title: Throat swab in the chronic tonsillitis: how reliable and valid is it?
abstract: BACKGROUND
  The diagnostic test of swabbing the surface of the tonsil as a culture specimen for the determination of the organism responsible for the tonsil infection is still in practice, despite controversy. To date there has been no reports of establishing the reliability and validity of this common diagnostic test by appropriate statistical test of Likelihood ratios taking into consideration the specificity and sensitivity.
  
  
  OBJECTIVE
  To assess the reliability and validity of throat swab in the diagnosis of bacterial microflora in chronic tonsillitis.
  
  
  METHODS
  A prospective study of 40 patients clinically diagnosed to have chronic tonsillitis undergoing tonsillectomy was undertaken. The reliability of the throat surface swab was then assessed and validated with the reference (gold) standard of tonsil core culture.
  
  
  RESULTS
  The likelihood ratio of this diagnostic test being positive (LR +ve) was 0.84 to similar and 1.3 to general organism pathogen.
  
  
  CONCLUSIONS
  Routine culture of the throat by surface swab in the accurate diagnosis of bacterial flora in chronic tonsillitis is neither reliable nor valid. The clinical implications of this investigation which is still very popular is discussed.
authors.affiliation: Department of ENT Speech & Hearing, Microbiology, Medicine and Clinical Epidemiology, Christian Medical College & Hospital, Vellore, Tamilnadu, India. kurien_mary@hotmail.com
authors.forename: M
authors.initials: M
authors.lastname: Kurien
authors.forename: A
authors.initials: A
authors.lastname: Stanis
authors.forename: A
authors.initials: A
authors.lastname: Job
authors.lastname: Brahmadathan
authors.forename: K
authors.initials: K
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D015373:Bacterial Typing Techniques / Q000706:statistics & numerical data; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D014066:Palatine Tonsil / Q000382:microbiology*; D010614:Pharynx / Q000382:microbiology*; D011446:Prospective Studies; D012015:Reference Standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013048:Specimen Handling / Q000295:instrumentation / Q000379:methods; D013203:Staphylococcal Infections / Q000175:diagnosis; D013290:Streptococcal Infections / Q000175:diagnosis; D014068:Tonsillectomy; D014069:Tonsillitis / Q000382:microbiology*