Tonsil, adenoid removal in children probed

Desiree Burns
June 9, 2018

Last Updated: June 07, 2018.

Could having your tonsils or adenoids out as a child mean you are more likely to get respiratory infections as an adult?

Removing tonsils and adenoids in childhood increases the long-term risk of respiratory disorders such as asthma and influenza, as well as allergic and infectious diseases, says a study of almost 1.2 million children.

Those respiratory diseases include asthma and pneumonia, the study authors said.

The researchers say there will always be a need to remove tonsils and adenoids when they are badly infected.

"Our study tends to suggest that, when possible, it might be better for long-term health to avoid these surgeries in childhood", said Byars, a research fellow at the University of Melbourne in Australia.

Of the nearly 1.2 million children, 17,460 had adenoidectomies, 11,830 tonsillectomy and 31, 377 had adenotonsillectomies, where both tonsils and adenoids removed. The investigators compared the medical records with data on 1.2 million peers born between 1979 and 1999.

The team also analysed conditions that these surgeries directly aimed to treat, and found mixed results.

Adenoidectomy is associated with a significantly reduced risk for sleep disorders.

However, there was no change in abnormal breathing up to the age of 30 for any surgery, and no change in sinusitis.

Patients who had adenoids removed experienced an increase of COPD and upper respiratory tract infections.

Researchers from the University of Melbourne looked at more than 1 million children under nine from Denmark who had the procedures, then followed them up until the age of 30.

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Until now, research has largely focused on short-term, post-operative risks, Byars said.

The promise of ice cream and hours of television do make the recovery a much more bearable prospect, even a source of jealousy for classmates and siblings but, for the first time, research has found longer lasting health risks. Adenoids are similar tissues hidden between the back of the nose and roof of the mouth.

The removal of both the tonsils and adenoids, known as an adenotonsillectomy, was linked to a "five-fold" risk of middle ear infection and sinusitis.

"This age was chosen because it captures when these surgeries are most commonly performed and also when tonsils and adenoids are most active in the body's immune responses and development".

Dr. Michael Grosso is chair of pediatrics and chief medical officer at Northwell Health Huntington Hospital in Huntington, N.Y. He said that this study can not prove that the operations caused problems for years to come.

"As it happens, children with large tonsils and adenoids typically have exactly the kinds of conditions that would be described as respiratory, infectious or allergic - not as a effect of operation, but as a pre-existing cause of the very condition that led to the surgery", he said.

Instead, the risks of having the operations continued through the patient's life.

But he agreed with Grosso that it isn't clear that surgery itself caused these later conditions.

He said the underlying reasons behind why the kids have their tonsils and adenoids removed in the first place could be responsible for the increased risk of other illnesses.

It used to be considered a cure-all for children who repeatedly endured sore throats and infections.

The paper has just been published in the journal JAMA Otolaryngology Head and Neck Surgery.

Adenoidectomy was found to be linked with a more than doubled relative risk of COPD and a almost doubled relative risk of upper respiratory tract diseases and conjunctivitis, according to the results published in the Journal of the American Medical Association Otolaryngology Head and Neck Surgery.

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