The quality of evidence is downgraded and by inconsistency (statistical heterogeneity), and by imprecise results (few patients and outcome events).
A Cochrane review [Abstract] 1 included 2 studies with a total of 67 children. One study (n=39) included children with periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome diagnosed according to rigid, standard criteria, and compared adenotonsillectomy to watchful waiting with a follow-up of 18 months. The other study (n=28) applied less stringent criteria for diagnosing PFAPA and probably also included participants with alternative types of recurrent pharyngitis. This study compared tonsillectomy alone to no treatment with a follow-up of 6 months.
Children with PFAPA experienced less fever and less severe episodes after surgery compared to those receiving no surgery (table T1). The number of patients who had "immediate and persistent resolution of PFAPA syndrome" after the surgery/randomisation, which was sustained until the end of follow-up (at 18 months) was 12/19 in the surgery group and 1/20 in the control group in one study. In the other study, corresponding numbers for the six-month follow-up period (their longest available follow-up) were 10/14 in the surgery group and 4/12 in the control group. Both studies reported that there were no complications of surgery but the numbers of patients randomly allocated to surgery (19 and 14 patients respectively) were too small to detect potentially important complications such as haemorrhage. Quality of life, number of days with pain after surgery and absence from school were not measured or reported.
| Outcome | Relative effect (95% CI) | Assumed risk (control) | Corresponding risk (surgery, 95% CI) | Participants (studies) |
|---|---|---|---|---|
| * statistical heterogeneity, I2 = 71% | ||||
| Complete resolution of symptoms | RR 4.38 (0.64 to 30.11)* | 156 per 1000 | 684 per 1000(100 to 1000) | 65 (2 studies) |
| Number of episodes of fever and associated symptoms | Rate ratio 0.08 (0.05 to 0.13) | Mean 0.5 episode per person per month (1 episode every 2 months) | Mean 0.04 episode per person per month (1 episode every 25 months) | 65 (2 studies) |
| Severity of episodes: number of days with fever and the associated symptoms (per episode) | MD 1.8 days per episode | Mean 3.5 (range of 2 to 6) days per episode | Mean 1.7 (range of 2 to 4) days per episode | 39 (1 study) |
| Use of corticosteroids | RR 0.58 (0.37 to 0.92) | 900 per 1000 | 522 per 1000(333 to 828) | 39 (1 study) |
It is uncertain whether adenoidectomy combined with tonsillectomy adds any additional benefit to tonsillectomy alone. One study performed adenotonsillectomy while the other only removed the tonsils.
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