Change in the Pharyngeal Microbial Environment after a Tonsillectomy: Difference between revisions
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==Introduction== | ==Introduction== | ||
[[Image:Strep photo - CDC.jpeg|thumb|200px|left|Streptococcus pyogenes (group A Streptococcus) Photo credit: [http://www.cdc.gov/ CDC.]]] | [[Image:Strep photo - CDC.jpeg|thumb|200px|left|Streptococcus pyogenes (group A Streptococcus) Photo credit: [http://www.cdc.gov/ CDC.]]] | ||
</b>Tonsillectomies, the surgical removal of the tonsils, are performed on individuals with recurrent tonsillitis infections, recurrent strep throat, enlarged tonsils, and other issues such as cancerous cells <ref name=aa>Brietzke, S.E. and Andreoli, S.M., 2021. Systematic review and meta-analysis of the change in pharyngeal bacterial cultures after pediatric tonsillectomy. Otolaryngology–Head and Neck Surgery, 164(2), pp.264-270.</ref>. The goal of this radical procedure is the eradication of bacteria assuming antibiotics have been frequently used and failed / resistance was developed <ref name=a>Yildizoglu, U., Polat, B., Gumral, R., Kilic, A., Tosun, F. and Gerek, M., 2015. Effect of antibiotic use on bacterial flora of tonsil core in patients with recurrent tonsillitis. European Archives of Oto-Rhino-Laryngology, 272, pp.1525-1528.</ref>. <i>Streptococcus pyogenes</i> (also called group A streptococci, or GAS) is the causative agent bacterium of strep throat, one of the leading causes that push individuals towards an elective tonsillectomy <ref name=b>Slonczewski, S.L, Foster, J.W, and Zinser, E, 2024. Microbiology an evolving science, sixth edition. W.W. Norton and Company.</ref>. Although viruses are also common, other problematic bacteria include: <i>Staphylococcus aureus</i>, <i>Haemophilus influenzae</i>, <i>Streptococcus pneumoniae</i>, <i>Escherichia coli</i>, and <i>Pseudomonas aeruginosa</i> <ref name=a/>. Bacteria such as <i>Staphylococcus aureus</i> can produce biofilms on the tonsils and can cause antibiotic resistance in the pharynx and make recurrent strep throat tonsillitis possible <ref name=a/>. | </b>Palatine tonsils are spheres of lymphoid tissue that sit in the back of the pharynx, or throat area, and play a huge role in the immune system due to their proximity to ingested or inhaled pathogens <ref name=ab>Masters KG, Zezoff D, Lasrado S. Anatomy, Head and Neck, Tonsils. 2023. StatPearls Publishing.</ref>. The immune cells on the tonsils help to filter and destroy bacteria and viruses by producing antibodies <ref name=ab/>. Tonsillectomies, the surgical removal of the tonsils, are performed on individuals with recurrent tonsillitis infections, recurrent strep throat, enlarged tonsils, and other issues such as cancerous cells <ref name=aa>Brietzke, S.E. and Andreoli, S.M., 2021. Systematic review and meta-analysis of the change in pharyngeal bacterial cultures after pediatric tonsillectomy. Otolaryngology–Head and Neck Surgery, 164(2), pp.264-270.</ref>. The goal of this radical procedure is the eradication of bacteria assuming antibiotics have been frequently used and failed / resistance was developed <ref name=a>Yildizoglu, U., Polat, B., Gumral, R., Kilic, A., Tosun, F. and Gerek, M., 2015. Effect of antibiotic use on bacterial flora of tonsil core in patients with recurrent tonsillitis. European Archives of Oto-Rhino-Laryngology, 272, pp.1525-1528.</ref>. <i>Streptococcus pyogenes</i> (also called group A streptococci, or GAS) is the causative agent bacterium of strep throat, one of the leading causes that push individuals towards an elective tonsillectomy <ref name=b>Slonczewski, S.L, Foster, J.W, and Zinser, E, 2024. Microbiology an evolving science, sixth edition. W.W. Norton and Company.</ref>. Although viruses are also common, other problematic bacteria include: <i>Staphylococcus aureus</i>, <i>Haemophilus influenzae</i>, <i>Streptococcus pneumoniae</i>, <i>Escherichia coli</i>, and <i>Pseudomonas aeruginosa</i> <ref name=a/>. Bacteria such as <i>Staphylococcus aureus</i> can produce biofilms on the tonsils and can cause antibiotic resistance in the pharynx and make recurrent strep throat tonsillitis possible <ref name=a/>. | ||
Revision as of 23:19, 9 April 2024
By Lindsey Abramson
Introduction
Palatine tonsils are spheres of lymphoid tissue that sit in the back of the pharynx, or throat area, and play a huge role in the immune system due to their proximity to ingested or inhaled pathogens [1]. The immune cells on the tonsils help to filter and destroy bacteria and viruses by producing antibodies [1]. Tonsillectomies, the surgical removal of the tonsils, are performed on individuals with recurrent tonsillitis infections, recurrent strep throat, enlarged tonsils, and other issues such as cancerous cells [2]. The goal of this radical procedure is the eradication of bacteria assuming antibiotics have been frequently used and failed / resistance was developed [3]. Streptococcus pyogenes (also called group A streptococci, or GAS) is the causative agent bacterium of strep throat, one of the leading causes that push individuals towards an elective tonsillectomy [4]. Although viruses are also common, other problematic bacteria include: Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, Escherichia coli, and Pseudomonas aeruginosa [3]. Bacteria such as Staphylococcus aureus can produce biofilms on the tonsils and can cause antibiotic resistance in the pharynx and make recurrent strep throat tonsillitis possible [3].
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Legend/credit: Magnified 20,000X, this colorized scanning electron micrograph (SEM) depicts a grouping of methicillin resistant Staphylococcus aureus (MRSA) bacteria. Photo credit: CDC. Every image requires a link to the source.
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What is a Tonsillectomy?
A tonsillectomy is the surgical removal of the tonsils which is performed as a last resort invasive effort to fight recurrent tonsillitis infection, cancer, and other issues that cannot be solved via antibiotics [2]. Tonsillectomies previously were the most popular procedure used to combat respiratory disease, however, now the prevalence of such procedures has decreased to less than one half of the number from 40 years ago [5]. The 20-30 minute procedure includes the use of general anesthesia, and the severing of the mucous membrane by electrocautery, or cold-knife cutting, or snare pulling, and then more electrocautery or sutures to stop the bleeding [6]. Due to the extremely high risk factors and complications that are associated with this procedure, it is only recommended if certain requirements are met. The Mayo clinic defined its criteria for surgery as the following, “Seven episodes of tonsillitis in a single year, or five episodes of tonsillitis in each of two consecutive years, or three episodes of tonsillitis in each of three consecutive years” [5]. After the procedure, painful swallowing and a sore incision site is to be expected. As is dehydration if fluid intake is decreased and possibly nausea [5]. The greatest concern comes from the risk of hemorrhage, which can arise at any moment after surgery when the scabs covering the incision site start to flake off [5]. Post tonsillectomy hemorrhage, which varies in risk from 0.28%-20%, is always considered an emergency and requires immediate attention and likely surgical intervention [7]. Individuals over the age of twelve are at greater risk for complication and higher levels of pain, due to the buildup of scar tissue on the tonsils themselves and an overall larger surface area [7]. Therefore, some doctors do not recommend this procedure for adults unless absolutely necessary.
Pre-Tonsillectomy Microbial Environment
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Post-Tonsillectomy Microbial Environment
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Success Rates
Conclusion
References
- ↑ 1.0 1.1 Masters KG, Zezoff D, Lasrado S. Anatomy, Head and Neck, Tonsils. 2023. StatPearls Publishing.
- ↑ 2.0 2.1 2.2 Brietzke, S.E. and Andreoli, S.M., 2021. Systematic review and meta-analysis of the change in pharyngeal bacterial cultures after pediatric tonsillectomy. Otolaryngology–Head and Neck Surgery, 164(2), pp.264-270.
- ↑ 3.0 3.1 3.2 3.3 Yildizoglu, U., Polat, B., Gumral, R., Kilic, A., Tosun, F. and Gerek, M., 2015. Effect of antibiotic use on bacterial flora of tonsil core in patients with recurrent tonsillitis. European Archives of Oto-Rhino-Laryngology, 272, pp.1525-1528.
- ↑ 4.0 4.1 Slonczewski, S.L, Foster, J.W, and Zinser, E, 2024. Microbiology an evolving science, sixth edition. W.W. Norton and Company.
- ↑ 5.0 5.1 5.2 5.3 5.4 Stuck, B.A., Windfuhr, J.P., Genzwürker, H., Schroten, H., Tenenbaum, T. and Götte, K., 2008. Tonsillectomy in children. Deutsches Ärzteblatt International, 105(49), p.852.
- ↑ 6.0 6.1 Younis, R.T. and Lazar, R.H., 2002. History and current practice of tonsillectomy. The Laryngoscope, 112(S100), pp.3-5.
- ↑ 7.0 7.1 7.2 Liu, J.H., Anderson, K.E., Willging, J.P., Myer III, C.M., Shott, S.R., Bratcher, G.O. and Cotton, R.T., 2001. Posttonsillectomy hemorrhage: what is it and what should be recorded?. Archives of Otolaryngology–Head & Neck Surgery, 127(10), pp.1271-1275.
Authored for BIOL 238 Microbiology, taught by Joan Slonczewski,at Kenyon College,2024
