Should we remove tonsils in children?

Are there long-term health risks after having adenoids or tonsils removed in childhood?...

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Should we remove tonsils in children?

Who have their tonsils removed before age 9 years are at higher risk.

Are there long-term health risks after having adenoids or tonsils removed in childhood?

And now it has been shown in June 7 issue of JAMA Otolaryngology–Head & Neck Surgery that children who have their tonsils or adenoids removed before age 9 years are at higher risk for respiratory, infectious, and allergic diseases up to the age of 30 years. Tonsillectomy was associated with a nearly tripled risk of upper respiratory tract diseases, and that adenoidectomy was associated with doubled risk of [CHRONIC OBSTRUCTIVE PULMONARY DISEASE] and upper respiratory tract diseases and nearly doubled risk of conjunctivitis. Doctors often remove adenoids and tonsils to treat recurrent tonsillitis or middle ear infections. Adenoids and tonsils are parts of the immune system, have known roles in pathogen detection and defence, and are usually removed at ages when the development of the immune system is sensitive.

In this population-based cohort study of almost 1.2 million children, removal of adenoids or tonsils in childhood was associated with significantly increased relative risk of later respiratory, allergic, and infectious diseases. Increases in long-term absolute disease risks were considerably larger than changes in risk for the disorders these surgeries aim to treat.

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.

Tonsils and adenoids play specialized roles in immune system

Current research suggests that tonsils and adenoids play specialized roles in immune system development and function.15 The tonsils protect against pathogens both directly 3,5 and indirectly by stimulating other immune responses.3,5,16 The pharyngeal, palatine, and lingual tonsils form Waldeyer’s ring around the apex of the respiratory and digestive tract, providing early warnings for inhaled or ingested pathogens.3,5,16 Evidence now suggests that altering early life immune pathways (including dysbiosis) 17 can have lasting effects on adult health, warranting concern that the long-term impact of removing adenoids and tonsils in childhood may not yet be fully appreciated.

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