I would like to know whether childhood adenoidectomy has any
significant effect on susceptibility to colds (a.k.a viral upper
respiratory infections) in later adult life.

Most textbooks describe the adenoids as being in the front line of
defense against respiratory infections, e.g. by flushing away
infectious agents entering through the nose.

Ideally I would like to find papers comparing the frequency of colds
among adults depending on whether or not they had their adenoids
removed as a child. 

I tried searching on medline with Mesh terms "Adenoidectomy" and
"Common Cold" but of the 9 papers listed the longest follow-up is 2
years (on children). I know that for children who suffer frequent
sinus infections due to enlarged adenoids, adenoidectomy is effective
in reducing the number of infections and
colds they get.  However, what I'm interested in is the long-term
effects (e.g. >15 years) when these children become adults.

I believe this data might be available somewhere in studies that look
at common illnesses in large groups of similar adults (such as
military units etc), or in experiments where adult subjects were
deliberately infected in the lab by putting a controlled dose of virus
in their nose.

I am looking for information with references to papers published in
the medical literature which address this subject.

Thanks for your help.

---

Request for Question Clarification by pafalafa-ga on 24 Sep 2003 17:57 PDT

These three studies from the NLM database offer some long-term
perspectives on immunological outcomes in patients that had
adenoidectomies.  Beyond that, I haven't found any studies (yet) of
the type you hoped for, but I'm still looking.

pafalafa-ga

--------------------


Adenoids and tonsils, indications for surgery and immunological
consequences of surgery.

Paulussen C, Claes J, Claes G, Jorissen M.

Acta Otorhinolaryngol Belg. 2000;54(3):403-8. 

ENT Department, UZ Sint Rafaėl, Leuven.

Tonsillectomy and adenoidectomy procedures are among the oldest
surgical procedures still performed today. Tonsils and adenoids are
part of Waldeyer's ring, the basic function of which is antibody
formation. Because of their location at the portal of entry of many
airborne and alimentary antigens, the tonsils and adenoids often have
been considered as the first line of defense against respiratory
infections. Indications for adenoidectomy or tonsillectomy are to date
still controversial. The two main indications for tonsillectomy are
upper airway obstruction due to tonsillar hypertrophy and recurrent
acute or chronic tonsillitis. Adenoid hypertrophy with upper airway or
eustachian tube obstruction and recurrent acute or chronic adenoiditis
or otitis media are main indications to perform an adenoidectomy. The
possible immunological effects of tonsillectomy and adenoidectomy are
still controversial. Some authors have found changes in immunoglobulin
levels after tonsillectomy, while others failed to find significant
changes. In a review of long-term follow-up studies, the authors
showed that while tonsillectomy may lead to certain changes in the
cellular and humoral immune system, these alterations are clinically
insignificant and no increased frequency of immunomodulated diseases
should be expected.

--------------

Adenotonsillectomy: the evaluation of the long-term results after more
than 7 years from the intervention]

Esposito E, Pucci V, Mesolella M, Motta S.

Acta Otorhinolaryngol Ital. 1992 Nov-Dec;12(6):593-604. 

[Article in Italian]

Istituto di Patologia e Clinica Otorinolaringoiatrica e di Foniatria
dell'Universitą di Napoli Federico II.

A study was carried out on 110 patients with various diseases related
to chronic inflammation of the tonsils and to hypertrophic adenoids.
Sixty-two of these patients underwent adenotonsillectomy, while the
others were followed clinically and, where necessary, given medical
treatment. At the first observation the patients were between the ages
of 2 and 12 (mean age 6.1 years). At the start of the present study
the patients ages ranged from 10 to 22 (mean age 17 years). Clinical
follow-up was carried out on the patients 2 and 7 years after the
first observation and/or adenotonsillectomy. The patients were divided
into homogeneous groups according to the severity of symptoms. The
A.A. evaluated changes of the following clinical parameters: annual
frequency of inflammatory pharyngotonsillar episodes, nasal
respiratory obstruction, sore throat, otologic pathology. Evaluations
were carried out statistically in each group. After more than 7 years
from surgery, the significant reduction of various diseases related to
chronic inflammation of the tonsils and to hypertrophic adenoids, in
accordance with the findings after 2 years from surgery, underline the
effectiveness of adenotonsillectomy in correctly selected candidates.

---------------

Long-term observation of postoperative course of habitual tonsillitis.

Ogino S, Notake N, Harada T, Matsunaga T.

Acta Otolaryngol Suppl. 1988;454:299-304. 

Department of Otolaryngology, Osaka University Medical School, Japan.

Tonsillectomy and adenoidectomy are among the most frequently held
operations in the ENT field. In our hospital, the number of cases of
tonsillectomy has been decreasing recently as compared with 10 to 15
years ago. Especially the number of cases under 10 years old has shown
a decrease. It is sometimes difficult to decide the indication for
tonsillectomy even for habitual tonsillitis. In this paper, the post
operative course of tonsillectomy with habitual tonsillitis was
investigated during 1976 to 1986 using a questionnaire. Answers
evaluable were obtained from 207 cases. The efficacy of the operation
on sore throats, high temperatures and recurrent colds was very high,
but a few cases complained that a foreign sensation of the throat had
occurred or worsened after operation. The incidence of nasal allergy
gradually increased after tonsillectomy, but further studies may be
necessary to decide the exact relationship. Laboratory examinations,
such as ASLO, CRP, white blood cell counts, immune complex, C3a and
C5a, were not particularly helpful in deciding the indication of
tonsillectomy for habitual tonsillitis. In general, it is thought that
tonsillectomy is very effective for habitual tonsillitis, but we must
be more careful in deciding such an indication.

---

Clarification of Question by briang-ga on 25 Sep 2003 05:26 PDT

to clarify, my interest is the role of the local action of the
adenoids  in the immediate defense against airborne virus droplets
entering through the nose, as opposed to overall effects on the immune
system.
 
As I understand it the adenoids provide important physical defenses
such as mucus production and a flushing action of the ciliated
surface, in addition to a local non-specific immune response.

Hence would like to find studies looking at susceptibility for adults
with childhood adenoidectomy compared with their peers, either
directly or on a  population basis.  Thanks.

There is a lot of redundancy in the immune system.  My guess is that
removal of nasopharyngeal lymphoid tissue would result in compensation
elsewhere.

The adenoid and tonsillar tissue is necessary for proper health in
children due to their relatively immunocompromised state - the immune
system does not become fully competent (to adult levels) until the
mid-teens - early on in childhood, the tonsills and adenoids serve as
important first bastions of lymphatic tissue to quickly mount
responses to incoming pathogens - this becomes less critical as the
child ages as the immune system becomes better able to deal with
infections.  The main problem with this lymphoid tissue in children is
that it can become hypertrophied and obstruct the eustachian tubes
(adenoids) or the oropharynx (tonsils) leading to a whole host of
other problems, and/or it can become infected itself leading to it
becoming a source for further, recurrent infections.  Further
recurrent infections can lead to more pronounced scarring and
maldevelopment of the oropharynx - the consequences of which might be
an increase in infections as an adult due to abnormally organized
tissue.

Overall, I would suspect that there is almost no impact on adult virus
infection as the result of adnoidectomy as a child.

synarchy