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Causes of Tonsillar Disease and Frequency of Tonsillectomy Operations
Petri S. Mattila, MD;
Olli Tahkokallio, MD;
Jussi Tarkkanen, MD;
Janne Pitkäniemi, MSC;
Marjatta Karvonen, PhD;
Jaakko Tuomilehto, MD
Arch Otolaryngol Head Neck Surg. 2001;127:37-44.
Objective To characterize the factors that influence the frequency of tonsillectomy
and adenoidectomy operations.
Design and Setting Nationwide questionnaire. Analysis of patients undergoing tonsillectomy
or adenoidectomy at Helsinki University Central Hospital, Helsinki, Finland.
Participants Four hundred eighty-three of 819 individuals randomly selected from
the Finnish National Public Registry. Two thousand two hundred thirty-one
individuals younger than 30 years who underwent tonsillectomy (888 patients),
adenotonsillectomy (294 patients), or adenoidectomy (1049 patients) at Helsinki
University Central Hospital from January 1, 1997, through December 31, 1998.
Main Outcome Measures Age of the individual at the time of operation. Indication for the operation.
Results The frequency of adenoidectomies was 24% (116 persons) and that of tonsillectomies
8% (39 persons) among the 483 individuals who returned the questionnaire.
The frequency of tonsillectomy operations by age was multimodal; the frequency
of tonsillectomies increased in preschool-aged children, declined thereafter,
and increased again in teenagers. Tonsillar hyperplasia was the most frequent
among children younger than 10 years, peritonsillar abscesses among teenagers,
and chronic tonsillitis among individuals older than 20 years. The proportion
of females was higher than males among teenaged patients. However, the cause
and sex distribution could not explain the multimodality in the age-specific
frequency. The age-specific frequency of tonsillectomies performed because
of peritonsillar abscesses still followed a multimodal distribution.
Conclusions Factors relating to respiratory tract infections, maturation of the
immune system, and the onset of puberty contribute to the cause of tonsillar
disease. Distinct indications for tonsillectomy should be defined for preschool-aged
children, teenagers, and individuals older than 20 years.
From the Departments of Otorhinolaryngology (Drs Mattila and Tahkokallio)
and Pathology (Dr Tarkkanen), Helsinki University Central Hospital, Helsinki,
Finland; and the National Public Health Institute, Diabetes and Genetic Epidemiology
Unit, Mannerheimintie, Finland (Mr Pitkäniemi and Drs Karvonen and Tuomilehto).
Corresponding author and reprints: Petri S. Mattila, MD, Department
of Otorhinolaryngology, Helsinki University Central Hospital, Haartmaninkatu
4 E, FIN-00290 Helsinki, Finland (e-mail: petri.mattila{at}huch.fi).
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