Tonsillectomy and Poliomyelitis

There is a causal relationship between the removal of tonsils and the onset of bulbar poliomyelitis within the time interval corresponding to the incubation period of the disease (approximately one month). Furthermore, it appeared that the relative frequency of occurrence of bulbar, as compared with the spinal form of poliomyelitis, was greater at all ages in persons giving a history of the previous tonsillectomy.

This relationship is explained as due to the fact that virus being present in the throat at the time of the operation passes directly into the central nervous system along traumatized nerve fibers.

Thus, so far as the evidence goes at present, it appears that the absence of
tonsils are in some measure a predisposing condition to bulbar localization of virus. Whether this absence of tonsils increases the risk of converting an immunizing alimentary infection into a paralytic attack is still unknown, nor is it clear how the absence of tonsils weakens resistance, although several explanations have been postulated. Nevertheless, if a tonsillectomy person develops clinically recognizable poliomyelitis, the likelihood of bulbar involvement may be three or four times as great as in one whose tonsils are in situ.

This higher proportion of bulbar cases in tonsillectorized persons occurs at all ages regardless of the time elapsed since the operation.

Even though the increased risk of bulbar localization of the virus is exceedingly small for the individual, it should be taken into account in considering the indications for tonsillectomy at any season of the year, but especially during the summer months.

PRACTISE QUESTION

Consider the following statements with regard to acute anterior poliomyelitis: Identify the wrong statement. (post your answer in the comments section)

1. It is caused by a virus belonging to the picornavirus family
2. Muscle pain and cramps may be associated with diffuse transient fasciculations at the onset
3. Tonsillectomy reduces the risk of bulbar poliomyelitis
4. Cerebrospinal fluid may show mild pleocytosis with increase polymorphonuclear cells in the early course of the disease.