To the Editor.—I note with interest the Letter to the Editor in the April issue of the Archives on "Microbiology of the Tonsils and Adenoids."
Many, many years ago, in fact, in 1930, during my residency in otolaryngology at the Massachusetts Ear Infirmary, Boston, I became quite interested in the bacterial flora of the tonsillar crypts, and the occurrence, at that time, of lung abscess following a tonsillectomy in the upright position. I demonstrated that the flora, as determined by culture, both aerobic and anaerobic, of the tonsillar crypts, was identical with that of lung abscesses occurring in patients who, at that time, were undergoing tonsillectomy in the upright position under general anesthesia. It seemed most probable that the lung abscesses were due to inhalation of tonsillar crypt debris into the lungs. Shortly after this demonstration, the sitting-up position for patients, during tonsillectomy under general anesthesia, was finally abandoned.
SHAMBAUGH GE. Microbiology of the Tonsils and Adenoids. Arch Otolaryngol Head Neck Surg. 1989;115(11):1388. doi:10.1001/archotol.1989.01860350122028
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