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. 2024 Dec 27;24(1):835.
doi: 10.1186/s12887-024-05312-x.

Assessment of recurrent fever among children undergoing tonsillectomy

Mana Espahbodi  1   2 , Kathryn M Edwards  3 , Steven L Goudy  2   4 , Edward B Penn Jr  2   5 , Kalpana Manthiram  6   7
Affiliations

Assessment of recurrent fever among children undergoing tonsillectomy

Mana Espahbodi et al. BMC Pediatr. .

Abstract

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.

Keywords: And cervical adenitis syndrome; tonsillectomy; recurrent tonsillitis; Aphthous stomatitis; Periodic fever; Pharyngitis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of Vanderbilt University (protocol number 140323). Informed consent/assent was obtained from parents and/or subjects. Consent for publication: Not applicable. Competing interests: KME receives grant funding from the CDC and NIH, serves as a consultant to BioNet and IBM on unrelated research, and serves on Data Safety and Monitoring Boards for Merck, Pfizer, Moderna, Roche, Seqirus, Sanofi, and X-4 Pharma. The authors report no other conflicts of interest.

Figures

Fig. 1
Fig. 1
Comparison of the mean number of episodes of tonsillitis with fever one year before and after tonsillectomy in all subjects and in those recurrent fever (formula image. Error bars represent 95% confidence intervals
See this image and copyright information in PMC

References

    1. Mitchell RB, et al. Clinical practice Guideline: Tonsillectomy in Children (Update)-Executive Summary. Otolaryngol Head Neck Surg. 2019;160:187–205. 10.1177/0194599818807917. - DOI - PubMed
    1. Paradise JL, et al. Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials. N Engl J Med. 1984;310:674–83. 10.1056/nejm198403153101102. - DOI - PubMed
    1. Paradise JL, et al. Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children. Pediatrics. 2002;110:7–15. 10.1542/peds.110.1.7. - DOI - PubMed
    1. Marshall GS, Edwards KM, Butler J, Lawton AR. Syndrome of periodic fever, pharyngitis, and aphthous stomatitis. J Pediatr. 1987;110:43–6. 10.1016/s0022-3476(87)80285-8. - DOI - PubMed
    1. Thomas KT, Feder HM Jr., Lawton AR, Edwards KM. Periodic fever syndrome in children. J Pediatr. 1999;135:15–21. 10.1016/s0022-3476(99)70321-5. - DOI - PubMed

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