Effectiveness of Adenotonsillectomy in PFAPA Syndrome: A Randomized Study

Objective To evaluate whether adenotonsillectomy leads to complete resolution in children with PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis) syndrome. Study design Thirty-nine children with PFAPA syndrome were randomized to either adenotonsillectomy (surgery group; n = 19) or expectant management (control group; n = 20). All patients were then invited prospectively to record all PFAPA episodes, and were evaluated clinically every 3 months for 18 months after randomization. Results The proportion of patients experiencing complete resolution was 63% in the surgery group and 5% in the control group (P < .001). The mean (standard deviation) number of episodes recorded during the study period was 0.7 +/- 1.2 in the surgery group and 8.1 +/- 3.9 in the control group (P < .001). The episodes were less severe in the surgery group. Conclusions Adenotonsillectomy is an effective treatment strategy for children with PFAPA syndrome. (J Pediatr 2009; 155:250-3).