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Published on: November 6, 2019
Assessment of recurrent fever among children undergoing tonsillectomy
Mana Espahbodi1,2, Kathryn M Edwards3, Steven L Goudy2,4
1Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
Insights
Recurrent tonsillitis symptoms overlap with PFAPA syndrome in children undergoing tonsillectomy. Many children with recurrent tonsillitis and fever episodes showed improvement after tonsillectomy.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Infectious Diseases
- Clinical Immunology
Background:
- Recurrent tonsillitis is a common reason for tonsillectomy in children.
- Phenotypic overlap exists between recurrent tonsillitis and PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis).
Purpose of the Study:
- To characterize symptoms associated with PFAPA syndrome among children undergoing tonsillectomy.
- To identify clinical signs of PFAPA in children evaluated for tonsillectomy.
Main Methods:
- A prospective survey of parents/guardians of children undergoing tonsillectomy at Vanderbilt Children's Hospital.
- Data collection on recurrent fever symptoms via initial and follow-up questionnaires at 3 and 12 months post-tonsillectomy.
Main Results:
- 82% of patients participated; 33% had recurrent tonsillitis as an indication for tonsillectomy.
- 11% reported ≥6 stereotypical fever episodes annually, with associated tonsillitis, cervical adenitis, or aphthous stomatitis.
- Children with ≥3 febrile tonsillitis episodes/year had a higher prevalence of recurrent aphthous ulcers.
- All participants, including those with recurrent fever, reported fewer febrile tonsillitis episodes one year post-tonsillectomy.
Conclusions:
- A subset of children undergoing tonsillectomy exhibit symptoms overlapping with PFAPA syndrome.
- Pediatricians and otolaryngologists should recognize PFAPA clinical signs in children evaluated for tonsillectomy.
- Further evaluation and tailored therapeutic approaches may be warranted for these patients.
Background:
Recurrent tonsillitis is a common indication for tonsillectomy in children and has phenotypic overlap with periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome. We sought to characterize symptoms associated with PFAPA among children undergoing tonsillectomy.
Methods:
Parents/guardians of children undergoing tonsillectomy at Vanderbilt Children's Hospital over a six-week period were queried regarding symptoms of recurrent fever. Follow-up questionnaires were administered 3 and 12 months after tonsillectomy.
Results:
82% (120/147) of patients who underwent tonsillectomy during the study period participated. Provider-documented indications for tonsillectomy were obstructive sleep apnea in 88% and recurrent tonsillitis in 33%. 11% (13/120) reported[Formula: see text]6 episodes of stereotypical fever in a one-year period. During febrile episodes among these 13 subjects, 11 had tonsillitis, 5 had cervical adenitis, 3 had aphthous stomatitis, and three reported regular and predictable episode timing. In addition, participants with ≥3 episodes/year of recurrent febrile tonsillitis (N = 33) had a significantly higher prevalence of recurrent aphthous ulcers than those without recurrent tonsillitis (24% vs. 9%, p = 0.04). All participants, including those with recurrent fever, reported fewer febrile tonsillitis episodes one year after tonsillectomy.
Conclusions:
In our survey of children undergoing tonsillectomy, a subpopulation had frequent, stereotypical fever episodes with recurrent tonsillitis, aphthous stomatitis, or regular timing like patients with PFAPA. Although we cannot diagnose such patients with PFAPA in this limited retrospective study, pediatricians and otolaryngologists evaluating patients for tonsillectomy should be aware of the clinical signs of PFAPA that may warrant additional evaluation and therapeutic approaches.
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