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Non-Group A or B Streptococcal and...
Group A Streptococcal Infections
PEDIATRICS Vol. 112 No. 1 July 2003, pp. 205

Tonsillectomies and Adenotonsillectomies—Will the Debate Never Be Over?

Jonathan B. Rosefsky, MD
Haverford, PA 19041

The first 20% of the full text of this article appears below.

To the Editor.—

The article by Doctors Paradise, Bluestone, and colleagues,1 which discourages tonsillectomies and adenotonsillectomies (T&As) yet again, is commendable for making readers think about criteria and outcome. But insufficient data and loose criteria make it difficult to evaluate pre- versus postsurgery study groups, or versus control patients.

As a concatenation of partial sets of observation and data, versus controls, the clinical trials studied:

  1. otitis media in children
  2. "obstructing adenoids" (and persistent mouth-breathing?)
  3. group A ß-hemolytic streptococcal infection in children with obstructing adenoids, or with "recurrent or persistent otitis media"
  4. culture-positive ß streptococcal pharyngitis in children postoperative T&A or tonsillectomy alone
  5. tonsil, adenoid, or pharyngeal infection, and maybe cervical lymphadenopathy, regardless of etiologic agent, in all enrollees.

Numbers 1, 2 and 3 above are contained within the "2-way trial." Readers would learn more if enrollment culture data and postoperative surveillance regarding otitis media and nasal passage obstruction were provided.

Number 4 is incomplete, lacking enrollment incidence of culture-positive ß streptococcal infection for the 3-way trial. With . . . [Full Text of this Article]