Association of Adult Chronic Rhinosinusitis With Pediatric Tonsillectomy and Adenoidectomy

ABSTRACT Objectives To evaluate epidemiological associations between the development of adult chronic rhinosinusitis (CRS) and treatment with surgery or biologic therapy following pediatric adenotonsillectomy. Methods This is a multicenter, retrospective cohort study utilizing data from 100 healthcare organizations in the United States. The TriNetX database identified adults older than 18 years with or without prior childhood tonsillectomy and/or adenoidectomy. Outcomes included CRS without nasal polyposis (CRSsNP), with nasal polyposis (CRSwNP), sinus surgery, and biologic therapy. Subgroup analysis of patients with childhood obstructive sleep apnea (OSA), recurrent/chronic tonsillitis, adenoiditis, or middle ear disease was performed. Results There was no statistically significant difference in the rate of adult CRSsNP, CRSwNP, surgery, and treatment with biologics after pediatric adenotonsillectomy for childhood OSA (HR: 0.94 [0.87–1.02]; 1.07 [0.79–1.44]; 0.87 [0.59–1.28]; 0.85 [0.66–1.09]). Children who had an adenoidectomy alone had a higher rate of CRSsNP as adults (HR: 1.55 [1.30–1.85]). Surgery for tonsillitis and adenoiditis had a higher rate of CRSwNP and surgery (HR: 1.63 [1.21–2.32]; 1.97 [1.36–2.86]). Adenoidectomy for adenoiditis was associated with CRSsNP (HR: 1.94 [1.73–2.19]). Adults with pediatric middle ear disease who had a childhood adenoidectomy alone had an increased rate of CRSsNP (HR: 1.47 [1.30–1.65]). Conclusions Tonsillectomy with adenoidectomy in the setting of specific childhood infectious diseases was associated with adult CRSwNP and the need for sinus surgery, whereas adenoidectomy was associated with CRSsNP. Level of Evidence 3.