Cohort studyindependent cross-checkabstract checked I-ORG-122 standard review

Do tonsil and adenoid operations change later infections in children?

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

Overview

Kim JY et al.. Laryngoscope 2021 · PMID 33720418 · DOI 10.1002/lary.29506

Over 9 years, children who had the operation had the same number of upper airway infections as similar children who did not.

Does the study support the specific claim? No · Methodological quality: moderate

Study explained simply

What did the researchers want to find out?: Test whether adenotonsillectomy changes later infections
How was the study done?: Matched population cohort with equivalence testing
How many people, animals or samples were studied?: 2377 operated Korean children and about 9000 controls
What was actually found?: No difference in pharyngitis, sinusitis or ear infections
How large was the observed effect?: Equivalent within ±0.5 visits
What do the results mean in everyday life?: The operation did not increase later airway infections
What are the study's limitations?: Claims data; children only
What does it say about Elawady's specific claim?: Contradicts the claim
Do the results apply to Germany and Europe?: Moderate
What can explicitly not be concluded from this study?: Cannot address adulthood

Authors: Kim JY et al.
Journal: Laryngoscope
Year: 2021
Identifier: PMID 33720418 DOI 10.1002/lary.29506
Verification: verified – PubMed efetch 2026-10-26; Crossref works API 2026-10-26
Retracted: no
Corrections: none
Extent checked: abstract only
Conflicts of interest and funding: Non-commercial support (PubMed).

Does childhood adenotonsillectomy change the later frequency of upper airway infections?

Study design: Cohort study – Population-based follow-up study with propensity-score-matched controls (Korean NHIS National Sample Cohort); equivalence testing
Population: Children < 10 years with adenotonsillectomy and matched controls
Country: South Korea
Period: Follow-up years 1-9 after surgery
Sample size: 2377 operated; controls 9204 (APT), 9196 (ARS), 8788 (AOM)
Inclusion and exclusion criteria: Children < 10 years in the NHIS sample cohort

Exposure / intervention: Adenotonsillectomy
Comparator: Propensity-matched children with the same infection diagnoses (1:4)
Endpoints: Hospital visits for acute pharyngotonsillitis, rhinosinusitis and otitis media
Statistical methods: Equivalence test (margin -0.5 to 0.5 visits)

Results: No significant differences in the incidence of pharyngitis, rhinosinusitis or otitis media between operated and control children from postoperative year 1 to year 9 (within the equivalence margin). Visits declined over time in both groups.
Absolute risks: Not reported
Authors' conclusion: Adenotonsillectomy does not alter the frequency of upper airway infections in children.

Orienting tool: ROBINS-E
Type of assessment: simplified assessment (abstract only)
Full formal assessment: no
Overall risk of bias: some concerns
Rationale: Matching on prior infection reduces confounding by indication compared with Byars 2018.

Equivalence design is appropriate for a 'no change' conclusion.

Directly contradicts the claim that childhood adenotonsillectomy increases later upper respiratory disease, at least up to 9 years.

Byars 2018 (A-ORG-01) found RR about 2-3 for upper respiratory disease to age 30.

Korean; biology transferable.

Important contradicting evidence from a design with better control for indication.

Multidimensional assessment
Multidimensional assessment
Authenticity of the source	verified
Methodological quality	moderate
Risk of bias	some concerns
Precision of results	moderate
Directness	direct
Reproducibility	unknown
Consistency with the overall evidence	inconsistent
Regional transferability	moderate
Adequacy of the interpretation (by the archive)	not applicable

Adult outcomes.