Evaluation of Children Undergoing Tonsillectomy for Recurrent Fever

Recurrent tonsillitis is a prevalent indication for tonsillectomy in children and shares symptoms with periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome. The present study aimed to explore the symptoms related to PFAPA in children undergoing tonsillectomy.

The researchers surveyed parents or guardians of children scheduled for tonsillectomy about symptoms of recurrent fever over six weeks. Follow-up questionnaires were conducted three- and twelve-months post-surgery.

The findings of the study showed the following:

• A total of 82% of patients who underwent tonsillectomy during the study period participated.
• The chief documented indications for tonsillectomy were obstructive sleep apnea in 88% and recurrent tonsillitis in 33%. 
• A total of 11% (13 patients) reported 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 had a significantly higher prevalence of recurrent aphthous ulcers than those without recurrent tonsillitis (24% vs. 9%).
• All participants, including those with recurrent fever, reported fewer febrile tonsillitis episodes one year after tonsillectomy.

To summarize, study recognized a subgroup of children undergoing tonsillectomy who exhibited frequent, predictable febrile episodes associated with recurrent tonsillitis or aphthous stomatitis, resembling PFAPA syndrome. While definitive PFAPA diagnoses could not get establish in this retrospective study, it highlights the need for pediatricians and otolaryngologists to identify potential PFAPA symptoms that may require further evaluation and treatment strategies.

Source: Espahbodi M, Edwards KM, Goudy SL, Penn EB Jr, Manthiram K. Assessment of recurrent fever among children undergoing tonsillectomy. BMC Pediatr. 2024 Dec 27;24(1):835. doi: 10.1186/s12887-024-05312-x. PMID: 39725936; PMCID: PMC11673685.