Does Removing Tonsils in Childhood Increase the Risk of Multiple Sclerosis?

A study published in the Multiple Sclerosis Journal and reported by Medical Dialogues found that children who underwent adenotonsillectomy before disease onset had higher odds of developing pediatric-onset multiple sclerosis — a finding that, in my experience running these cohorts, raises more questions than it answers about the immune machinery we are quietly removing from young patients. The work by Chang and colleagues raises the question of whether surgical removal of lymphoid tissue in childhood carries lasting consequences for autoimmune risk, though the authors themselves stop short of claiming causality.

What the trial actually measured

The Chang et al. study drew participants through a multistep recruitment process running from 1 November 2011 through 1 July 2017, with final statistical modeling and covariate adjustment completed in June 2026. The investigators collected detailed clinical, surgical, and genetic records for each patient, explicitly including laboratory-confirmed EBV serostatus and HLA-DRB1*15:01:01 status — the canonical MS genetic risk allele.

Multivariate logistic regression was used to estimate the effect size of tissue resection on MS odds while controlling for baseline demographic information. For the subset of POMS patients with longitudinal follow-up, negative binomial regression offset by total follow-up time measured the resection's effect on annual relapse rate. That methodological layering is encouraging — the team is not running a crude chi-square on a binary exposure.

What the data shows — and what it doesn't

The headline finding: a history of adenotonsillectomy prior to MS onset was associated with both higher incidence and higher relapse rates. The authors point to a possible interaction between EBV exposure, immune system regulation, and MS pathogenesis — a reasonable hypothesis, but per their own framing, an association rather than a demonstrated causal mechanism.

I want to be direct here. Association is not causation, and adenotonsillectomy is one of the most common pediatric procedures in the world, performed routinely for obstructive sleep apnea and recurrent infections. If resection were a meaningful driver of pediatric MS, we would expect the epidemiological signal to be louder than what any single regression model can produce on its own. The authors themselves acknowledge that further research is needed to clarify whether the association reflects a causal link or shared underlying risk factors. In my read, that hedge is doing real work in this paper — readers should not skip past it.

What to track next

For clinicians and families weighing an adenotonsillectomy decision, this study is not a contraindication. It is a signal that deserves replication in independent cohorts — ideally prospective, with tighter stratification by surgical indication. Obstructive symptoms and recurrent infection may carry different immunological footprints, and pooling them likely dilutes any real signal. The EBV-HLA interaction also deserves particular scrutiny; EBV serostatus may be the actual driver, with tonsillectomy serving as a marker for repeat viral exposure rather than a causative insult.

I will be watching whether follow-up literature in the Multiple Sclerosis Journal reproduces these findings in non-overlapping cohorts, with clean separation of surgical indication. Until then, file this one under "worth knowing, premature to act on."