Adenotonsillectomy Does Not Alter Risk of Upper Airway Infections in Children

What is the risk of developing upper airways infections (UAIs) following adenotonsillectomy in a childhood population?

BOTTOM LINE

Adenotonsillectomy does not alter the frequency of UAIs in children.

BACKGROUND: Adenotonsillectomy, a common surgical procedure in children, is usually indicated by recurrent UAIs and obstructive sleep apnea. However, the palatine tonsils and adenoids are also lymphoid tissues that may help defend against infections of the upper respiratory tract, bringing into question whether tonsillectomy or adenoidectomy might hinder immune response.

STUDY DESIGN: Retrospective cohort study.

SETTING: Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea.

SYNOPSIS: Researchers accessed the National Health Insurance Service database to form a sample cohort of 2,377 patients aged <10 years who underwent an adenotonsillectomy. For every patient with acute pharyngitis (APT), acute rhinosinusitis (ARS), and acute otitis media (AOM) in the adenotonsillectomy group, four participants were randomly selected for three control groups using propensity score matching. The number of postoperative hospital visits for UAIs was recorded for one to nine years, and the equivalence test was used to compare the number of visits between the adenotonsillectomy and control groups. Study findings showed that adenotonsillectomy did not alter the risk of UAI development in children during the postoperative follow-up period, even after adjusting for sociodemographic factors and the number of preoperative UAIs. The number of hospital or clinic visits for APT, ARS, and AOM in the two years prior to surgery was precisely the same for both groups, and not significantly different between the groups. In both groups, the number of hospital visits for any reason gradually decreased over time, suggesting maturation of the patients’ immune system regardless of adenotonsillectomy. Study limitations include the use of diagnostic codes rather than medical records.

CITATION: Kim JY, Ko I, Kim DK, et al. Adenotonsillectomy does not alter the risk of upper airway infections in children. Laryngoscope. 2021;131:2376-2383.