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 Currently there are only few outdated analyses of tonsillectomy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
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Article info
Publication history
Published online: April 28, 2020
Accepted:
April 13,
2020
Received in revised form:
February 24,
2020
Received:
November 15,
2019
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
