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Medicine (Baltimore) 1992 Sep;71(5):311-5; discussion 324-5  

Tonsillectomy and poliomyelitis. I. Epidemiologic considerations. 1942.

Aycock WL.

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From the article:  "In the data given by Top and Vaughan, a history of tonsillectomy is more frequent in all cases of poliomyelitis than in the several sets of controls in the same area.  These figures, barring any unseen selection - for example, in making up the control groups - would indicate that the absence of tonsils predisposes to poliomyelitis......Data concerning the comparative frequency of the bulbar and spinal forms of poliomyelitis in tonsillectomized and non-tonsillectomized individuals (excluding cases occurring within 30 days after the operation)..........all show a higher percentage of the bulbar form of the disease in individuals with a history of tonsillectomy than in those with tonsils present.  Non-paralystic poliomyelitis occurs in both groups of individuals with the same frequency as the bulbar and spinal forms combined.  These data, therefore, suggest that removal of tonsils is not a determinant between non-paralytic and paralytic poliomyelitis, but rather between the bulbar and spinal forms of the paralytic disease."

PMID: 1522807 [PubMed - indexed for MEDLINE]


Rev Infect Dis 1990 May-Jun;12(3):547-56 Related Articles, Books, LinkOut

Incubation of poliomyelitis as calculated from the time of entry into the central nervous system via the peripheral nerve pathways.

Wyatt HV.

University of Leeds, United Kingdom.

A new theory of how poliovirus reaches the central nervous system (CNS)--that it enters at many peripheral nerve endings with passage along nerve pathways to the CNS, with limited dispersal in the CNS--is used in making predictions of incubation periods, and these are compared with data from the literature and with predictions from other theories. The virus transit speed along the nerve of 2.4 mm/h has been used in calculating the incubation time. The calculated incubation time for Cutter vaccinees is similar to the actual times reported, and the calculated minimal and maximal incubation times in humans are similar to the published ranges. Incubation times in different animals and for different paralyses are explained. The pathology of lesions in humans and the consequent paralyses are compatible with the model. Tonsillectomy-associated poliomyelitis is reviewed and discussed in relation to possible entry of virus from peripheral nerve endings in muscle. Increased lymphocyte concentrations in the muscle may account for continuing susceptibility after tonsillectomy. Severe paralysis following exercise is explained as an effect of increased blood supply to nerves in the CNS that has already been invaded by virus. In developing countries, the phenomenon of paralysis in the injected muscle a few hours after injection in febrile children may occur in a similar fashion. The entry of poliovirus from many sites at nerve endings in muscles is consistent with clinical, experimental, and pathologic data and provides an explanation of the incubation times and related phenomena of poliomyelitis.

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PMID: 2163095 [PubMed - indexed for MEDLINE]
Otolaryngol Clin North Am 1976 Oct;9(3):581-96 Related Articles, Books, LinkOut

The immunologic substrate: role of local and systemic immunity in the head and neck.

Reed WP.

From the article:  "Two diseases have been reported to occur with increased frequency following tonsillectomy: poliomyelitis and Hodgkin's disease.  The association between polio and tonsillectomy was first suggested in 1938, and subsequently a number of epidemiologic and experimental studies have verified that such a relationship exists, at least when a child is infected with wild poliovirus shortly before or following tonsillectomy.  There is also some evidence that tonsillectomy performed in the remote past increases later susceptibility to paralytic poliomyelitis. In more recent studies by Ogra and coworkers, vaccine induced antipolio SIgA levels dropped sharply in nasopharyngeal secretions following tonsillectomy and adenoidectomy.  Antipolio IgG levels transiently increased in the secretions following surgery and the depression in SIgA levels, but later the levels of this immunoglobulin also decreased.  Additionally, immunization following tonsillectomy produced lower antipolio SIgA levels than immunization in children with intact tonsils.  It is difficult to translate this information into advice regarding the hazards of tonsillectomy, especially since poliomyelitis has now become a relatively rare disease."


PMID: 980496 [PubMed - indexed for MEDLINE]


HNO 1975 Sep;23(9):265-9 Related Articles, Books, LinkOut

[Tonsils and immunology (author's transl)]

[Article in German]

Blaker F.

Tonsils are lymphatic organs carrying out functions of humoral and cellular immunity. They form a local immunologic barrier; they are also involved in general immunologic defence mechanisms. Tonsillectomy or the destruction of tonsils by infections does not reduce the immunoglobulin concentration and antibody titres in peripheral blood. Only the local formation of IgA antibodies against poliomyelitis antigen seems to be impaired at least for a short time. The clinical relevance of this finding is unknown. Signs of defects in immunosurveillance, which were found in some study groups resulting from an increase of the morbidity rates of Hodgkin's disease and thyroid carcinoma, must be considered seriously although there is no statistic evidence for an increase of tumor frequency after tonsillectomy. The indication for tonsillectomy must be decided on clinical findings. Signs for a reduction of local antibody synthesis or for a possible diminuation of immunosurveillance should serve to critical indication.

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PMID: 1104543 [PubMed - indexed for MEDLINE]
N Y State J Med 1975 Nov;75(13):2428-30 Related Articles, Books, LinkOut

Tonsillectomy and adenoidectomy: are too many being done?

Karelitz S.
From the article:  When poliomyelitis was common in the United States, it was observed by several that of the children who had developed bulbar poliomyelitis, a considerable number had had tonsillectomies in the past month and some in the past six months.  This resulted in a recommendation by the health department of New York that tonsillectomies should not be done during the period when poliomyelitis is likely to be present, unless these children have previously been immunized against all three types of the poliovirus at least a month before surgery."

PMID: 1059022 [PubMed - indexed for MEDLINE]
: Fortschr Med 1974 Sep 12;92(25):971-3 Related Articles, Books, LinkOut

[Tonsillectomy in childhood. Dangers and complications]

[Article in German]

Munzel M.

PMID: 4547107 [PubMed - indexed for MEDLINE]
N Engl J Med 1971 Jan 14;284(2):59-64 Related Articles, Books, LinkOut

Effect of tonsillectomy and adenoidectomy on nasopharyngeal antibody response to poliovirus.

Ogra PL.
From the article:  "These observations suggest that complete removal of tonsils and adenoids, particularly in young male children, who have recently been immunized with poliovaccine, may deprive them of a valuable source of immunocompetent tissue, which may be actively involved in the replication of poliovirus and the synthesis of specific antibody.  Although direct evidence of local antibody production to polio virus in the tonsils and adenoids is not available, it is known that extensive replication of poliovirus takes place in the tonsillar tissues after natural or induced infection with poliovirus."

PMID: 4321186 [PubMed - indexed for MEDLINE]

Med J Austr  1953 Aug 22; II(8): 281-298

        Studies on a long rage association between bulbar poliomyelitis and previous tonsillectomy.

         Southcott RV

         From the article:  "In 1952 the writer stated in a paper read at the Eighth Session of the Australasian Medical Congress (British Medical Association) in Melbourne, that the patients who contracted bulbar poliomyelitis during the 1947-1948 poliomyelitis epidemic in South Australia had nearly all undergone tonsillectomy at some time prior to the onset of poliomyelitis, and that in only a few cases was the tonsillectomy recent......The preliminary studies suggested that the association between prior tonsillectomy and bulbar poliomyelitis lasted for five to ten years.  In the present paper the completed studies of the 1947-1948 bulbar cases are given, and the association and duration are confirmed."