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Poliomyelitic Paralysis and Tonsillectomy Reconsidered FREE

REIMERT T. RAVENHOLT, M.D., M.P.H.
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Submitted for publication Feb. 20, 1961.

Presented at the Annual Conference of the Epidemic Intelligence Service, C.D.C., U.S. Public Health Service, Atlanta, April 27, 1961.


Am J Dis Child. 1962;103(5):658-668. doi:10.1001/archpedi.1962.02080020673005.
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Does tonsillectomy cause lifelong alteration in susceptibility to poliomyelitic bulbar paralysis? This question may soon be only of academic interest because of the rapid progress which is being made in the prevention of paralytic poliomyelitis. But in the interest of scientific truth it seems important to determine the effect of tonsillectomy on poliomyelitic paralysis before nature's poliomyelitis book is closed—which may be within a few seasons.

That tonsillectomy does dispose to bulbar paralysis during the first subsequent month, if the tonsillectomized person becomes infected with poliovirus just before or after the operation, has been amply confirmed by epidemiological1-9 and experimental10-13 studies since it was first suggested14 by Ayer 32 years ago.

But the concept that tonsillectomy produces lifelong increased susceptibility to bulbar paralysis, if the person develops paralytic poliomyelitis, which was suggested by Fischer,15 has not been confirmed by experimental studies and has received less, although

REFERENCES

Aycock, W. L., and Luther, E. H.:  The Occurrence of Poliomyelitis Following Tonsillectomy , New Engl. J. Med. 200:164-167 ( (Jan. 24) ) 1929;.
Silverman, A. C.:  Acute Poliomyelitis in Syracuse, N.Y. Clinical Analysis of 5 Successive Outbreaks from 1922 to 1929, with Special Reference to Epidemiology and Treatment with Serum , Amer. J. Dis. Child. 41:829-861 ( (April) ) 1931;.
Fischer, A. E., and Stillerman, M.:  Acute Anteror Poliomyelitis in New York in 1935: A Review of 686 Cases , Amer. J. Dis. Child. 54: 984-995 ( (Nov.) ) 1937;.
Eley, R. C., and Flake, C. G.:  Acute Anterior Poliomyelitis Following Tonsillectomy and Adenoidectomy—with Special Reference to the Bulbar Form , J. Pediat. 13:63-70 ( (July) ) 1938;.
Francis, T.; Krill, C. E.; Toomey, J. A., and Mack, W. N.:  Poliomyelitis Following Ton sillectomy in 5 Members of a Family , J.A.M.A. 119:1392-1396 ( (Aug. 22) ) 1942;.
Anderson, J. A.:  Poliomyelitis and Recent Tonsillectomy , J. Pediat. 27:68-70 ( (July) ) 1945;.
Siegel, M.; Greenberg, M., and Magee, M. D.:  Tonsillectomy and Poliomyelitis: I. Studies on Incidence in 1949 , J. Pediat. 38:537-547 ( (May) ) 1951;.
Siegel, M.; Greenberg, M., and Magee, M. D.:  Tonsillectomy and Poliomyelitis: II. Frequency of Bulbar Paralysis, 1944-1949 , J. Pediat. 38:548-558 ( (May) ) 1951;.
Mills, C.:  Tonsillectomy—Poliomyelitis Problem: A Review of the Literature , Laryngoscope 61:1188-1196 ( (Dec.) ) 1951;.
Sabin, A. B.:  Experimental Poliomyelitis by the Tonsillopharyngeal Route, with Special Reference to the Influence of Tonsillectomy on the Development of Bulbar Poliomyelitis , J.A.M.A. 111:605-610 ( (Aug. 13) ) 1938;.
Burnet, F. M.; Jackson, A. V., and Robertson, E. G.: Poliomyelitis: 3. The Use of Macacus Cynomolgus as an Experimental Animal (1939)
von Magnus.12
von Magnus, H., and Melnick, J.:  Tonsillectomy in Experimental Poliomyelitis , Am. J. Hyg. 48:113-125 ( (July) ) 1948;.
Faber, H. K.; McNaught, R. C.; Silverberg, R. J., and Dong, L.:  Experimental Production of Post-Tonsillectomy Bulbar Poliomyelitis , Proc. Soc. Exp. Biol. Med. 77:532-534 ( (July) ) 1951;.
Ayer, W. D.: Poliomyelitis (1928;)
Eley.4
Fischer, A. E.; Stillerman, M., and Marks, H. H.:  Relation of Tonsillectomy and of Adenoidectomy to the Incidence of Poliomyelitis, with Special Reference to the Bulbar Form , Amer. J. Dis. Child. 61:305-321 ( (Feb.) ) 1941;.
Lucchesi, P. F., and LaBoccetta, A. C.:  Relationship of Tonsils and Adenoids to the Type of Poliomyelitis: An Analysis of 432 Cases , Amer. J. Dis. Child. 68:1-4 ( (July) ) 1944;.
Top, F. H.:  Occurrence of Poliomyelitis in Relation to Tonsillectomies at Various Intervals , J.A.M.A. 150:534-538 ( (Oct. 11) ) 1952;.
Southcott, R. V.:  Studies on a Long-Range Association Between Bulbar Poliomyelitis and Previous Tonsillectomy , Med. J. Austr. 2:281-298 ( (Aug. 22) ) 1953;.
Weinstein, L., and Vogel, M. L.:  A Study of the Relationship of the Absence of Tonsils to the Incidence of Bulbar Poliomyelitis , J. Pediat. 44:14-19 ( (Jan.) ) 1954;.
Anderson, G. W., and Rondeau, J. L.:  Absence of Tonsils as a Factor in the Development of Bulbar Poliomyelitis , J.A.M.A. 155:1123-1130 ( (July 24) ) 1954;.
Paffenbarger, R. S., and Wilson, V. O.:  Previous Tonsillectomy and Current Pregnancy as They Affect Risk of Poliomyelitis Attack , Ann. N.Y. Acad. Sci. 61:856-868 ( (Sept. 27) ) 1955;.
Paffenbarger, R. S.:  The Effect of Prior Tonsillectomy on Incidence and Clinical Type of Acute Poliomyelitis , Amer. J. Hyg. 66:131-150 ( (Sept.) ) 1957;.
Ravenholt, R. T.:  Poliomyelitis in an Immunized Community , Public Health Rep. 76:166-178 ( (Feb.) ) 1961;.
Lehman, S. P., and LaVeck, G. D.:  Local Study of Epidemic Poliomyelitis , Northw. Med. 53:250-256 ( (March) ) 1954;.
Horstmann, D. M.:  Poliomyelitis: Severity and Type of Disease in Different Age Groups , Ann. N.Y. Acad. Sci. 61:956-967 ( (Sept. 27) ) 1955;.

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References

Aycock, W. L., and Luther, E. H.:  The Occurrence of Poliomyelitis Following Tonsillectomy , New Engl. J. Med. 200:164-167 ( (Jan. 24) ) 1929;.
Silverman, A. C.:  Acute Poliomyelitis in Syracuse, N.Y. Clinical Analysis of 5 Successive Outbreaks from 1922 to 1929, with Special Reference to Epidemiology and Treatment with Serum , Amer. J. Dis. Child. 41:829-861 ( (April) ) 1931;.
Fischer, A. E., and Stillerman, M.:  Acute Anteror Poliomyelitis in New York in 1935: A Review of 686 Cases , Amer. J. Dis. Child. 54: 984-995 ( (Nov.) ) 1937;.
Eley, R. C., and Flake, C. G.:  Acute Anterior Poliomyelitis Following Tonsillectomy and Adenoidectomy—with Special Reference to the Bulbar Form , J. Pediat. 13:63-70 ( (July) ) 1938;.
Francis, T.; Krill, C. E.; Toomey, J. A., and Mack, W. N.:  Poliomyelitis Following Ton sillectomy in 5 Members of a Family , J.A.M.A. 119:1392-1396 ( (Aug. 22) ) 1942;.
Anderson, J. A.:  Poliomyelitis and Recent Tonsillectomy , J. Pediat. 27:68-70 ( (July) ) 1945;.
Siegel, M.; Greenberg, M., and Magee, M. D.:  Tonsillectomy and Poliomyelitis: I. Studies on Incidence in 1949 , J. Pediat. 38:537-547 ( (May) ) 1951;.
Siegel, M.; Greenberg, M., and Magee, M. D.:  Tonsillectomy and Poliomyelitis: II. Frequency of Bulbar Paralysis, 1944-1949 , J. Pediat. 38:548-558 ( (May) ) 1951;.
Mills, C.:  Tonsillectomy—Poliomyelitis Problem: A Review of the Literature , Laryngoscope 61:1188-1196 ( (Dec.) ) 1951;.
Sabin, A. B.:  Experimental Poliomyelitis by the Tonsillopharyngeal Route, with Special Reference to the Influence of Tonsillectomy on the Development of Bulbar Poliomyelitis , J.A.M.A. 111:605-610 ( (Aug. 13) ) 1938;.
Burnet, F. M.; Jackson, A. V., and Robertson, E. G.: Poliomyelitis: 3. The Use of Macacus Cynomolgus as an Experimental Animal (1939)
von Magnus.12
von Magnus, H., and Melnick, J.:  Tonsillectomy in Experimental Poliomyelitis , Am. J. Hyg. 48:113-125 ( (July) ) 1948;.
Faber, H. K.; McNaught, R. C.; Silverberg, R. J., and Dong, L.:  Experimental Production of Post-Tonsillectomy Bulbar Poliomyelitis , Proc. Soc. Exp. Biol. Med. 77:532-534 ( (July) ) 1951;.
Ayer, W. D.: Poliomyelitis (1928;)
Eley.4
Fischer, A. E.; Stillerman, M., and Marks, H. H.:  Relation of Tonsillectomy and of Adenoidectomy to the Incidence of Poliomyelitis, with Special Reference to the Bulbar Form , Amer. J. Dis. Child. 61:305-321 ( (Feb.) ) 1941;.
Lucchesi, P. F., and LaBoccetta, A. C.:  Relationship of Tonsils and Adenoids to the Type of Poliomyelitis: An Analysis of 432 Cases , Amer. J. Dis. Child. 68:1-4 ( (July) ) 1944;.
Top, F. H.:  Occurrence of Poliomyelitis in Relation to Tonsillectomies at Various Intervals , J.A.M.A. 150:534-538 ( (Oct. 11) ) 1952;.
Southcott, R. V.:  Studies on a Long-Range Association Between Bulbar Poliomyelitis and Previous Tonsillectomy , Med. J. Austr. 2:281-298 ( (Aug. 22) ) 1953;.
Weinstein, L., and Vogel, M. L.:  A Study of the Relationship of the Absence of Tonsils to the Incidence of Bulbar Poliomyelitis , J. Pediat. 44:14-19 ( (Jan.) ) 1954;.
Anderson, G. W., and Rondeau, J. L.:  Absence of Tonsils as a Factor in the Development of Bulbar Poliomyelitis , J.A.M.A. 155:1123-1130 ( (July 24) ) 1954;.
Paffenbarger, R. S., and Wilson, V. O.:  Previous Tonsillectomy and Current Pregnancy as They Affect Risk of Poliomyelitis Attack , Ann. N.Y. Acad. Sci. 61:856-868 ( (Sept. 27) ) 1955;.
Paffenbarger, R. S.:  The Effect of Prior Tonsillectomy on Incidence and Clinical Type of Acute Poliomyelitis , Amer. J. Hyg. 66:131-150 ( (Sept.) ) 1957;.
Ravenholt, R. T.:  Poliomyelitis in an Immunized Community , Public Health Rep. 76:166-178 ( (Feb.) ) 1961;.
Lehman, S. P., and LaVeck, G. D.:  Local Study of Epidemic Poliomyelitis , Northw. Med. 53:250-256 ( (March) ) 1954;.
Horstmann, D. M.:  Poliomyelitis: Severity and Type of Disease in Different Age Groups , Ann. N.Y. Acad. Sci. 61:956-967 ( (Sept. 27) ) 1955;.

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