Impact of adenotonsillectomy on asthma control in children: a systematic review and meta-analysis of clinical outcomes.

Abstract

Objective: This study evaluated the impact of adenotonsillectomy on asthma symptoms in children by combining observational evidence with pooled analysis.

Data sources: We searched MEDLINE/PubMed, Cochrane Central Register of Controlled Trials, Web of Science, ProQuest, and Scopus from inception to March 17, 2025.

Study selection: Eligible studies assessed asthma outcomes in children undergoing adenotonsillectomy using retrospective or prospective cohort designs, case series, or database analyses. Eleven studies involving 74,204 participants were identified. Outcomes included asthma control scores (ACT/cACT), acute asthma exacerbations (AAEs), emergency department (ED) visits, oral corticosteroid use, hospitalization, inflammatory biomarkers, and atopic risk. Risk of bias was evaluated using ROBINS-I.

Results: Meta-analysis incorporated five studies with 52,479 participants. Adenotonsillectomy improved ACT/cACT scores by a mean of 2.5 points (95% CI:1.6-3.4; I²=0%), indicating better asthma control. A reduced risk of AAEs was observed (RD = 0.29; 95% CI:0.01-0.58), though with extreme heterogeneity (I²=100%). ED visits showed a small but significant reduction (MD=-0.01; 95% CI:0.00-0.02; I²=0%). Narrative synthesis found corticosteroid courses decreased by 23.7%, hospitalization rates fell by up to 35.8%, and patients reported improved quality of life and lower inflammatory biomarkers. However, most studies carried moderate to severe risk of bias due to confounding and selection issues.

Conclusions: Adenotonsillectomy may improve asthma control, reduce ED visits, and lessen medication use and hospitalization among children. Evidence regarding its effect on exacerbations remains inconsistent, and causality cannot be inferred due to reliance on observational data. Well-designed prospective controlled trials are needed to confirm effectiveness and clarify underlying mechanisms.