Adenotonsillectomy Linked to Increased Risk of Pediatric-Onset Multiple Sclerosis: Study
A study published online in the Multiple Sclerosis Journal found that a history of adenotonsillectomy was associated with increased odds of developing pediatric-onset multiple sclerosis (POMS). The findings suggest a potential link between the surgical removal of the adenoids and tonsils and the risk of MS onset during childhood. Further research is needed to clarify the underlying mechanisms and determine whether this association reflects a causal relationship or shared underlying risk factors. The study was conducted by Gina C. and colleagues.
The wide recruitment window extended over a multistep process from 1 November 2011 to 1 July 2017, and the final statistical modeling and covariate adjustment occurred in June 2026. The study team collected all clinical, surgical, and genetic information from each patient, including explicit records of previous adenotonsillectomy, laboratory confirmed EBV serostatus, and the robust MS genetic risk allele HLA-DRB1*15:01:01. Multivariate logistic regression was used to determine the exact effect size of tissue resection on MS risk and to strictly control for any baseline demographic information. Simultaneously, for the subgroup of POMS patients with longitudinal follow-up information, the statistical team used negative binomial regression modeling offsetting by the total follow-up period to determine the exact effect size of resection on relapse rate per year.
Key findings:
- The multisite neuroimmunological study recruited, examine and process data from a total of 919 children.
- The analysis cohort at baseline comprised 359 patients diagnosed with pediatric onset multiple sclerosis (POMS) who were being matched with 560 healthy controls.
- The results from multivariable logistic regression indicated that people with a history of previous adenotonsillectomy had 63% more risk of developing multiple sclerosis and their odds ratios (OR) was 1.63 (95% CI, 1.01-2.64, p=0.046).
- In the primary surgery database, there is a sub-cohort of 239 POMS patients who had detailed longitudinal follow-up information that could be used to monitor their relapses.
- For the followed patients, a history of previous adenotonsillectomy meant an immediate doubling of annualized clinical relapse rate with statistically significant results.
- The result from the negative binomial regression analysis indicated an adjusted incidence rate ratio (IRR) of 2.00 (95% CI, 1.15-3.48, p=0.013).
In summary, the presence of adenotonsillectomy before the development of MS had an influence on its higher incidence and recurrence rates among children, indicating that there may be an interaction between EBV, immune system regulation, and the development of MS. The dramatic results of this study provide an invaluable basis for contemporary neuroimmunology by showing how local childhood surgery permanently affects the immune system worldwide.
Reference:
Chang, G., Nasr, Z., Schoeps, V. A., Virupakshaiah, A., Zamvil, S. S., Moseley, C. E., Sabatino, J. J., Chong, J., Graves, J. S., Waltz, M., Rodriguez, M., Tillema, J.-M., Chitnis, T., Rensel, M., Abrams, A. W., Krupp, L., Waldman, A. T., Mar, S., Schreiner, T., & Rose, J. (2026). Adenotonsillectomy is associated with increased risk and disease activity in pediatric-onset multiple sclerosis. Multiple Sclerosis Journal. https://doi.org/10.1177/13524585261444244
