Comparison of the Surface and Core Bacteria in Tonsillar and Adenoid Tissue With Beta-Lactamase Production

  • Işıl Taylan
  • İbrahim ÖzcanEmail author
  • İpek Mumcuoğlu
  • Irmak Baran
  • K. Murat Özcan
  • Özgür Akdoğan
  • Adin Selcuk
  • Neriman Balaban
  • Hüseyin Dere
Original Article


Adenoidectomy and tonsillectomy, indicated for children with recurrent or persistent symptoms of infection or hypertrophy, are among the most frequent operations performed in children. This study was carried out for investigating the microbial flora of the tonsils and adenoids regarding to core and surface microorganisms and also pathogen microrganisms’ beta-lactamase production rate. Cultures were taken from the core and surface of tonsils and adenoids of the 91 patients at the time of the surgery for tonsillectomy and adenoidectomy. Aerobic and anaerobic cultures were inoculated and identified. Beta-lactamase production was detected also. The most frequently isolated aerobic microorganisms were Streptococcus viridans and Neisseria spp. The number of the microorganisms isolated from the tonsil core compared to the surface of the tonsils was found statistically insignificant (P > 0.05). The number of the adenoid surface aerobic microorganisms was found higher from the adenoid core (P < 0.05). The amount of adenoid and tonsil core anaerobic microorganisms were alike. The patients’ preoperative antibiotherapy whether using beta-lactam or beta-lactamase resistant were compared for beta-lactamase producing bacteria production and the number of beta-lactamase producing bacteria were found statistically insignificant (P > 0.05). The togetherness of Staphylococcus aureus and other beta-lactamase producing bacteria was found statistically significant (P < 0.05). This study demonstrates that there is polymicrobial aerobic-anaerobic flora in both adenoids and tonsils. There was a close relationship between the bacteriology of the tonsil and adenoid flora. Staphylococcus aureus and and other beta-lactamase producing bacteria may be responsible for treatment failures in patients with tonsillitis.


Bacteriology Tonsil Adenoids Beta-lactamases 


  1. 1.
    Brook I, Yocum P (1984) Bacteriology of chronic tonsillitis in young adults. Arch Otolaryngol Head Neck Surg 110:803–805Google Scholar
  2. 2.
    DeDio RM, Lawrence WCT, McGowan KL, Wetmore RF, Handler SD, Potsic WP (1988) Microbiology of the tonsils and adenoids in a pediatric population. Arch Otolaryngol Head Neck Surg 114:763–765PubMedGoogle Scholar
  3. 3.
    Gaffney RJ, Timon CI, Freeman DF, Walsh MA, Cafferkey MT (1993) Bacteriology of tonsil and adenoid and sampling techniques of adenoidal bacteriology. Respir Med 87:303–308PubMedCrossRefGoogle Scholar
  4. 4.
    Özek O, Eğilmez S, Ang O, Savaş I (1967) A bacteriological study of chronic tonsillitis. Acta Otolaryngol 63:455–461PubMedCrossRefGoogle Scholar
  5. 5.
    Timon CI, McAllister VA, Walsh MA, Cafferkey MT (1990) Changes in tonsil bacteriology of recurrent acute tonsillitis: 1980 vs 1989. Respir Med 84:395–400PubMedCrossRefGoogle Scholar
  6. 6.
    Brook I (1984) The role of beta-lactamase producing bacteria in the persistance of streptococcal tonsillar infection. Rev Infect Dis 6(5):601–607PubMedCrossRefGoogle Scholar
  7. 7.
    Brook I, Yocum P, Foote PA Jr (1995) Changes in the core tonsillar bacteriology of recurrent tonsillitis: 1977–1993. Clin Inf Dis 21:171–176CrossRefGoogle Scholar
  8. 8.
    İnci E, Kakakullukçu B, Aygün G, Özdoğan A (2002) Tonsil surface and core microflora in children undergone tonsillectomy for recurrent tonsillitis. Turkish Otolaryngol Arch 40(4):247–251Google Scholar
  9. 9.
    Wiatrak BJ, Woolley AL (1993) Pharyngitis and adenotonsillar disease. In: Cummings CW, Frederickson JM, Harker LA, Krause CJ, Schüller DE (eds) Otolaryngology Head and Neck Surgery, 2nd edn. Mosby Year Book, Inc, St. Louis, pp 2795–2801Google Scholar
  10. 10.
    Brook I, Shah K (2001) Bacteriology of adenoids and tonsils in children with recurrent adenotonsillitis. Ann Otol Rhinol Laryngol 110:844–848PubMedGoogle Scholar
  11. 11.
    Uppal K, Bais AS (1989) Tonsillar microflora, superficial surface versus deep. J Laryngol Otol 103:175–177PubMedCrossRefGoogle Scholar
  12. 12.
    Kielmovitch IH, Keleti G, Bluestone CD (1989) Microbiology of obstructive tonsillar hypertrophy and recurrent tonsillitis. Arch Otolaryngol Head Neck Surg 115:721–724PubMedGoogle Scholar
  13. 13.
    Mitchelmore IJ, Reilly PG, Hay AJ, Tabaqchali S (1994) Tonsil surface and core cultures in recurrent tonsillitis: prevalence of anaerobes and beta-lactamase producing organisms. Eur J Clin Microbiol Infect Dis 13(7):542–548PubMedCrossRefGoogle Scholar
  14. 14.
    Surow JB, Handler SD, Telian SA, Fleisher GR, Baranak CC (1989) Bacteriology of tonsil surface and core in children. Laryngoscope 99:261–266PubMedCrossRefGoogle Scholar
  15. 15.
    Ünal A, Kürkçüoğlu S, Aslan A, Işıldak İ, Nalça Y (1998) Tonsil surface and core flora in chronic recurrent tonsillitis. ENT Head Neck Surg 6(1):33–36Google Scholar
  16. 16.
    Kumai A, Gupta V, Chandra K, Gupta P, Varshney S (2005) Clinico bacteriological evaluation of surface and core microflora in chronic tonsillitis. Indian J Otolaryngol Head Neck Surg 57(2):118–120Google Scholar
  17. 17.
    Brook I, Foote P (1989) Microbiology of the tonsils and adenoids. Arch Otolaryngol 115:528–530Google Scholar
  18. 18.
    Brodsky L, Koch R (1993) Bacteriology and immunology of normal and diseased adenoids in children. Arch Otolaryngol Head Neck Surg 119:821–829PubMedGoogle Scholar
  19. 19.
    Brook I, Yocum P, Shah K (1980) Surface vs core tonsillar aerobic and anaerobic flora in recurrent tonsillitis. JAMA 224:1696–1698CrossRefGoogle Scholar
  20. 20.
    Maw RA, Speller DCE (1985) Are the tonsils and adenoids a reservoir of infection in otitis media with effusion? Clin Otolaryngol 10:265–269PubMedCrossRefGoogle Scholar
  21. 21.
    Teele DW, Healy GB, Tally FP (1980) Persistant effusions of the middle ear. culture for anaerobic bacteria. Ann Otol Rhinol Laryngol 89(Suppl A):102–103Google Scholar
  22. 22.
    Soylu L, Özşahinoğlu C, Aydoğan LB (1992) The inflamatory diseases of tonsil and adenoid tissue and tonsillectomy. Archive (1)157–165Google Scholar
  23. 23.
    Simon HJ, Sukai W (1968) Staphylococcal antagonism to penicilin-G therapy of hemolytic streptococcal pharyngeal infection: effect of oxacillin. Pediatrics 31:463–469Google Scholar
  24. 24.
    Kundsin RB, Miller JM (1964) Significance of the Staphylococcus aureus carrier state in the treatment of disease due to group A streptococci. N Engl J Med 271:1395–1397PubMedCrossRefGoogle Scholar
  25. 25.
    Brook I (1986) Direct and indirect pathogenicity of Branhamella catarrhalis. Drugs 31(suppl 3):97–102PubMedCrossRefGoogle Scholar
  26. 26.
    Brook I (1993) Infections caused by beta-lactamase producing Fusobacterium spp. in children. Pediatr Infect Dis J 12:532–533PubMedCrossRefGoogle Scholar
  27. 27.
    Bernstein SH, Stillerman M, Allerhand J (1964) Demonstration of penicilin inhibition by pharyngeal microflora in patients treated for streptococcal pharyngitis. J Lab Clin Med 63:14–22PubMedGoogle Scholar
  28. 28.
    Brook I (2001) Failure of penicilin to eradicate Group A Beta-Hemolytic Streptococci tonsillitis: causes and management. J Otolaryngol 30:324–329PubMedCrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2011

Authors and Affiliations

  • Işıl Taylan
    • 1
  • İbrahim Özcan
    • 1
    Email author
  • İpek Mumcuoğlu
    • 2
  • Irmak Baran
    • 2
  • K. Murat Özcan
    • 1
  • Özgür Akdoğan
    • 1
  • Adin Selcuk
    • 1
  • Neriman Balaban
    • 2
  • Hüseyin Dere
    • 1
  1. 1.Ankara Numune Education and Research Hospital 4th ENT ClinicDikmenTurkey
  2. 2.Ankara Numune Education and Research Hospital Department of Infectious Diseases and Clinical MicrobiologyAnkaraTurkey

Personalised recommendations