Tonsil, adenoid removal in early life may up risk for stress-related disorders later on

Key takeaways:

• Tonsillectomy or adenoidectomy in early life was associated with a higher risk for stress-related disorders.
• The association was independent of sex, age at surgery, time since surgery and familial confounding.

Children and young adults who underwent surgical removal of tonsils or adenoids had a higher risk for stress-related disorders later in life vs. those who did not undergo either procedure, according to a study published in JAMA Network Open.

“In contrast to other psychiatric disorders, little is known about the risk of stress-related disorders, including PTSD, acute stress reaction, adjustment disorder and other stress reaction, following tonsillectomy,” Xue Xiao, MD, PhD, of the department of otolaryngology-head and neck surgery at First Affiliated Hospital of Guangxi Medical University and Key Laboratory of Early Prevention and Treatment for Regional High-Frequency Tumor in China, and colleagues wrote.

They added, “As stress-related disorders are common in our society, it is important to understand their causes and risk factors for better prevention and treatment strategies.”

In a nationwide matched cohort study conducted from Dec. 15, 2023, to Oct. 11, 2024, Xiao and colleagues used data from the Swedish Total Population Register to investigate whether tonsillectomy or adenoidectomy in early life was associated with a subsequent risk for stress-related disorders among 1,050,287 children and young adults born in Sweden between Jan. 1, 1981, and Dec. 31, 2016.

The researchers formed a population-matched cohort, which included 83,957 individuals who underwent surgical removal of tonsils or adenoids and 839,570 unrelated individuals who did not (median age, 14.4 years; 55.2% female). Participants were matched by sex and birth year.

To address potential familial confounding, the researchers also created a sibling-matched cohort, which included 51,601 individuals who underwent surgical removal of tonsils or adenoids (median age, 14.9 years; 55.8% female) and 75,159 full siblings who did not (median age, 13.3 years; 47.4% female).

The study outcome was a first diagnosis of a stress-related disorder, including PTSD, acute stress reaction and adjustment disorder or other stress reaction, during follow-up.

The researchers found that individuals who underwent surgical removal of tonsils or adenoids demonstrated a higher subsequent risk for stress-related disorders (HR = 1.43; 95% CI, 1.38-1.48), especially PTSD (HR = 1.55; 95% CI, 1.43-1.69), compared with those who did not undergo either procedure.

They observed similar associations in the sibling-matched cohort, with an HR of 1.34 (95% CI, 1.25-1.44) for any stress-related disorder and 1.41 (95% CI, 1.18-1.69) for PTSD.

Additionally, the researchers noted that these associations were independent of sex, age at surgery, time since surgery, parental educational attainment or parental history of stress-related disorders.

“If our findings here are validated in future studies of independent study populations, mechanistic studies would be needed to disentangle the role of human tonsils and their diseases, via inflammation or other associated health conditions, in the development of psychiatric disorders in general and stress-related disorders specifically,” the researchers wrote.

Xiao and colleagues acknowledged several study limitations, including the registry-based nature of the study and the fact that they could not rule out the possibility of residual confounding due to factors not shared between siblings, such as pubertal changes and adult lifestyle factors.