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Surgery vs medical treatment in the management of PFAPA syndrome: a comparative trial

Firat Erdogan1, Kudret Kulak2, Ozmen Öztürk3

  • 1a Department of Pediatrics , Medipol University.

Paediatrics and International Child Health
|August 11, 2015
PubMed

Insights

Surgery, such as tonsillectomy, is more effective than medical treatment for managing Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis (PFAPA) syndrome in children. Surgical intervention leads to higher remission rates and fewer, shorter episodes.

Area of Science:

  • Pediatric Otolaryngology
  • Pediatric Immunology
  • Clinical Pediatrics

Background:

  • Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis (PFAPA) syndrome is a common pediatric condition.
  • Optimal diagnosis and management strategies for PFAPA remain unclear, lacking consensus among clinicians.

Purpose of the Study:

  • To compare the effectiveness of medical management versus surgical intervention (tonsillectomy) for PFAPA syndrome.
  • To evaluate outcomes based on disease recurrence, duration, and remission rates.

Main Methods:

  • Retrospective review of medical records for children diagnosed with PFAPA between 2008 and 2013.
  • Patients were categorized into two groups: medical treatment (corticosteroids, methylprednisolone injection) and surgical treatment (tonsillectomy +/- adenoidectomy).
  • Disease course, including episode frequency, duration, and remission, was documented and compared between groups.

Main Results:

  • Tonsillectomy group (75 patients) showed significantly fewer episodes (1.8 vs 5.8) and shorter episode duration (1.1 vs 2.2 days) compared to the medical group (30 patients).
  • The surgical group experienced significantly lower hospitalization rates (0.1 vs 1.1) and a markedly higher remission rate (98.6% vs 56.6%).
  • All outcome measures demonstrated statistically significant improvements favoring the surgical intervention.

Conclusions:

  • Surgical management, specifically tonsillectomy, is superior to medical treatment for PFAPA syndrome in children.
  • Tonsillectomy significantly increases remission rates and reduces the frequency and duration of PFAPA episodes.
  • This study supports surgical intervention as a primary treatment option for PFAPA syndrome.
Abstract

Keywords:
Medical treatmentPFAPA syndromePeriodic feverSurgery

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