Removing tonsils may help kids with asthma

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Removing the tonsils and adenoids appears to offer many benefits to children with Asthma, including a drop in medication use and a reduction in missed schools days, according to study findings presented this past weekend at the meeting of the American Society of Pediatric Otolaryngology in Las Vegas.

The role that the tonsils and adenoids, which lie in the back of the throat, play in asthma is “grossly under-appreciated,” Dr. David Karas, from Yale University in New Haven, Connecticut told.

“If you look at the demographics of asthma in the last 30 years, there has been a dramatic rise in rates among children,” he pointed out, which parallels a decrease in adenotonsillectomy—the operation that removes these structures.

Adenoidectomy Definition
Adenoid removal, also called adenoidectomy, is the surgical removal of the adenoid glands from the area between the nasal airway and the back of the throat (nasopharynx). Adenoidectomy is frequently done in conjunction with surgical removal of tonsils (tonsillectomy).

Despite data such as this, Karas noted, only one prior study has looked at the effect of adenotonsillectomy on asthma outcomes in children. That study, conducted by Japanese investigators, gave results similar to the current one.

For their analysis, Karas’s team reviewed the medical records of 87 children with asthma who underwent adenoidectomy with or without tonsillectomy at their center in the last 5 years. Between 6 months and 5 years after surgery, the parents were surveyed about their child’s asthma symptoms before and after the operation.

Thirty-three subjects were excluded because their parents could not be reached and 16 were excluded due to the presence of other diseases, such as cystic fibrosis. The remaining 38 subjects included 25 boys and 13 girls, who were an average of 5.4 years old.

Surgery was associated with a marked reduction in the number of kids needing regular asthma medications. For example, the number of patients using inhaled steroids fell from 26 to 17, and the number using albuterol went from 34 to 18.

A drop in asthma severity was also observed following surgery. Preoperatively, the average severity score was 2.12, whereas postoperatively the score was 0.74.

Before surgery, the children missed 7.76 days of school each year, on average. After surgery, the average number of missed days was 3.28. For parents, the reduction in missed work days was even more pronounced: 7.35 to 1.8.

Still, it should be noted that all of the children in the study had accepted reasons for undergoing adenotonsillectomy, such as Obstructive sleep apnea or chronic tonsillitis, and not just asthma. At this point, it is unclear if asthma will become a stand-alone indication for the operation in the future.

“If I saw a child with (swollen tonsils/adenoids) who has asthma, I would definitely consider doing an adenotonsillectomy,” Karas said. However, in the absence of asthma, “I usually tell patients that having big tonsils without symptoms is not a reason to have them out.”

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