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November 1989

Microbiology of the Tonsils and Adenoids-Reply

Author Affiliations

Gainesville, Fla

Arch Otolaryngol Head Neck Surg. 1989;115(11):1388. doi:10.1001/archotol.1989.01860350122029

In Reply.—We read with interest the letter by Shambaugh, who has observed the occurrence of lung abscesses following tonsillectomy in the upright position, and the correlation he documented between the tonsillar flora and the organisms recovered in the lung abscesses. This important observation brought about the abandonment of the sitting-up position during that procedure.

The observation by Shambaugh confirms the association between the normal aerobic-anaerobic oral flora and the ones recovered from lung abscesses.1-5 The organisms that predominate in lung abscesses (ie, Bacteroides species, Fusobacterium species, Peptostreptococcus species, and Streptococcus species)2-5 are the primary isolates recovered from the surface and core of tonsils.6 Patients with recurrent tonsillitis may harbor organisms that are more pathogenic in forming abscesses than those recovered in normal tonsils.7 Furthermore, these pathologic tonsils may contain more organisms per tonsil,8 and more organisms that produce the enzyme β-lactamase.6,8 These factors

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