Surgical Removal of Tonsils and Risk of COVID-19: a Nested Case-control Study Using Data from UK Biobank and AMORIS Cohort

Overview

Journal BMC Med

Publisher Biomed Central

Specialty General Medicine

Date 2024 Oct 13

PMID 39396957

Authors

Yanping Yang

Kejia Hu

Karin Modig

Maria Feychting

Imre Janszky

Niklas Hammar

Fang Fang

Zhe Zhang

Dang Wei

Affiliations

Soon will be listed here.

Abstract

Background: To investigate the association between surgical removal of tonsils and risk of COVID-19 with different severity.

Methods: Through a nested case-control study during January 31st to December 31st 2020, including 58,888 participants of the UK Biobank, we investigated the association of tonsillectomy with the future risk of mild and severe COVID-19, using binomial logistic regression. We further examined the associations of such surgery with blood inflammatory, lipid and metabolic biomarkers to understand potential mechanisms. Finally, we replicated the analysis of severe COVID-19 in the Swedish AMORIS Cohort (n = 451,960).

Results: Tonsillectomy was associated with a lower risk of mild (odds ratio [95% confidence interval]: 0.80 [0.75-0.86]) and severe (0.87 [0.77-0.98]) COVID-19 in the UK Biobank. The associations did not differ substantially by sex, age, Townsend deprivation index, or polygenic risk score for critically ill COVID-19. Levels of blood inflammatory, lipid and metabolic biomarkers did, however, not differ greatly by history of surgical removal of tonsils. An inverse association between tonsillectomy and severe COVID-19 was also observed in the AMORIS Cohort, primarily among older individuals (> 70 years) and those with ≤ 12 years of education.

Conclusions: Surgical removal of tonsils may be associated with a lower risk of COVID-19. This association is unlikely attributed to alterations in common blood inflammatory, lipid and metabolic biomarkers.

Citing Articles

A symphony of immunity to SARS-CoV-2 in the adenoids.

Manthiram K, Xu Q, Schwartzberg P Nat Immunol. 2025; 26(2):150-151.

PMID: 39890932 DOI: 10.1038/s41590-024-02060-z.

References

Armstrong J, Rudkin J, Allen N, Crook D, Wilson D, Wyllie D . Dynamic linkage of COVID-19 test results between Public Health England's Second Generation Surveillance System and UK Biobank. Microb Genom. 2020; 6(7). PMC: 7478634. DOI: 10.1099/mgen.0.000397. View

Choi H, Park B, Sim S, Ahn S . Tonsillectomy Does Not Reduce Upper Respiratory Infections: A National Cohort Study. PLoS One. 2016; 11(12):e0169264. PMC: 5201261. DOI: 10.1371/journal.pone.0169264. View

Arambula A, Brown J, Neff L . Anatomy and physiology of the palatine tonsils, adenoids, and lingual tonsils. World J Otorhinolaryngol Head Neck Surg. 2021; 7(3):155-160. PMC: 8356106. DOI: 10.1016/j.wjorl.2021.04.003. View

Wilson J, OHara J, Fouweather T, Homer T, Stocken D, Vale L . Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA): a multicentre, open-label, randomised controlled trial. Lancet. 2023; 401(10393):2051-2059. DOI: 10.1016/S0140-6736(23)00519-6. View

Grifoni A, Weiskopf D, Ramirez S, Mateus J, Dan J, Rydyznski Moderbacher C . Targets of T Cell Responses to SARS-CoV-2 Coronavirus in Humans with COVID-19 Disease and Unexposed Individuals. Cell. 2020; 181(7):1489-1501.e15. PMC: 7237901. DOI: 10.1016/j.cell.2020.05.015. View

Mandel H, Colleen G, Abedian S, Ammar N, Bailey L, Bennett T . Risk of post-acute sequelae of SARS-CoV-2 infection associated with pre-coronavirus disease obstructive sleep apnea diagnoses: an electronic health record-based analysis from the RECOVER initiative. Sleep. 2023; 46(9). PMC: 10485569. DOI: 10.1093/sleep/zsad126. View

Janszky I, Mukamal K, Dalman C, Hammar N, Ahnve S . Childhood appendectomy, tonsillectomy, and risk for premature acute myocardial infarction--a nationwide population-based cohort study. Eur Heart J. 2011; 32(18):2290-6. DOI: 10.1093/eurheartj/ehr137. View

Kara A, Elden H, Okur E, Yilmaz M, Mutlu F, Guven M . Impact of tonsillectomy on COVID-19 pandemic: an observational study of the incidence and prognosis. Acta Otolaryngol. 2021; 141(9):857-859. DOI: 10.1080/00016489.2021.1970803. View

Chung S, Hung S, Lin H, Chen K . Decreased clinic visits for acute respiratory infections following an adult tonsillectomy: A population-based study. Am J Otolaryngol. 2017; 38(4):488-491. DOI: 10.1016/j.amjoto.2017.05.004. View

10.

Strausz S, Kiiskinen T, Broberg M, Ruotsalainen S, Koskela J, Bachour A . Sleep apnoea is a risk factor for severe COVID-19. BMJ Open Respir Res. 2021; 8(1). PMC: 7804843. DOI: 10.1136/bmjresp-2020-000845. View

11.

Brooke H, Talback M, Hornblad J, Johansson L, Ludvigsson J, Druid H . The Swedish cause of death register. Eur J Epidemiol. 2017; 32(9):765-773. PMC: 5662659. DOI: 10.1007/s10654-017-0316-1. View

12.

Chiang P, Liu H, Chen Y, Wang Y, Cheng-Chung Wei J . Association between tonsillectomy and COVID-19 in chronic tonsillitis patients. Br J Surg. 2023; 110(11):1553-1554. DOI: 10.1093/bjs/znad291. View

13.

Capriotti V, Mattioli F, Guida F, Marcuzzo A, Lo Manto A, Martone A . COVID-19 in the tonsillectomised population. Acta Otorhinolaryngol Ital. 2021; 41(3):197-205. PMC: 8283408. DOI: 10.14639/0392-100X-N1436. View

14.

Sjoberg F, Walther S . Intensive care registries and the evolution of the concept of 'quality of care' - reflections from the 10-year anniversary symposium of the Swedish Intensive Care Registry. Acta Anaesthesiol Scand. 2012; 56(9):1073-7. DOI: 10.1111/j.1399-6576.2012.02757.x. View

15.

Sudlow C, Gallacher J, Allen N, Beral V, Burton P, Danesh J . UK biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age. PLoS Med. 2015; 12(3):e1001779. PMC: 4380465. DOI: 10.1371/journal.pmed.1001779. View

16.

Byars S, Stearns S, Boomsma J . Association of Long-Term Risk of Respiratory, Allergic, and Infectious Diseases With Removal of Adenoids and Tonsils in Childhood. JAMA Otolaryngol Head Neck Surg. 2018; 144(7):594-603. PMC: 6145787. DOI: 10.1001/jamaoto.2018.0614. View

17.

Kim H, Kim H, Lee M, Choi W, Jang Y, Shin J . Generation of human tonsil epithelial organoids as an ex vivo model for SARS-CoV-2 infection. Biomaterials. 2022; 283:121460. PMC: 8901203. DOI: 10.1016/j.biomaterials.2022.121460. View

18.

Huang N, Perez P, Kato T, Mikami Y, Okuda K, Gilmore R . SARS-CoV-2 infection of the oral cavity and saliva. Nat Med. 2021; 27(5):892-903. PMC: 8240394. DOI: 10.1038/s41591-021-01296-8. View

19.

Kim C, Aronow W, Frishman W . Coronavirus Disease 2019 and Cardiometabolic Disease. Cardiol Rev. 2021; 30(3):123-128. PMC: 8983615. DOI: 10.1097/CRD.0000000000000405. View

20.

Walldius G, Malmstrom H, Jungner I, de Faire U, Lambe M, Van Hemelrijck M . Cohort Profile: The AMORIS cohort. Int J Epidemiol. 2017; 46(4):1103-1103i. DOI: 10.1093/ije/dyw333. View