomy in tonsillogenic neurological diseases and neuropsychiatric disorders

Abstract

The association between chronic tonsillitis and neurological and neuropsychiatric disorders is well described in the literature. The role of streptococcal infections is considered obvious, although there is no clear understanding of the pathophysiological mechanism. A cross autoimmune reaction with basal ganglia antigens is thought to play a key role in the development of this group of disorders. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are the most studied of these groups. Antibacterial therapy is the main treatment option, but there are no reliable recommendations for its use. No significant changes in the clinical manifestations were observed after tonsillectomy, and the positive results described in some observational studies could have been caused by postoperative treatments. The paper suggests that chronic tonsillitis may have an effect on the risk of other mental disorders, such as obsessive-compulsive disorder, bipolar disorder, attention-deficit/hyperactivity disorder, autism spectrum disorder, anxiety disorders, and migraines. Large randomized trials are needed to make definitive conclusions about the advisability of tonsillectomy in patients with PANDAS and other disorders. One of the most promising areas is to study the microbiota of the palatine tonsils and its contribution to migraine. If confirmed, these data will increase importance of nonsurgical treatment of palatine tonsils by their thorough irrigation.