Introduction
The adenoids are a soft tissue mass present at the back of the throat. Adenoidectomy means removal of the adenoids. On the other hand, tonsillectomy involves the removal of the palatine tonsils (present on each side of the throat). The adenoids and tonsils function as a part of the immune system. Adenotonsillectomy is the combination of two procedures: adenoidectomy, and tonsillectomy (T&A). They are very common procedures in ear, nose, and throat (ENT) surgery.
What Are the Indications for Adenotonsillectomy?
The indications of tonsillectomy are obstructive sleep apnoea (OSA, a sleep-disordered breathing), acute tonsillar inflammation (tonsillitis), peritonsillar (around the tonsils) abscess, and tonsillar hypertrophy (increase in size). Adenoidectomy is done for nasal passage obstruction, OSA, recurrent middle ear infection (otitis media), and chronic inflammation of the nose and sinuses (rhinosinusitis).
What Are the Complications of Adenotonsillectomy?
Adenotonsillectomy can lead to bleeding, infection, taste disturbances, breathing problems, and dehydration. However, various studies have also noted weight gain in children following the procedure.
What Factors Are Responsible for Weight Gain After Adenotonsillectomy in Children?
It is suggested that weight gain should not be linked only to T&A, as it is complex and multifactorial in nature. Scientists have put forward different factors that may contribute to weight gain in children following adenotonsillectomy.
Diet: It is reported that children with acute tonsillitis or tonsillar hypertrophy have less dietary intake. It may be because of throat pain that accompanies tonsillitis. Tonsillitis makes it very difficult to swallow food. Furthermore, many children have weight loss as a symptom of tonsillitis. The removal of tonsils alleviates the symptoms. Hence, weight gain following adenotonsillectomy can be due to increased oral intake.
- A study was done in Greece in preschool children suffering from tonsillar hypertrophy before and after tonsillectomy. Dietary habits of thirty children aged 4 to 6 were assessed before and after six months of surgery. They were compared with those of healthy children of the same age. There was a significant weight gain in children suffering from tonsillar hypertrophy following their surgery. It can be because of an increase in their consumption of sugar products, soft drinks and edible fats. The authors concluded that parents should be aware of the possible diet related weight increase following tonsillectomy.
Activity: It is observed that OSA is severe in inactive children. As a result, they have decreased concentration, increased daytime sleep, irritability, and depression.
- Roemmich et al., examined the effect of T&A in children with OSA. They studied 54 children aged six to twelve before and twelve months after the procedure. The authors measured the children’s height, weight, and hyperactivity scores. The weight percentage was increased following T&A. Moreover, the hyperactivity and total motor activity decreased after the procedure. The authors concluded that increased weight may be due to reduced physical activity and less energy expenditure. Decreased fidgeting (making quick nervous movements) is also observed after surgery that leads to energy conservation.
Growth and Biochemical Factors: It is postulated that growth and metabolism also has an effect on OSA patients.
- A study was done to assess the circulating growth parameters such as insulin like growth factor-1 (IGF-1) and growth hormone before and after T&A. IGF-1 and growth hormone have positive effects on weight and growth. The authors evaluated seventy children with adenotonsillar hypertrophy six months after the surgery. Body mass index (BMI, weight and height ratio), fat-free mass, and body fat mass increased during that period. Authors reported an increase in IGF-1 after surgery. The study indicates that growth hormone is decreased in OSA patients. Moreover, respiratory improvement after the surgery leads to weight gain and restored growth hormone secretion.
Decreased Catecholamines: Catecholamines are neurotransmitters (chemical messengers) released in the body. A hypothesis states that the surgery decreases the level of circulating catecholamines. Catecholamines regulate the body growth.
Demographic Factors: Demographics are characteristics of a particular population. One of the important factors is age. Age under six is more prone to weight gain after T&A. It can be due to ‘catch-up growth.’ Catch-up growth is used for the compensatory rapid weight and height gain in underweight children. The age three to six is most common for catch-up growth.
- A case series was done in the US for a three-year period. The authors reported a weight gain in children similar to previous studies. However, children younger than six years gained more weight than the others. Hence, the authors reported an age <6 years as a significant predictor of weight gain. The authors also suggested research on weight gain after T&A with an emphasis on demographic factors such as age.
- Recently, a randomized controlled trial was carried out in 2021 on 398 children before and after T&A. About 45 % of the children who underwent the surgery reported an undesirable weight gain. However, the authors stated that T&A is not a single risk factor for weight gain. Other factors include activity, mother's body mass index, average night sleep duration, and eating habits.
Tonsillectomy is a potential risk factor for childhood obesity. A study was carried out in children’s hospital to investigate weight gain and increased risk of obesity in children after tonsillectomy. The study included 200 children aged two to twelve undergoing tonsillectomy compared to normal individuals. The authors recorded BMI of the children before and after the surgery. The BMI had no significant change before and after surgery. However, the authors reported a significant weight gain in the children.
Another study clinically assessed weight gain after tonsillectomy in children. The authors included 240 children in the study. The height, weight, and BMI were calculated before, one-month, and six months after the procedure. The findings indicated a weight gain six months after tonsillectomy. The authors suggest further studies to evaluate the other risk factors of weight gain after surgery.
Conclusion
Excessive weight gain or obesity has become a global pandemic. The exact mechanism of weight gain after T&A is not clear. Still, the clinicians and parents should be cognizant of the weight gain in children after T&A. For better long-term outcomes, interprofessional care is necessary for children with sleep disorders and obesity. Emphasis should be on nutrition, healthy lifestyle changes, and weight management before and after the surgery.
