Strep throat after tonsillectomy
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Strep Throat Recurrence After Tonsillectomy: Incidence and Outcomes
Tonsillectomy and Reduction in Streptococcal Throat Infections
Research consistently shows that tonsillectomy significantly reduces the frequency of recurrent strep throat (caused by group A beta-hemolytic streptococci) in both children and adults who have a history of repeated infections. Several studies report a marked decrease in the number of strep throat episodes and sore throats after tonsillectomy, as well as a reduction in the need for antibiotics and clinic visits for throat infections 2367910. In children, the number of diagnosed group A streptococcal infections and school absences also drops in the first year after surgery compared to those who do not have the procedure .
Effect on Antistreptolysin O (ASO) Titers
ASO titers, which indicate recent streptococcal infection, are often elevated in patients with recurrent strep throat. Multiple studies demonstrate that tonsillectomy leads to a significant reduction in ASO titers over time, with most patients showing normalization of these levels within a year after surgery 36910. This reduction in ASO titers supports the conclusion that tonsillectomy decreases the risk of future strep infections.
Short-Term vs. Long-Term Benefits
The benefits of tonsillectomy in reducing strep throat episodes are most pronounced in the short term, particularly within the first year after surgery 47. Over time, the difference in infection rates between those who had surgery and those who did not becomes less clear, and long-term benefits are less certain . However, for patients with frequent, documented strep infections, tonsillectomy provides clear short-term relief and reduces the risk of complications like rheumatic fever and glomerulonephritis 3910.
Residual Risk of Strep Throat After Tonsillectomy
While tonsillectomy greatly reduces the risk of recurrent strep throat, it does not eliminate it entirely. Some patients may still experience occasional episodes of strep throat after surgery, but these are generally less frequent and less severe 267. The majority of patients report significant improvement in symptoms and quality of life after the procedure 26.
Considerations for Surgery
Tonsillectomy is most beneficial for patients with documented, recurrent group A strep infections that do not respond to medical treatment. Strict criteria for surgery, including positive throat cultures and elevated ASO titers, help ensure that only those who are likely to benefit undergo the procedure 148. Throat cultures should continue to be performed for any episodes of throat infection, even after tonsillectomy, to guide further management .
Conclusion
Tonsillectomy is effective in significantly reducing the frequency and severity of strep throat episodes, especially in the first year after surgery, for both children and adults with recurrent infections. It also leads to a marked decrease in ASO titers, indicating fewer streptococcal infections. However, while the risk of strep throat is greatly reduced, it is not completely eliminated, and some patients may still experience occasional episodes. Careful patient selection and ongoing monitoring remain important for optimal outcomes.
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