Long-term effects of tonsillectomy

Intended for Healthcare Professionals

Long-term effects of tonsillectomy

Tom Marshall, Professor of Public Health and Primary Care, University of Birmingham
Other Contributors:
- Dana Šumilo, Research Fellow, University of Birmingham, University of Birmingham

19 November 2018

Thank you for your interest in our analysis.

Although personal experience of improvement following tonsillectomy is intuitively compelling, it is not evidence of effectiveness. We can easily cherry pick case studies of specific patients with unusual outcomes: either dramatic improvements or even deaths.¹ These tell us as little about overall effectiveness as reports of lottery winners do about the value of investing in a lottery ticket. Recurrent sore throats improve with time and dramatic improvement is common even without surgery. The first clinical trial to show evidence of clinically important improvement with tonsillectomy (in severely affected children) found 14% (95% CI: 7% to 20%) of children in the control group had no sore throats in the next year.²

Long-term effects of tonsillectomy were not the subject of our research, so we did not systematically review the research literature. We know of a few large, long-term, follow-up studies of childhood tonsillectomy. A study of 1.2 million Danish children identified an increased risk of developing respiratory, infectious, and allergic conditions including asthma among the 43,207 who underwent tonsillectomy.³ A Tasmanian study observed increased mortality in young adults who previously underwent tonsillectomy.⁴ An increased risk of autoimmune conditions such as thyroid disease, rheumatic diseases, inflammatory bowel disease and type 1 diabetes was observed in 179,875 Swedish tonsillectomy patients.⁵ Tonsillectomy may have caused these increased risks or may merely be an indicator of other factors linked to poorer health. There is certainly no evidence that tonsillectomy reduces incidence of asthma.

References

1. Østvoll E, Sunnergren O, Ericsson E, et al. Mortality after tonsil surgery, a population study, covering eight years and 82,527 operations in Sweden. Eur Arch Otorhinolaryngol 2015; 272(3):737-43. doi: 10.1007/s00405-014-3312-z.
2. Paradise JL, Bluestone CD, Bachman RZ, et al. Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and non-randomized clinical trials. N Engl J Med 1984; 310: 674-83.
3. 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; 144(7):594-603. doi: 10.1001/jamaoto.2018.0614.
4. Mészáros D, Dharmage SC, Matheson MC, et al. Poor lung function and tonsillectomy in childhood are associated with mortality from age 18 to 44. Respir Med 2010; 104(6):808-15. doi: 10.1016/j.rmed.2009.12.001.
5. Ji J, Sundquist J, Sundquist K. Tonsillectomy associated with an increased risk of autoimmune diseases: A national cohort study. J Autoimmun 2016; 72:1-7. doi: 10.1016/j.jaut.2016.06.007.

Competing Interests: None declared.

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