Surgical Removal Of Adenoids Research Articles

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.

IRRADIATION FOR THE ELIMINATION OF NASOPHARYNGEAL LYMPHOID TISSUE

INFECTION in the nasopharyngeal lymphoid tissue commonly plays a uniquely important role in the causation of the common cold, deafness due to malfunctioning eustachian tubes, recurring or acute infection of the ear, bronchial asthma (especially in children) and chronic bronchitis. This is partly due to the anatomic location of such tissue, but a great deal about its etiologic role is as yet only poorly understood. In many patients irradiation of nasopharyngeal lymphoid tissue is essential for its adequate elimination. Surgical removal of adenoids is at best not perfect, and even if all the nasopharyngeal lymphoid tissue could be removed, that within the orifice of the eustachian tube would not be affected. Lymphoid tissue is an integral part of the mucous membrane in this region and is bound to recur as the mucous membrane grows back. Lymphoid tissue is so sensitive to irradiation that minute dosages will cause its regression and

POLIOMYELITIS AND TONSIL OPERATIONS

To the Editor:— For some time I have noted with concern articles which attempt to connect the avenue of infection of poliomyelitis, at present unknown, with the surgical removal of adenoids and tonsils. To foster such ideas, directly or indirectly, which long experience on the part of practically all nose and throat men over the United States in no way bears out, is to do harm to countless children who need tonsillectomy. Considering that operations for tonsillectomy and adenectomy number possibly one fourth of all major operations that are performed yearly in the country and under all sorts of varying conditions and circumstances, one could well promote almost any idea, however untrue or remote, by citing the occurrence of a few sporadic cases. The removal of adenoids and tonsils, when necessary, is so important in the welfare of children that attempts to raise doubts and issues not clearly proved is