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Tonsillotomy for Periodic Fever Syndrome: A Randomized and Controlled Trial

Ulla Lantto1,2, Terhi Tapiainen1,3, Tytti Pokka1

  • 1Clinical Medicine Research Unit, Medical Research Center, University of Oulu, Oulu, Finland.

The Laryngoscope
|July 21, 2023
PubMed

Insights

Tonsillotomy significantly reduced symptoms in children with periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome compared to observation. This procedure offers a promising alternative for managing PFAPA in pediatric patients.

Area of Science:

  • Pediatric Otolaryngology
  • Pediatric Immunology
  • Clinical Trial Research

Background:

  • Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is a common autoinflammatory disorder in children.
  • Tonsillectomy is an established treatment, but tonsillotomy presents a less invasive option with a potentially better safety profile.
  • The comparative efficacy of tonsillotomy versus observation for PFAPA syndrome requires further investigation.

Purpose of the Study:

  • To evaluate the efficacy of tonsillotomy compared to observation alone in children diagnosed with PFAPA syndrome.
  • To assess symptom resolution and fever burden at a 3-month follow-up period.
  • To determine the need for subsequent tonsillectomy in both treatment arms.

Main Methods:

  • A randomized, multicenter trial with a sequential design was conducted.
  • 16 pediatric patients with PFAPA syndrome were randomized into either a tonsillotomy group or an observation-only control group.
  • Daily symptom diaries were utilized to monitor disease activity and treatment outcomes.

Main Results:

  • A significantly higher proportion of patients in the tonsillotomy group (87.5%) achieved symptom resolution compared to the observation group (25%) (p=0.0021).
  • The mean number of fever days compatible with PFAPA syndrome was substantially lower in the tonsillotomy group (0.8 days) versus the control group (6.5 days) (p=0.007).
  • All patients in the observation group ultimately required rescue tonsillectomy, while none in the tonsillotomy group did.

Conclusions:

  • Tonsillotomy appears to be an effective treatment for children suffering from PFAPA syndrome.
  • The procedure demonstrated a significant reduction in PFAPA symptoms and fever episodes.
  • Further research is warranted to establish the long-term effectiveness of tonsillotomy in managing PFAPA syndrome.
Abstract

Keywords:
childrenlymphoid tissueperiodic fevertonsillotomytonsills

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