What is tonsillectomy?
Tonsillectomy is one of the most commonly performed pediatric surgeries in the world. In the United States, over 530,000 children under the age of 15 undergo this surgery each year.
The procedure is often performed in conjunction with adenoidectomy – removal of the adenoids (the so-called third tonsil) to improve breathing by clearing the airways.
For a long time, doctors thought that the adenoids and tonsils were unnecessary because they shrink with age and have no effect on the body’s functions. But that turned out to be wrong. Because these tissues are located in the nose and throat, they are the first line of defense against pathogens that enter the body through the air – viruses and bacteria. They activate the immune system to prevent infections from entering the body.
The surgery involves removing the tonsils, two soft tissues at the back of the throat, on both sides. Historically, this was done for chronically inflamed tonsils (tonsillitis), but today the surgery is mainly recommended for sleep disorders related to breathing and for frequent recurrences of tonsillitis that do not respond to other treatments.
Long-term health risks after childhood tonsillectomy
A study of almost 1.2 million children who had their tonsils or adenoids removed shows a higher risk of respiratory, allergic and infectious diseases in adulthood. The study was led by Dr Sean Byers from the University of Melbourne, Professor Jacobus Boomsma from the University of Copenhagen and Professor Stephen Stearns from Yale University.
It involved 1,189,061 children born in Denmark between 1979 and 1999. They were followed in national registries until 2009, covering the first 10–30 years of their lives. Tonsils or adenoids were removed within the first nine years of their lives.
Of these, 17,460 underwent adenoidectomy, 11,830 tonsillectomy, and 31,377 combined surgery (adenotonsillectomy). The control group included 1,157,684 healthy children without surgery.
“We calculated the risk of disease depending on whether the adenoids, tonsils, or both were removed in the first nine years, as that is when they are most active in the development of the immune system,” explains Dr. Byers.
The results show the following:
Tonsillectomy is associated with a threefold increased risk of upper respiratory tract diseases – such as asthma, influenza, pneumonia and COPD.
Adenoidectomy is associated with over a two-fold higher risk of COPD and almost double the risk of upper respiratory tract diseases.
“Therefore, the association between tonsillectomy and respiratory disease later in life may be significant for people who have undergone this surgery,” Professor Boomsma points out.
Statistically, scientists estimate that one in five people who have their tonsils removed will develop an upper respiratory tract illness.
The team also analyzed the diseases for which these surgeries are typically performed to assess their effectiveness – the results were mixed:
Adenoidectomy is associated with a reduced risk of sleep disorders.
All surgeries significantly reduce the risk of future problems with the tonsils, as they are removed.
No change in breathing is observed in people up to the age of 30.
There is no change in cases of sinusitis after the surgeries.
After adenotonsillectomy, the risk of otitis media and sinusitis increases 4–5 times.
The researchers emphasize that there are cases in which removal of the tonsils or adenoids remains necessary for serious medical indications.
“However, our results suggest that postponing these surgeries, when possible, may support normal immune system development in childhood and reduce the risk of disease in later life,” explains Dr. Byers.
He recalls the words of Charles Darwin in 1870, who called the appendix “a useless vestige of evolution.” Today we know that it plays an important role in the immune system, protecting the body from intestinal infections and supporting the growth of beneficial bacteria.
“The more we learn about the function of immune tissues and the consequences of their removal, especially in childhood, the better we will be able to guide treatment decisions for children,” he adds.
Questions about the study
Dr. Nikila Raol and Dr. Steven Gowdy, professors of otolaryngology at Emory University School of Medicine (Georgia, USA), agree that the report highlights the need for increased caution when removing tonsils and adenoids.
“I think the study is commendable and thought-provoking, but it doesn’t provide definitive answers,” Dr. Raol said. “It shows statistical significance, but not clinical significance.”
They say the study lacks the participation of doctors, which is a significant omission. In addition, the specific reasons for the surgeries are not specified, which makes it difficult to assess the real effectiveness of the treatment. The study also does not take into account differences between control groups and whether the participants were fully comparable.
However, the number of tonsillectomy procedures has declined significantly since the 1970s and 1980s. Today, there are clear medical guidelines that the surgery is only recommended for children with frequent infections that don’t respond to antibiotics or who have serious breathing problems. It is usually offered to children who have six or more episodes of tonsillitis per year or who have sleep apnea.
“The decision to have surgery is never made lightly – it is always the result of a shared decision between parents and doctors,” says Dr. Gowdy.
In conclusion, tonsillectomy may be justified if there are serious health problems – such as chronically inflamed or enlarged tonsils that impair quality of life. Each case is individual and must be carefully assessed, taking into account all the details.
This article is for informational purposes only. Do not self-medicate and always consult a qualified medical professional before applying any information from the text. The editorial team does not guarantee results and is not responsible for any damages resulting from its use.
