Adenotonsillectomy Does not Alter the Risk of Upper Airway Infections in Children

Effects of tonsillectomy and adenoidectomy on the immune system

Surgical removal of the tonsils and adenoids, important immune organs, is a frequent and recurrent class of surgery, and currently, there is no consensus on the effects these surgical procedures may have on the immune system. Here, we examine individual studies on tonsillectomy, adenoidectomy, and adenotonsillectomy, discuss their postoperative humoral and cellular immune changes, and explore their effects on the incidence of related diseases. There is evidence that these three surgeries have no negative effects on humoral immunity; however, there has been contrary results. Furthermore, these procedures seem to have no significant effects on cellular immunity, although tonsil and adenoid removal can cause an increased incidence of certain illnesses, especially infectious diseases. Based on this comprehensive review, we conclude that the removal of tonsils and adenoids does not negatively affect cellular and humoral immunity. However, surgery may lead to an increased incidence of related infectious diseases. This finding may inform the surgeon's decision to perform the procedure in a clinical setting.

Panel 1: Epidemiology and global health, including child development, sequelae and complications

OBJECTIVE

To summarise the published research evidence on the epidemiology of otitis media, including the risk factors and sequelae associated with this condition.

DATA SOURCES

Medline (PubMed), Embase, and the Cochrane Library covering the period from 2019 to June 1st, 2023.

REVIEW METHODS

We conducted a broad search strategy using otitis [Medical Subject Heading] combined with text words to identify relevant articles on the prevalence, incidence, risk factors, complications, and sequelae for acute otitis media, otitis media with effusion, and chronic suppurative otitis media. At least one review author independently screened titles and abstracts of the retrieved records for each condition to determine whether the research study was eligible for inclusion. Any discrepancies were resolved by reviewing the full text followed by discussion with a second review author. Studies with more than 100 participants were prioritised.

RESULTS

Over 2,000 papers on otitis media (OM) have been published since 2019. Our review has highlighted around 100 of these publications. While the amount of otitis media research on the Medline database published each year has not increased, there has been an increase in epidemiological studies using routinely collected data and systematic review methodology. Most of the large incidence studies have addressed acute otitis media (AOM) in children. Several studies have described a decrease in incidence of AOM after the introduction of conjugate PCV vaccines. Similarly, a decrease was noted when rates of coronavirus disease of 2019 (COVID-19) were high and there were major public health efforts to reduce the spread of infection. There have been new studies on OM in adults and OM prevalence in a broader range of countries and population subgroups.

CONCLUSION

Overall, the rates of severe and/or suppurative OM appeared to be decreasing. However, there is substantial heterogeneity between populations. While better use of available data is informative, it can be difficult to predict rates of severe disease without accurate examination findings. Most memorably, the COVID-19 pandemic had an enormous impact on the research and clinical services for otitis media for most of the period under review.

IMPLICATIONS FOR PRACTICE

The use of routinely collected data for epidemiological studies will lead to greater variability in the definitions and diagnostic criteria used. The impact of new vaccines will continue to be important. Some of the lessons learned during the COVID-19 pandemic concerning behaviours that reduce spread of respiratory viruses can hopefully be used to decrease the burden of otitis media in the future. There are still many countries in the world where the burden of otitis media is not well described. In countries where otitis media has been studied over many years, new potential risk factors continue to be identified. In addition, a better understanding of the disease in specific subgroups has been achieved.

The beneficial effects of an adenotonsillectomy upon upper respiratory tract infections, asthma and rhinitis in children: a national database study in Korea

BACKGROUND

Adenotonsillectomy is the most commonly performed surgery in children.

AIMS

To evaluate the effects of pediatric adenotonsillectomy on health care utilization.

METHODS

From 2006 to 2017, age/sex-matched adenotonsillectomy participants (n = 243.396) and controls (n = 730.188) were selected (62% of male and 38% of female. 47% age≦ 6, 16% 7-9years, 8% 10-12years, 29% 13-18years). The changes in outpatient visits, hospitalization days, and drug prescriptions due to a URI, asthma, and rhinitis before and after the surgery date (from 13 months to 1 month) were compared.

RESULTS

Outpatient visits decreased more in the surgery group than the control group (mean change, 3.24 ± 8.61 d and 1.16 ± 6.57 d for URI, 2.07 ± 8.63 d and 0.51 ± 6.47 d for rhinitis, and 0.72 ± 4.81 d and 0.42 ± 3.91 d for asthma, p < .001 for all). Hospitalizations also showed greater decreases in the surgery group (mean change, 0.31 ± 2.96 d and 0.04 ± 1.70 d for URI, 0.13 ± 2.40 d and 0.02 ± 1.48 d for rhinitis, 0.11 ± 2.32 d and 0.04 ± 1.83 d for asthma, p < .001 for all). The prescription of antihistamines, leukotriene modulators, oral antibiotics, oral steroids, and expectorants, cough suppressants and oral bronchodilators was also decreased after surgery.

CONCLUSIONS

The adenotonsillectomy group showed a greater decrease in post-operative outpatients visits, hospital days and drug prescriptions associated with URI, rhinitis and asthma than the control group.

Effect of fasting time before anesthesia on postoperative complications in children undergoing adenotonsillectomy

OBJECTIVES

Although the guidelines clearly recommend the fasting time of children before anesthesia, it is usually difficult to control. For pediatric patients, prolonged fasting time before surgery will lead to dehydration and hypoglycemia. Adenotonsillectomy is one of the most common operations in pediatric patients, but its complications are not rare. The purpose of this study is to analyze the relationship between preoperative fasting time and postoperative complications in children undergoing adenotonsillectomy.

METHODS

The medical and surgical records of 480 pediatric patients who underwent adenotonsillectomy were analyzed retrospectively. They were divided into three groups, including adenoidectomy group, tonsillectomy group, and adenotonsillectomy group. Logistic regression analysis was used to analyze the effect of preoperative fasting time on postoperative complications and hospital stay in pediatric patients of the three groups.

RESULTS

The postoperative bleeding rate in the adenoidectomy group (5.16%) was lower than tonsillectomy group and adenoidectomy group (P < .001). Logistic regression analysis showed that the fasting time was positively correlated with the vomiting and pain in adenoidectomy group, tonsillectomy group, and adenotonsillectomy group. And, the postoperative hospital stay was also positively correlated with fasting time in three groups.

CONCLUSION

The prolonged fasting time before otolaryngology surgery in children is related to the occurrence of postoperative complications like vomiting and pain, and also to the increase of postoperative hospital stay.