Tonsil, Adenoid Removal Associated with Long-Term Respiratory Disease Risk


Tonsillectomy was associated with an almost tripled relative risk for upper respiratory diseases, including asthma, influenza, pneumonia, and chronic obstructive pulmonary disorder.

Tonsil and adenoid removal surgery during childhood increases the long-term risk of respiratory, allergic, and infectious diseases, according to a study published in the Journal of the American Medical Association Otolaryngology Head and Neck Surgery.

The tonsils and adenoids act as a first line of defense against airborne pathogens, such as bacteria and viruses. However, tonsillectomies, which often occur alongside the removal of adenoids, are often performed to correct recurring tonsillitis and middle ear infections. Adenoidectomies are performed to improve breathing when the airway is blocked.

In the study, the researchers examined the long-term effects of removing the tonsils and adenoids in children, compared with children who had not undergone the surgeries. The researchers analyzed data from Denmark of nearly 1.2 million children born between 1979 and 1999, covering at least the first 10 years and up to 30 years of their life.

Of these children, 17,640 had adenoidectomies, 11,830 had tonsillectomies, and 31,377 had adenotonsillectomies.

According to the data, tonsillectomy was associated with an almost tripled relative risk for upper respiratory diseases, including asthma, influenza, pneumonia, and chronic obstructive pulmonary disease (COPD). The absolute risk was also substantially increased at 18.61%

Additionally, adenoidectomy was associated with more than a doubled relative risk of COPD and a nearly doubled relative risk of upper respiratory tract disease and conjunctivitis. The absolute risk was also almost doubled for upper respiratory diseases, but corresponded to a small increase for COPD.

“The association of tonsillectomy with respiratory disease later in life may therefore be considerable for those who have had the operation,” Jacobus Boomsma, PhD, study author, said in a press release.

Only 5 individuals needed to have the operation to cause an extra upper respiratory disease to appear in 1 of those individuals, Dr Boomsma added.

Although adenoidectomy was associated with a significantly reduced risk for sleep disorders, there was no change in abnormal breathing up to the age of 30 for any surgery and no change in sinusitis after tonsillectomy or adenoidectomy. Additionally, individuals who underwent an adenotonsillectomy had a four- or five-fold increased relative risk for otitis media, and sinusitis also showed a significant increase.

Apart from the reduced risk for tonsillitis from all surgeries and sleep disorders from adenoidectomies, the researchers indicated that the shorter-term benefits may not continue up to the age of 30. The longer-term risks for abnormal breathing, sinusitis, and otitis media were either significantly higher after surgery or not statistically different.

Although the researchers noted that there will always be a need for these surgeries, their findings support delaying tonsil and adenoid removal, if possible, to reduce possible long-term disease risks.


Byars SG, Stearns SC, Boomsma JJ. Association of long-term risk of respiratory, allergic, and infectious diseases with removal of adenoids and tonsils in childhood. JAMA Otolaryngol Head Neck Surg. 2018. doi:10.1001/jamaoto.2018.0614.

What are the long-term health risks of having your tonsils out? [news release]. University of Melbourne’s website. Accessed June 11, 2018.

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