Advertisement

Tonsillectomy in multiple sclerosis patients: Retrospective, case-controlled, exploratory study

  • Dejan Jakimovski
    Affiliations
    Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Biomedical Sciences, State University of New York at Buffalo, NY, USA

    Jacobs MS Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
    Search for articles by this author
  • Muhammad K Ahmed
    Affiliations
    Jacobs MS Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
    Search for articles by this author
  • Caila B Vaughn
    Affiliations
    Jacobs MS Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
    Search for articles by this author
  • Robert Zivadinov
    Affiliations
    Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Biomedical Sciences, State University of New York at Buffalo, NY, USA

    Jacobs MS Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA

    Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
    Search for articles by this author
  • Bianca Weinstock-Guttman
    Correspondence
    Corresponding author: Jacobs MS Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, 1010 Main Street, 2nd Floor, Buffalo, NY 14202. USA.
    Affiliations
    Jacobs MS Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
    Search for articles by this author

      Highlights

      • People with history of tonsillectomy may have a higher risk of autoimmune diseases.
      • History of tonsillectomy was higher in MS patients compared to healthy controls.
      • History of tonsillectomy is a predictor of higher EDSS scores in RRMS patients.
      • Further study is needed on role of tonsillectomy, early infections, and antibiotics.

      Abstract

      Background

      Previous studies have shown an effect of tonsillectomy and greater risk for future autoimmune diseases. Currently there are only few outdated analyses of tonsillectomy and multiple sclerosis (MS) risk.

      Objective

      To investigate the prevalence of tonsillectomy in MS patients and healthy controls (HCs).

      Methods

      A total of 1000 subjects (779 MS patients and 221 HCs) completed a structured study questionnaire regarding MS diagnosis, age of onset, history of tonsillectomy, and age of tonsillectomy. In a subgroup of patients with available electronic medical records, Expanded Disability Status Scale (EDSS) scores at the time of recruitment and 5-years later were collected. Statistical analyses were performed with χ2 test, odds ratio (OR), Student's t-test, Mann-Whitney U test, and ordinal regression..

      Results

      The MS population had a greater percentage of patients with history of tonsillectomy when compared to HCs [39.5% vs. 31.7%, OR 1.411 (CI 1.027–1.938), p = 0.034], driven by participants aged 50 or older [45.7% vs. 36.1%, OR 1.495 (CI 1.037–2.155) p = 0.031]. There was no difference of the age at tonsillectomy (median 8.0 vs. 6.5 years old, p = 0.26). However, the RRMS patients had their tonsillectomy procedure performed significantly later when compared to HCs (median 6.5 vs. 9.0 years old, p = 0.049). In an analysis of RRMS patients with available longitudinal data (n = 459), patients with a history of tonsillectomy were significantly older and had a longer disease duration (p < 0.001 and p = 0.025). After adjusting for the demographic differences, no history of tonsillectomy remained significant predictor of lower EDSS score categories both at the first (estimate = -0.467, Wald = 6.68, 95% CI -0.82 to -0.11, p = 0.01) and second timepoint (estimate = -0.376, Wald = 4.4, 95% CI -0.73 to -0.02 p = 0.037).

      Conclusion

      When compared to HCs, a greater percentage of MS patients underwent tonsillectomy. The role of tonsils, its relationship with early infection rates and/or antibiotic use in MS should be further investigated.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Multiple Sclerosis and Related Disorders
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Jakimovski D.
        • Weinstock-Guttman B.
        • Gandhi S.
        • et al.
        Dietary and lifestyle factors in multiple sclerosis progression: results from a 5-year longitudinal MRI study.
        J. Neurol. 2019; 266: 866-875
        • Guan Y.
        • Jakimovski D.
        • Ramanathan M.
        • Weinstock-Guttman B.
        • Zivadinov R
        The role of Epstein-Barr virus in multiple sclerosis: from molecular pathophysiology to in vivo imaging.
        Neural Regen. Res. 2019; 14: 373-386
        • Abdollahpour I.
        • Nedjat S.
        • Mansournia M.A.
        • Eckert S.
        • Weinstock-Guttman B
        Infectious exposure, antibiotic use, and multiple sclerosis: a population-based incident case-control study.
        Acta Neurol. Scand. 2018; 0
        • Bitar M.A.
        • Dowli A.
        • Mourad M
        The effect of tonsillectomy on the immune system: a systematic review and meta-analysis.
        Int. J. Pediatr. Otorhinolaryngol. 2015; 79: 1184-1191
        • Ji J.
        • Sundquist J.
        • Sundquist K
        Tonsillectomy associated with an increased risk of autoimmune diseases: a national cohort study.
        J. Autoimmun. 2016; 72: 1-7
        • Kurtzke J.F.
        Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS).
        Neurology. 1983; 33: 1444-1452
        • Poskanzer D.C
        Tonsillectomy and multiple sclerosis.
        Lancet. 1965; 2: 1264-1266
        • Currier R.D.
        • Martin E.A.
        • Woosley P.C
        Prior events in multiple sclerosis.
        Neurology. 1974; 24: 748-754
        • Eftekharian M.M.
        • Mousavi M.
        • Hormoz M.B.
        • Roshanaei G.
        • Mazdeh M
        Multiple sclerosis and immunological-related risk factors: results from a case-control study.
        Hum. Antib. 2014; 23: 31-36
        • Broadley S.A.
        • Deans J.
        • Chataway S.J.
        • Sawcer S.J.
        • Compston D.A
        Multiple sclerosis and tonsillectomy: no evidence for an influence on the development of disease or clinical phenotype.
        Mult. Scler. 2000; 6: 121-123
        • Baugh R.F.
        • Archer S.M.
        • Mitchell R.B.
        • et al.
        Clinical practice guideline: tonsillectomy in children.
        Otolaryngol. Head Neck Surg. 2011; 144: S1-30
        • Lunny C.
        • Knopp-Sihota J.A.
        • Fraser S.N
        Surgery and risk for multiple sclerosis: a systematic review and meta-analysis of case-control studies.
        BMC Neurol. 2013; 13: 41
        • Norgaard M.
        • Nielsen R.B.
        • Jacobsen J.B.
        • et al.
        Use of penicillin and other antibiotics and risk of multiple sclerosis: a population-based case-control study.
        Am. J. Epidemiol. 2011; 174: 945-948
        • Seishima N.
        • Kondo S.
        • Wakisaka N.
        • et al.
        EBV infection is prevalent in the adenoid and palatine tonsils in adults.
        J. Med. Virol. 2017; 89: 1088-1095
        • Durovic B.
        • Gasser O.
        • Gubser P.
        • et al.
        Epstein-Barr virus negativity among individuals older than 60 years is associated with HLA-C and HLA-Bw4 variants and tonsillectomy.
        J. Virol. 2013; 87: 6526-6529
        • Quintana F.J.
        • Patel B.
        • Yeste A.
        • et al.
        Epitope spreading as an early pathogenic event in pediatric multiple sclerosis.
        Neurology. 2014; 83: 2219-2226
        • Jakimovski D.
        • Weinstock-Guttman B.
        • Ramanathan M.
        • et al.
        Ocrelizumab: a B-cell depleting therapy for multiple sclerosis.
        Expert Opin. Biol. Ther. 2017; 17: 1163-1172
        • Hausler D.
        • Hausser-Kinzel S.
        • Feldmann L.
        • et al.
        Functional characterization of reappearing B cells after anti-CD20 treatment of CNS autoimmune disease.
        Proc. Natl. Acad. Sci. U. S. A. 2018; 115: 9773-9778
        • Jakimovski D.
        • Ramanathan M.
        • Weinstock-Guttman B.
        • et al.
        Higher EBV response is associated with more severe gray matter and lesion pathology in relapsing multiple sclerosis patients: a case-controlled magnetization transfer ratio study.
        Mult. Scler. 2019; (1352458519828667)
        • Jakimovski D.
        • Guan Y.
        • Ramanathan M.
        • Weinstock-Guttman B.
        • Zivadinov R
        Lifestyle-based modifiable risk factors in multiple sclerosis: review of experimental and clinical findings.
        Neurodegener. Dis. Manag. 2019; 9: 149-172
        • Lavery A.M.
        • Collins B.N.
        • Waldman A.T.
        • et al.
        The contribution of secondhand tobacco smoke exposure to pediatric multiple sclerosis risk.
        Mult. Scler. 2018; (1352458518757089)
        • Darrow D.H.
        • Siemens C.
        Indications for tonsillectomy and adenoidectomy.
        Laryngoscope. 2002; 112: 6-10
        • Vaughn C.B.
        • Jakimovski D.
        • Kavak K.S.
        • et al.
        Epidemiology and treatment of multiple sclerosis in elderly populations.
        Nat. Rev. Neurol. 2019; 15: 329-342