Comparative study in Bacteriological findings between the surface and the core of chronic infected Tonsils


  • Ahmed Al –Ansary M.B.Ch.B,F.I.M.C.S,Head of Department of ENT,Basrah General Hospital
  • Firas B. AL-HAMEED MB.Ch.B,CABMS.Department of Otolarynglogy-Head &Neck Surgery,College of medicine,Thi-qar university.
  • Rukaia NS M.B.CH.B,Msc.Department of Microbiology and Immunology, microbiology,Basra children,s specialty hospital.
  • Muna MK M.B.CH.B,Msc.Department of Microbiology and Immunology, microbiology,Basra children,s specialty hospital


  Background: This study was conducted to elucidate the tonsil surface swabs versus core swabs bacterial cultures in relation to some selected variables in patients group with recurrent chronic tonsillitis of different age and sex groups in Basrah General Hospital.  Aims of the study:  The study was designed to determine if the surface swab is of benefit in prediction of the core bacteria in chronically infected tonsillitis, to identify the commonest causative organisms in the studied patients, to determine the prevalent bacterial etiology of chronic tonsillitis among both children and adults. Patients  and  Methods : A prospective study was carried out during the period from  March  2012 till   April   2013  at Basrah General Hospital ,Iraq. The total numbers of tonsillectomies specimen were 100 tonsils. Surface swabs and core swabs were sent for microbiological study and culture.   Results: The overall proportion of surface swabs revealed pathogenic organisms was 40% of studied cases while core swabs detected pathogenic organisms was 58% of cases. Staphylococcus aureus was the commonest pathogen isolated from both surface and core of tonsils. Group A β hemolytic streptococcus was more common in children than in adults.


- Wiatrak BJ, Woolley AL. Tonsil and Adenoids: In pediatric Otolaryngology Head and Neck Surgery. 3rd. edition. Richardson MA (Ed.), Chales CW et al. (Gen. Eds.) Mosby-year book. Inc. St. Louis. 1998; 12: 188-205.

- Cowan D.L. & Hibbert J. Acute and chronic infection of the pharynx and tonsils. In: Scott-Brownʼs Otolaryngology. Vol 5. 6thed. Oxford: Butterworth Heinemann, 1997;4:1-24.

- Ylikoski J, Karjalanainen J. Acute tonsillitis in young men: etiological agents and their differentiation. Scand J Infect Dis 1989; 21:169-174.

- Gaffney RJ, Freeman DJ, Walsh MA, et al. Differences in tonsil core bacteriology in adults and children: a prospective study of 262 patients. Resp Med 1991; 85:383-388.

- Kurien M, Stanis A, Job A, et al. Throat swab in the chronic tonsillitis: How reliable and valid is it? Singapore Med J 2000; 41 (7): 324-346.

- Robinson AC, Hanif J, Dumbreck LA, et al. Throat swabs in chronic tonsillitis: a time-honoured practice best forgotten. Br J ClinPract 1997; 51:138-139.

- Brodsky L, Nagy M, Volk M, et al. The relationship of tonsil bacterial concentration to surface and core cultures in chronic tonsillar disease in children. Int J Paed Otolaryngol 1991; 21:33-39.

- Chole RA, Faddis BT. Anatomical evidence of microbial biofilms in tonsillar tissues: a possible mechanism to explain chronicity. Arch Otolaryngol Head Neck Surg 2003: 129:634-636.

- Osterlund A, Popa R, Nikkila T, et al. Intracellular reservoir of Streptococcus pyogens in vivo: a possible explanation for recurrent pharyngotonsillitis. Laryngoscope 1997; 107: 640-647.

- Surow .IB, Handler SD, Telian SA, Fleisher GR, Baranak CC. Bacteriology of tonsil surface and core in children. Laryngoscope 1989; 99: 261-266.

- Brook I, Yocum P, Shah K. Surface vs core-tonsillar aerobic and anaerobic flora in recurrent tonsillitis. Journal of the American Medical Association 1980; 244: 1696-1698.

- Caplan C. Case against the use of throat culture in the management of streptococcal pharyngitis. Journal of Family Practice 1979; 8: 485-490.

- Feery BJ, Forsell P, Gulasekharam M. Streptococcal sore throat in general practice-a controlled study. Medical Journal of Australia 1976; 1: 989-991.

- Abdulrahman AS, Kholeif LA, El-Beltagy YM, et al. Bacteriology of tonsil surface and core in children with chronic tonsillitis and incidence of bacteraemia during tonsillectomy. Egypt J Med Lab Sci, (ESIC) 2004; 13(2).

- Rosen G, Samuel J, Vered I. Surface tonsillar microflora versus deep tonsillar microflora in recurrent acute tonsillitis. J Laryngol. Otol. 1977; 10:911-913.

- Endo LH, Sakano E, Carvalho DS, et al. Comparative bacteriology of the surface of normal and pathological palatine tonsil in children. Acta Otolaryngol. (Stockh); Suppl, 1996; 523: 130-132.

- Abbas EM, Hamouda M, Karameldin M, et al. Chronic tonsillitis: clinical diagnosis versus laboratory evaluation with its effect on scholastics achievement. Thesis submitted for partial fulfillment of PhD degree in childhood studies, Ain Shams University, Institute of postgraduate childhood studies, 1997.

- Loganathan A,Arumainathan UD, Raman R, et al. Comparative study of bacteriology in recurrent tonsillitis among children and adults. Singapore Med J 2006; 47(4) : 271-275.

- Yildirim I, Okur E, Ciragil P, et al. Bacteraemia during tonsillectomy. J. Laryngology and Otology 2003; 117: 619-623.

- Brook I, Shah K. Bacteriology of adenoids and tonsils in children with recurrent adenotonsillitis. Ann OtolRhinolaryngol 2001; 110: 844-847.

- Lidroos R. Bacteriology of the tonsil core in recurrent tonsillitis and tonsillar hyperplasia – a short review. Acta Otolaryngol Suppl 2000; 543:206-208.

- Sood R. Medical Laboratory Technology. 6th edition. 2009; 2:1527.

- Brook I, Yocum P, Foote P. Changes in the tonsillar bacteriology of recurrent tonsillitis: 1977-1993. Clin Infect Dis 1995; 21:171-176.

- Brook I, Foote P. Comparison of the microbiology of recurrent tonsillitis between children and adults. Laryngoscope .1986; 96:1385-1387.

- Ramirez A, Peidrola D, Lopez A, et al. Beta-hemolytic streptococci in tonsil hypertrophy and recurrent tonsillitis. Enferm. Infecc. Microbiol. Clin. 1997; 15:315-318.