The relationship of tonsil bacterial concentration to surface and core cultures in chronic tonsillar disease in children.

Fifty-five tonsils removed for chronic tonsillar disease (chronic tonsillitis and obstructive tonsillar hyperplasia) underwent surface swab and quantitative core cultures in order to identify the relationship between core bacterial concentration and the presence of aerobic bacteria on the tonsil surface. The accuracy of a single core culture was further established by quantitative cultures of 9 sections per tonsil in an additional 19 tonsils. The results indicate that many (61.5%) but not all aerobic bacteria which were found in the tonsil core were cultured from the surface of the tonsil. Conversely, the tonsil core bacteria with the highest bacterial concentrations are more likely to be present on the tonsillar surface and the greater the bacterial concentration, the more likely the bacteria are to be found in most if not all areas of the tonsil core. Therefore, the core bacterial concentration appears to be related to the presence of aerobic bacteria on the tonsillar surface. Surface bacteria may not, however, be truly representative of the core bacterial environment. Implications for the management of chronic tonsillar disease will be discussed.