title: Recurrences in chronic tonsillitis substained by tonsillar biofilm-producing bacteria in children. Relationship with the grade of tonsillar hyperplasy.
abstract: OBJECTIVE
  It has been suggested that bacterial biofilms are involved in chronic tonsillar disease, but there is a lack of strong evidence concerning their etiopathogenic role in childhood chronic tonsillar infections. The aim of this study was to assess the presence of biofilm-producing bacteria (BPB) in tonsillar bioptic specimens taken from children with recurrent exacerbations of chronic hyperplastic tonsillitis, and to evaluate the possible relationship between them and the patients' demographic and clinical characteristics.
  
  
  METHODS
  22 children (68.2% males; median age 6.5 years, range 3-13) with recurrent exacerbations of chronic hyperplastic tonsillitis were included. The presence of tonsillar BPB was assessed by means of the spectrophotometric analysis of tonsillar bioptic specimens taken during tonsillectomy between episodes of tonsillar infection.
  
  
  RESULTS
  BPB were found in 50.0% of the 44 tonsillar specimens, and Staphylococcus aureus was the most frequent pathogen (81.8%). There was a significant relationship (p=0.02) between the grade of tonsillar hyperplasy (GTH) and the presence of tonsillar BPB, with an increased relative risk (RR=4.27, standard error=2.57, p<0.01) of tonsillar BPB development in children with GTH scores of >2.
  
  
  CONCLUSIONS
  The findings of this study: (1) confirm the presence of tonsillar BPB in children with recurrent exacerbations of chronic tonsillar infections; (2) suggest that GTH is an important indicator of the presence of tonsillar BPB; and (3) raise the question as to whether tonsillar biofilm is a causative factor or just a consequence of recurrent exacerbations of chronic hyperplastic tonsillitis.
authors.affiliation: Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy. sara.torretta@policlinico.mi.it
authors.forename: Sara
authors.initials: S
authors.lastname: Torretta
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Drago
authors.forename: Paola
authors.initials: P
authors.lastname: Marchisio
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cappadona
authors.forename: Vittorio
authors.initials: V
authors.lastname: Rinaldi
authors.forename: Erica
authors.initials: E
authors.lastname: Nazzari
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Pignataro
mesh_terms: D000293:Adolescent; D018441:Biofilms; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000382:microbiology / Q000473:pathology*; D007558:Italy; D008137:Longitudinal Studies; D008297:Male; D014066:Palatine Tonsil / Q000382:microbiology / Q000473:pathology*; D012008:Recurrence; D014069:Tonsillitis / Q000382:microbiology* / Q000473:pathology