A randomized, controlled trial of tonsillectomy in periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome

Objective We carried out a prospective, randomized, controlled trial to clarify the effect of tonsillectomy on tile clinical course of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome. Study design Twenty-six consecutive children (mean age 4.1 years) with at least 5 PFAPA attacks were recruited front 3 tertiary care pediatric hospitals during 1999-2003 and randomly allocated to tonsillectomy or follow-up alone. They were an followed tip with symptom diaries for 12 months. Tonsillectomy was allowed after 6 months in the control group if the attacks recurred. Results Six months after randomization all 14 children in the tonsillectomy group and 6/12 children in the control group (50%) were free of symptoms (difference 50%, 95% confidence interval 23% to 75%, P < .001). Tonsillectomy was perfomed on 5/6 of the patients in the control group who still had symptoms after 6 months. The remaining unoperated child in the control group bad recurrences of the fever episodes throughout the follow-tip, but the symptoms became less severe, and the parents did not choose tonsillectomy. Conclusion Tonsillectomy appeared to be effective for treating PFAPA syndrome. The fever episodes ceased without any intervention in half of the control subjects. We conclude that although the mechanisms behind this syndrome are unknown, tonsillectomy can be offered its in effective intervention for children with PFAPA.