Removal Of Tonsils Research Articles

Surgical removal of tonsils and risk of COVID-19: a nested case–control study using data from UK Biobank and AMORIS Cohort

BackgroundTo investigate the association between surgical removal of tonsils and risk of COVID-19 with different severity.MethodsThrough a nested case–control study during January 31st to December 31st 2020, including 58,888 participants of the UK Biobank, we investigated the association of tonsillectomy with the future risk of mild and severe COVID-19, using binomial logistic regression. We further examined the associations of such surgery with blood inflammatory, lipid and metabolic biomarkers to understand potential mechanisms. Finally, we replicated the analysis of severe COVID-19 in the Swedish AMORIS Cohort (n = 451,960).ResultsTonsillectomy was associated with a lower risk of mild (odds ratio [95% confidence interval]: 0.80 [0.75–0.86]) and severe (0.87 [0.77–0.98]) COVID-19 in the UK Biobank. The associations did not differ substantially by sex, age, Townsend deprivation index, or polygenic risk score for critically ill COVID-19. Levels of blood inflammatory, lipid and metabolic biomarkers did, however, not differ greatly by history of surgical removal of tonsils. An inverse association between tonsillectomy and severe COVID-19 was also observed in the AMORIS Cohort, primarily among older individuals (> 70 years) and those with ≤ 12 years of education.ConclusionsSurgical removal of tonsils may be associated with a lower risk of COVID-19. This association is unlikely attributed to alterations in common blood inflammatory, lipid and metabolic biomarkers.

Comparison of Post-Tonsillectomy Hemorrhage rate in patients undergoing two commonly used Tonsillectomy Methods.

Objective: To compare the cold steel method and bipolar diathermy in tonsillectomies in terms of post-tonsillectomy hemorrhage. Study Design: Randomized Controlled Trial. Setting: Department of ENT, Head & Neck Surgery, Ayub Teaching Hospital, Abbottabad. Period: 29th October 2020 to 1st June 2022. Methods: A total of 102 patients of both genders with ages 3 to 59 years undergoing tonsillectomy were included. Patients undergoing antiplatelet therapy, experiencing bleeding diathesis, possessing a high anesthetic risk, having uncontrolled medical conditions, suffering from anemia, or currently dealing with acute infections were not included in the study. Patients were divided into two groups A & B. Group A patients were operated by the Cold steel method and Group B were operated by Bipolar diathermy. All the surgeries were performed by the same surgical team. Both tonsils were fully exposed by Boyl Devi's mouth gag under general anesthesia. Complete removal of both tonsils was done with the Cold steel method in group A and by using Bipolar diathermy in group B. Post-operative hemorrhage (occurring 24 hours after surgery) without the necessity to return to the operation theatre for intervention was assessed. Results: The mean age of patients in group A was 20.0 ± 13.83 years and in group B was 19.12 ± 13.17 years. The majority of the patients 79 (77.45%) were between 3 to 30 years of age. Out of 102 patients, 63 (61.76%) were males and 39 (38.24%) were females with male to female ratio of 1.6:1. Frequency of secondary hemorrhage in Group A (cold steel method) was found in 01 (1.96%) while in Group B (bipolar diathermy) was 06 (11.76%) (p-value = 0.050). Conclusion: This study concluded that the frequency of post-tonsillectomy hemorrhage is higher in patients operated by bipolar diathermy as compared to the cold steel method.

Absorption and pharmacokinetics of bupivacaine after bilateral topical administration in tonsillar fossae for posttonsillectomy pain relief.

No previous studies have investigated the systemic absorption of bupivacaine when used topically for posttonsillectomy pain. The present study was undertaken to investigate the pharmacokinetics of bupivacaine after administration by a swab in the tonsillar fossae over 4 min after tonsillectomy. Eleven adult patients undergoing elective tonsillectomy were recruited. After removal of both tonsils, each of the two tonsillar fossae was covered with a swab moistened with 2 mL of bupivacaine 5 mg/mL, that is, a total of 20 mg bupivacaine. Blood samples were drawn after 0, 5, 10, 20, 30, 45, and 60 min. Bupivacaine was analyzed with an ultra-high-performance liquid chromatography-tandem mass spectrometry method. The highest single measured bupivacaine serum concentration was 23.2 ng/mL and took place 10 min after drug administration. Mean (±SD) Cmax was 11.4 ± 6.0 ng/mL and mean tmax was 11.3 ± 4.7 min. Mean t1/2 was 31.6 ± 9.3 min. As the toxic concentration threshold has been reported to be in the interval 1500-4500 ng/mL, the concentrations measured were well below 2% of the lowest cited toxic threshold. In conclusion, this study shows that applying 4 mL of bupivacaine 5 mg/mL by a swab in the tonsillar fossae posttonsillectomy yields very low plasma concentrations, suggesting its safe application without any risk of systemic toxic effects.

Comparison of Postoperative Secondary Haemorrhage Rates and Pain Threshold between Conventional Cold Dissection, Bipolar, Monopolar Electrocautery and Laser Tonsillectomy, Meta Analysis Study

Abstract Background Tonsil surgery is one of the most common surgical procedures performed in otorhinolaryngology. The earliest known removal of tonsils was performed by Celsius in the first century A.D. Aim of the Work To compare the postoperative secondary haemorrhage rates and pain threshold between conventional cold dissection, bipolar, monopolar electrocautery and laser tonsillectomy. Patients and Methods This review was done using standard methodology outlined in the Cochrane Handbook and reported the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines. An initial search will be carried out using the PubMed, Cochrane library Ovid, Scopus & Google scholar using the following keywords: Dissection, Diathermy, Laser electrocautery, Tonsillectomy. Results Highly significant decrease in mean 7-day post-operative pain score, in conventional dissection group compared to diathermy group (p < 0.01). Significant decrease in mean 7-day post-operative pain score, in conventional dissection group compared to laser electrocautery group (p = 0.024). Nonsignificant difference in mean 7-day post-operative pain score, in diathermy group compared to laser electrocautery group (p > 0.05). Non-significant difference in revision or re-operation rate, in conventional dissection group compared to diathermy group (p > 0.05). Non-significant difference in secondary haemorrhage rate, in conventional dissection group compared to diathermy group (p > 0.05). Non-significant difference in secondary haemorrhage rate, in conventional dissection group compared to laser electrocautery group (p > 0.05). Conclusion Based on the findings of the present study, all the methods used in the study are safe but there was significant decrease in mean 7-day post-operative pain score using conventional dissection method compared to diathermy and laser electrocautery methods with no difference found in secondary haemorrhage rates between different methods used.

Cancer risk following surgical removal of tonsils and adenoids — a population-based, sibling-controlled cohort study in Sweden

BackgroundRemoval of tonsils and adenoids is among the most common surgical procedures worldwide. Evidence of increased risk of cancer following such surgery is, however, inconclusive.MethodsWe conducted a population-based, sibling-controlled cohort study of 4,953,583 individuals in Sweden with a follow-up during 1980–2016. History of tonsillectomy, adenotonsillectomy, and adenoidectomy was identified from the Swedish Patient Register whereas incident cases of cancer during follow-up were identified from the Swedish Cancer Register. We used Cox models to calculate hazard ratios (HR) with 95% confidence intervals (CI) of cancer in both a population and a sibling comparison. The sibling comparison was used to assess the potential impact of familial confounding, due to shared genetic or non-genetic factors within a family.ResultsWe found a modestly increased risk for any cancer following tonsillectomy, adenoidectomy, or adenotonsillectomy in both the population (HR 1.10; 95%CI 1.07–1.12) and sibling (HR 1.15; 95%CI 1.10–1.20) comparisons. The association did not differ greatly by type of surgery, age at surgery, or potential indication for surgery, and persisted more than two decades after surgery. An excess risk was consistently observed for cancer of the breast, prostate, thyroid, and for lymphoma in both population and sibling comparisons. A positive association was observed for pancreatic cancer, kidney cancer, and leukemia in the population comparison whereas a positive association was observed for esophageal cancer in the sibling comparison.ConclusionsSurgical removal of tonsils and adenoids is associated with a modestly increased risk of cancer during the decades following the surgery. The association is unlikely attributed to confounding due to shared genetic or non-genetic factors with a family.

A Siddha Management of Chronic Tonsillitis - A Case Report

Aim and objective: In the present scenario the medicine system from the west has started acknowledging the importance and wisdom of the ancient medicine system such as Siddha, Ayurvedha, Unani. There are many diseases that need surgical procedures till date, so in order to find a probable cure now a paradigm shift is really important. Tonsillitis is an infection of the tonsils associated with a sore throat, difficulty in swallowing, fever, etc. Still, surgical removal of tonsils is one of the most frequent procedures during childhood. In the Siddha system of medicine tonsillitis can be compared with Virana silatham. To evaluate the effect of Siddha medicine in the management of tonsillitis. Materials and Methods: The subject approached Out Patient Department of Siddha Clinical Research Unit(SCRU),under Central Council for Research in Siddha(CCRS), Safdarjung Hospital Campus, New Delhi with symptoms of sore throat, ear pain, difficulty in swallowing, sleep apnoea, which involved problems of breathing at night and foul smell from the mouth for past four months systemically. Discussion: The manifestation of symptoms and their severity depends on the extent of involvement of Uyir thathukkal (Vali,Azhal, Iyyam). Though the disease is Iyyam and Azhal predominant, there is derangement of Iyyam and Azhal Dosham in Virana silatham. Results: In this case, the subject showed a marked improvement as depicted in the photographs taken at different levels of treatment, also there was a significant improvement noted in both subjective and objective parameters. By adopting the Siddha treatment approach with an external treatment modality an attempt is made to bring about satisfactory results.

Albucasis (936–1013), a pioneer in tonsillectomy

Background The surgical removal of tonsils has been performed from as long as three thousand years ago, as mentioned in Hindu literature. The role medieval physicians like Albucasis played in the history of tonsillectomy is very important. This article aims to show the contributions Albucasis made to this procedure. Methods The present library-documentary research relied on the third chapter of the book al-Tasrif, Albucasis’ surgical text, as the main information source. Results Albucasis discussed the conditions necessary for tonsillectomy, he introduced three surgical tools for this operation, and he also described the surgical method. Albucasis succeeded in inventing and discovering new tools and methods for tonsillectomy. Conclusion The comparison of the tonsil surgery introduced by Albucasis and those of earlier and later surgeons reveals Albucasis’ superiority in both operation performance and equipment used. Some of his methods are comparable with approaches to operations used in the 20th century.

Furlow Palatoplasty and Tonsillectomy for Treating Patients With Submucous Cleft Palate and Tonsillar Hypertrophy: A One-Stage Procedure.

Children with cleft palate are more liable to have obstructive sleep apnea than children with normal palate due to narrow airways. Tonsillar hypertrophy is a common cause of pediatric obstructive sleep apnea; hence, it is not surprising to be encountered during cleft palate repair. The aim of this study was to evaluate the feasibility of tonsillectomy and Furlow palatoplasty performed as a 1-stage operation in patients presenting with submucous cleft palate (SMCP) and tonsillar hypertrophy. Eleven pediatric patients with SMCP and hypertrophied tonsils were included in this case series study. Furlow palatoplasty and tonsillectomy were performed for the patients in 1 sitting. The evaluation of velopharyngeal function was done preoperatively and postoperatively via auditory-perceptual-assessment, nasometry, and flexible nasopharyngoscopy. In addition, the Epworth sleepiness scale for children/adolescents was administered to the parents to assess daytime sleepiness of their children. The speech improved postoperatively. Auditory-perceptual-assessment showed significant reductions in hypernasal speech, nasal air escape, and weak pressure consonants. In addition, nasometry revealed significantly decreased nasalance scores for nasal and oral sentences. A postoperative increased velar movement was observed with a significant improvement in velopharyngeal closure. The preoperative Epworth sleepiness scale for children/adolescents assessment revealed excessive daytime sleepiness in 8 patients, with significant improvement of scores postoperatively. Removal of hypertrophied tonsils during the repair of SMCP with Furlow palatoplasty did not negatively affect speech outcome or velar movement postoperatively. It is logical to perform both procedures simultaneously in 1 sitting to avoid postoperative sleep-related breathing disorder, which may necessitate a second stage operation.

Adenotonsillectomy may increase the risk of alopecia areata in childhood: A nationwide population-based cohort study

Adenotonsillectomy may increase the risk of alopecia areata in childhood: A nationwide population-based cohort study

Tonsillectomy as a Prevention Strategy in the Light of Increasing Incidence of Oropharyngeal Cancer - a Research of Current Literature.

While in many Western countries the number of tonsillectomies decreases significantly, there is an increasing incidence of oropharyngeal carcinomas. For, obviously, removal of the tonsils will reduce individual risk for tonsil cancer, the question of tonsillectomy as a prevention strategy is suggested. This study focused on this question by carrying out a literature research. A literature research was performed (www.pubmed.gov; Search words: tonsillectomy, oropharyngeal cancer, tonsil cancer, prevention) without applying additional filters. Out of the 16 identified studies, three population-based studies were evaluated. Individual incidence of tonsil cancer is significantly lower after removal of tonsils; however, risk elimination by tonsillectomy has not been proven. One of the studies revealed increasing numbers of base of the tongue cancer after previous tonsillectomy. The increase in oropharynx carcinomas can currently be attributed not to the decreasing tonsillectomy rates, but to the increase in HPV infections. A previous tonsillectomy reduces the individual risk of developing tonsil carcer. Tonsillectomy as prevention for oropharyngeal cancer cannot be recommended and may even be a disadvantage concerning base of the tongue cancers.

Conserving resources in the diagnosis of intraoral fibroepithelial polyps

Fibroepithelial polyps (FEPs) are common, benign intraoral lesions that tend to develop slowly at predictable sites, often in response to local irritation or trauma. Historical precedent often results in referral to oral and maxillofacial surgery (OMFS) departments for biopsy, often irrespective of symptoms, and histological assessment. OMFS and pathology services are struggling to cope with an increasing workload that will potentially lead to widespread delays to diagnosis and treatment. Over the past 20 years, clinical pathways and guidance have been developed to ensure that healthcare interventions, such as the removal of third molars, tonsils, skin tags, and benign moles, are evidence-based, have a net patient benefit, and ensure the best use of finite NHS resources. However, no such guidance exists for intraoral lesions and we regard this as an oversight. We analysed the removal of 682 FEPs over a seven-year period and report sensitivities of 92.4% for a “confirmed clinical suspicion of an FEP” and 99.7% for a “confirmed clinical suspicion of a benign diagnosis”. The incidence of non-benign disease was 0.3%. Primary care dentists should be able to diagnose and monitor FEPs and refer only if symptoms are serious or in high-risk patients or sites. Adopting this practice across the UK could free up to 1825 four-hour OMFS clinics, 405hours of consultant histopathologists’ time, and recurring savings to the NHS estimated to be in the region of £620 000/annum. We believe that the removal of FEPs should be reclassified as an “intervention not normally funded”, and the time and resources put to better use treating patients with lesions of questionable pathology.

Anti-inflammatory medications for obstructive sleep apnoea in children.

Anti-inflammatory medications for obstructive sleep apnoea in children.

Сравнительный анализ физических методов хирургического лечения пациентов с хроническим тонзиллитом

The authors carried out a detailed analysis of various methods of physical exposure to tissues during surgical treatment of patients with chronic tonsillitis. Removal of palatal tonsils in their chronic inflammation has been carried out since ancient times. Today modern medical technologies allow performing this intervention using various technologies, whether – classic „cold“ tools or one of the variants of „hot“ methods of tonsillectomy. In the article, the authors analyzed the advantages and disadvantages of semi-surgical treatments for chronic tonsillitis, when most of the palatal tonsil remains intact, and also compared the effectiveness of possible surgical methods of radical tonsillectomy: using an electrocoagulator, harmonic or ultrasonic scalpel, surgical laser or cold plasma; frequency of intra- and postoperative hemorrhagic complications is estimated.

Tonsillectomy in Adults: Analysis of Indications and Outcome in Sokoto, North Western Nigeria

Background: Tonsillectomy is a well-established surgical procedure practiced commonly by otolaryngologist for removal of tonsils. Although being a relatively simple and common procedure, it is not without considerable complications. This study aimed to profile the indication and outcome of adult tonsillectomy in our region.
 Method: This was a retrospective study of all adults who had tonsillectomy in the department of Otorhinolaryngology, Usman Danfodiyo Teaching Hospital, (UDUTH) Sokoto, over a seven-year period from 1st January 2011 to 31st December 2017. All information was carefully retrieved from each patient’s case file and from the operation register. The data retrieved was subsequently analysed.
 Results: A total of 55 adults patients had tonsillectomy over the period of study. Age range was 18 to 45 years with a mean age of 26.3 years. There were 16 males (29.1%) and 39 females (70.9%) with a male to female ratio of 1:2.4. Recurrent tonsillitis 28(50.9%) was the commonest indication; others include: post quinsy 13(23.6%), tonsillomegally 6(10.9%); suspected neoplasm 6(10.9%); recurrent otalgia secondary to tonsillomegally 2(3.6%) Five patients had unilateral tonsillectomy for suspected neoplasm while others had bilateral tonsillectomy. Cold dissection was used in 37 (67.2%) of the patients, while 18(32.7%)were by electro cautery (Bipolar diathermy).
 The commonest post-operative complication was pain in all patients, followed by otalgia (29.1%) and secondary post tonsillectomy bleed in two patients. No patient had blood transfusion. Hospital average stay was 3 days.
 Follow up was uneventful in 16 (29.1%) of patients while 4(7.3%) patients had squamous cell carcinoma and were refered to Oncologist. The remaining 35 patients were lost to follow up.
 Conclusion: The commonest indication for Adult tonsillectomy is chronic recurrent tonsillitis. Histopathological analysis of every tonsil specimen is advocated.

SYM9.9E Necker Experience of Frontofacial Monobloc Advancement with Distraction (FFMBA): 145 cases in faciocraniosynostotic children

Introduction: in faciocraniosynostotic children, simultaneous correction of raised intracranial pressure, frontal retrusion, exorbitism, and facial retrusion causing sleep apnea syndrome can be achieved by frontofacial monobloc advancement. Methods: Since year 2000, 145 children aged between 9 months and 17 years were operated on by the same surgeon (EA) of a frontofacial Monobloc osteotomy. Frontal bone elevation was performed in all cases. Main group of 138 patients underwent insertion of 4 internal distractors (KLS Martin, Arnaud and Marchac distractors). A subgroup of 7 patients aged under 15 months underwent postoperative external traction (3kg) applied to a zygomatic transfacial pin (K-wire 2mm in diameter). In the subgroup of young patients, a prolongated sedation was necessary during one week. In all primary patients (never operated of a frontoorbital advancement before), transposition periosteal flaps were used to seal the anterior fossa.A systematic simple protocol of lumbar puncture during 3 days was used in case of suspicion of postoperative CSF leak. In a subgroup of 109 patients who were prospectively evaluated for respiratory outcome, 44% had a systematical removal of adenoids and tonsils prior to Monobloc. Results: in 95% of patients exorbitism was corrected. Class I occlusion was obtained only in 75% of the cases at the end of distraction. The mean OSAS measured on AHI was reduced from 19.1 (+/-17.2) to a mean 12.5 (+/-13.6). But, only the patients in whom adenoids and tonsils were removed preoperatively benefited frankly from the Monobloc.The rate of major infections was 2% (3 out of 145) mostly in secondary patients. The rate of mortality was 1,3 % (2 patients out of 145): one was due to an untreated preoperative Chiari, the other to very severe venous malformations (both these complications occurred at the beginning of our experience). Minor complications included frequently contaminations of internal distractors (30%), and CSF leaks requiring temporary treatment in 8%. The use of transfacial pin was detrimental to tooth buds but helped correction of airways obstruction in severe patients around one year of age. Postoperative OSAS was significantly lower when premonobloc ENT surgery was performed (tonsils and adenoids) Conclusions: Recommendations for surgical management of FFMBA include the following: - Preoperative screening including CT scan, MRI with venous analysis, polysomnography and ophthalmologic examination. - Preliminary systematic ENT removal of tonsils and adenoids (if significally present). - Preliminary management of Chiari by posterior vault distraction associated to foramen magnum decompression if necessary - Prefer primary cases for FFMBA allowing systematic closure of anterior cranial fossa by bilateral anteriorly based pericranial flaps (those flaps rarely available in previously operated patients)- This step necessitates frontal bone elevation - Use 4 internal distractors with consolidation time of 4–6 months. - Sedation of 2–4 days useful in the immediate post-operative period. - Slow distraction rate to 0,5mm/day starting at day 3 until completion (20–25 mm). - Obtain overcorrection at orbital level, and at dental level if possible. - In the very young and very severe, a very early FFMBA could be performed with adjunction of transfacial pin and external traction during one week. - Postoperatively, reeducate mouth opening to prevent trismus

S3-17 SESSION 3: FACIOCRANIOSYNOSTOSIS – PART I FRONTO-FACIAL MONOBLOC ADVANCEMENT WITH DISTRACTION REDUCES SEVERE OBSTRUCTIVE SLEEP APNEA IN FACIOCRANIOSYNOSTOSES: PROSPECTIVE ASSESSMENT OF 109 CASES

Introduction: Obstructive sleep apnea syndrome (OSAS) is prevalent in children with faciocraniosynostoses and is associated with poor cognitive outcome and risk for increased intracranial pressure. Fronto-facial monobloc advancement (FFMBA) with distraction advances the midface and is performed for OSAS management. Here we aimed to provide a quantitative and prospective assessment of the effects of FFMBA on OSAS in faciocraniosynostoses. Methods: We prospectively included all patients managed for faciocraniosynostoses over a period of 18 years and followed-up their apnea-hyponea index (AHI) based on polysomnographic (PSG) studies, before and after FFMBA with internal distraction. AHI was assessed using several linear and logistic multivariate models, in order to quantify (1) pre-operative AHI values, (2) absolute decrease in AHI values after FFBMA, (3) AHI normalization (AHI<5) after FFMBA, (4) need for a secondary facial advancement and (5) genotype-phenotype correlations. In the second half of the experience, systematical removal of adenoids and tonsils were performed prior to monobloc surgery Results: A total of 109 patients were included and 407 PSG at different time points were collected. We showed a global and significant decrease in AHI after FFMBA: mean pre-operative AHI was 19.11+/-17.25 (19.31+/-18.31 in Crouzon, 17.00+/-11.87 in Apert and 21.82+/-19.38 in Pfeiffer syndrome). The mean post-operative AHI value for all patients was 12.47+/-13.58, which corresponded to a significant decrease from the mean pre-operative value of 19.11+/-17.25 (p<0.05); the decrease from pre-operative values was significant for all three syndromes (p<0.05). Pre-operative lateral and/or posterior decompression was associated with more AHI decrease in absolute value. FFMBA at older ages, Pfeiffer syndrome and pre-operative tonsillectomy and/or adenoidectomy were associated with more AHI normalization. In this subgroup with premonobloc ENT surgery, the intermediate OSAS (AHI between 10–20) the mean pre-op was 16/h and mean post-op was 11/h. In the severe OSAS patients (pre op AHI >20), the mean pre op was 43/h and mean post op was 15/h. Conclusion: FFMBA is efficient in reducing OSAS in faciocraniosynostoses. Pre-operative adenoido-tonsillectomy and lateral and/or posterior skull decompression are recommended before FFMBA in order to improve the respiratory results of the fronto-facial advancement. Delaying surgery when allowed by the neurosurgical and respiratory medicine teams is also a parameter favoring better respiratory outcomes.

Estimating the impact on the food chain of removal of bovine tonsils from specified risk material in Great Britain assuming negligible risk status for bovine spongiform encephalopathy

The earliest estimate for Great Britain (GB) as a whole to achieve negligible risk (NR) status for bovine spongiform encephalopathy (BSE) is 2021. This status allows certain tissues, such as bovine tonsils, to no longer be designated as Specified Risk Materials (SRM). The BSE control model was used to estimate what effect any additional lingual tonsillar material from harvested tongues inadvertently entering the human food chain would have on the amount of infectivity being consumed. Using the baseline model, with tonsils classed as SRM, a mean of 0.08 Bovine Oral (BO) ID50 was estimated to enter the food chain over one year for GB. Under NR status this mean was estimated to increase to 0.83 BO ID50. Whilst this equates to a 10 fold increase in BO ID50 the amount is still small due to the very low likelihood of infected animals being present in the 2017 healthy slaughter population. There are a number of assumptions made within the model, namely, the amount of lingual tonsil inadvertently entering the food chain, and the infectivity titre within this particular tonsillar material.

Does Removing Tonsils, Adenoids, or Both in Childhood Increase Illness Later?

Removal of tonsils, adenoids, or both is frequently considered in hopes of reducing chronic childhood infections or breathing problems. Using a Danish

Association of Long-Term Risk of Respiratory, Allergic, and Infectious Diseases With Removal of Adenoids and Tonsils in Childhood

Surgical removal of adenoids and tonsils to treat obstructed breathing or recurrent middle-ear infections remain common pediatric procedures; however, little is known about their long-term health consequences despite the fact that these lymphatic organs play important roles in the development and function of the immune system. To estimate long-term disease risks associated with adenoidectomy, tonsillectomy, and adenotonsillectomy in childhood. A population-based cohort study of up to 1 189 061 children born in Denmark between 1979 and 1999 and evaluated in linked national registers up to 2009, covering at least the first 10 and up to 30 years of their life, was carried out. Participants in the case and control groups were selected such that their health did not differ significantly prior to surgery. Participants were classified as exposed if adenoids or tonsils were removed within the first 9 years of life. The incidence of disease (defined by International Classification of Diseases, Eighth Revision [ICD-8] and Tenth Revision [ICD-10] diagnoses) up to age 30 years was examined using stratified Cox proportional hazard regressions that adjusted for 18 covariates, including parental disease history, pregnancy complications, birth weight, Apgar score, sex, socioeconomic markers, and region of Denmark born. A total of up to 1 189 061 children were included in this study (48% female); 17 460 underwent adenoidectomy, 11 830 tonsillectomy, and 31 377 adenotonsillectomy; 1 157 684 were in the control group. Adenoidectomy and tonsillectomy were associated with a 2- to 3-fold increase in diseases of the upper respiratory tract (relative risk [RR], 1.99; 95% CI, 1.51-2.63 and RR, 2.72; 95% CI, 1.54-4.80; respectively). Smaller increases in risks for infectious and allergic diseases were also found: adenotonsillectomy was associated with a 17% increased risk of infectious diseases (RR, 1.17; 95% CI, 1.10-1.25) corresponding to an absolute risk increase of 2.14% because these diseases are relatively common (12%) in the population. In contrast, the long-term risks for conditions that these surgeries aim to treat often did not differ significantly and were sometimes lower or higher. In this study of almost 1.2 million children, of whom 17 460 had adenoidectomy, 11 830 tonsillectomy, and 31 377 adenotonsillectomy, surgeries were associated with increased long-term risks of respiratory, infectious, and allergic diseases. Although rigorous controls for confounding were used where such data were available, it is possible these effects could not be fully accounted for. Our results suggest it is important to consider long-term risks when making decisions to perform tonsillectomy or adenoidectomy.

The significance of antistreptolysin O characteristics for the determination of indications for tonsillectomy in the children

The objective of the present work was to evaluate the diagnostic significance of the measurement of the antistreptolysin O (ASLO) titers in the children presenting with chronic tonsillitis for determining the indications for tonsillectomy. The study included 54 patients at the age varying from 4 to 17 years who had undergone bilateral tonsillectomy for the treatment of chronic tonsillitis. The diagnosis was confirmed by the results of the histological study of the removed amygdalae. Prior to surgery, all the patients had been subjected to the bacteriological investigation of the smears taken from the surface of the palatal tonsils. The titers of antistreptolysin O in the serum were determined with the use of the kinetic nephelometric technique before, 6 and 12 months after the surgical intervention. The results of the measurements were treated using the Statzilla software package (version 3.2, R Foundation for Statistical Computing, Vienna, Austria). Streptococcus pyogenes (group A) was identified only in 7 (13%) patients. The initially enhanced content of ASLO ranging from 273 to 1880 IU/ml was documented in 42 (77.7%) of the 54 patients. Twelve patients had the ASLO titers within the normal limits (from 13 to 124 IU/ml). The removal of palatal tonsils resulted in a significant decrease of the ASLO titers in the patients who had presented with the initially enhanced content of antistreptolysin O (p < 0.05); nevertheless, their ASLO titers remained higher than the normal values in 69% and 82% of the patients examined within 6 and 12 months after the surgical intervention, respectively. The patients who had exhibited the high levels of antistreptolysin O during the preoperative period did not experience normalization of this parameter after surgery. It is concluded, taking into account the absence of correlation between the enhancement of serum antistreptolysin O titers and the presence of group A beta-chemolytic Streptococci (BCSA), that the result of the measurement of ASLO titers can not be considered as a valid indication for tonsillectomy in the children.