U Lantto et al. J Pediatr 2016; 179: 172-7.  This retrospective study showed that tonsillectomy was highly effective in children with PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and adenitis) -both those with classic features and incomplete features.

“In the group that met Thomas criteria, 97% (56/58) had complete resolution of fever episodes after tonsillectomy; in the group that did not meet Thomas criteria (50/50) had complete resolution.”

Thomas criteria:

1. Recurring fevers with early age of onset (<5 years) [the authors suggest a minimum of 5 episodes]
2. Constitutional symptoms in the absence of over upper respiratory infection with at least one of the following: aphthae, cervical adenitis, pharyngitis
3. Exclusion of cyclic neutropenia
4. Completely asymptomatic interval between episodes
5. Normal growth and development