Abstract
Ten years follow-up studies of 269 cases of chronic tonsillitis and 205 cases of rheumatic heart disease were performed to investigate the effect of tonsillectomy after a long period of time. In the cases of chronic tonsillitis, effects of tonsillectomy and subjective symptoms were examined with questionnaires and the results were related to the preoperative findings of the tonsils. In the cases of rheumatic heart disease, effects of tonsillectomy upon cardiac symptoms were investigated in connection with depedency of the heart disease upon habitual angina, the preoperative states of the tonsils, erythrocyte sedimentation rates before tonsillectomy, c-reactive protein, and electrocardiogram.
The results obtained were as follows:
(1) In the cases of both chronic tonsillitis and rheumatic heart disease, subjective symptoms such as pharyngeal pain, headache and frequent occurrence of common cold or fever were improved after tonsillectomy in most cases. However, abnormal sensation or dryness of the throat was improved less frequently after the surgery.
(2) In 50% of cases with chronic tonsillitis that showed no improvement of subjective symptoms, especially of pharyngeal pain, there were injection and swelling of follicles on the posterior pharyngeal wall.
(3) Tonsillectomy for chronic tonsillitis newly produced abnormal sensation or dryness of the pharynx in 27% and 23% of the cases respectively.
(4) In chronic tonsillitis, subjective symptoms were improved more in the cases with non-hypertrophied tonsils than in those with hypertrophied tonsils. In the patients with rheumatic heart disease, no significant relation was found between the size of the tonsils and the effects of tonsillectomy on cardiac symptoms.
(5) In chronic tonsillitis, the effects of tonsillectomy on subjective symptoms did not differ between the tonsils with pus in the crypts and those without pus. In rheu- matic heart disease, improvements of cardiac symptoms were obtained more frequently in the cases with pus in the tonsillar crypts than those without pus.
(6) In cases with habitual angina related to the occurrence and aggravation of rheumatic fever, tonsillectomy produced more frequent improvements of cardiac symptoms than in cases in which rheumatic fever had not been related to habitual angina.
(7) Cardiac symptoms in rheumatic heart disease were more frequently improved in the cases with favorable results of laboratory examination, ESR of 10mm or less before tonsillectomy and or negative reaction of CRP after tonsillectomy than in the cases with abnormal test results.
(8) In the cases that had received heart operation as well as tonsillectomy, the cases that had tonsillectomy prior to heart operation presented more frequent improvements of cardiac symptoms than the cases that had tonsillectomy after heart operation.
(9) In 34.5% of rheumatic heart disease improvements in electrocardiograms were observed.
The results in the present investigation suggest that tonsillectomy for focal infection such as rheumatic heart disease should be intensively indicated.
