COVID-19 in the tonsillectomised population

Capriotti, Vincenzo; Mattioli, Francesco; Guida, Francesco; Marcuzzo, Alberto Vito; Manto, Alfredo Lo; Martone, Andrea; Molinari, Giulia; Fabbris, Cristoforo; Menegaldo, Anna; Calvanese, Leonardo; Latini, Giulio; Cingolani, Cristina; Gradoni, Paolo; Nata, Francesca Boscolo; Sisti, Clelia De; Selle, Vittorio; Leone, Giordano; Indelicato, Pietro; Pilolli, Francesco; Mevio, Niccolò; Roncoroni, L.; Papi, Simona; Meschiari, Marianna; Tominz, Riccardo; D’Ascanio, Luca; Dragonetti, Alberto; Torelli, Lucio; Trenti, Loris; Spinato, Giacomo; Boscolo‐Rizzo, Paolo; Bussi, Mario; Cossarizza, Andrea; Presutti, Livio; Tirelli, Giancarlo

doi:10.14639/0392-100x-n1436

Cited by 9 publications

(5 citation statements)

References 21 publications

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“…A study from Italy reported that tonsillectomized adults had significantly higher risk of symptomatic COVID‐19, though an increase in hospitalization was not seen. 13 In addition, though studies have shown decreased immune function in chronic tonsillitis, it is unclear if adenotonsillar hypertrophy leads to an effective change in immune function in these organs. 14 Further studies are needed to understand the differences in local immune function in those children with tonsillar disease states including adenotonsillar hypertrophy, OSA, and chronic tonsillitis in addition to whether humoral immunity at these mucosal sites is protective against future infection.…”

Section: Discussionmentioning

confidence: 99%

“…Whether local immunity in the tonsils protects from repeated SARS‐CoV‐2 infection is unknown. A study from Italy reported that tonsillectomized adults had significantly higher risk of symptomatic COVID‐19, though an increase in hospitalization was not seen 13 . In addition, though studies have shown decreased immune function in chronic tonsillitis, it is unclear if adenotonsillar hypertrophy leads to an effective change in immune function in these organs 14 .…”

Section: Discussionmentioning

confidence: 99%

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Examining multi‐level immune response to determine prevalence of COVID‐19 in pediatric tonsillectomy

et al. 2022

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Objective To determine the prevalence of COVID‐19 in a cohort of children undergoing tonsillectomy through assessment of B cell immune responses to SARS‐CoV‐2 in both peripheral blood and tonsil tissue. Methods In this cohort study at a tertiary pediatric hospital (Children's National Hospital) in Washington, DC, we recruited 100 children undergoing tonsillectomy from late September 2020 to January 2021. Serum, peripheral blood cells, and tonsil tissue were collected and examined for immune reactivity to SARS‐CoV‐2. Parent‐reported clinical histories were compared to antibody and B‐cell responses. Results Among 100 children undergoing tonsillectomy, 19% had evidence of immune responses to SARS‐CoV‐2 (CoV2+), indicating prior COVID‐19. In all seropositive participants, we detected SARS‐CoV‐2 specific B cells in both peripheral blood mononuclear cells and tonsils, providing evidence for tissue‐specific immunity in these children. Of the 19, 63% reported no known history of COVID‐19, and an additional 3 were asymptomatic or unaware of an acute infection when detected on pre‐surgery screen. Hispanic children represented 74% of CoV2+ subjects compared to 37% of the full cohort. 100% of CoV2+ children lived in a zip code with poverty level >10%. Conclusions Nearly one‐fifth of children undergoing tonsillectomy at an urban U.S. hospital had evidence of prior COVID‐19 during the early pandemic, with the majority unaware of prior infection. Our results underscore the ethnic and socio‐economic disparities of COVID‐19. We found concordant evidence of humoral immune responses in children in both blood and tonsil tissue, providing evidence of local immune responses in the upper respiratory tract. Level of Evidence 3 Laryngoscope , 2022

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Examining multi‐level immune response to determine prevalence of COVID‐19 in pediatric tonsillectomy

et al. 2022

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“…Tonsillectomy does not seem to have a negative effect on the immune system, when humoral and cellular immunity is measured after surgery ( 84 – 86 ). During the COVID-19 pandemic, it was speculated that patients who underwent a tonsillectomy might have a higher risk for a more severe course of the SARS-CoV2 infections ( 87 , 88 ). This has remained so far unproven ( 89 ).…”

Section: Discussionmentioning

confidence: 99%

Treatment of recurrent acute tonsillitis—a systematic review and clinical practice recommendations

Guntinas-Lichius,

Geißler,

Mäkitie

et al. 2023

Front. Surg.

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BackgroundThere is an ongoing debate on the indications for tonsil surgery in both children and adults with recurrent acute tonsillitis. The aim is to provide practical recommendations for diagnostics and treatment for recurrent acute tonsillitis including evidence-based decision making for tonsillectomy.MethodsA systematic literature search in PubMed, Embase, Web of Science, and ScienceDirect from 2014 until April 2023 resulted in 68 articles. These were the basis for the review and a comprehensive series of consensus statements on the most important diagnostics and indications for both non-surgical and surgical therapy. A consensus paper was circulated among the authors and members of the International Head and Neck Scientific Group until a final agreement was reached for all recommendations.ResultsThe differentiation between sore throat and tonsillitis patient episodes is mostly not feasible and hence is not relevant for diagnostic decision making. Diagnostics of a tonsillitis/sore throat episode should always include a classification with a scoring system (Centor, McIssac, FeverPAIN score) to estimate the probability of a bacterial tonsillitis, mainly due to group A streptococcus (GAS). In ambiguous cases, a point-of-care test GAS swab test is helpful. Consecutive counting of the tonsillitis/sore throat episodes is important. In addition, a specific quality of life score (Tonsillectomy Outcome Inventory 14 or Tonsil and Adenoid Health Status Instrument) should be used for each episode. Conservative treatment includes a combination of paracetamol and/or non-steroidal anti-inflammatory drugs. In case of high probability of bacterial tonsillitis, and only in such cases, especially in patients at risk, standard antibiotic treatment is initiated directly or by delayed prescription. Tonsillectomy is indicated and is highly effective if the patient has had ≥7 adequately treated episodes in the preceding year, ≥5 such episodes in each of the preceding 2 years, or ≥3 such episodes in each of the preceding 3 years. An essential part of surgery is standardized pain management because severe postoperative pain can be expected in most patients.ConclusionIt is necessary to follow a stringent treatment algorithm for an optimal and evidence-based treatment for patients with recurrent acute tonsillitis. This will help decrease worldwide treatment variability, antibiotic overuse, and avoid ineffective tonsillectomy.

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“…Different papers have been published so far regarding the importance of symptoms in early detection of COVID-19, especially alterations of sense of smell [ 17 – 20 ]. Since among laryngectomized patients, the nasal airflow is practically absent, other symptoms should be investigated (e.g., fever, dyspnea, fatigue…).…”

Section: Discussionmentioning

confidence: 99%

Discrepancies of SARS-CoV-2 testing results among patients with total laryngectomy

Fabbris

Boaria²,

Boscolo‐Rizzo

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose Prevention of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is obtained with nasopharyngeal swabs. By the way, there is no consensus regarding sampling in totally laryngectomized subjects (who thus breathe directly by the tracheostomy and, theoretically, may be infected in the trachea). The aim of this study is to evaluate possible differences between swab results in the trachea and in the nasopharynx of this category of patients. Methods A retrospective chart review was performed in April 2021 among patients who previously had been operated on for total laryngectomy and who underwent swabs for SARS-CoV-2 research in 3 health-care centers in Northern–Eastern Italy. Data regarding the site of swabbing (trachea or nasopharynx) were analyzed. A comprehensive review of the literature regarding the same topic was then performed. Results A total of 25 totally laryngectomized subjects underwent swabs. Among them, 5 tested positive in the trachea (1) and in the nasopharynx (4). According to the literature review, 4 more subjects tested positive in the trachea (1) and in the nasopharynx (3). Data were overall divergent and no statistically significant correlations emerged between results of the tests performed in the two sites. Conclusion Due to these discrepancies, both tracheal and nasopharyngeal swabs are recommended in these kinds of patients, to obtain a reliable test and to avoid false negatives. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-021-07203-8.

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COVID-19 in the tonsillectomised population

Cited by 9 publications

References 21 publications

Examining multi‐level immune response to determine prevalence of COVID‐19 in pediatric tonsillectomy

Examining multi‐level immune response to determine prevalence of COVID‐19 in pediatric tonsillectomy

Treatment of recurrent acute tonsillitis—a systematic review and clinical practice recommendations

Discrepancies of SARS-CoV-2 testing results among patients with total laryngectomy

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