A new study of over 1 million Danes reports increased risks of infection and allergy in a group of over 60,000 children who had tonsils or adenoids removed.
Byars, S. G., Stearns, S. C., & Boomsma, J. J. (2018). Association of long-term risk of respiratory, allergic, and infectious diseases with removal of adenoids and tonsils in childhood. JAMA Otolaryngology–Head & Neck Surgery. https://doi.org/10.1001/jamaoto.2018.0614 (open access)
The authors, all leaders in evolutionary medicine, conclude that “tonsillectomy was associated with a nearly tripled risk of upper respiratory tract diseases, and that adenoidectomy was associated with doubled risk of COPD and upper respiratory tract diseases and nearly doubled risk of conjunctivitis. Large increases in absolute risk for upper respiratory tract diseases also occurred. Smaller elevated risks for a broad range of other diseases translated into detectable increases in absolute disease risks with high prevalence in the population (infectious/parasitic, skin, musculoskeletal,andeye/adnexadiseases).”
An accompanying commentary notes the possible influence of confounding variables, such as a predisposition to infections or smoking in the home or made infections and therefore surgery more likely, and also caused subsequent health problems. However, the probability that surgical removal of tonsils and adenoids cause later problems is high, and the documented benefits are low. Like many medical treatments, tonsillectomy is implemented when a problem peaks, ensuring that simple regression to the mean will create the illusion the treatment is effective.
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This paper suggests that there is yet another good reason to consider implementing early (between 3-9 years old) non-retractive orthodontics (NRO), which can result in (non-surgical) enlargement of the naso/oro-pharyngeal airway corridor via maxillo-mandibular dentofacial orthopedic expansion and protraction (i.e., non-surgical MMA-Maxillo-Mandibular Advancement).
Surgical removal of the adenoid mass, while usually therapeutic, only affects the posterior pharyngeal wall and recurrent SDB/OSA symptoms S/P T&A surgery indeed acommon post surgical morbidity; the non-surgical maxillary-mandibular ‘expand-protract’ MMA regimen in little kids (under 9) can additionally move the entire anterior
pharyngeal wall (i .e., soft palate and tongue) away from the adenoid area, thus serving at least, as a maybe a good adjunctive to T&A surgery.
Over the next six months at different meetings throughout the US and elsewhere, I will be showing several (not yet published) case study examples of this phenomenon from my private practice patients, many of whom are under the age of 9……and will also show peer-reviewed literature that is supportive of this regimen as being a medical-defensible strategy aimed primarily at improving certain malocclusion phenotypes that are often comorbid with ‘sleep disordered breathing/obstructive sleep apnea’ (SDB/OSA) traits, such as mouthbreathing and chronic nasal disuse that are commonly associated with pediatric naso-pharyngeal crowding-constriction.
I am wondering how you can say anything about infections and astma/allergies from hospital data. In both the Danish (and Norwegian) data, then you do not get a diagnose of astma/allergy/infections at the hospital, but at your own generel practitioner – and those two datasets are not coupled (general practitioner do not report to health registries as hospitals does).
So how do you know the children who had surgery did not have a previous history of asthma/allergy/infections (but never got hospitalised) ?
How do you know if the control group (all the ones who never had surgery) do not have an alike risk of asthma/allergy/infections as you cannot see them in your data (they would again only appear if they are hospitalised which is rare for common diseases)?