Adenotonsillectomy in Children with Recurrent Acute Tonsillitis: Review and Implications for Practice Adenotonsillectomy in Recurrent Acute Tonsillitis
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 7, Issue 1
Abstract
This paper aims at defining the therapeutic role of (adeno)tonsillectomy in children affected by recurrent acute tonsillitis (RAT), and at drawing some practical implications based on the current evidence. A literature search was performed to find pertinent study accessible by means of a MEDLINE search (accessed via PubMed). 15 papers were selected for literature analysis. The evidence suggests that although significant, the effect of tonsillectomy in children with moderate to severe RAT is modest and limited to 12 months post-operatively. In the case of patients with mild symptoms, it seems that the benefits are not sufficient to balance the disadvantages of the procedure. This can be explained by the fact that the procedure is intrinsically characterised by pharyngeal pain and that the surgical removal of a palatine tonsil does not exclude the subsequent onset of successive episodes of pharyngitis. An analysis of the literature indicates that the efficacy of (adeno)tonsillectomy in treating pediatric RAT is generally limited and relatively transient. Acute pediatric pharyngotonsillary inflammation is very frequently encountered in clinical practice, and its symptoms often limit children’s everyday activities. Furthermore, a number of children have recurrent or persistent symptoms characterised by a succession of acute infections associated with fever, pharyngeal pain, general malaise and, respiratory sleep disorders, and the limitations on their everyday activities cause them to miss school and prevent their parents from going to work. In such cases, (adeno)tonsillectomy can be considered, although it is necessary to consider the possible risks of surgery, including those related to the use of general anesthesia [1-3]. Although probably not the only cause, the palatine tonsils certainly play a major role in the genesis of episodes of recurrent acute pharyngeal inflammation, which means that, even if it cannot eliminate the risk, tonsillectomy could theoretically prevent further episodes of pharyngeal pain and/or reduce the severity of subsequent infections, thus improving the patient’s quality of life [4]. However, it is still not clear whether an accompanying adenoidectomy can lead to a further clinical benefit in terms of the number and/or severity of infections [4]. This paper will provide an overview on pathogenesis and surgical treatment of recurrent acute tonsillitis (RAT) in children (Section 1) and it will review the therapeutic role of (adeno)tonsillectomy such patients to draw practical recommendations for clinical practice (Section 2). Defining acute tonsillitis Pharyngeal pain may be due to infection of the pharynx and/or tonsils but, as there are no specific diagnostic criteria, it is difficult (if not impossible) to distinguish pharyngitis and tonsillitis in clinical practice and the literature often refers generically to “sore throat” [4]. Since the publication of the paper by Paradise et al. in the New England Journal of Medicine [5], many authors have differentiated tonsillar infections into severe, moderate or mild, but without specifying whether they are bacterial or viral, and so neither their site nor their etiology is defined. Nowadays, most authors define episodes of acute purulent tonsillitis as those that are medically documented as being characterised by the presence of pyrexia (>38.3 °C), tonsillary exudate, and jugodigastric adenopathy, and requiring antibiotic treatment [5,6]. Furthermore, the nosological terms “recurrent acute tonsillitis” (RAT) and “chronic tonsillitis” (CT) are usually used as synonyms, thus making it difficult to compare different trials. Burton [4] has recently defined RAT as the presence of at least two acute episodes in the preceding 12 months, and CT as the presence of persistent symptoms lasting more than three months; however, most authors define severe RAT as five episodes of acute tonsillitis a year, the presence of symptoms for at least a year, disabling episodes and limitations on everyday activities [7], whereas others continue to use Paradise’s definition of at least five episodes a year in the two preceding years, or at least three a year in the three preceding years [5,6]. It should also be pointed out that, unlike in the case of acute rhinosinusitis, the term “CT” or “CT with recurrent acute exacerbations”, which suggest the presence of chronic structural changes in tonsillar tissue with periodic acute episodes [8], should be avoided because of the absence of real chronic tonsillar inflammation associated with symptoms lasting for more than four weeks and permanent structural alterations [3].
Authors and Affiliations
Lorenzo Pignataro, Tullio Ibba, Paola Marchisio, Sara Torretta
Keywords
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- EP ID EP592677
- DOI 10.26717/BJSTR.2018.07.001440
- Views 164
- Downloads 0
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