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Comment & Response
December 2018

Limitations to the Association of Risk of Airway Disease With Removal of Adenoids and Tonsils in Children

Author Affiliations
  • 1Illawarra ENT, Wollongong, New South Wales, Australia
JAMA Otolaryngol Head Neck Surg. 2018;144(12):1187-1188. doi:10.1001/jamaoto.2018.2447

To the Editor The conclusion by Byars et al1 that the children who have had adenoidectomy and/or tonsillectomy are at a greater lifetime risk of airway disease may be supported by their data; however, their implication that surgery is causally related to this incidence is unfounded.

Baseline characteristics of the control and intervention groups in this study are likely significantly different. A significant proportion of children undergoing adenotonsillectomy have a predisposition to airway diseases (asthma, allergy, and sinusitis) and recent publications point to a shared etiology with sleep-disordered breathing.2 Owing to difficulties identifying asthma under the age of 5, most national guidelines do not allow for diagnosis3—invalidating any estimates of incidence prior to this age. Because the surgical arm of this cohort had an underlying predisposition to airway diseases (visible as the extra disease burden of around 1-in-5 identified in the study), the so-called causality is incorrect. The appropriate control group would be patients meeting criteria for surgery but not having it, so both groups are exposed to the same predisposition.

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