The Role of Tonsils in Predisposing to Streptococcal Infections and Recurrences of Rheumatic Fever

Feinstein, Alvan R.; Levitt, M. D.

doi:10.1056/nejm197002052820601

Cited by 44 publications

(14 citation statements)

References 35 publications

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“…The size of each tonsil was recorded in patient's medical records using a CAS scale of 0, 1+, 2+, 3+, and 4+. 3 In some cases, the CAS of the tonsils was equivalent but an asymmetry was noted. Any noted difference between the right and left sides was considered a case of asymmetric tonsils.…”

Section: Methodsmentioning

confidence: 99%

Incidence of Carcinoma in Incidental Tonsil Asymmetry

2000

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Objective: To determine the incidence of malignancy in patients with incidentally discovered unilateral tonsillar enlargement with an otherwise normal physical examination. Study Design: A retrospective review of our institution's experience with unilateral tonsillar enlargement. Results: During a five-year period, 570 patients underwent tonsillectomy at our institution. Of patients undergoing tonsillectomy, 49 patients (8.6%) underwent tonsillectomy with normal mucosa, no lymphadenopathy, and asymmetry of the tonsils. Two (4.8%) of the 49 patients with unilateral enlargement had the presence of malignancy. The two adult patients had B-cell lymphoma. Of all of the patients undergoing tonsillectomy, 0.35% had occult malignancy. In additional, the ability of the clinically assessed size (1؉, 2؉, 3؉, and 4؉) to predict volume was evaluated. The clinically assessed size and pathologically measured volume were significantly correlated (R ‫؍‬ 0.333, P < .013). In 60.5% of the patients, the clinically assessed size and the pathologically measured volume agreed with the asymmetry reported on physical examination. Conclusion: A relatively high number of tonsillectomies will be performed to yield an approximately 5% positive rate of malignancy within removed tonsils that are asymmetrical with normal mucosa and no cervical adenopathy.

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Section: Methodsmentioning

confidence: 99%

Incidence of Carcinoma in Incidental Tonsil Asymmetry

2000

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“…Our results support the theory that palatine tonsils have an important role in recurrent streptococcal pharyngitis. 5 Comparison with other studies A recent systematic review of randomised trials in children estimated that (adeno)tonsillectomy reduced the incidence of episodes of sore throat by 1.2 episodes a year and reduced school absence associated with sore throat by 2.8 days a year, differences regarded by the authors as clinically insignificant. 12 The respective decreases we found after tonsillectomy in adults were significantly higher at 3.3 episodes and 20 days with sore throat.…”

Section: Principal Findingsmentioning

confidence: 99%

Tonsillectomy versus watchful waiting in recurrent streptococcal pharyngitis in adults: randomised controlled trial

Alho

Koivunen

Penna

et al. 2007

BMJ

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Objective To determine the short term efficacy and safety of tonsillectomy for recurrent streptococcal pharyngitis in adults. Design Randomised controlled trial. Setting Academic referral centre in Finland. Participants 70 adults with documented recurrent episodes of streptococcal group A pharyngitis. Intervention Instant tonsillectomy (n=36) or remaining on waiting list as control (n=34). Main outcome measures Percentage change in the risk of an episode of streptococcal pharyngitis at 90 days. Rates of all episodes of pharyngitis and days with symptoms and adverse effects. Results The mean (SD) follow-up was 164 (63) days in the control group and 170 (12) days in the tonsillectomy group. At 90 days, streptococcal pharyngitis had recurred in 24% (8/34) in the control group and 3% (1/36) in the tonsillectomy group (difference 21%; 95% confidence interval 6% to 36%). The number needed to undergo tonsillectomy to prevent one recurrence was 5 (3 to 16). During the whole follow-up, the rates of other episodes of pharyngitis and days with throat pain and fever were significantly lower in the tonsillectomy group than in the control group. The most common morbidity related to tonsillectomy was postoperative throat pain (mean length 13 days, SD 4). Conclusions Adults with a history of documented recurrent episodes of streptococcal pharyngitis were less likely to have further streptococcal or other throat infections or days with throat pain if they had their tonsils removed. Trial registration Clinical Trials NCT00136877.

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“…As yet, though, despite the large numbers of studies documenting substantial variations between GPs in referral rates to all outpatient clinics-which hold true when referral rates to ENT are considered separately (Forsyth and Logan, 1960)-very little is definitely known about the reasons for these variations and there has been little scrutiny of the relationship between referral rates and attitudinal data on GPs. Even if such a relationship were demonstrated, the question remains why GPs' attitudes to the operation should vary from area to area.…”

Section: Evaluative Studiesmentioning

confidence: 99%

A review of investigations into adenotonsillectomy

Venters

Bloor

1974

Journal of Epidemiology & Community Health

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SUMMARYOperations on the tonsils and adenoids are among the most commonly performed of all operations but present a wide range of problems when attempts are made to evaluate the results. This article reviews the findings of the major evaluative studies and discusses the general difficulties that confront them, particularly those that arise from failure to take into account the extensive web of social factors that precipitate a child towards operation and colour interpretation of symptomatology. It suggests that, while variations in operation rate persist on a geographic basis, variations according to social class have almost disappeared.

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The Role of Tonsils in Predisposing to Streptococcal Infections and Recurrences of Rheumatic Fever

Cited by 44 publications

References 35 publications

Incidence of Carcinoma in Incidental Tonsil Asymmetry

Incidence of Carcinoma in Incidental Tonsil Asymmetry

Tonsillectomy versus watchful waiting in recurrent streptococcal pharyngitis in adults: randomised controlled trial

A review of investigations into adenotonsillectomy

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