UNLABELLED: To understand whether parental smoking influences adeno/tonsillectomy rates in their offspring. A population-based case-control study using data from Clalit Health Services. Israeli children aged 0-18 years who underwent adeno/tonsillectomy between 2003 and 2022 were 1:3 matched with same-age, sex, and ethnicity controls. Parental smoking habits were linked to their children's files. Conditional logistic regression models estimated odds ratios (ORs) for adeno/tonsillectomy associated with parental smoking, adjusting for socioeconomic status. We identified 11,184 children who underwent surgery and 33,552 controls (mean age ± SD 4.10 ± 2.50 years). The likelihood of undergoing adeno/tonsillectomy was significantly higher for children with either one smoking parent (OR 1.14
95%CI 1.09-1.19) or both (OR 1.53
95%CI 1.39-1.68) compared to children of non-smokers. The association was more evident for tonsillectomy alone, with an OR of 3.20 (95%CI 2.06-4.97) when both parents were smokers. These associations remained consistent even after adjusting for socioeconomic status. Parental smoking rates were higher in the surgical group across all categories. Maternal smoking prevalence was 10% versus 7.5%, and paternal smoking prevalence was 36% versus 32%, in the surgical group vs. the control group, accordingly. The proportion of children with only one smoking parent was 34% compared to 31%, and for cases with both parents smoking, the rate was 6.3% versus 4.3%. CONCLUSION: Parental smoking is associated with higher rates of pediatric adenoidectomy, tonsillectomy, and adenotonsillectomy, especially if both parents smoke. Counseling parents on the negative effects of smoking on their children is crucial in reducing the incidence of these surgeries. WHAT IS KNOWN: • Parental smoking can cause multiple pediatirc diseases. WHAT IS NEW: • Parental smoking is associated with higher rate of adenotonsillar surgery.