Role of tonsillectomy and adenoidectomy in parental satisfaction of treatments for PANDAS

Am J Otolaryngol. 2021 Jul-Aug;42(4):102963. doi: 10.1016/j.amjoto.2021.102963. Epub 2021 Feb 27.


Objective: To examine caregiver satisfaction with treatments for pediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS) and how symptom frequency changes over time.

Methods: A list was created for PANDAS subjects seen at the Georgetown Pediatric Otolaryngology clinic from 2015 to 2018. Questionnaires were distributed to caregivers able to be contacted; 62% responded (n = 60). Subjects were placed in groups based on treatments reported: tonsillectomy and adenoidectomy (T&A, n = 28), T&A and intravenous immunoglobulin (IVIG, n = 22), or nonsurgical treatment(s) (n = 10). Caregivers reported frequencies for each of 10 associated symptoms from time of treatment to 12 months and also expressed their satisfaction with treatment.

Results: Patients were treated with antibiotics (n = 60, 100%), T&A (83.3%), IVIG (40%), Rituximab (15%), steroids (20%), and/or plasma exchange (10%). Caregivers for 66% (n = 33) of surgical patients identified T&A as the most effective treatment, and 80% would choose the operation again. No difference in median caregiver satisfaction level was found among the groups (n = 0.196). There was no significant difference in frequency for any of the symptoms (all p > 0.05) except choreiform movement (p = 0.0296).

Conclusion: Caregivers reported a decreasing frequency of symptoms over time regardless of treatment and had no difference in satisfaction. T&A was the most preferred treatment and the most impactful on symptoms for surgical patients. Given the challenges of immunologic therapies, T&A in combination with antibiotics should be considered as an early intervention for PANDAS.

Keywords: 1; Adenoidectomy; Immunologic therapy; Level of evidence; Neuropsychiatric disorder; Streptococcus infection; Tonsillectomy.

MeSH terms

  • Adenoidectomy*
  • Adolescent
  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • Autoimmune Diseases / complications
  • Autoimmune Diseases / surgery*
  • Caregivers / psychology*
  • Child
  • Child, Preschool
  • Combined Modality Therapy
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use
  • Middle Aged
  • Parents / psychology*
  • Personal Satisfaction*
  • Streptococcal Infections / complications
  • Streptococcal Infections / surgery*
  • Time Factors
  • Tonsillectomy*


  • Anti-Bacterial Agents
  • Immunoglobulins, Intravenous