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A randomized, controlled trial of tonsillectomy in periodic fever, aphthous stomatitis, pharyngitis, and adenitis

M Renko1, E Salo, A Putto-Laurila

  • 1Department of Pediatrics, University of Oulu, Finland. marjo.renko@oulu.fi

The Journal of Pediatrics
|August 28, 2007
PubMed

Insights

Tonsillectomy effectively treats periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome in children. While some PFAPA cases resolve spontaneously, surgery offers a significant benefit for persistent symptoms.

Area of Science:

  • Pediatric Otolaryngology
  • Pediatric Immunology
  • Clinical Trial Research

Background:

  • Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis (PFAPA) syndrome is a common autoinflammatory disorder in children.
  • The clinical course and optimal management of PFAPA syndrome remain subjects of investigation.

Purpose of the Study:

  • To evaluate the efficacy of tonsillectomy in managing PFAPA syndrome through a prospective, randomized, controlled trial.
  • To compare tonsillectomy versus conservative management for PFAPA syndrome in pediatric patients.

Main Methods:

  • A randomized controlled trial involving 26 children diagnosed with PFAPA syndrome.
  • Participants were allocated to either tonsillectomy or watchful waiting, with the option for tonsillectomy after 6 months if symptoms persisted.
  • Symptom tracking was conducted using diaries over a 12-month follow-up period.

Main Results:

  • After 6 months, 100% of children who underwent tonsillectomy were symptom-free, compared to 50% in the control group (P < .001).
  • Tonsillectomy was subsequently performed on 5 out of 6 children in the control group who did not achieve remission.
  • One child in the control group experienced less severe, recurrent symptoms but did not opt for surgery.

Conclusions:

  • Tonsillectomy is an effective intervention for children diagnosed with PFAPA syndrome.
  • While spontaneous remission occurs in some cases, tonsillectomy provides a significant therapeutic option for persistent PFAPA symptoms.
  • The underlying mechanisms of PFAPA syndrome require further elucidation, but surgical intervention is a viable treatment strategy.
Abstract

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