Nezam El-Tayebat Fact CheckA scientific assessment of the “نظام الطيبات” nutrition system
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Potentially true Overinterpreted Certainty of evidence: low provisional C-ORG-03

Childhood adenoidectomy or tonsillectomy doubles to triples the risk of upper respiratory disease later in life (Byars 2018, 1.19 million Danish children).

In short: The figures from Byars 2018 are reported correctly, but they show an association, not that surgery doubles or triples respiratory disease; a better-matched study found no increase in later airway infections.
Conclusion: Association correct; causation uncertain.
  1. Original statement
  2. Scientific assessment
  3. Scientific evidence in detail
  4. In plain language
  5. Studies on this claim
  6. Regional context
  7. What applies in my country?
  8. References

Original statement

في دراسة بيارز ومعاونيه على 1.19 مليون طفل دنماركي (JAMA Otolaryngology 2018)، ارتفع خطر أمراض الجهاز التنفسي العلوي 2-3 أضعاف بعد استئصال اللوزتين أو الزوائد الأنفية

verbatim according to source. Translation by the project; the Arabic wording is authoritative.

Translation

Childhood adenoidectomy or tonsillectomy doubles to triples the risk of upper respiratory disease later in life (Byars 2018, 1.19 million Danish children).

Origin

Source status
Archive editors
Attribution
Archive editors (eltayebat.com); not necessarily Elawady's own words
Origin
https://eltayebat.com/rule/unnecessary-organ-removal/
Attribution uncertainty
Editorial summary/narrative and study selection written by the archive operators; the archive states that the cited research documents harm independently of Dr. Diaa's words.
Claimed mechanism

Loss of lymphoid tissue during immune development.

Claimed health effect

Respiratory, allergic, infectious disease.

Population concerned

Children operated before age 9

Geographic restriction by Elawady

not applicable

Scientific assessment

Potentially true – Some evidence points in favour of the statement, but it is not sufficient for a clear judgement.

Certainty of evidence: low – Further research is likely to change the assessment considerably.

1. What was claimed?

Surgery doubles/triples later respiratory disease.

2. What is demonstrably correct?

The association was reported: RR 1.99 (adenoidectomy) and 2.72 (tonsillectomy) for upper respiratory tract disease; infections RR 1.17 (+2.14% absolute) after adenotonsillectomy (A-ORG-01).

3. What is wrong or exaggerated?

Causal phrasing: the authors note that confounding may not be fully accounted for; children who need these operations may be predisposed to airway disease. Absolute risks are not given by the archive.

4. What remains unclear?

Replication in other populations.

5. Which studies support it?

A-ORG-01.

6. Which studies contradict it?

A-ORG-03, I-ORG-04 (short-term benefits).

7. What applies to Germany and Europe?

Most cited cohorts are Scandinavian (Denmark, Sweden) and directly European; RCTs from the UK and Finland are directly transferable. Guidelines in Europe also emphasize defined indications (not verified here in detail).

8. What is known about Egypt?

No Egypt-specific data on rates or outcomes of tonsillectomy, cholecystectomy, hysterectomy, splenectomy or thyroid surgery were identified in this review.

9. What practical conclusion is appropriate?

Supports considering long-term risks in borderline indications.

Assessment details

Rationale for certainty of evidence

One very large register study with careful adjustment; confounding by indication possible; not replicated in the evidence reviewed.

Source quality

Numbers correct; causal wording ('doubled to tripled the risk') stronger than the authors' associational conclusion.

Regional transferability

Danish data, directly European.

Individual exceptions

Absolute risk increase small for infections (2.14%).

Regional scope of the claim
general (biological/medical)
Last reviewed
26 October 2026 provisional

Scientific evidence in detail

Overinterpreted – A real finding exists, but the claim draws more from it than the data allow (e.g. association taken as cause, animal data applied to humans, small effect presented as large).

Research question: Does childhood adenoidectomy or tonsillectomy cause a 2-3-fold increase in later upper respiratory tract disease?

Research question in detail (PECO)
Population
Children undergoing adenoidectomy/tonsillectomy
Intervention or exposure
Childhood adenoidectomy/tonsillectomy
Comparison
Children not operated (ideally with the same indications)
Geographic scope
universal biology
Outcomes
  • Upper respiratory tract disease
  • Upper airway infections

Study results as reported by the authors. Our assessment follows below.

What speaks for the claim?

What speaks against the claim?

What does the overall evidence say?

Editorial assessment based on the studies above – not itself a study result.

Which position is better supported?

The Byars figures are reproduced correctly, but whether surgery causes later respiratory disease is uncertain; a better-matched cohort found no increase.

Why some studies weigh more

Matching on prior infection (Kim 2021) controls confounding by indication better than general-population comparison.

Is a causal relationship established? Not established Children operated on differ in airway and immune characteristics; findings inconsistent.

Remaining uncertainty

Adult outcomes in matched designs.

Justified conclusion

Association correctly quoted; causal 'doubles to triples' not established.

Why do studies seem to disagree?

Byars (Denmark, outcomes to age 30, general-population comparator) vs Kim (Korea, outcomes to 9 years after surgery, matched on the same infections) answer different questions; the difference is consistent with confounding by indication.

Does this depend on the country?
General biological effects
Universal.
Eating habits
Not relevant to this claim.
Origin of the food
Not applicable.
Contaminants
Not applicable.
National production conditions
Not applicable.
Legal rules
Not applicable.
Actual monitoring data
No Egypt-specific monitoring data identified.

A regional difference that changes the conclusion is not supported by robust data.

Statistical re-check
  • Wording check: RR as reported – RR 1.99 and 2.72 correspond to 'doubles to triples' for the point estimates; CI for tonsillectomy (1.54-4.80) is wide not recalculable from the published data
Certainty of the overall evidence (GRADE, simplified)
Main outcome
Later upper respiratory disease after childhood adenotonsillar surgery
Starting level
low (observational studies)
Reasons for downgrading
  • inconsistency
  • risk of bias (confounding by indication)
Result
very low

Simplified assessment by a single reviewer, following the GRADE approach; not a formal GRADE panel. GRADE rates the body of evidence for one outcome, not individual studies.

Search strategy

Documented literature searches for this review (search strings in the original database syntax).

DatabaseDateSearchLooking forHitsIncluded
Europe PMC26 October 2026(TITLE:tonsillectomy OR TITLE:adenoidectomy OR TITLE:adenotonsillectomy) AND (TITLE:"long-term" OR TITLE:"later life" OR TITLE:risk) AND (TITLE:respiratory OR TITLE:asthma OR TITLE:allergic OR TITLE:infections OR TITLE:infectious) AND (cohort OR registry OR "population-based")both directions15
PubMed26 October 2026(organ removal OR appendectomy OR tonsillectomy OR cholecystectomy OR splenectomy OR hysterectomy) AND long-term[ti] AND (sibling[tiab] OR confounding[tiab]) AND cohort[tiab]contradicting evidence9

Open questions

Matched adult outcomes.

How deeply was this checked?

4 linked studies: 1 checked in full text (1 of them with a structured risk-of-bias assessment), 3 on the basis of the abstract, 0 bibliographically only. No formal assessment with two independent reviewers and no independent human expert review has taken place yet.

Last scientific review: 26 October 2026

History of the verdict
  1. 25 October 2026 · Phase 1 · Initial assessment: Potentially true (low)
  2. 26 October 2026 · Phase 4 (systematic evidence review) · Re-examined with extended evidence; verdict unchanged: Potentially true (low)
    Verdict and certainty unchanged (“Potentially true”, low). The contradicting matched cohort lowers confidence in causality but the claim correctly reproduces the cited association; the existing low certainty already reflects this.
    New sources: I-ORG-122

In plain language

The archive cites a Danish study of 1.2 million children: those who had their adenoids or tonsils removed had about 2-3 times more upper airway diseases later. The numbers are correct. But this kind of study cannot prove that the operation caused the diseases, because children who need these operations may already be more prone to airway problems. The study is a good reason not to operate without a clear indication.

Studies on this claim

Studies supporting the claim (1)

  • Danish children: tonsil/adenoid removal and later illness

    Byars SG et al.. JAMA Otolaryngol Head Neck Surg 2018 · PMID 29879264 · DOI 10.1001/jamaoto.2018.0614
    Cohort studycited by the Tayebat archiveabstract checked★ key study

    Children who had the operations had more respiratory illnesses later (2-3 times for upper airway disease), but the study cannot prove the operation caused it.

    Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim

    Original publication · Scientific details

    Study explained simply
    What did the researchers want to find out?

    Long-term risk

    How was the study done?

    Register cohort

    How many people, animals or samples were studied?

    1.19 million

    What was actually found?

    Associations with later respiratory/infectious/allergic disease

    How large was the observed effect?

    RR 1.99-2.72; infections +2.14% absolute

    What do the results mean in everyday life?

    A reason to avoid unnecessary operations

    What are the study's limitations?

    Confounding

    What does it say about Elawady's specific claim?

    Supports a cautious approach, not a ban

    Do the results apply to Germany and Europe?

    Directly European

    What can explicitly not be concluded from this study?

    That surgery causes the diseases

    Scientific details →

Studies contradicting or limiting the claim (3)

  • Trial: tonsil/adenoid surgery for children with sleep apnea

    Marcus CL et al.. N Engl J Med 2013 · PMID 23692173 · DOI 10.1056/NEJMoa1215881
    Randomised controlled trialcited by the Tayebat archivefull text, structured risk-of-bias assessment

    Surgery normalized sleep studies in 79% vs 46% with waiting and improved behaviour and quality of life.

    Does the study support the specific claim? No · Methodological quality: high · Certainty of evidence: see overall assessment of the claim

    Original publication · Scientific details

    Study explained simply
    What did the researchers want to find out?

    OSA treatment

    How was the study done?

    RCT

    How many people, animals or samples were studied?

    464

    What was actually found?

    Symptom, QoL and sleep-study benefit; no cognitive benefit; 46% normalized with waiting

    How large was the observed effect?

    79% vs 46%

    What do the results mean in everyday life?

    Surgery helps children with sleep apnea

    What are the study's limitations?

    7 months

    What does it say about Elawady's specific claim?

    Contradicts blanket rejection of surgery, but supports watchful waiting as a valid option for many children

    Do the results apply to Germany and Europe?

    Applicable

    What can explicitly not be concluded from this study?

    Long-term cognition

    Scientific details →

  • Cochrane review: tonsil removal for repeated throat infections

    Burton MJ et al.. Cochrane Database Syst Rev 2014 · PMID 25407135 · DOI 10.1002/14651858.CD001802.pub3
    Systematic reviewindependent cross-checkabstract checked★ key study

    Surgery reduced sore throats modestly in the first year (about 0.6 episodes fewer in children); many children get better without surgery.

    Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim

    Original publication · Scientific details

    Study explained simply
    What did the researchers want to find out?

    Effectiveness

    How was the study done?

    Cochrane review

    How many people, animals or samples were studied?

    1143

    What was actually found?

    Modest benefit

    How large was the observed effect?

    0.6 fewer episodes

    What do the results mean in everyday life?

    Surgery helps a little, mainly in severe cases

    What are the study's limitations?

    Short follow-up

    What does it say about Elawady's specific claim?

    Supports caution, not a ban

    Do the results apply to Germany and Europe?

    Applicable

    What can explicitly not be concluded from this study?

    Long-term effects

    Scientific details →

  • Do tonsil and adenoid operations change later infections in children?

    Kim JY et al.. Laryngoscope 2021 · PMID 33720418 · DOI 10.1002/lary.29506
    Cohort studyindependent cross-checkabstract checked

    Over 9 years, children who had the operation had the same number of upper airway infections as similar children who did not.

    No increase in upper airway infections over 9 years versus matched children with the same infections.

    Does the study support the specific claim? No · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim

    Original publication · Scientific details

    Study explained simply
    What did the researchers want to find out?

    Test whether adenotonsillectomy changes later infections

    How was the study done?

    Matched population cohort with equivalence testing

    How many people, animals or samples were studied?

    2377 operated Korean children and about 9000 controls

    What was actually found?

    No difference in pharyngitis, sinusitis or ear infections

    How large was the observed effect?

    Equivalent within ±0.5 visits

    What do the results mean in everyday life?

    The operation did not increase later airway infections

    What are the study's limitations?

    Claims data; children only

    What does it say about Elawady's specific claim?

    Contradicts the claim

    Do the results apply to Germany and Europe?

    Moderate

    What can explicitly not be concluded from this study?

    Cannot address adulthood

    Scientific details →

Studies with mixed or unclear results (0)

No studies in this group.

Regional context

Germany / EU

Most cited cohorts are Scandinavian (Denmark, Sweden) and directly European; RCTs from the UK and Finland are directly transferable. Guidelines in Europe also emphasize defined indications (not verified here in detail).

Egypt

No Egypt-specific data on rates or outcomes of tonsillectomy, cholecystectomy, hysterectomy, splenectomy or thyroid surgery were identified in this review.

What applies in my country?

General scientific assessment

Potentially true Association correct; causation uncertain.

This statement concerns biological or medical relationships. The scientific assessment above applies regardless of the country; country-specific food data do not change it.

References

  1. Association of Long-Term Risk of Respiratory, Allergic, and Infectious Diseases With Removal of Adenoids and Tonsils in Childhood.. Byars SG et al.. JAMA Otolaryngol Head Neck Surg 2018 · PMID 29879264 · DOI 10.1001/jamaoto.2018.0614
  2. A randomized trial of adenotonsillectomy for childhood sleep apnea.. Marcus CL et al.. N Engl J Med 2013 · PMID 23692173 · DOI 10.1056/NEJMoa1215881
  3. Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis.. Burton MJ et al.. Cochrane Database Syst Rev 2014 · PMID 25407135 · DOI 10.1002/14651858.CD001802.pub3
  4. Adenotonsillectomy Does not Alter the Risk of Upper Airway Infections in Children.. Kim JY et al.. Laryngoscope 2021 · PMID 33720418 · DOI 10.1002/lary.29506

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