Tonsil Removal Surgery Could Have Negative Impact on Patient Immune System

Stephen C. Stearns, PhD

Each year, over 530,000 children receive tonsillectomies to treat recurring middle-ear infections and obstructive sleep apnea (OSA) that are unresponsive to other remedies, but a recent study published shows the surgery could have long-terms effects on respiratory and immune function.

The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) stated that 30 years ago, 90% of tonsillectomies (which can also include adenoid removal) were done because of recurrent infection. Now, 20% of surgeries are performed to treat chronic infection, while 80% are done to treat OSA.

But since the 1970s, tonsillectomies have declined significantly and frequency can vary depending on region, highly dependent on how individual practitioners manage recurring tonsillitis and related conditions.

What has not changed is the belief that having tonsils and/or adenoids removed has little to no effect on long-term health. However, there is inadequate evidence to support this claim. Current research is showing that the tonsils and adenoids play specialized roles, offering protection against pathogens and stimulating immune responses. Removing them at such early ages could have a negative impact on present and future immune function, as both organs serve as the first line of defense against infection.

For this study, data was retrieved from the Danish Birth Registry and included 1.2 million people born between 1979 - 1999 that had their tonsils and/or adenoids removed at age 9 or younger. Disease groups were selected based off their impact on immunity (allergies, infections, autoimmune, nervous, circulatory, and endocrine) and disorders examined in studies focusing on the short-term impact of the surgery (respiratory infections).

Results showed that tonsillectomies were associated with nearly triple relative risk (RR) of disease of the respiratory tract (RR= 2.72; 95% CI, 1.54 - 4.80). Absolute risk was increased substantially (absolute risk difference [ARD], 18.61%). Patients that received adenoidectomies had double the relative risk for chronic obstructive pulmonary disorder (RR= 2.11; 95%CI; 1.53 - 2.92), upper respiratory tract diseases (RR= 1.99; 95% CI; 1.51 - 2.63), and conjunctivitis (RR= 1.75; 95% CI; 1.35 - 2.26).

A 17% increase in risk for infectious diseases were also associated with adenotonsillectomies (RR= 1.17; 95% CI; 1.10 - 1.25).

“Until now, physicians performing the surgeries knew the consequences for 1-2 years down the line and mostly for the sorts of conditions they treated pertaining to the ears, nose and throat,” study co-author Stephen C. Stearns, PhD, professor of ecology and evolutionary biology at Yale University, told MD Magazine®. “But these new results show that removing those organs does increase the risk in particular of inner ear infections and COPD, as well as less striking increases in other diseases.”

Stearns said there will not be any official revision of AAO-HNS guidelines for tonsil and adenoid removal until the results are independently confirmed. In the event they are, new recommendations might include watchful waiting, with surgery being the very last resort when there is a serious, immediate threat to health.

“Many ear, nose, and throat physicians already practice watchful waiting and this study lends some support to those already leaning that way,” Stearns said.

One limitation of this study was that Denmark is not representative of most other populations. Infectious disease is not a chronic problem because of the availability of childhood vaccines, and there is low exposure to diverse pathogens.

“Top priorities are to see if results can be independently confirmed in a country like Sweden or Finland, where comprehensive health records are kept,” Stearns said. “Then, see whether the consequences change significantly in a population in which infectious disease is a more serious issue, such as India or the Congo.”

The study, “Association of Long-Term Risk of Respiratory, Allergic, and Infectious Diseases With Removal of Adenoids and Tonsils in Childhood,” was published online in JAMA Otolaryngology.