Childhood Surgical Removal of Tonsils, Adenoids Increases COPD Risk Later, Study Says

The surgical removal of tonsils and adenoids, a common procedure in children, has been linked to an increased risk of respiratory infectious diseases, particularly chronic obstructive pulmonary disease (COPD), a new study reports.

The study, “Association of Long-Term Risk of Respiratory, Allergic, and Infectious Diseases With Removal of Adenoids and Tonsils in Childhood,” was published in the journal JAMA Otolaryngology-Head & Neck Surgery.

Tonsillectomy, a surgical procedure to remove the tonsils, is one of the most common childhood surgeries. More than 530,000 tonsillectomies are performed in children and adolescents in the United States every year, according to recent literature.

Prescribed as a treatment for painful and recurring tonsillitis — inflammation of the tonsils along with middle ear infection — the surgery is often accompanied by the removal of the adenoids, which are small lumps of tissue at the back of the nose.

The surgical removal of both the tonsils and the adenoids was historically presumed to cause no harm, especially because adenoids shrink as a person grows into adulthood.

However, researchers have since realized that the glands are part of the immune system, and located at the back of the throat, they are one of the first lines of defense against infections.

Now, a study by researchers at the University of Melbourne set out to investigate how removing tonsils and adenoids in childhood affects people later in life.

Researchers analyzed comprehensive health records from Denmark of up to 1.2 million children born between 1979 and 1999. The records covered from the first 10 years of life to 30 years.

Of those studied, 17,460 children had adenoidectomies, 11,830 had tonsillectomies, and 31,377 had adenotonsillectomies, or the surgical removal of both tonsils and adenoids.

Researchers then assessed the risk of 28 respiratory, infectious, and allergic diseases and compared it to children who didn’t undergo the surgery.

“We calculated disease risk later in life depending on whether adenoids, tonsils or both were removed in the first 9 years of life,” Sean Byars, from Melbourne Integrative Genomics and the School of BioSciences at the University of Melbourne, and the study’s lead author, said in a press release.

“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,” he added.

Results showed that both tonsillectomy and adenoidectomy were associated with a higher relative risk for diseases of the upper respiratory tract, particularly COPD. Tonsillectomy was linked to almost three times the risk of upper respiratory tract diseases, and adenoidectomy had double the risk.

Additional upper respiratory tract diseases besides COPD included asthma, influenza, and pneumonia.

“The association of tonsillectomy with respiratory disease later in life may therefore be considerable for these people,” Byars said.

People who underwent the surgeries showed no abnormal breathing up to the age of 30, but they showed a four- or five-fold risk of otitis media (inflammation of the middle ear) and a higher risk of sinusitis.

The surgeries also had an impact on other aspects of people’s lives, and researchers found that adenoidectomy was associated with a significantly reduced risk of sleep disorders.

Overall, the researchers suggest that the shorter-term benefits of these surgeries may not be sustained later on in life, apart from the reduced risk of tonsillitis (for all surgeries) and sleep disorders (for adenoidectomy).

Therefore, researchers emphasize that removal of both the tonsils and the adenoids should only be an option when disease is severe.

Overall, “our results support delaying tonsil and adenoid removal if possible, which could aid normal immune system development in childhood and reduce the possible later-life disease risks we observed in our study,” Byars said.