Association of Adult Chronic Rhinosinusitis With Pediatric Tonsillectomy and Adenoidectomy

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.