X-From_: Sun May 2 23:23:05 1999
From: "Robert Mauro" <>
To: <>
Subject: Re: indications for tonsilectomies
Date: Sun, 2 May 1999 21:18:09 -0600
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Reply-To: "Robert Mauro" <>
>>Mike Rothschild is here, listening, and flattered that you are asking for his opinion!
Bravo, Mike. That was a well-written and well-considered answer.
My own take (and I would like your comments on this) is that frequent Strep throat is not an indication for tonsillectomy. After all, you're not removing the throat -- the child can still get Strep. (I've had Strep throat twice in the last 15 years, and I'm 45 years S/P tonsillectomy!) For me, the question is to what degree the child gets severe tonsillitis with those Strep infections, and particularly how much trouble he or she has with swallowing and airway obstruction during those bouts. So I agree with your implication, Mike, that requiring a certain arbitrary frequency of infections may be too conservative, for children who suffer severely when they get Strep tonsillitis.
Bob Mauro, MD
Greenwood Pediatrics
Littleton. CO
<mailto:>
Bob,
Thanks for your kind words!
What you say is correct, however, the distinction between strep tonsillitis and strep pharyngitis is, in most cases, an academic one. Even if the tonsils do not enlarge or "look sick" during episodes, they may participate in the disease process. I'm sure that you have all seen truly awful looking tonsils in cases of infectious mono, and fairly normal looking tonsils in cases where the children have severe pain, fever, and positive strep cultures.
The theory behind tonsillectomy for recurrent strep is that the crypts and recesses of the tonsils are reservoirs for bacteria in a way that the lymphoid tissue distributed in normal pharyngeal mucosa is not. Therefore, removing the tonsils and adenoids removes a notorious source for recurrent bacterial infection.
Of course, I am careful to tell parents that no surgery can prevent the spectrum of upper respiratory tract infections, including strep and viral sore throats. All you can say (again, going back to the Pittsburgh data) is that tonsillectomy does reduce the incidence of sore throats for some period of time (about 2 years).
Furthermore, you are correct that the important thing is the clinical scenario... a child with a chronically
positive strep culture and no symptoms would likely be considered a carrier, and therefor NOT the typical T&A candidate.
Best Wishes,
Michael Rothschild, MD, FAAP, FACS
Associate Professor and Chief
Pediatric Otolaryngology
Mount Sinai Medical Center
New York, NY USA
212-241-9410
http://www.kids-ent.com